Mayor London Breed and three moderate supervisors said on Tuesday that a proposal to drug test San Francisco welfare recipients would keep individuals “accountable” and help shepherd those struggling with addiction into treatment.
But more than half a dozen addiction experts and political figures told Mission Local that, if the goal of the measure is to address people’s addictions, the plan is likely to backfire.
Tell welfare recipients to undergo drug testing or risk their cash, and “they’re going to say — pardon my French — ‘Eff you, I’ll find something else,’” said Dr. William Andereck, a doctor of internal medicine who runs the ethics committee at Sutter Health/California Pacific Medical Center.
Andereck said that, because addiction is a serious disease that changes brain function, most drug users will probably want to use, and decline treatment and forgo the cash.
Even if they accept, there do not appear to be sufficient treatment options for the potentially hundreds or thousands of additional patients the measure would create.
The proposal, announced by Breed on Tuesday, would require drug testing for some 5,200 people who receive cash through the County Adult Assistance Program, a city-run program that disburses between $100 and $700 a month to low-income San Franciscans.
The city’s Human Services Agency, which administers the program, said that some 20 percent of those receiving cash assistance during 2018 to 2020 had reported substance-use disorder. Twenty percent of today’s program enrollees is 1,040.
Presently, there are almost no slots available for drug treatment, according to Vitka Eisen, the CEO of nonprofit HealthRight 360, which provides addiction services across the city.
There are just 2,600 overnight beds in the city for various drug and mental health purposes, according to the Department of Public Health; another 50 are in the pipeline.
The majority of these beds, however, are currently occupied, said Eisen.
“If everybody decided today to go, and they get urine tested … there’s definitely not enough capacity for that,” Eisen said.
Drug users and experts said that, in reality, the proposal would likely lead users to other means, like crime, to fund their addiction. Cutting off cash could even worsen health outcomes by limiting access to basic needs, like food or housing, they said.
Many experts said there is little evidence that coercive proposals help people sober up. Even doctors who believe in forced treatment for severe addiction said restricting cash assistance did not make sense.
“I don’t see how [this proposal] accomplishes what they want,” said Dr. Daniel Ciccarone, a professor on family addiction medicine at the University of California, San Francisco. “This is another piece of proof that the war on drugs is a war on people.”
Is cash enough to compel people into treatment?
Andereck, the internal medicine doctor, said that he generally supports Breed’s efforts to address the “frustrating” drug epidemic.
When he first heard Tuesday’s proposal, he was supportive, he said. “But then, you start thinking about it — it’s harsh,” he said. “The only consequence is creating more crime.”
Of the choice to revoke cash assistance or get help, he said: “I basically see it as a bribe.”
Several medical experts said the compulsory proposal runs counter to best practices in harm reduction and public health. The approach “aligns, in people’s minds, a coercive public response that can be unhelpful,” said Harold Pollack, the co-director of the Health Lab, a public health division at the University of Chicago.
Pollack compared the situation to a doctor whose diabetes patient comes in for an appointment while slurping down a Pepsi.
“You want to say: ‘Let’s work on that, because that’s going to hurt you, given your health,’” Pollack said. “We’re not going to say: ‘We’re not going to give you any medical care for your diabetes right now, and we’re not going to give you food stamps.’”
Janet Coffman, head of the Master of Science and Health Policy and Law Program at UCSF, added that the most successful outcomes are when individuals voluntarily participate in programs.
In reality, cutting people off from cash may actually worsen people’s health by depriving them of basic needs, like food or housing, experts said.
Supervisor Catherine Stefani said she supports the measure, and she suggested that some individuals are using welfare cash to buy drugs off the street. Dr. David Smith, an addiction expert, said this was true in some cases, and that drug markets should be disrupted. However, he estimated that just 10 to 15 percent of patients he has studied who were experiencing addiction use cash for drugs.
“Which implies that 80 to 90 percent, if they get [cash], use part of it for the intended purpose,” Smith said.
Capacity unlikely to meet demand
Withholding cash may incentivize some to accept help, experts agreed. But in a time when nursing shortages abound and bed availability is scanty, many wondered if those who accepted the preconditions would receive adequate treatment.
“The big question for the mayor is: Do we have the resources to provide treatment to everybody who … will accept?” said Coffman, adding that there are also not adequate withdrawal medications for methamphetamines on the same scale as for opioids.
