For over a decade, the city of San Francisco has been carrying out an experiment. What happens when thousands of drug addicts are not only permitted to use heroin, fentanyl and meth publicly, but also enabled to do so? The results are in: hundreds of them die annually. Last year, 712 people in San Francisco died from drug overdoses or poisoning, and this year a similar number are on track to do so.
And cities around the country have been copying San Francisco’s approach. Partly as a result of these supposedly progressive policies, 93,000 people in the US died in 2021 from illicit drugs, a more than five-fold increase from the 17,000 people killed by illicit drugs in 2000.
Rather than arresting hard drug users when they break laws, and giving them the choice of jail or drug treatment, the only strategy which has proven to work, the city of San Francisco provides addicts with the cash, housing and drug paraphernalia they need to purchase and use deadly drugs.
Former homeless addict Tom Wolf maintained his habit for six months by surviving on the city’s cash welfare payments. “I got $581 a month in General Assistance and $192 in food stamps,” he told me. San Francisco gives other addicts free hotel rooms without requiring that they stop using drugs while living in them.
While many people are able to end their addictions without external help, many others require multiple interventions by family, friends, and, if their addiction results in them breaking the law, the police. Many formerly homeless drug addicts, including Wolf, credit being arrested with motivating them to finally overcome their addictions.
Researchers have known since 1997 that “patients who have been forced to enter a substance abuse treatment have shown during and post treatment results that are quite similar to those shown by supposedly ‘internally motivated’ patients.”
In a major 2014 study of how five large European cities shut down “open drug scenes,” researchers found, “Prevention, harm reduction and treatment should be combined with law enforcement.”
Progressives justify their withholding of the best-available medical treatment of drug addiction in the name of reducing racial disparities in jails and prisons. But the result of the city’s hands-off policy is far worse: racial disparities in drug deaths. African American men in San Francisco were almost six times more likely to die from illicit drugs than the average city resident.
According to race theorist Ibram Kendi, whose views are shared by many of San Francisco’s progressive policymakers, policies that result in racial disparities are themselves racist. As a result, progressives should view harm reduction-only policies, including Housing First, as racist.
Indeed, San Francisco is engaged in an unethical refusal to mandate proven medical treatment to drug addicts that is no different from the denial of medical treatment to syphilis sufferers by US government researchers in Tuskegee, Ala., between 1932 and 1972. In those infamous, racist experiments, US health and medical professionals denied penicillin to African American men long after it became clear, in 1947, that the antibiotic saved lives.
It’s true that, in Tuskegee, health officials denied medical treatment in service of the experiment itself — they wanted to be able to prove scientifically that penicillin cured syphilis — while in San Francisco, health officials don’t require medical treatment for addicts out of the belief that doing so is more ethically justified than jail and prison.
But the experts who oversaw the Tuskegee experiment similarly claimed it was “ethically justified” since they believed it would give the government the proof that penicillin worked and save more lives in the long run.
Progressive San Francisco officials have refused to mandate treatment to addicts, and enabled addiction through Housing First policies, for nearly as long as Tuskegee officials denied penicillin to syphilitics. In 2009 a team of scholars and doctors warned, “One potential risk [of Housing First’s harm reduction approach] would be worsening the addiction itself.” And in 2002, the director of psychiatric services at the San Francisco Haight-Ashbury Free Clinic said, “It is not only clinically incorrect but almost sadistic to give money on a regular basis to people who have a demonstrated inability to handle cash funds.”
In truth, what San Francisco and other progressive cities are doing is worse than Tuskegee. Of the approximately 600 men enrolled in the Tuskegee experiment, 128 died of syphilis. Six times more people died of drug overdoses and poisonings in San Francisco last year alone, 178 of whom were black.
There is a better way. San Francisco and other progressive cities should arrest addicts who break the law, offer drug treatment as an alternative to jail and prison, and make cash and housing for addicts contingent upon drug treatment. A major scientific review in 2016 found that 151 studies of “abstinent-contingent” housing, or 86 percent of total studies surveyed, had an effect size that ranged from moderate to large, a vastly superior result to addiction-enabling Housing First policies.
It is high time that San Francisco and other progressive cities started using proven strategies for saving lives and ending addiction, and ended their deadly and immoral experiment on vulnerable people.
Michael Shellenberger is the author of “San Fransicko: Why Progressives Ruin Cities” (Harper), out Tuesday.
