Drugs are destroying San Francisco’s most densely populated and desirable neighborhoods, as more and more addicts, many of them homeless, fill the streets. Politicians and activists are pushing “harm reduction,” which, in a clinical sense, means a “set of practical strategies and ideas aimed at reducing negative consequences associated with drug use,” such as overdose or the transmission of disease. But in a contemporary context, it also means “a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.”
Harm reduction, originally a controversial public-health measure, has become a religion among advocates, even as fears that the practice would normalize drug use have been borne out. Organizations like the San Francisco Drug Users Union demand “a safe environment where people can use & enjoy drugs” and a “positive image of drug users to engender respect within our community and from outside our community.” True believers dominate City Hall as well as a network of affiliated, politicized nonprofits that operate in the city with little oversight or accountability. In this environment, questioning harm reduction or its effects borders on heresy. But are the programs actually helping impoverished addicts? And what is the impact on the community?
The Department of Public Health distributes 4.45 million needles each year to the city’s 22,000 intravenous drug users. Heroin and prescription opioids are the most injected substances, though use of methamphetamines and Fentanyl is on the rise. It’s true that sterile needles reduce the transmission of blood-borne infections, and injecting narcotics under supervision can lower the risk of overdose and death. But harm reduction goes far beyond promoting these kinds of needle-safety measures. For example, At the Crossroads, a nonprofit, assembled “safe snorting kits” for at-risk and homeless youth. Baggies were filled with straws, chopping mats, plastic razor blades, and instruction sheets. Other groups offer crack-cocaine “safe-smoking” kits. A proposal to open “safe injection” sites, opposed by Jerry Brown, is favored by Governor Gavin Newsom, and is likely to succeed.
Harm-reduction efforts are sometimes sold as ways to connect with addicts, offer them other services, and help them get off drugs. But those laudable goals are not really what motivate advocates, who want mostly to remove the stigma surrounding drug use. Addicts may eventually pursue treatment or stop using on their own, but a central principle of harm-reduction theory is accepting and respecting drug use. As a result, an astonishing number of addicts on San Francisco streets hover on the edge of death, despite a continuous supply of clean needles.
Visit city neighborhoods ranging from the iconic Union Square and the Financial District to historically troubled areas such as the Tenderloin, Civic Center, and South of Market, and the unintended consequences of harm reduction become hard to ignore. The advocates have certainly succeeded in reducing stigma—it’s easy to find people openly injecting into their arms, legs, toes, and necks. Their exposed flesh shows infected sores; they stumble, fall, and pass out. There seem to be more of them, and in worse condition, every day. Addicts congregate on sidewalks, in parks, subway stations, and outside businesses. They die in school doorways.
As for the needles, addicts are encouraged to take as many as they want. The city program does not involve needle exchange, so it offers no incentive properly to dispose of used needles. San Francisco’s streets and transportation system are littered with discarded syringes. After massive public outcry (and streams of embarrassing media reports) about the proliferation of hazardous medical waste on the streets and sidewalks, the city contracted with the San Francisco AIDS Foundation, at approximately $1 million per year, to hire a cleanup crew. Roughly 60 percent of the needles now get collected.
Meantime, quality of life in the city continues to erode. Tourism is threatened, retailers close, and families leave. Yet harm-reduction zealots remain adamant in their views. During public discussions about safe-injection sites, they dismiss legitimate concerns about increased drug-dealing, burglaries, violence, and vagrancy. In community meetings, Department of Public Health representatives disregard residents’ misgivings. Typical complaints—“Why are you doing this? Bloody needles are everywhere, people are injecting in front of my kid’s preschool, I’m afraid to take my dog for a walk”—are met with responses that usually begin, “This is harm reduction.” In San Francisco’s brave new world, there is no room for the skeptic.