SF mayor's shift in harm reduction policy targets distribution of safe smoking supplies

San Francisco Mayor Daniel Lurie announced Wednesday he is modifying the city's policy of handing out clean drug use supplies in an effort to combat the fentanyl crisis.

"Fentanyl has changed the game," Lurie said in a news release. "We've been relying on strategies that preceded this new drug epidemic, which ends today."

The new policy will require drug users to receive treatment counseling or be connected to services if they want to get any safe drug supplies like tin foil and syringes.

As part of a harm reduction strategy, the city has contracts with nonprofits that provide clean supplies used to smoke and inject drugs. Groups that receive city funding to distribute safe supplies for drug use will be mandated to pair treatment referrals and connections to addiction care with handing out supplies.

The shift is a part of Lurie's executive directive called "Breaking the Cycle" to tackle the city's fentanyl epidemic. It calls for more coordinated services, better measurement of outcomes, and accountability for government. The idea is to get more people off the street and connected to services and keep public spaces clean and safe, while better managing taxpayer resources.

The policy also prohibits the distribution of smoking supplies in public spaces, a change that some people say may lead to more people opting to inject drugs if safe smoking supplies become less accessible.

Daniel Ciccarone is a professor in family and community medicine at University of California, San Francisco and a researcher studying the intersection of drug use and HIV. He's concerned that the new policy will only lead to more overdose deaths and transmission of viruses if people switch to syringes.

"Smoking fentanyl is safer than injecting it," Ciccarone said in a statement. "It is likely that inhibiting smoking paraphernalia will drive folks back to injection. And this will make overdoses and infections rise."

The city's Department of Public Health said it will closely monitor HIV and hepatitis C transmission as well as overdose rates once the shift goes into effect.

Some groups say that banning the distribution of safe smoking equipment in public is the biggest change since many organizations that hand out safe drug use supplies, such as Glide, already provide information on treatment options and resources.

"That's the most significant pivot from what Glide is doing right now," said Glide spokesperson Karl Robillard in an interview. "The other half is something that Glide has always advocated for."

Glide is an organization that provides a myriad of services such as free meals, case management, hygiene kits, testing for HIV and hepatitis C, harm reduction outreach, and recovery resources like 12-step meetings.

Part of its harm reduction outreach included walking around the Tenderloin neighborhood and approaching people with resources to treatment services and providing drug users with clean supplies like tin foil.

"The more touch points we can have with people to bring them back into centers where we can offer more wraparound services, the better," Robillard said. "We will continue to do the touch point, but we will do that without distributing safe smoking supplies. That's something that we will stop doing when we're in public."

Glide is also willing to help with Lurie's goal of creating 1,500 short-term beds for people who are living on the streets, which Robillard says will make it easier to connect people to services for treatment or other needs to get them.

"I know a priority for the mayor is to stand up 1,500 shelter beds. To have an immediate and uncomplicated referral system would allow us to then pass them into a system which gives them the bed and the treatment options that they need," Robillard said.

"We can't do all of that at Glide, but we can be a willing partner in making sure that when we're seeing folks on the front lines and we're bringing them in for that first triage step, then we have really strong partnerships to refer them to," he said.

San Francisco Department of Public Health director Daniel Tsai, who helped devise the plan, emphasized that the city will continue to employ evidence-based strategies while making changes that focus on getting people into treatment.

"As public health, we are responsible for the health of the individual on the street and the health of the community impacted by this crisis," Tsai said in the mayor's news release. "We are implementing strategic changes to build a more responsive system of care that moves people from the streets into effective treatment and sustained recovery."

The new policy will go into effect April 30. In the meantime, the San Francisco Department of Public Health will be working with its partner nonprofits to ensure a smooth transition and ensure compliance with the changes.