Of all problems that make San Francisco notorious, its lax attitude to drug addiction comes out on top. Multiple neighborhoods of the City by the Bay are besieged by zoned-out fentanyl addicts, their tents, their syringes, and their waste matter. 

Although newly elected District Attorney Brooke Jenkins indicated she intends to be very tough with drug dealers, for decades the city’s attitude towards the problem of addiction has been one of accommodation. The many nonprofits serving addicts and the homeless operate on the idea of harm reduction, or the belief that the negative effects of drugs can be reduced, if not altogether eliminated, with the right cocktail of government policies. The programs in question range from needle exchange—ostensibly aimed at halting the spread of blood-borne pathogens such as HIV and hepatitis—to government-provided narcotics.

In August, California Governor Gavin Newsom vetoed a bill that would allow cities like San Francisco to establish “safe injection sites” where government agents would supervise junkies in the process of getting high and interfere to reverse drug poisonings as necessary. By then, San Francisco had already illegally operated one such location, now slated to be closed.

The activists' newest idea is “safe supply." Granted, illicit substances are often contaminated with fentanyl, and many users lost their lives thinking they were taking different drugs. An argument can be made that if the users understood what they were taking, they would choose to take the correct amount, eliminating the possibility of an “overdose."

But it’s worth noting that the proponents of “safe supply” have a larger cultural agenda than merely saving lives:

[San Francisco] Department of Public Health behavioral health director Hillary Kunins said that the city is looking to broaden access to medically assisted treatment for people suffering from drug dependency. Kunins pointed to Canada and Switzerland, which offer prescription opioids—including heroin and fentanyl—in an effort to stabilize the drug supply and destigmatize drug use (emphasis mine). 

What is to be gained by the destigmatization of drug consumption, and why should a San Francisco government agency be involved in this project? Columbia psychologist Carl Hart is a leading American proponent of decriminalization and destigmatization. An author of several books on the subject, Hart is known to get standing ovations at conferences on addiction. Of course: while other speakers nerd out on subjects like chemistry, he is a Timothy Leary, only without the extravagant civilizational pronouncements. American bureaucrats are suckers for credentialed gurus. Hart preaches that drug prohibition is racist, that in most cases hard drugs like heroin or cocaine are not addictive, are a great enhancement to social life, and are a habit easily controlled with proper information. It’s a personal choice, and a good one. 

Hart practices what he preaches: he does heroin on a regular basis. The psychologist believes he is in control of his habit, going on drug binges for no longer than 10 consecutive days after which he only experiences mild symptoms of withdrawal. But the way he describes the benefits of the opiates suggest he is dependent on them. He said, for instance, that heroin makes him feel “prepared to face another day." And the statement “There aren't many things in life that I enjoy more than a few lines by the fireplace at the end of the day” seems artfully crafted not to say heroin is better than sex.

Hart doesn’t think he has a problem—and neither do many of the homeless on the streets of San Francisco. I subscribe to multiple social media accounts that interview the homeless. It’s not unusual to see video of a fentanyl user who can’t control the movement of his limbs but thinks he has his addiction figured out. 

If denial is a feature of drug dependency, ease of access is often the cause. Because safe supply allows for easy access and gives false comfort to the users, it encourages addiction. Take it from the Rolling Stones's own Keith Richards, the man who did more than anyone else in the history of the West to glamorize hard drugs. 

Switzerland was not the only country in recent history to establish a safe-supply heaven. The United Kingdom experimented with similar program in until the mid-70s. As Richards recalls in his autobiography:

At the same time, Anita [Pallenberg, guitarist’s girlfriend] and I had drifted into heroin. We just snorted it for a year or two, along with pure cocaine. Speedballs. A beautifully bizarre law of that time, when the National Health started, was that if you were a junkie, you register with your doctor, and that would register you with the government as being a heroin addict, and then you would get pure heroin pills, with a little phial of distilled water to shoot it up with. And of course any junkie is going to double how much he says he needs. Now, at the same time, whether you wanted it or not, you got the equivalent in cocaine. 

So the junkies sold off the smack they didn’t need to pay the bills. The parties involved found it reassuring:

When I was introduced to dope, it was pure, pure, pure. You didn’t have to worry about what’s it cut with and go through all that street shit. Sometimes, eventually, you would have to drift to the bottom — by the time the dope had got you by the scruff of the neck.

A rock star lifestyle, with heroin sprees punctuated by withdrawals, lasted until Richard “was truly hooked." “It’s a subtle thing," he explained. “It grabs you slowly. After the third or fourth time, then you get the message.”

Maybe it takes five times for Ivy League professors on account of high intellect, but I find the personal story of a Rolling Stone more trustworthy than that of an active addict. Especially when his story is in line with the consensus of a century of medical and sociological research. 

Eventually Richards just said no, but not until he was court-ordered into rehab. His lady friend had a more difficult time quitting. After the couple’s third child died in infancy, the musician’s mom proclaimed Pallenberg unfit to be a mother and took away the middle daughter.

Maybe there is a magical way to fine tune safe-supply policies to make them work as destigmatization proponents intend, to empower more people to do drugs safely, but Switzerland's approach, which Hart often points to, does not qualify as an example. As Michael Shellenberger explained in San Fransicko, in Switzerland, heroin maintenance is only offered to addicts who do not respond to other treatments. It’s not a lifestyle choice enabled by the government, but a treatment of last resort. 

Cities like San Francisco are not Switzerland. For one, those cities have notoriously inefficient governments. San Francisco recently allocated $1.7 million dollars out of its bloated budget to build a single-stall public toilet. Despite spending $1.1 billion on the homeless in 2021-2022 fiscal year, it managed only to deepen the crisis. In fact, the city manages to make itself into an addict Mecca. For instance, in an interview with Shellenberger, a drifter admitted that he came to the city because it’s easy to be a junkie there. Rest assured, if San Francisco is allowed spend taxpayer money to push drugs, it will do so, and the results will be horrendous. 

A crucial distinction between Swinging London and today’s San Francisco is the higher potency of the opiates sold on the latter's streets. San Francisco's druggies use more habit-forming and deadly fentanyl, and thousands of the addicts are extremely low functioning and live on the streets. The argument that their addiction is merely a personal choice doesn't hold water, because they represent an acute problem for everyone in the city. 

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Stigma and access restrictions keep people from doing drugs. Hart himself admitted that he started snorting heroin after conducting research at the Swiss maintenance clinic. The boundaries were broken when he was in close proximity to the drug and decided to start using. The clinic’s purpose is to keep otherwise hopeless cases alive, but by simply existing, it also created more addiction.

It’s hard to see how a policy like “safe supply” can bring anything but misery to San Francisco. Given Newsom’s presidential ambitions, particularly extravagant ideas like safe supply can be probably kept at bay until 2024. What happens after is anyone’s guess. 

This New Urbanism series is supported by the Richard H. Driehaus Foundation. Follow New Urbs on Twitter for a feed dedicated to TAC’s coverage of cities, urbanism, and place.