San Francisco will no longer allow the distribution of safe drug use supplies, including sterile syringes and smoking kits, unless the outfits distributing the supplies offer counseling services or connect recipients to services, the Mayor’s Office announced on Wednesday.
The city confirmed it will also allocate more money to support the treatment and counseling services these nonprofits are now mandated to facilitate in order to provide safe-use supplies.
“We have to do something differently,” said Daniel Tsai, the new director of the Department of Public Health, during a press conference on the steps of City Hall on Wednesday. “And that’s part of what’s in this policy.”
The policy will also prohibit any distribution of clean drug supplies in public spaces.
During Wednesday’s press conference, Tsai emphasized that the policy shift would not veer away from scientific evidence. “The use of sterile-syringe-access programs is two and a half decades of evidence-based, peer-reviewed scientific literature that has a legacy here in San Francisco. We’re not backing away from that.”
In a recent meeting with Tsai, Dr. Dan Ciccerone, an addiction expert at the University of California, San Francisco, said he told the health director that if fentanyl users were diverted from smoking to injection, it would result in dire consequences.
“To the degree that restricting paraphernalia forces people back to injecting, you’ll see overdoses go up and also see infections go up,” Ciccerone said.
He felt, however, that the policy of requiring counseling is a good one, but “the devil is in the details: Can they get enough funding to create the space they need, and have counselors on site?” he asked.
“I do like creating greater linkages between harm-reduction programs and treatment programs. It might cost a bit of money, though. Hopefully they are prepared for that.”
The city actually spends very little on drug supplies; roughly $700,000, per the Department of Public Health, with the vast majority of that being expended on syringes. The lion’s share of the drug supplies distributed in the city are actually paid for by the state.
San Francisco can, however, impose restrictions on the distribution of even state-funded supplies, as the city funds the distribution of those state-funded supplies. Even if nonprofits found alternative means of funding the distribution of state-funded paraphernalia, the city’s position is that it could still impose its chosen distribution demands, because these nonprofits, bottom line, receive some level of city funding.
Lydia Bransten, the executive director of the Gubbio Project, noted that the effectiveness of this policy is contingent on there being enough organizations willing and able to distribute supplies indoors. “Distribution is the lowest barrier to contact with someone who may otherwise not be accessing any kind of support,” she said. “Traditionally, that’s done on the street.”
Tsai did not specify exactly what the counseling would look like at today’s press event on the City Hall steps, but said the city would require nonprofits to have “skilled resources” and use “proven clinician tools.”
“There’s ample evidence that distributing supplies, in general, helps to actually engage people and get them connected to treatment,” Tsai said today. “So, what you see in the policy is all about that. We want to use that process of providing supplies in a more indoor, controlled, installed space to actually have higher-quality interactions, to help someone get motivated to get plugged in to treatment and recovery.”
Other experts are cautiously optimistic that the new policy might lead to better outcomes.
“I think it is a good, positive direction to increase the offers and referrals to substance-use disorder treatment from our harm-reduction programs,” said Dr. Leslie Suen, a primary-care and addiction doctor at UCSF.
The new policy, effective April 30, 2025, is one prong in the mayor’s new “Breaking the Cycle” initiative aimed at tackling the city’s drug epidemic and getting people off the streets through increased enforcement, new treatment beds and unified street teams. In January and February of this year, 118 people died of drug overdoses, according to the Office of the Medical Examiner. That’s a rate of two people per day.
Chaz said “Countries with properly funded harm reduction programs have far better success getting people off drugs and into stable living situations, while those with the punitive approach have poor success and more deaths. ” Right but why? because they, from the beginning, did address the problems head on, not let the situation go out of control; like for example not making their lifestyles easier during the pandemic . We had a succession of city administration which failed miserably. we are still asking ourselves basic questions that those countries have not been asking themselves for a long time. So at the stage we are here right now, people feel no more tax money should go to unsupervised entities which distribute paraphernalia to unsupervised drug users who often refuse to enter treatment or get their story straight. Some people working at unsupervised entities also make very decent salaries at the top. Now it is only time to make it tough on them, both entities and drug users..we wasted enough time. At one point in your life you got to make some decisions, the right ones, with help and treatments but we should stop treating you like victims or babies.
