When I visited San Francisco in 2023, parts of the city looked like open-air drug dens. Users made homes in tents that lined block after block. They bought, sold and smoked fentanyl, crack and meth in public. They used drugs in front of a police station, visibly undeterred by the threat of the law. I once saw four people hunched over, in what’s called the “fentanyl fold,” along a sidewalk in sight of City Hall. It was a startling vision of what had gone wrong with West Coast progressivism.
This year, I went back to find San Francisco in the early stages of recovery. The tents were gone. I spotted public drug use much less frequently. Officials didn’t ignore the remaining addicts. Community ambassadors, as the city calls them, patrolled the streets and tried to persuade users to get into treatment. At a minimum, they made sure that people didn’t treat sidewalks as campgrounds. I could move through the city without having to walk in the road — something most of America mercifully takes for granted.
After the failures of the 1980s and ’90s, when lawmakers responded to a crack epidemic with mass incarceration, progressives united around an approach that decriminalized drugs, either literally (as in Oregon) or effectively (as in San Francisco). The change was well intentioned, grounded in the reasonable view that addicts need help, not punishment. The government’s role was to make treatment available and keep people alive, but not force them to stop. Eventually, people would seek out help on their own. That was the theory.
In practice, drug users didn’t get help. Free of serious consequences for even public drug use, they took over urban neighborhoods across the West Coast and injected, smoked and snorted more freely than ever before. Fentanyl’s spread turbocharged the problem. By the time I visited in 2023, drug users and their tents clogged city streets, and overdose deaths reached a record high for San Francisco (in a year when national overdose deaths declined).
San Franciscans grew fed up. One of them, Daniel Lurie, ran for mayor. Mr. Lurie was not a politician before his campaign; he was an heir to the Levi Strauss clothing fortune and founded and ran a local anti-poverty nonprofit. He said he changed tack because of the slide into disorder.
“We lost our way as a city,” Mr. Lurie told me in an interview from his wood-paneled office. “When you swing so far that there are no consequences, that you’re allowing this many people to use and to die on your streets, something has gone wrong.”
The city’s voters agreed, electing Mr. Lurie and a more centrist board of supervisors in 2024. The new government set about dismantling the lax approach of recent years, but without re-embracing the old war on drugs. Local officials describe their lodestar as getting addicts into treatment, even if that requires more force and coercion than the city’s previous odes to bodily autonomy would have supported.
Democratic rule, particularly at the local level, has been marked by a rise in public disorder not just in San Francisco but also in progressive bastions nationwide. It’s one reason the Democratic Party is currently less popular than President Trump, I.C.E. and artificial intelligence.
The transformation is in its early stages, but what I saw in San Francisco was promising — a big step closer to safe and orderly streets. Until recently, the city was a model of Democratic governance gone wrong. Can Mr. Lurie turn it into an example of Democrats getting it right?
San Francisco started relaxing its attitude toward drug use in reaction to the excesses of the drug war and the horrors of the H.I.V./AIDS pandemic. Progressives reeled at how three-strikes laws fueled mass incarceration, in part by locking up people who needed treatment. Simultaneously, H.I.V. was quickly spreading, in part because infected drug users shared syringes with the noninfected.
In 1988, Dave Purchase founded what is believed to be the country’s first needle exchange program in Tacoma, Wash. The idea was to keep people alive, not necessarily get them sober. Over time, activists expanded the concept beyond needles. They handed out clean straws and foil for fentanyl and meth smokers, and established sites in which people could use drugs under some form of supervision.
In 2000, the San Francisco Health Commission unanimously approved a resolution adopting “harm reduction,” as the concept came to be known, as city policy. By 2020, harm reduction was in effect the city’s only drug policy. Treatment and recovery became secondary goals, if they were goals at all. During my 2023 trip, one harm reduction provider, Michael Discepola of the social services program GLIDE, told me his group had recently dissuaded a client from quitting drugs cold turkey because the goal was unrealistic. Harm reduction providers did not want to push users into treatment. They worried that doing so could hurt their ability to help clients by scaring them away. The approach was all carrot, no stick.
This failed to acknowledge the realities of drug use. Addiction is not a disease like diabetes or cancer. Diabetics and cancer patients typically want treatment. Many addicts, because of the nature of addiction, do not. This is why people struggling with addiction often need an outside push — from a family member, a friend or ultimately the government — to seek help.