Smith, who opened the Haight-Ashbury Free Clinics and is the former president of the California and American Societies of Addiction Medicine, agrees with Breed and Andereck that the status quo is “not working.”
Smith is open to forced treatment in certain instances, but proposals like Breed’s should only focus on the heaviest users — not all welfare recipients.
“The extension of drug testing for everybody seems to be a little beyond,” Smith said, saying he would like to see programs targeted to those cycling in and out of emergency rooms, or “frequent flyers,” instead.
And, he said, he has asked the city to study how similar programs have fared elsewhere before implementation. “I would like to see more clinical evaluations,” he said.
Why go after the poor? It’s politics.
Meanwhile, political consultants and progressive supervisors accused Breed of using the proposal to play politics. Breed’s announcement came the same day that Daniel Lurie, the Levi Strauss heir and Breed’s most well-heeled opponent, announced his candidacy for mayor.
“There are no coincidences in politics,” said political consultant Eric Jaye, who helmed then-Supervisor Gavin Newsom’s Care Not Cash measure and subsequent mayoral campaign.“If she loses the billionaires, who does she have?”
Board President Aaron Peskin swiftly denounced Breed’s proposal on Tuesday. He questioned how the mayor could test thousands of welfare recipients if she could not even act against hundreds of drug dealers.
“She can’t, and she won’t, and this would simply be silly politics if the issues we face as a city were not so serious,” Peskin said.
The proposal is unlikely to pass the Board of Supervisors, which is controlled by a progressive faction, though Breed could take the measure to voters directly as a ballot initiative.
For his part, Jaye said he was tempted to introduce a ballot measure of his own: Mandating drug-testing for elected officials and their aides.
“I’ve known many people who are on welfare and I’ve known many people at City Hall,” said Jaye, “and there are many more people at City Hall who are high on drugs.”
The city should end cash payments regardless. We should not be funding and enabling their addiction.
End cash payments because it makes sense to punish all poor people for what 10-20% of them do. why not apply that to politicians and lock them all up?
Mission Local fundamentally misunderstands the goal of the program.
It isn’t to help the individual junkies who have come to San Francisco to smoke fentanyl and shoplift.
It is to help the city. So if withholding cash from the junkies makes a few of them decide to go live on the street, smoke fentanyl and shoplift somewhere else, that will be a success.
But instead, we will probably give them MORE money, so they can get better drugs (like the ones their enablers do).
You know, equity and all that.
Everyone who’s ever dealt with a friend or family member who became an addict knows that they won’t quit until they’re ready. We also know giving them more money isn’t helping; it’s called enabling.
This article is a bit vague. “Won’t work” it says, but it doesn’t mention the purpose. What if the objective is to encourage drug users to leave and to discourage drug users from coming? I think that is the intended goal. We can debate whether that is a worthy objective, but would this policy “work” to help reach it? I don’t know the answer, but I suspect it would get us at least part way there.
“I’ve known many people who are on welfare and I’ve known many people at City Hall,” said Jaye, “and there are many more people at City Hall who are high on drugs.”
Nearly 20 years ago, Gavin “Hair Goop” Newsom proposed cutting funding for outpatient drug treatment. Mayor for a Day Chris Daly called him out on that. Daly specifically mentioned the Stimulant Treatment Outpatient Program and reminded all who didn’t know that Newsom was a coke fiend whose addiction was so strong that he needed private outpatient services from his friend at Delancey Street. (Plus, prior to his career as an elected official, Newsom was a drug (wine) dealer.)
While I agree that we need to fund drug treatment programs, I don’t much care about someone’s drug or alcohol use, as long as they can support themselves.
I’d support this if all SF elected officials, including GHB addict Matt Dorsey, had to pass a clean drug test before getting their paycheck.
By the way, has Dorsey turned himself in for criminal prosecution after years of “relapsing” while being well paid as spokesperson for SFPD? Has Dorsey referred his dealers to the authorities for prosecution or do they continue to walk the streets and peddle death?
With this corrupt, drug addled crowd, accusations are confessions.
Hell relapse again. We’ll all have the last laugh.
It is not a “relapse.” Dorsey is a healthy gay man who likes to party and to play. There is nothing wrong with that.
Dorsey’s deep sense of shame is what is driving this projection of his anxieties surrounding substances and sex onto those less powerful than he. The only thing wrong in this picture is Dorsey’s rank hypocrisy.
Portugal does this as one among the many ways they get people into treatment, except they actually don’t involve a court and only involve a medical panel, with actual treatment infrastructure without wait.
