Julia, 22, holds a baby carrier filled with toiletries, socks and wipes as she waits outside San Francisco’s Tenderloin Centre, which provides showers, sterile drug use supplies, and caseworkers for the city’s unhoused population. With clips holding back her blonde hair, she is one of San Francisco’s nearly 8,000 unhoused residents. “I love the city and I hate it,” she says.
Julia began using drugs as a teenager. Now struggling with an opioid addiction, she stays in San Francisco for its cheap drugs, lenient policing, and accessible social services. “You love [the city] for the same reason you hate it. I love fentanyl because I love forgetting about my problems. But I hate that I’m not dealing with them.”
The comic absurdity of San Francisco is easy to see. Steps away from Julia, Kombucha is on sale at an upscale organics store: $6 for a small can. San Francisco is one of the most expensive cities in America—an individual with an annual salary of $104,400 (around £91,500) qualifies as low-income—but at the same time, it is witnessing a crippling crisis of homelessness and drug addiction. Its middle class is moving to lower-cost places, leaving only the wealthy and the homeless.
Nationally, San Francisco has become a political pariah. Commentators on Fox News point to the city as evidence that Democratic lenience towards drug use has failed. Moderate Democrats like President Joe Biden have criticised the city’s former district attorney for failing to deal with crime. And leftist Democrats, including democratic socialists, argue that the city has failed to adequately treat poverty, mental illness and drug addiction.
President Kennedy once said that victory has 100 fathers, and defeat is an orphan. For Democrats, making an orphan of San Francisco will be a challenge given their decades-long control of city government. Republican candidates have failed to cinch the mayorship or even a single seat on the board of supervisors since the 70s.
With the midterm elections approaching, public health advocates fear that people affected by addiction and poverty will be stuck in the crosshairs of this war over what has gone wrong in America’s most beautiful city.
From 2005 to 2020, San Francisco’s unsheltered homeless population increased by 95 per cent. In New York and Miami, the unsheltered homeless populations shrank. In contrast to homeless people in New York, where shelters and other forms of temporary housing are more accessible, the vast majority of homeless Californians are unsheltered and sleeping outdoors. Data from 2019 suggests that about half of the city’s unhoused population suffer from mental illness or addiction.
“San Francisco is a homeless dream,” says Kimbel Welch, who was homeless and struggled with addiction for 20 years. “People come out here because the drugs are cheap, there’s a lot of free food, and the police leave you alone. That’s how I ended up in the Bay Area.” In 2017, faced with jail time, Welch entered recovery and began working at a charity that runs a drug treatment programme.
The consequences for the city and homeless people struggling with addiction have been severe. Addiction in the city is becoming more lethal, as potent opioids like fentanyl spread on its streets. Overdose deaths have skyrocketed from 13 per 100,000 people in 2010 to 49 per 100,000 people in 2020. Drug overdose is now the leading cause of death for homeless San Franciscans. Conditions are also growing worse on the city’s streets. From 2012 to 2021, the number of complaints reported to San Francisco’s helpline about waste on the street grew from 6,266 to 30,056, while the number of complaints about needles jumped from 445 to 3,923.
San Francisco’s problems persist despite its dramatic increase in homelessness spending. From 2016 to 2019, it ballooned by 83 per cent, even as the homeless population grew by 33 per cent. So—what has gone wrong?
San Francisco has failed at harm reduction
San Francisco’s moderate Democratic leaders decided to tackle homelessness and addiction by focusing on harm reduction. In January 2022, San Francisco Mayor London Breed opened the Tenderloin Linkage Centre to provide sustenance, link people to treatment, and serve as a safe place for people to use drugs.
It didn’t work. The centre grew infamous for failing to link people to treatment—with less than 1 per cent of visitors being referred to or placed in a substance abuse programme between January and May 2022. The centre eventually dropped “Linkage” from its name. “It’s not a safe consumption site because you don’t have trained medical professionals supervising the drug use,” says Tom Wolf, who lived on the streets of San Francisco and suffered from an opioid addiction before entering recovery and becoming a political organiser. “It’s an opium den.” San Francisco Mayor London Breed announced that the Tenderloin Centre will close at the end of this year.
The city has also taken a housing-first approach, where those suffering from mental illness or addiction are housed before receiving treatment. To help people rebuild their lives after periods of homelessness, the city has a $160m programme, through which it funds single-room-occupancy (SROs) hotels without requiring people to seek addiction or mental health treatment as a condition of their stay.
“There are clients who are using drugs, and they’re just out of it,” Gabriel Flores, who works as a case manager for a such a programme in the Bay Area, told me. Flores points out that the housing-first approach has the advantage of linking service providers with homeless individuals. “We’re able to meet in the same place and talk with the client directly. And this saves a lot of money—rather than us going from encampment to encampment trying to find them,” he said. “We have several families who would be on the street but are in a safe zone because of the housing-first approach.”
But he says that getting people into drug treatment is difficult. An investigation by the San Francisco Chronicle found that 14 per cent of all confirmed overdose deaths in San Francisco occurred in city-funded supportive housing SROs, despite these housing less than 1 per cent of its population. Out of 515 tenants tracked by the government after leaving permanent supported housing in 2020, 25 per cent died while participating in the programme, and 21 per cent returned to homelessness.