When fentanyl reached San Francisco in the mid-2010s, the city’s policy did not keep people alive by making their drug use safer. Instead, annual accidental overdose deaths spiked to more than 800 at their peak in 2023, triple the national rate. Public drug use soared. And as addicts sought money to pay for drugs, shoplifting increased, too, buoyed by voter-approved changes to state law in 2014 that reduced penalties on property offenses. Some businesses fled, including about half of CVS stores and pharmacies. The city’s illegal drug problem made it harder for San Franciscans to get their legal drugs.
As the situation deteriorated, the city’s progressives defended their strategy. They argued that people have physical autonomy, meaning they should be allowed to put whatever they want into their bodies. San Francisco’s experience showed those freedoms, when translated into public drug use, infringed on other people’s right to public safety and order. Many San Franciscans lost access to basics of modern life: walkable spaces, secure parks, grocery stores and pharmacies. A minority’s unchecked drug use was wrecking the city for everyone else.
“I walk my kids to school,” said Mr. Lurie, the mayor. “I couldn’t explain to my kids why they were seeing a guy walking across the street naked at 8 a.m.”
In 2023, Mr. Lurie announced his campaign for mayor. He argued that the incumbent, fellow Democrat London Breed, had failed the city. San Francisco voters agreed. The following year, they elected him by 10 points in the final round of ranked-choice voting, along with a moderate majority to the city’s board of supervisors.
Jessica DiDia exemplifies the failures of the city’s old drug policy, as well as the kind of person the new government hopes to help. I first met her in 2023, as she sat on a mattress set down on a sidewalk. She had slept there the previous night, and she was starting to plan how she would get her fix that day. I met her under similar circumstances this year. She showed me two animal plushies, calling them her buddies. Then she took a hit of crack.
Many people have tried to help Ms. DiDia. Her mother briefly moved to San Francisco to try to get her daughter sober, to no success. A local deli owner, Adam Mesnick, regularly speaks to Ms. DiDia, giving her food, money and encouragement. She has cycled in and out of hospitals, including when she had a baby in 2024.
Ms. DiDia is resistant to addiction treatment programs, and no one can truly force her to get sober. She is largely cut off from the rest of the world. She has never seen the Golden Gate Bridge, and she now mostly talks to her mom through Mr. Mesnick.
Sometimes the government can use its extraordinary powers of force and coercion to fill the role that friends and family cannot.
Blocks away from Ms. DiDia, Tom Wolf, a local addict turned activist, walked me through some of his old spots for drug use. When I asked him how he got into recovery, he said his stints in jail were the push he needed. I have talked to hundreds of former and current addicts across the country in my 15 years covering drugs. The importance of consequences is a regular theme: Pressure and threats from friends, family and the government are often the tipping point into stopping drug use.
San Francisco’s new government is working to operationalize this concept. Officials talk up concepts like “compassionate accountability” and “tough love” to push addicts into recovery, not just to keep them alive. Mr. Lurie holds weekly meetings with around 20 agencies to keep the city focused on the same mission, something his predecessor struggled to do. The board of supervisors passed a law that made getting addicts into recovery the city’s explicit goal. The city plans to open hundreds of new treatment beds. San Francisco still has harm reduction services, such as needle exchanges, but they’re treated as a bridge to treatment, not the end game.
So far, the approach is holding steady. Overdose deaths are down from their peak, but most of the drop preceded Mr. Lurie’s time in office — most likely because fentanyl had already killed much of the vulnerable population and the drug supply had become less toxic. Deaths dropped further, although only slightly, during Mr. Lurie’s first year as mayor. They are on track to fall more this year.
The initial phase of the strategy used a lighter touch, exemplified by community ambassadors. They’re outreach workers who try to get the homeless and drug users off the streets and into social services. On my first morning back in San Francisco, I saw a community ambassador speak to a woman who had slept on the streets outside my hotel. He suggested addiction treatment. She complained that city services are bad. He persisted; she resisted. Eventually, he persuaded the woman to at least leave the sidewalk. When I came back to my hotel later that day, she was gone. Community ambassadors have dozens of such interactions a day, some more successful than others.
Getting drug users off the streets is not merely to make the city look better. It gives addicts a clear social signal that their drug use, especially in public, is no longer tolerated. That kind of friction could drive some to seek help, as community ambassadors can attest. Everyone else benefits, too, from cleaner, safer and walkable spaces.