They also don’t involve hitting the wrong people who actually use the money properly at 80%, and yet, it’s mostly scorched earth.
We don’t have any of the above, and even worse, don’t have the staff to manage the drug processing of 5,200 people in a labor and budget shortage, because obviously things take people to do and all City departments are basically understaffed.
Not even the treatment behind it, which means it’s just empty ass rhetoric.
And we’re going to let 80% of them fall into the same pit, and see that right in the street.
Just, harm, harm, harm I guess.
The only reason this is news is that the mayor knows the supervisors will never pass this and so she can claim that the reason the city is in the shape it’s in is because they won’t allow her to run the city the way she wants and it’s not her fault that homelessness and drug use are out of control.
It would be great to try some of the ways they’re helping people treat addiction in Portugal but it takes a more holistic treatment than this individualistic capitalist society will allow even in San Francisco.
Politically, that’s her aim.
Daniel Lurie must’ve hit a chord, because she’s now desperately trying to differentiate ideologically because she can’t beat him in competence.
Policy-wise, it isn’t capitalism on why we can’t do it in this city.
It’s because mayors come in using a playbook that doesn’t work except for politics.
They can’t keep their temptation to score an easy win, and, against advice from our own city agencies and analysts, fuck it all up.
Many of the SF Drug treatment programs need to be moved to Treasure Island and create a divide between users and drug dealers or the users triggers.
Annika, thank you so much for actually doing real journalism.
SF’s 2024 budget for the homeless is $423 million. I don’t think this includes state and federal money nor the money spent on police, EMTs, or by churches and other charities. And it likely doesn’t include hospital and incarceration costs. All this for about 10,000 people.
So, in other words, Scott, you actually don’t have any idea what you’re talking about.
Presuming that the % of folks receiving assistance and using it for unintended purposes is 0-20% (unintended not being defined here) – is the argument from opponents that any change not springing from the user is bound to fail? i.e. either the grip of drugs is so strong that this just hurts them or it will backfire? why would the city continue to provide money without any incentive to change to someone who’s either facing a grim future, enabled by said funds, or would not cooperate anyway?
I recently listened to Breed’s speech at the 8/23 “rally” where she and her lapdog Rafael Mandelman passed the megaphone back and forth while rabid mostly white people looked on…..the same angry people who support expensive recalls, but who don’t have a plan for what comes next. Breed’s voice was shrill and ragged. Former Breed staffer and failed supervisor candidate Marjan Philhour was there too……stoking the fear and loathing. The photos from the “rally” tell you everything: Breed’s, Philhour’s, Mandelman’s, Engardio’s and Dorsey’s faces are contorted in rage. Breed blames progressives for her failures. If you criticize her decisions, you are called a racist and/or a misogynist. It is disgraceful that electeds like Governor Hairdo and London Breed use the power of their offices to incite pitchfork mobs against judges, social workers, doctors and the very people who remain in the trenches ministering to those who suffer. It’s gross. Breed is unhinged. She never was good at policy making. She is a skilled maker of speeches. Worst. Mayor. Ever.
I’ve always called her “London Greed” and this is just one further reason why. This is inhumane.
Haha what a perfect nickname.
The purpose has nothing to do with drugs or drug use. Breed is sucking up to the billionaire boyz who will blame the board of supervisors, police commission and the battalions of zombie homeless drug addict progressives who rule/ruin the city streets. And if you want to test welfare cheats why not test coke-headed mentally-ill tech moguls to whom Breed gives tax breaks (and who knows what else). Will they leave town if they don’t get their way?? Please. Please. Garry, Elon, Zuck — all you bros — I’ll buy you each a bus ticket to Austin, Miami, you name it.
I simply would like to refer the Mayor, Matt Dorsey, Supervisor Stafani and anyone else who supports this draconian initiative to the following website.
https://www.aclu.org/documents/drug-testing-public-assistance-recipients-condition-eligibility
Thank you Paul. Written in 2008, but still a snap shot of the perspectives at the time. Really points to the goals of this policy is completely political, shore up Breed’s right flank.
The most important part you saved until the end: The insinuation that people on welfare are criminals and drug addicts is sick in itself.
The idea that the city shouldn’t hand out money indiscriminately could only be a condemnation is silly. Even if the amount misused is ‘only’ 10-20%, that’s enough folks to cause plenty of problems. Today’s Chron coverage makes it apparent enough that these resources are a draw.