Are Lax Laws Causing San Francisco's Drug Problem?

If you’ve been to San Francisco lately, you may wonder what is going on. There are people injecting heroin on the streets, abandoned needles on sidewalks and groups using drugs in many public spaces. It’s been termed as open drug use, and unfortunately, it’s a big problem in the city.

There are around 22,000 intravenous drug users in San Francisco, according to the Department of Public Health. Most use heroin or prescription opioids, but methamphetamines are reported to be on the rise too (as are hospitalizations from them).

Is California’s lenient drug policy to blame? If so, why has San Francisco been identified as the main problem zone compared with other Californian cities? And are other options, like safe injecting spaces, a viable option for minimizing the impact of public drug use?

What is California’s current drug policy?

In the United States, 1.6 million people a year come to the attention of the law for drug violations. In most states, people who are found in possession of drugs are charged and sentenced. This was the case for California until a new drug treatment diversion plan came into effect in 2014 (Proposition 47).

The new law allows people to face a misdemeanor, rather than a felony, if they are found to be in possession of drugs. What’s the difference between these crimes? Well, a felony is the most serious type of crime and often results in a prison sentence that could last many years, whereas a misdemeanor is a less serious crime which can still result in jail time, but often allows individuals to be quickly released to the community on probation.

What does this mean for the streets of San Francisco?

While it is still prohibited to have drugs in your possession, people who use drugs are more likely to be offered treatment rather than jail time. In theory, this is a real step forward in how we view drug addiction as a society and is something that’s supported by many organizations who aim to reduce the drug/alcohol problem in this country — rather than punish people who use drugs, the aim is to help them.

But with resource pressures and the amount of paperwork involved, picking up drug users on misdemeanors is hardly a priority for the San Francisco Police Department. Could this be why people are out on the streets using drugs? They no longer live in fear of the consequences and they no longer have to hide their habits.

And if they wanted to, many have nowhere else to go.

In terms of its demographics and socioeconomic status, San Francisco is a particularly interesting city. Gentrification of the city has been a source of contention since the early 1990’s between the traditional poor immigrant neighborhoods and the influx of technology sector workers who drove up real estate prices with increased demand. San Francisco has become one of the most expensive cities to live in the United States.

This means people in San Francisco who are drug dependent are increasingly vulnerable and being forced out onto the streets. Abandoned homes are being rebuilt and rents have skyrocketed to record levels, so finding a place to hide and use is difficult. Homeless and with nowhere else to go. Drug users congregate in public spaces, because they don’t have anywhere private or safe to seek refuge.

And resources for housing, drug treatment, and mental health care are as scarce as ever, meaning that even if users are intervened on by police towards getting them help, there isn’t much to be offered…

When we look at gentrification, California’s lax drug policy and the fact that people no longer fear jail time but do not have broad access to help they can use, it’s no wonder San-Franciscans are tripping over drug users in the streets.

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Should California revert back to criminalization of drugs?

So how does stumbling over someone injecting heroin on your way home really help the city? It doesn’t. Perhaps you’re thinking decriminalization isn’t such a great idea after all. Many of the city’s residents are starting to believe this as well.

That’s because decriminalizing drug use is just one aspect of tackling the drug epidemic and California sure has a long way to go to get a real handle on this. Allowing people to stay away from long-term prison sentences only helps if there are comprehensive resources to get them care when they need it. Otherwise, it’s a little like telling your kid that you really want to allow them to make some of their own decisions and then handing them the credit cards and keys to the house and the car and going on vacation. Good luck!

I am clear on the fact that I don’t believe you should punish people who use drugs by throwing them in jail. They need effective, caring and accessible treatment and this won’t be found in the criminal justice system. If 1.6 million people are arrested for drugs annually, then it’s clear that deterrence is not the answer (otherwise our jails wouldn’t be filled with drug users who rotate in and out of the system).

Why do ‘laws’ about drug use make drug problems worse?

When we make ‘one size fits all’ laws about drug use we neglect the individual experience. And when it comes to why people develop problems with alcohol or drugs it is about nothing but their individual circumstances. Childhood trauma, genetic predisposition, environmental stressors, relationship breakdowns, job loss, grief and loss and more - these are the factors that contribute to why someone may develop a problem with drugs or alcohol in the first place. Drug problems are the symptom of the condition, not the real underlying cause. So why are we punishing people who actually need our help?

Solutions to the drug crisis lie along a continuum. On one end you have lax drug policy (like California’s), open drug use, and safe injection spaces, on the other end you have no tolerance laws, criminalization, and abstinence-only treatments. Solutions must be tailored to the individual. Stigma must be reduced. And treatment must be available, affordable, and accessible to everyone regardless of income, race, gender. No one starts using because they want to end up on the BART platform with a needle in their arm (and no drug user wants to end up using there – they do it because they see no better option). We must start getting serious about addressing the real culprits.

How can we help people who use drugs and protect our city?

San Francisco is one of four US cities that has expressed interest in opening safe injection spaces for drug users. While some people may think this will just encourage further drug use, or attract groups of drug users who will run rampant on the streets, we do need to face the facts - People are going to keep using drugs, no matter what the laws say, and people are already congregating on the streets - because they have nowhere else to go. So why not provide them somewhere to go, if they are going to do it anyway?

A safe injection space is a dedicated hub where people can use their drug of choice, under supervision. It’s private and much safer than using on the streets.

What are the advantages of safe injection spaces?

• It reduces risk of infectious disease

• Users have access to sterile injection equipment

• Supervision from trained staff

• Access to medical treatment of opioid overdoses

• Introduction to supportive staff that may be able to refer to treatment

• Keeps drug users off the street

Do they work? While they’ve had little community support, safe injection spaces have an abundance of evidence behind them that says they do work. While this was briefly contested by a meta-analysis of the impact of medically supervised injection centers, the research paper which made these claims has since been retracted due to ‘methodological weaknesses.’ But has this already damaged the already fragile public opinions of safe injection spaces?

To be clear, safe injection sites are not THE answer to the problem, although they can absolutely be part of a comprehensive approach. We must address the multitude of barriers for entry that exist for individuals who struggle with addiction. In The Abstinence Myth book, I mention the main four barriers I found in my research – Cost, Shame, Access and abstinence. Increasing access and removing abstinence as a barrier while reducing drug user shame by giving them a place to be safe and out of sight as they tackle the real problems they’re facing would be an incredible benefit in this battle.

In Summary

We need to look at the BIG picture when it comes to keeping our streets safe and helping people who are drug dependent. We need to think deeper about the drug crisis, look beyond ‘laws’ and humanize those who abuse drugs and alcohol. We need to offer alternatives to the current drug crisis solutions and find ways to destigmatize addiction.

Stigma induces shame and shame prevents people from seeking help. I explore shame and addiction in The Abstinence Myth book and in my online coaching I offer people alternatives to traditional AA or abstinence-only methods of recovery. IGNTD Recovery seeks to meet people where they are, give them the privacy of a recovery treatment in their own home, free from stigma or judgment. We need to minimize shame and guilt and instill hope. Because hope and acceptance is the starting point for change.