“I think as much about how we help someone struggling on our streets as I think about the harm that’s inflicted on children who see public drug use over and over and over again when they walk to school,” said Kunal Modi, the chief of health and human services for San Francisco. “We have to care about their public health, too.”
The city’s next phase will put some much-needed stick in these policies. This spring, the city is trialing what it calls a Rapid Enforcement, Support, Evaluation and Triage — or RESET — Center in the neighborhood known as SoMa. Police can arrest public drug users and hold them until they are sober. If nothing else, this introduces another layer of friction into public drug use. When users are held at the center, its staff of medical personnel will push them to sign up for treatment. This might not work the first time. The city hopes users will tire of getting picked up and eventually relent.
“We don’t want to criminalize someone in the throes of addiction,” Sheriff Paul Miyamoto said. “We want to get them help.”
Keith Humphreys, a drug policy and addiction expert who lives in the Bay Area, described the old policy as “almost the addicted person’s fantasy: ‘I can do whatever I want to do. I have no responsibilities. The damage I do, you all have to clean up, and you can’t ask me to do anything.’”
He continued: “Cancer isn’t fun, depression isn’t fun, but drugs and alcohol are. So people often need pressure to get out of it.”
Some progressives in the city remain skeptical, arguing that coerced treatment is ineffective. Yet some studies suggest that involuntary treatment works as well as its voluntary counterpart. It is certainly better than unchecked drug use on the streets.
San Francisco’s new vision reminds me of Portugal’s, which is widely seen as a drug policy success story. Portugal decriminalized all drugs in 2001, meaning that possession no longer carried the threat of jail or prison time. But that’s not all the country did. It funded more treatment and set up a system that threatened drug users with sanctions such as fines, community service or revoking professional licenses to push them into seeking care.
As João Goulão, the architect of Portugal’s system, told me in 2023, “There’s a little bit of muscle involved.”
Portugal’s experience shows governments can impose sanctions without resorting to draconian prison sentences — and that the approach can work. In the 1990s, Lisbon was known as “Europe’s heroin capital.” Today, Portugal has some of the lowest rates of drug-related deaths across the continent.
While drug policy in San Francisco tightens up, the city faces a major obstacle: the state government in Sacramento. San Franciscans may have changed their minds, but the state and its lawmakers remain deep blue. California voters have repeatedly enacted ballot measures making the criminal justice system more lenient. Local officials frequently complain that state policies restrict how much they can do. “We absolutely need more support and tools from the state,” Mr. Lurie said. “We are coming up against our limit on what we’re able to do here, locally.”
The biggest problem is the state’s enforcement of drug laws. In theory, possession is a misdemeanor punishable with jail time — the kind of leverage a prosecutor could use to push a user into treatment. In practice, lax and conflicting state laws in combination with liberal judges and juries have made it nearly impossible to get a conviction, let alone jail time, for simple drug possession or public use. The San Francisco district attorney, Brooke Jenkins, told me it can be difficult to get prison time even for drug dealers. She estimated it takes two to three attempts in court before juries will convict. That’s an improvement from the four to five cases required when she started the job in 2023.
Some of the hurdles stem from the desk of Gov. Gavin Newsom, who’s often mentioned as a potential 2028 presidential candidate. Last year, he vetoed a bill that would have allowed up to 10 percent of California’s housing funds to go to sober houses. These homes provide a drug-free environment for addicts in recovery, with a measure of accountability to ensure they stay sober. Mr. Newsom argued that state funds can already be used for sober housing, but guidance he released made clear — literally in bold text — that people can’t be kicked out of state-funded homes for using drugs only. A place that allows drug use is not a sober home.
The good news is that state policy could be changing. Mr. Newsom will leave office next year. A Supreme Court ruling in 2024 allowed officials to break up homeless encampments, which San Francisco has already done. That same year, California voters approved a ballot measure that created “treatment-mandated felonies.” Courts can now require hard drug users get treatment to avoid jail time after two or more previous drug convictions.
Perhaps Californians are moving in the same direction as San Franciscans in seeking to reconcile two values that can be at odds: personal freedom and public order. Mr. Lurie weighed those same concepts during our conversation. “We have our really important progressive values here in San Francisco and in the state of California,” he said. “But we have to take care of people in a different manner, and it’s not by allowing them to continue to use and die on our streets.”
German Lopez is an Opinion writer.
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