Sorry, you haven’t refuted the success of those foreign harm-reduction programs. Mischaracterized them, yes. Inserted your own emotions and opinions, yes.
You, Joe Schmoe tax paying type there, ever wonder how stuff works at one of the “harm reduction” outlets? Find out how to get shooed away real quick. Bonus: Scratch your head how the goodies are handed out in plastic bags, when every retail business in town is being told how they’re bloody murdering the planet if they use them.
Let’s also remember how this used to be a needle *exchange* program, which, in the dark of night, was changed to, just hand stuff out. At the time, the AIDS foundation was swearing at her mother’s grave it wouldn’t come this. In fairness, that was before Fentanyl changed everything from the ground up. OTOH, this also means we can throw the old “harm reduction” playbook away altogether. Should have done so years ago.
An absolutely common sense decision. This approach has been trapping people in a life of addiction, masqueraded around as “harm reduction” when it is augmenting the problem. Nice to see the overwhelming support from people along the west coast in the NYT comment section. Ciccerone is a perfect example of a progressive that leans into failing practices and drums up sensationalized fear based clickbait which lead to the chaos we see on Market and in the TL.
A frequent problem with a “common sense” opinion is that it’s often contradicted by facts. Countries with properly funded harm reduction programs have far better success getting people off drugs and into stable living situations, while those with the punitive approach have poor success and more deaths. No shortage of data out there!
So let’s see, what we’re saying is, contrary to Brandon’s claim, that our harm reduction practices are actually not failed.
(Opens door, steps into the street, walks a few blocks while taking note of the street conditions)
Upon returning home, I got to say, in good faith, there is no way one could disagree with Brandon.
If you actually knew what you’re talking about, you would be thrilled to see that the requirements in the new plan more closely resemble the programs in the countries you pretend to want to emulate.
Maybe if SF did harm reduction like those other countries it could work. For example in Portugal harm reduction is coupled with enforcement – a summons, drugs are confiscated, and the suspect is interviewed by a “Commission for the Dissuasion of Drug Addiction”. But in San Francisco we just give people needles and pipes no questions asked, no contact, nada. Also, the user is not required to give back used needles (that was how the program was sold to the public in the 90s) . That is why these used needles end up littering our city. Fun fact: SF kindergartners are taught about the dangers of used needles they might find on the playground 🙁
Ssssh, Chaz — the “common sense” people really don’t like it when you remind them that their policies are motivated by emotion, not facts.
Title of article is misleading or just plain false. Requiring places to offer counseling services or connect recipients to services does not limit access.
The title should read, “San Francisco requires more from facilities that provide drug-use supplies.”
Mission Resident —
I’m concerned about your lower back, because you’ve twisted yourself into a pretzel.
By imposing a series of new demands on purveyors and users of drug paraphernalia, the city is, by definition, limiting the access. Reasonable people can disagree about the efficacy of this, and even the intent — but not the effect.
To wit: You read this article for free. We proactively send it to you, where you are. If we ceased doing that and you had to come indoors to our office and talk to us about how to fund journalism before we allowed you access to the article, then we’d be limiting access.
Yours,
JE
If these people can walk into Walgreens to steal, they can walk into a building to receive information on resources to better their lives before skipping off with a handful of tooters.
Ok, pay attention a second, this puts a requirement that you put these things all “under one roof” in order to be able to do the end service at all, even if the person already has access to services and health care etc. It’s like saying you can’t have a pharmacy dispensary if there’s not a diverse team of doctors on call standing around right there along with a team of social workers. The end result is only larger operations can sustain that, it costs more, and effectively the same result is achieved except with several fewer facilities to share the burden. If that’s your goal, say that.
Do you have any evidence that these are the same people? Is anyone measuring this correlation? I’m curious to know.
Equating a change in access to your articles with a change in access to drug paraphernalia as example of “limiting access” …… is wrong.
