Prop F would take San Francisco backwards on homelessness and drug use

By Brett Andrews, All Home & Alex Visotzky, National Alliance to End Homelessness

The opioid epidemic is taking an enormous toll on communities across California. In San Francisco, there were 806 drug overdose deaths last year—the most ever. San Franciscans are confronted by this crisis every day when they step outside. It is deeply alarming and saddening to see the impacts of the fentanyl crisis on our communities, and the public is right to demand action. But if voters care about solving this problem, they should reject Prop F on the March 5th ballot. 

Prop F proposes compulsory drug screening and treatment as a condition for receiving cash assistance from the County of San Francisco, a wrong-headed idea that runs counter to public health best practices and would very likely worsen the problems it claims to address. This approach has been tried and failed many times before.

Our organizations work on the deeply connected issues of homelessness and poverty here in the Bay Area and across the country. Homelessness is primarily driven by housing market and economic forces—high rents and scarce affordable housing are the common denominator among places with high rates of homelessness. While a recent statewide study found that about 35% of adults experiencing homelessness in California were regularly using illegal substances, many people struggling with addiction are housed. In fact, two thirds of the people who died of overdoses in 2023 were housed at the time. 

Poverty is more of a root cause of homelessness than substance use, which is why we oppose cutting people who are already struggling to survive off the cash assistance they rely on. Prop F ignores the evidence on treating substance use and preventing overdoses, and would be a significant step backward for San Francisco’s efforts to address the drug crisis and homelessness. County cash assistance is a lifeline for the people who receive it. These neighbors have little or no incomes and often don’t qualify for other benefit programs. The cash assistance they receive is essential for meeting their basic needs and staying housed. If San Francisco passes such a measure, it would make national headlines and give other cities license to make similar misguided choices.

Decades of evidence shows that mandating people into drug treatment doesn’t work. Instead of reducing drug use and overdoses, these policies push people with addiction further away from services. By removing what may be the only financial resources that these neighbors have access to, Prop F would increase housing insecurity and homelessness rather than connect people to support. 

Cash assistance, which this initiative would further restrict, is one of the most effective policy interventions we have to fight poverty and homelessness, which often drive and exacerbate addiction. In fact, there is considerable evidence for the efficacy of policies that do the opposite of Prop F: providing incentives (including financial assistance) for people to voluntarily reduce their substance use and engage in treatment. 

San Francisco is pursuing other innovative and more worthy strategies. Expanding mobile crisis response teams, access to opioid medication and other evidence-based harm reduction strategies can increase access to services and treatment for people with substance use disorders. Programs like hotel conversions, shared housing, and rental subsidies are quickly increasing affordable housing options, while cutting red tape to get people into housing faster. We know that stable housing gives people a solid foundation from which to address other challenges they may face.

But despite the important work that is happening, San Francisco does not have enough treatment beds or services for those who seek them out today. So Prop F’s mandate for drug treatment is a setup for failure, as it would gum up the already stressed system with people who are obligated to seek treatment as a condition for receiving their benefits, and push aside those who are ready and in need of help. There is no implementation plan; even the City’s own Controller’s office estimates this measure will cost more money to implement than it will save the city. 

All these reasons have led medical experts, housing providers, and over two dozen of the city’s service providers to oppose Prop F.  If we want to help people struggling with addiction in our city, let’s expand evidence-based harm reduction strategies, outreach efforts, and residential treatment services—all part of the city’s existing Overdose Prevention Plan plan that could actually have a positive impact on these challenges. That plan, along with the other solutions mentioned above, could benefit from the resources and political will that are being wasted on Prop F. 

The brutal experience of deep poverty exacerbates the stress and trauma that drive substance abuse and the disease of addiction. Withholding cash from people who are already struggling to survive each day will not scare them straight, it will just make their lives that much more tenuous. Prop F would inflict a lot of pain with no gain to the city or our neighbors in need. Voters should reject it and support proven solutions to the problems we face.