To the Editor:
Re “It Was West Coast Progressivism at Its Worst. Not Anymore,” by German Lopez (Opinion, April 12):
I am a resident physician who has been living in San Francisco and working for several years in the city’s safety net system.
Many in the Bay Area and across the United States are excited about San Francisco’s more aggressive approach to dealing with its issues of addiction and homelessness. But focusing almost entirely on the visibility of people living and using drugs on the street has led to false assumptions about how the city’s recent policy changes actually affect the people facing these struggles.
Mr. Lopez asserts that more forceful intervention and forsaking of harm reduction principles have led to more people getting the help they need. However, since 2023, as law enforcement crackdowns have intensified, the jail population in San Francisco County has nearly doubled. While Mr. Lopez supposes that incarceration can help people overcome addiction, numerous studies have shown dramatic increases in the rates of fatal overdose after release from jail and prison.
Furthermore, although many of the city’s addiction experts and community leaders recognize the importance of harm reduction interventions as part of an evidence-based approach to reduce transmission of H.I.V. and other communicable diseases, I am certain that none would suggest that it exist as an isolated strategy to address the current housing and overdose crisis.
It may be true that San Francisco has had success in decreasing visible homelessness and drug use, but doing so by using forceful intervention harms our city’s most vulnerable inhabitants.
John C. Messinger San Francisco
To the Editor:
German Lopez paints a misleading picture, one that points in exactly the wrong policy direction. The emergence of dangerous synthetic drugs like fentanyl has nothing to do with progressivism or harm reduction. In fact, cities with the highest overdose death rates — places like Baltimore, Philadelphia, Louisville, Ky., and Cleveland and Columbus in Ohio — are neither harm reduction leaders nor exemplars of progressive politics.
It’s true that the drug crisis is very visible in high-rent cities with more unsheltered homelessness. It’s also true that public drug use should be addressed — but not by arresting people. Instead, cities should invest in affordable, low-barrier housing, increase treatment beds and allow overdose prevention sites. They should also expand lifesaving harm reduction services, as people who use them are five times more likely to enter treatment than people who do not.
As part of his attack on West Coast progressivism, Mr. Lopez insists that involuntary treatment is better than letting people use drugs in public. But these are not the only options. Framing this as a choice between coercion and chaos may make for a compelling narrative, but it is a poor guide for policy and an even worse one for saving lives.
Katherine Beckett Forrest Stuart Dr. Beckett is a professor of sociology at the University of Washington. Dr. Stuart is a professor of sociology at Stanford and the director of its program on urban studies and the Stanford Ethnography Lab.
To the Editor:
Are people with severe addiction who live on the street having fun?
German Lopez quotes the psychologist Keith Humphreys to explain why involuntary treatment is justified for addiction: “Cancer isn’t fun. Depression isn’t fun. But drugs and alcohol are. So people often need pressure to get out of it.”
This glib comment conflates recreational drug use with severe addiction, which is defined by an inability to stop using drugs despite negative social or health consequences. Most patients we see with addiction and homelessness are simply trying to survive, and the pressure provided by arrests and encampment sweeps only compounds their suffering. If they resist treatment, it is usually because they have tried available programs and ended up back on the street.
When forcing people into programs that treat patients disrespectfully, fail to use evidence-based treatments and leave them vulnerable to overdose, we risk feeding a dangerous cycle.
San Francisco’s sidewalks may be clearer now. But there are no quick fixes to homelessness and addiction. Our patients do not need more punishment; they need affordable housing, a high-quality treatment system and reasons to feel hopeful about the future.
Zoe Adams Aaron D. Fox New York The writers are, respectively, an addiction medicine fellow and the president of the New York Society of Addiction Medicine.
To the Editor:
I appreciate efforts like this one by German Lopez to provide diverse perspectives on policies perceived as politically liberal. However, as an addiction medicine physician, I must point out that harm reduction is not an example of liberalism gone too far.
Syringe service programs (needle exchanges) have decades of data to support them and have been shown to decrease the risk of blood-borne viruses by 50 percent without any associated increase in drug use or crime.
Overdose prevention centers, where drug use is not prevented but supervised, have existed for more than 20 years internationally without a single documented overdose death within a facility.
The United States has fought a war on drugs for nearly half a century, with the result being a more concentrated, toxic and contaminated drug supply. The solution is addressing the underlying reasons for addiction by using resources to address poverty, to empower rather than punish those in need of treatment and to connect them to lifesaving medications such as methadone and buprenorphine.
Eric Kutscher New York
To the Editor:
As a San Francisco resident, I read German Lopez’s view of my city with interest. Yes, it is true that the illegal drug problem was serious in the city when Mr. Lopez visited in 2023, but to attribute that situation to the city’s progressive policies leaves out a major factor: the lingering effects of the pandemic.
During the pandemic, homeless shelters and other services were shut down temporarily, and there was less police presence on the streets, which inevitably led to the open-air drug markets that Mr. Lopez describes.
The reversal in our drug problem may partly be because of our new mayor Daniel Lurie’s more forceful drug enforcement policies, but the winding down of the pandemic was also a major reason. I wish Mr. Lopez had mentioned this important point.
Andrew Littlefield San Francisco
The post How to Relieve Suffering on the Streets of San Francisco appeared first on New York Times.