Admitting that past practice has failed and asking the users of services to participate “more” in a system designed to help them…..that is not limiting access.
“New demands” does not limit access….
Yet, you don’t even mention how DL signed SF Matt Dorsey’s reduction of harm reduction services into law “Recovery First Ordinance”.
You’re not a real journalist.
Hey champ —
The mayor signed that ordinance in May and this article was written in April.
Best,
JE
Harsh Their Mellow!
San Francisco needs to turn the use of illegal drugs in SF into a horrible nightmare experience. Regardless of the infraction, 48 Hours Confinement. If there’s one thing junkies don’t like is not getting their drugs. Make them suffer for 48 hours. Every time and for every excuse. eventually they’ll decide that we’re all a bunch of a$$holes and they’ll leave, and the dealers will follow them. BTW, that’s the way it really works: If the addicts go to a new place the dealers will follow the money. The addicts only go to the dealer in the most local sense.
I can see not distributing straws or foil, but denying access to clean syringes crosses the line into lowering the barriers to transmission of HIV and HCV and is not acceptable.
We fought long and hard for needle exchange and are not about to forfeit that win on the altar of anti-scientific hysteria even if these infections are now treatable with expensive meds that require strict adherence.
I don’t even understand why we need to provide any drug paraphernalia.
If you want to be an addict, go get it yourself? We are just enabling drug use.
Use the 700k to clean our streets, and help those who actually want help.
No.
The problem is not a lack of understanding; if that were the problem, you’d have fixed it already, by … learning.
The problem is that ignorance is not, in fact, a good substitute for knowledge. But you seem to think it is.
Because it is in the public interest to prevent the spread of infectious diseases and clean syringes are perhaps the least expensive option to do just that.
We learned this during the depths of the HIV pandemic, when people were dropping like flies and Puritans like yourself were condemning people for making poor moral, sexual choices.
Choices have consequences .
Zero drug tolerance or enabling.
No supply then then no drugs .
Why dont the nonprofits help get the dealers and distrubition of drugs removed ?
Possession of drug paraphenalia is illegal.
This game is getting really old .
Taxpayers are done footing the bill to pay for persons to hang out on the streets and do drugs all day .
In reality few even want treatment.
There should be a limit on how much the city spends on each and every person to help them.
For addiction for homeless etc once you have spent your limit then unfortunately government is done.
Why do addicts get free emergency medical care are ambulance ride and er visit yet the rest of us get stuck with a bill if we call an ambulance and go to the er ?
See SF Chronicle article from past that reported millions spent on just a few addicts transporting and caring for them in er over and over .
That is not sustainable .
Im all about equity and equality .
The city is discriminating .
It needs to distribute the taxpayers money equally to every resident . Once your cut is spent then sorry .
Law enforcement and services cost . Addicts get their chance for intervention and treatment . If they refuse or decline then mark them off .
The babysitting and “Im not ready , oh drug withdrawl is hard , etc etc excuses is so selfish .
Addicts are addicts . They are harming themselves and all of us .
They cannot be allowed to rot and left of the street.
Wake up,
A rat will keep eating poison until it dies .
Anyone or nonprofit that contributes or aids in their continued usage of illegal poison is sick and evil.
Clean this place up . Stop the drug death dens.
The segment of responders to this article and this paper should understand compassion begins when you stop harming people and stop allowing them to take poisons one more time.
In 2005, Republican populist governor Schwarznegger did what Dingy Gray Davis never would, which was to sign the legislation eliminating the prescription requirement for syringes. That prescription requirement is what drove needle exchange. Once that barrier was lowered, needle exchange was no longer needed to avoid legal exposure. I’d imagine that outreach workers giving away free rigs would also be able to capture used needles.
JFC.
Unless and until there are enough places for people to get and stay sober, people won’t be sober. Unless and until there are enough places for people to not live on the streets, they will live on the streets.
Funny how the “common sense” people do not ever, ever seem to have accepted that very basic bit of common sense.