The election of Chesa Boudin
In 2020, San Francisco elected Democrat Chesa Boudin as district attorney. Boudin had campaigned against punishment-focused approaches to drug addiction, instead urging the city to get “serious about treating addiction and the root causes of drug use and selling.” He said that “open-air drug use and drug sales are… technically victimless crimes,” and went on to secure only three drug dealing convictions in 2021, despite the police seizing over 56 pounds of fentanyl in the Tenderloin neighbourhood—five times more than 2020. Scientists estimate that three mgs of fentanyl is enough to kill an average man—less than the weight of a coin. In contrast, Boudin’s predecessor secured around 90 drug dealing convictions in 2018.
Boudin’s supporters often took a hostile tone towards police, chanting “Fuck the POA” (Police Officers Association) during his election night celebration. Unsurprisingly, Boudin’s relationship with San Francisco’s police chief deteriorated early into his tenure, with the city’s most senior officer alleging that the DA’s office too often failed to prosecute cases.
Moderate Democrats grew disillusioned with Boudin’s approach. Several organised an election to recall him, partly funded by a Republican donor. “Chesa Boudin was framing this [policy debate] about housing, public health and racism,” says Tom Wolf, who was one of the organisers of the recall effort. “He was leaving out the fact that we have an organised drug dealing ring, which has no connection to the community. I’m a progressive, but Boudin was causing a lot of harm to San Francisco.”
While the crime statistics from Boudin’s tenure are mixed, democratic socialist supervisor Dean Preston argues that the DA’s opponents inflated the perception of crime. “Chesa Boudin was recalled over a perception of surging crime that did not exist as an objective reality—a lie that was repeated nonstop by the media,” he says.
During Boudin’s tenure, property crime dropped by about 11 per cent. Violent crime, including rape, robbery, and assault, fell by 45 per cent, 27 per cent, and 6 per cent respectively. However, burglaries also rose by 47 per cent, while motor vehicle theft rose by 36 per cent. Crime statistics are based on those reported to the police, meaning the actual figures could be higher.
“He kept saying that crime is down,” John Dennis, chairman of the San Francisco Republican Party and the candidate running against Nancy Pelosi in this year’s mid-terms, told me. “That’s the opposite experience of everyone living here.”
A new era in San Francisco
On the night of the recall, 7th June 2022, 55 per cent of voters backed the campaign against Boudin. Mayor Breed appointed Brooke Jenkins as the new DA. A former San Francisco prosecutor and moderate Democrat, Jenkins helped organise the recall effort against her former boss. She has promised to pursue convictions against drug dealers, ordering a review of all open drug cases and revoking misdemeanour plea offers for at least 30 offenders to introduce felony charges.
“The previous administration did not obtain a single conviction for the sale of fentanyl, despite what was happening on our streets,” said Jenkins. “Starting today, drug crime laws will be enforced in this city.”
The change of direction has left city agencies uncertain how to act. San Francisco police cited people for possession of drug paraphernalia which was provided to them by the city through harm reduction programmes. Police citations are summons issued by law enforcement that direct people to appear in court for misdemeanours or infractions. Several of the charges were made just metres from the Tenderloin Centre, where the city provides sterile drug use supplies. Jenkins said her office would dismiss the paraphernalia charges, but it could still adjust the policy on paraphernalia charges in the future. “Her public statements are an announcement of a war on drugs that has failed for decades,” supervisor Preston told me. “It’s no different from the 70s and 80s.”
San Francisco’s politicians have fundamental differences of opinion about where policies on homelessness and drug use should go next. “There are people in city leadership who think we shouldn’t make the city too hospitable for people living on the street. It’s not a view I support,” says supervisor Preston, who advocates for more safe consumption sites and permanent supportive housing and maintains that socialist approaches have never been tried in earnest in San Francisco. “If the left wing runs this city, it’s news to me. It’s absurd to look at San Francisco as this leftist, socialist utopia. It’s very far from it.”
Meanwhile, Republicans are more focused on crime and safety, particularly for the housed population. “It’s not the mayor’s job to solve society’s problems,” said John Dennis. “It’s her job to protect the citizens of San Francisco.” Dennis lays responsibility for the city’s failure at the feet of Democrats, pointing to the long legacy of Democratic governance in San Francisco.
At the same time, Republicans hope that San Francisco voters are waking up to the crisis they perceive in public safety. “San Francisco has followed a Republican agenda for the past year,” said Dennis, referring to the support for the recall elections. “We’re seeing an uptick in [Republican] registration.”
Though Republicans are gaining popularity, Democrats are all but certain to remain in control. The true battle will be between progressive and moderate Democrats, including those who led the Boudin recall effort.
Supervisor Matt Dorsey, who is also a recovered alcoholic, is one of the moderate Democrats who supported the recall campaign. “There was a public health crisis that was being fuelled partially by a criminal justice system in retreat,” said Dorsey’s told me in a statement. “The district attorney could have done better, especially when we have a record-shattering crisis in drug overdose deaths.” Mirroring moderate Democrats nationally, Dorsey is supportive of the new district attorney’s approach.
As the police budget grows and San Francisco’s leaders take a tough-on-crime approach, people on the street are once again advocating for more treatment options, housing, and safe consumption sites. “I have addiction,” says Julia, as she nervously thinks towards the future. “But hopefully I can change my life.”
