District 2 Supervisor

Addiction is a crisis

The addiction crisis in San Francisco is an unmitigated disaster. Drug overdoses have caused twice as many deaths as Covid-19 since the start of the pandemic, and it continues nearly unabated. When I walk through our city, I don’t see thousands of people living on the streets — I see thousands slowly dying, and each of them is someone’s father, mother, son, or daughter.

In 2018, there were 259 documented overdose deaths in San Francisco. In 2020, that number nearly tripled to 717 deaths. There were at least 592 overdose deaths in 2021. These tragic numbers could have been a lot worse. In the first six months of last year, Narcan was used to reverse an overdose more than 4,200 times. These numbers are stark indicators that our current response to the overdose epidemic is deeply flawed.

That’s why I supported the mayor’s emergency declaration for overdose deaths in the Tenderloin. We must earnestly try to address the most serious public health crisis facing our city. 


San Franciscans voted to allocate more than $1 billion to address homelessness, and more than $25 million to address mental health crises and drug overdoses in the 2020 budget. Yet, these linked crises continue to get worse. We have significantly broadened who can access shelter-in-place hotel rooms and temporary housing, we’ve drastically increased our supply of needles for safe drug use, and we’ve gone to great lengths to support harm reduction approaches to the overdose crisis. 

What do we have to show for all that? We have one of the highest overdose death rates in the country. We have to accept that these practices alone are not working. 

Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine. We have thousands of people horrifically addicted to and dying from it in the city, and the individuals selling it face no consequences. 

I read about one mother who described how her daughter’s drug dealer was arrested three different times; each time he was out within days and selling to her daughter again. I know of another case where a dangerous drug dealer was arrested on drugs and firearms charges and sent to drug court for an eventual dismissal. On Oct. 27, a known Tenderloin drug dealer was in court on four counts of felony possession for sales and only given diversion with the promise that his case would be dismissed if he completed five Narcotics Anonymous meetings. We see cases like this over and over again. 

Despite the fact these dealers are coming in from outside our city causing harm to our communities, and doing so with total impunity, the district attorney has vowed not to participate in the emergency declaration. In fact, he held a press conference denouncing the mayor and her plan. Meanwhile, his own dashboard shows that the district attorney’s office hasn’t tried a single drug sales case — even as the death toll from overdoses skyrockets.


The epicenter of this crisis is in the Tenderloin. More than 40 percent of the overdose deaths in the city occur in the Tenderloin and nearby SOMA neighborhoods. It is also where a significant number of immigrant and refugee families with children live and work. 

In November, more than 400 Tenderloin residents and families signed a letter begging the city to intervene. The brutal reality that they face day after day is abhorrent, and we cannot continue to ignore it.

In November, an 11-year-old girl wearing a hijab was walking her younger sibling to school in the Tenderloin when she was violently assaulted, and had to go to the intensive care unit for her injuries. The attacker was arrested for assault, child endangerment and a hate crime, but is roaming the neighborhood again and contributing to the ongoing fears these families and children face every single day. 

When we talk about public health, we have to think about the whole community, including the children and families in these neighborhoods. We have a public health obligation to them, too, and right now, we are failing them.

Addiction is a terrible disease. It can cause people to do things they don’t want to do or commit crimes they don’t want to commit. We must get them the treatment they need, but the disease of addiction doesn’t give anyone license to use on the streets until they kill themselves or seriously harm someone else. We cannot continue to enable people into oblivion.


We need a combination of law enforcement and social services. We need a combination of consequences and treatment. This is the kind of approach that was used successfully all over Europe, and it is exactly what our mayor is asking for. In my opinion, it is the only humane option, given how dire the emergency has become.

Under the director of emergency management, the city is using its emergency powers to create a linkage center where those suffering from addiction can receive treatment, mental health, and other services. This declaration allows us to circumvent existing bureaucracy to lease new facilities and hire hundreds of vacant behavioral health positions. It also allows us to disrupt the deadly open-air drug market, and expedite street cleaning and infrastructure requests. 

The department managing this crisis will be the same one that successfully managed our Covid-19 response. Director of Emergency Management Mary Ellen Carroll has proven herself to be one of the most competent emergency managers in the country, and if anyone can disrupt this vicious cycle, it is she and the people she leads. The task before her is enormous, but I have the utmost faith that she is up for it. The situation in the Tenderloin is untenable, and it deserves a sustained emergency response from the city. This is something that has been begged for and demanded by families in the Tenderloin for years. The alternative seems to be a combination of doing nothing, arguing about what to do, or doing the same thing over and over again and expecting different results. 

It’s past time we treat this like the emergency it is and demand policies that actually work. I voted in support of this emergency declaration on Dec. 23 and will continue to vote in its support, because the status quo is beyond unacceptable; those perpetuating it must be challenged and called out.

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