Cynthia, please no more posts about how you pretend to know the literature and follow it
Thanks Cynthia, my thoughts exactly. The same people screaming about the addicts and homeless on the streets spend tens of thousands on lawyers to sue and prevent Navigation centers and other shelters that can help folks get off drugs and the streets.
Twenty thousand San Franciscans who died from AIDS are turning in their (early) graves.
With millions in federal funding for HIV prevention being removed from health agencies and universities nationwide (along with USAID investments worldwide), now is not the time for San Francisco to experiment with unproven policies to make the Mayor look good. We know how that ends.
We have long been the home of groundbreaking HIV research and treatment, and innovation in related tools like PrEP and DoxyPEP. This type of unscientific policy change puts that reputation and legacy at risk – and we will not be able to Get to Zero.
Evidence over vibes. With a solid dose of empathy for people who are going through it. We can do so much better.
We need way more Residential facilities, both locked and unlocked.
Taking away safe supplies without offering real treatment will only assure we have more die.
Get an ice-cream truck that rolls into the Tenderloin regularly to dole out the needles etc. Even have ice-cream truck music so the Junkies can respond to it’s seductive call!!!
Campers,
Is there and echo in here or just me repeating the Solution …
Just legalize the shit already.
Takes cops and dealers out of the equation and leaves it as a Public Health problem which it is.
If they break the law bust them like everyone else.
Otherwise …
Give them a Prescription not a Citation.
go Niners !!
h.
I stop using drugs like Heroin,Crystal Meth(IV) in 2017, Alcohol 2018 Just so y’all know,we didn’t have “no harm reduction” BULLS___, no access to needles,so we just couldn’t shoot our dope,that was it! So I don’t know if you who are commenting have ever shoot drugs or whatever. YOU NEED TO BE QUIET,IM TALKING TO THOSE WHO KNOW NOTHING BOUT WHAT WE GO THROUGH..IF I WANTED TO GET OFF HEROIN,I KICKED COLD TURKEY OR GOT ON Methadone. And went into CHRISTIAN REHAB(Woke folk dont say nada!) I got off drugs that way,and a whole lot of us did it that way! But then we got these SISSIFIED supervisors,Mayors(breed was one the worst Mayors ever!), Governor NEWSCUM,Democrats we went to the craps,they ENABLED,PAMPERED THESE ADDICTS AND BECAUSE
OF WOMEN RUNNING THE SHOW FOR SO LONG DESTROYED EVERYTHING WITH THERE MAMA-ING ,NURTHERING TREATING ALL THESE DRUG ADDICTS AS thoughTHEY your CHILDREN AND NOW WE GOTS A BIG MESS ON OUR HANDS,THEY ARE MAKING EVERYTHING WORSE.Mayor Luries idea to stop all the paraphernalia IS A DAMN GOOD IDEA!!! KICK TO THE CURB “NO HARM REDUCTION PLEASE!!!” ITS NOT WORKING,NOTHING IS,BUY THEM A BUS TICKET BACK HOME!! GET THEM OUTTA HERE,MY CITY,MY BARRIO
STOP GIVING OUT PARAPHERNALIA NOW,TAKE IT AWAY AND SEND THEM TO “CHRISTIAN REHAB” ALL THOSE OTHER PROGRAMS FAIL, ESPECIALLY WALDEN HOUSE(SEX,DRUGS,ROCK N ROLL) OR SEND THEM TO “JAIL” “PRISON” THATS HOW I STOP USING DRUGS,ALCOHOL,CLEN UP, ATTENDED BIBLE STUDY,READ BIBLE AND I DIDNT WANT DRUGS, ALCOHOL,ETC . NO MORE!!! PRAISE THE LORD, THANK YOU JESUS FOLKS!
(JOHN 14:6📖) HE IS THE WAY,AND THE TRUTH AND THE LIFE, NO ONE CAN COME TO THE FATHER BUT BY ME(JESUS CHRIST)
(Mark 1:15) REPENT(turn from ur sin against God) and BELIEVE the GOSPEL (Good News of ME Jesus DEATH,BURIEL and RESURRECTION)
ROMAN 1:18,JOHN 3:3-5