How can S.F. tell if its approach to the drug crisis is working? 

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City department heads and supervisors agree that San Francisco is seeing an unprecedented level of collaboration across city departments to tackle the drug crisis. But now, District 9 Supervisor Jackie Fielder is looking for the next step: A clear way to measure how well this collaboration is working.

“How are we identifying metrics of success?” Fielder asked at a hearing Thursday at the Government Audit and Oversight Committee. The Police Department, the Department of Public Health, and the Department of Emergency Management had just presented their plans and actions to address the open-air drug markets, drug addiction and treatment, including the six neighborhood street teams Mayor Daniel Lurie announced in March.

Collecting this kind of data is important, Fielder said, because so far, efforts to reduce public drug use, drug dealing, and fencing of stolen goods in Civic Center, South of Market and the Tenderloin appear to have resulted in an increase in all of these things at the 16th Street BART Plaza. Now that police have established a 24/7 presence at the plaza, at least some of that activity has dispersed into streets around the station which had been relatively quiet before. 

A prominent goal of the crackdown is to help tourists and residents feel comfortable visiting (and shopping, and dining in) areas like San Francisco’s downtown. The committee’s vice chair, District 3 Supervisor Danny Sauter, left halfway through, joining one of the hearing’s co-sponsors District 5 Supervisor Bilal Mahmood to attend the opening of a Nintendo store in Union Square. 

“My district is feeling the pain with the displacement,” said Fielder, who represents the Mission District, now the current hotspot for drug arrests and citations. “I don’t think I’m in a position to tell my constituents that we are, by any means, close to solving the drug crisis.”

Commander Derrick Lew from the San Francisco Police Department acknowledged that the displacement of drug users and dealers is unavoidable, based on the current strategy. 

Success will clearly mean some displacement, Lew said, showing before-and-after photos of United Nations Plaza, which was an early focus of DMACC, a drug crackdown and tough-on-enforcement operation launched by former Mayor London Breed and former Police Chief Bill Scott, which coordinates resources from 13 city departments. “People will move to where the pressure is not.”

Lew also underscored “dispersion,” as an effect of DMACC. What really makes a street start to feel unsafe, he said, “is the grouping.” 

“A person going down the sidewalk pushing their baby carriage can get over one person,” Lew said, as an example. “But when 20, 30, 40, 50 people are lined up, then it starts getting scary.”

Fielder said she passes the 16th Street BART Plaza on her bus ride to work everyday, pointing to another problem she sees as what she described as the city’s “catch-and-release” strategy. In March, Mission Local reported that a raid by the police department and the sheriff’s deputies led to the arrest of about 40 people at Market Street and Van Ness Avenue, but no criminal charges came out of the mass arrests. 

“Do you think it’s an effective use of limited public safety resources just for people to get released and not connect to the treatment?” Fielder asked Lew about those arrested and released.

“I do,” Lew answered. 

Dr. Dan Ciccarone, an addiction expert at the University of California, San Francisco, who spoke at the hearing, disagreed. “Why is there not a next step for that person?” Ciccarone said after the hearing. “Any time you do that, you lose what Daniel Tsai suggested, which is ‘stickiness.’” In an earlier presentation, Tsai, the director of the Department of Public Health, had described the city’s goal as “stickiness and flow;”  helping move people quickly from the streets into treatment and recovery. 

Ciccarone noted that people with drug addictions, after being arrested and spending a few days detoxing in jail, are more sensitive to drugs when they return to the streets.

“It should not be catch-and-release,” Ciccarone said. “It should be catch-and-retain.”

The Thursday hearing, called by Fielder, is based on a city report that compares DMACC’s approach to the drug crisis with the “Four Pillars” strategy developed in Zurich, Switzerland. The “Four Pillars” is a model that combines prevention, treatment, harm reduction, and law enforcement, which helped the Swiss city get through its heroin epidemic in the 1990s. 

The report was commissioned by former Supervisor Dean Preston and released by the San Francisco Budget and Legislative Analyst in November 2024.

While Zurich and San Francisco share similarities on the drug crisis, there are major differences, according to Fred Brousseau, the Budget and Legislative Analyst who presented the finding at the meeting. 

For example, Brousseau pointed out that Zurich is about half the size of San Francisco.  Switzerland is also less diverse, has a public healthcare system, and doesn’t have a homelessness problem. Also, fentanyl is stronger than heroin, and was not as widely present in Zurich as it is in San Francisco now. 

“Addiction is a chronic disease, not a moral failing with a quick fix,” said Dr. Ayesha Appa, an addiction medicine and infectious diseases physician at San Francisco General. On average, Appa added, most people require five to nine treatment attempts before sustained recovery. Appa also underscored that treatment requires a variety of tools, such as medication, harm reduction, housing, and mental health support. 

One of the few metrics that does exist for judging the success of San Francisco’s drug-abuse-prevention efforts suggests that, collaborative or not, current efforts may be doing more harm than good. 

After 14 months of declining drug overdose deaths from a record high of 88 in August 2023, the city’s fatal overdoses are increasing again. In March 2025, San Francisco reported 65 accidental overdose deaths, the second highest since it was on the rise starting in October 2024, according to the Chief Medical Examiner’s office. Fielder called it “not just a policy failure, but a public health emergency.” 

“I see genuine efforts to do something different,” Fielder said. “But we have to be able to tell San Franciscans what our measures of success are.”