For years, San Francisco nonprofits have handed out illegal drug-use supplies to the city’s growing population of addicts. With official approval from the San Francisco Public Health Department, groups like the San Francisco AIDS Foundation and GLIDE set up mobile distribution points in areas where the drug scene thrives.
Those days are now numbered. Last week, Mayor Daniel Lurie announced sweeping changes to this practice. By the end of the month, city-funded nonprofits that rely on local and state grants will no longer be permitted to distribute so-called harm-reduction supplies in public spaces. If they ignore these orders, city contracts will be placed under scrutiny, jeopardizing future funding.
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The Department of Public Health also appears likely to comply with the policy change. Weeks after taking office, Lurie appointed a new director, Daniel Tsai, to lead the department. He replaces Grant Colfax, who received criticism for the department’s permissive harm-reduction strategies, especially as overdose deaths spiked during his tenure.
The policy change is part of Lurie’s Breaking the Cycle initiative, which focuses on getting people off the streets and into treatment. It represents a welcome break with the city’s far-left leaders, who have fought against recovery-based programs.
Until now, following a city-published schedule, harm-reduction activists would drive vehicles stocked with drug-use supplies to various locations—behind the Safeway in the Castro, Hemlock Alley in the Tenderloin, or 16th Street in the Mission District. Once there, they would park and unload plastic bins filled with equipment: needles and cookers for intravenous drug use, glass pipes for meth and crack, and aluminum foil and straws for fentanyl. No questions asked. No treatment offered.
Under Lurie’s new policy, these distributions will technically still be permitted—but only indoors and under strict conditions. Participating organizations must provide proactive treatment counseling and connect users to recovery programs, with on-site engagement and access to services. To meet the expected demand, the city plans to add treatment beds and expand recovery options.
With the end-of-month deadline still weeks away, I visited the Mission District. On Wednesdays, around 6:30 p.m., the harm-reduction van is usually parked in front of one of the neighborhood’s SRO hotels. This time, I found a heavy police presence and a noticeably cleaner environment. Several drug users were puzzled by the van’s absence. It was already clear that public scrutiny of harm-reduction efforts was having a deterrent effect.
One of the only places where open drug use persisted was outside the Gubbio Project, a nearby homeless shelter. Roughly a dozen people were surrounded by piles of gear, doing drugs. One man was passed out in his own vomit.
“Lurie has the right idea,” says Susan Dyer Reynold, editorial director of the moderate-leaning Voice of San Francisco. “[Addicts] need to go indoors, be offered services, and be supervised. But harm reduction is so deeply entrenched here. Gubbio is supposed to be a respite, but they allow drug use and hand out paraphernalia. They don’t believe in offering services or recovery; they think it’s dangerous.”
Ardent activists are unlikely to get on board with Lurie’s policy. According to Keith Humphreys, a Stanford addiction policy specialist, harm reduction can resemble a faith, “like being a Baptist.”
“Some [harm reduction supporters] will stamp out and refuse to comply,” says Humphreys. “That’s their right. But it’s our right not to pay their salaries anymore. We can say, ‘You don’t get the job. Your nonprofit won’t be funded.’ If they want to do harm reduction, they need to show us that people are going into treatment, that they aren’t dead in six months.”
San Franciscans are fed up with harm reduction. The city has become synonymous with open-air drug use and the crime and blight that go with it. Meantime, the activists disregard the damage being done to the communities where they distribute drug paraphernalia. “Maintaining people on the street has health impacts on other people,” Humphreys notes. “It’s not pearl clutching. It’s a mother with her child walking through traffic to avoid the people doing drugs on the sidewalk.”
Zealous harm reductionists insist that curtailing the distribution of complementary fentanyl foil will result in dire consequences, such as drug smokers transitioning to injecting, which carries a higher risk of disease transmission. Humphreys disagrees. “Just because you aren’t given a fentanyl kit, you’re not going to switch to needles,” he says. “There is no evidence to support that.”
But such myths can persist. The original intent of harm reduction—to stem HIV and other blood-borne diseases that are easily spread through intravenous drug use—has mutated. Advocates now consider it stigmatizing even to mention detox or recovery to addicts. Some claim that providing free crack and meth pipes is necessary because it reduces sharing, which can pose a disease risk (users’ lips are frequently cracked and bloody). It’s all part of “meeting people where they’re at,” a core principle of harm reduction.
“We have all been told to stop being so judgmental,” observes Humphreys. He explains that this attitude emerged from the killing of George Floyd in 2020. “It changed the way we regulated public space, saw law enforcement. We all went a bit crazy after that.”
For some, the drug-delivery supply vans were the breaking point. In 2024, an incredulous German news crew and I watched as a San Francisco AIDS Foundation team set up tables behind the Castro-area Safeway and dispersed drug-use supplies to users. A few people who came for the items fought one another, throwing punches. Some yelled incoherently before settling into the supermarket parking lot to party. Others nodded off.
These activists had certainly met the drug users “where they were at.” But after they packed the empty boxes back into their van, they left the users to suffer. One could only hope someone would open the boxes of naloxone in time to revive a person dying from an overdose.
The city’s shift away from radical harm reduction shouldn’t come as a surprise. As fatal overdoses have climbed, San Franciscans have lost both their patience with and their trust in the “expert” community. Residents, workers, and business owners demand answers and action. Mayor Lurie appears to be giving both.
“The fever has broken in San Francisco,” Humphreys says. “In 2020 and 2021, bullying worked. [Harm-reduction activists] are still trying, because they’re desperate, but they have lost the public of a left-wing city.”
Top Photo by Tayfun Coskun/Anadolu via Getty Images
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