‘If you’re asking me as a public health advocate: It’s a disaster,’ says UCSF doctor
by JOE ESKENAZI FEBRUARY 10, 2025 (MissionLocal.org)
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Man, I do miss Wilderness Exchange. Rather than spending a fortune on chic new camping equipment, you could buy second-hand gear, ranging from like-new to humorously antiquated “Swiss Family Robinson”-era stuff. You could even buy the second-hand pocket knives seized at the airports.
It was, in its way, a magical place. But it didn’t sell magical equipment. Too bad for San Francisco: We need magical equipment. All too often, this city attempts to address its most intractable problems … with a tent. As we noted back in 2023: “Too many disturbingly impromptu city plans seem to start with someone saying, ‘Hey! Let’s get a tent! A big tent!’”
By late last week, a number of tents had sprouted in the fenced-off area of a former Nordstrom parking lot at Sixth and Jesse streets in SoMa, stumbling distance from one of the city’s most notorious drug bazaars. Neighbors told us that both fences and tents had been blowing over in the wind. This city is just a sucker for symbolism.
And that goes for the overall site, too: The parking lot where, in headier times, San Francisco officials argued that a massive housing development would serve as a gentrification bomb is now being converted into a one-stop shop to arrest the city’s most down-and-out drug users or coerce them into treatment or a bus out of town.
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No, there isn’t a big tent, but, instead, a series of “little pop tents with the four legs, that you see at, like, a street fair.” Let no one say that San Francisco cannot evolve and adapt in its thinking and approach.
Last week, San Francisco Police Department officials addressed community members living and working in the city’s put-upon Sixth Street corridor. It was a remarkable meeting: It is difficult to simultaneously offer so few details and so many contradictions.
City officials we spoke with had been led to believe this would be “a public-safety tent” in which cops would merely expedite the onerous procedure of booking and processing arrested drug-users. They were surprised to hear the police say that the “triage center” would also be a place for treatment referrals or the “Journey Home” program to bus homeless drug users elsewhere. Similarly, SFPD-announced co-management roles at the site for the Department of Emergency Management and Department of Public Health also came as a surprise to many in city government, who had been led to believe this was a police affair.
This level of amorphousness and evident lack of intergovernmental communication doesn’t bode well. That’d be the case if the city was trying to build a playground, let alone tackle decades-long problems in San Francisco’s most desperate neighborhood. Cracking down on public drug use and offering people the choice of a bus ticket, treatment or a trip to San Francisco’s increasingly crowded and chaotic jails is not cutting-edge material. It’s ostensibly what we were already doing. It’s the “round up the usual suspects” of municipal policy.
But now, there are tents.
Separate and apart from whether it’s good and efficacious policy, let’s assume that San Francisco wants to speed up arresting and processing people doing drugs in public. The logistics and paperwork required to deal with a single person smoking fentanyl on the stoop can pull officers off the street for hours (That’s why, a decade ago, cops told me they simply took away drugs and crushed users’ drug paraphernalia; they called this “The San Francisco Way”).
But if your goal is to speed up arrests, the tent site at Sixth and Jesse streets might be useful. Adam Smith could tell you a bit about the expediency of separation of labor; dropping off suspects at a processing site akin to a factory line would allow cops to head back out and do more work.
But at last week’s community meeting, police announced the site would be doing more. It’d be doing everything, in fact. Arrests! Treatment! Busing! On Friday, they were pouring free cups of coffee.
This, too, is a San Francisco tic: In an attempt to do everything, the city makes it difficult to do anything. We too often strive to put everything in one place, without having proven we can do one thing well.
But, more fundamentally, are get-tough solutions for fentanyl users helpful? That depends on what the goal is. This study, from public-health researchers at Yale University and the University of Colorado, found that get-tough solutions lead to massive spikes in both incarcerations and overdose deaths. It’s not hard to find studies like this.
But only if you care. Or look. Or care to look. So, it’s understandable why this city and so many of its exhausted inhabitants are pushing the jail-or-treatment line. San Franciscans have lost patience with drug-induced street disorder: Last year, 58 percent of voters approved a measure to drug-screen welfare recipients, the milder version of a policy endorsed by former MAGA Rep. Matt Gaetz.
San Franciscans are clearly fed up with visible chaos and misery. So are the folks who choose where to hold conventions. And street conditions and the ongoing failure of downtown retail continue to be catnip for national and international media. The city is ready to tell drug-using street dwellers to “shape up or ship out;” this is, literally, the deal being offered to someone weighing jail or a bus ticket.
Is the city’s approach useful for getting people out of sight and off the street, thereby improving the curb appeal of Sixth Street? It’s a possibility. Will it reduce addictions and save lives? If you follow the science, that’s more doubtful: See here, here, here, here, here, here, here, here and here.
Meanwhile, what manner of treatment will be offered? And what, exactly, does “accepting treatment” entail? If a drug user chooses treatment to avoid arrest and attends a session or two — or none — then what? What kind of follow-up and monitoring will there be? Or do cops simply say “that person accepted treatment” and check a box?
But San Francisco isn’t running a science experiment here. And there’s more than one way to gauge “success.”
When asked if the concepts of a plan that police espoused to Sixth Street denizens about the “triage site” could work, Dr. Daniel Ciccarone, a University of California, San Francisco addiction specialist, said they could. But that depends on what your desired outcome is.
“Is it fewer civilian complaints about public drug-use? You might be successful. Is it a lower number of people in San Francisco who are some combination of homeless plus drug-using because you’ve bused them out of town? You might be successful there, too,” says the doctor.
“But if you’re asking me as a public health advocate: It’s a disaster.”
San Francisco, like so many cities, arrested scads of drug users in decades past. “With some outcomes, you do see short-term benefits,” says Ciccarone. “Visibility, crime issues; those may go down. As far as reducing overdoses and saving lives, you can’t find that study.”
And there is no chance of real success if city agencies don’t work cooperatively and stay on the same page. “But that,” Ciccarone says with a laugh, “is a bit of a pipe dream.”
Do the liberal European enclaves touted by San Francisco progressives arrest the hell out of folks using drugs in public? You bet they do. But they also have robust treatment options and supervised consumption sites that a drug user in a public space would have willfully spurned.
We don’t have those here. There is nowhere near enough treatment for drug users who desire it, let alone for those who don’t. Yes, there are slots in outpatient programs where people can get medications like buprenorphine. But then they’re back out on Sixth Street, and surrounded by lunacy and temptation. Inpatient facilities are in demand, and nearly full.
As for the Journey Home busing program, Mission Local reported last year that a number of the guardrails in earlier homeless-busing programs have been eliminated. A key component of the Homeward Bound program, which moved more than 11,000 homeless people out of town between January 2005 and June 2023, was checking to ensure that friends or family would be receiving a homeless person when he or she stepped off the bus.
We’re not doing that anymore. City officials told us that they have made the program “low-barrier,” so someone in the midst of a drug crisis can have an epiphany and be bundled onto a bus within relatively short order.
To reiterate: We are making it easier for someone with no resources and in withdrawal to get on a bus and be sent to a place where they may have no connections and nobody is looking out for them.
SoMa workers and residents who attended last week’s meeting with the cops certainly hope for the best. But they expect the worst.
Mark Sackett, a SoMa event space owner and entrepreneur, said he voted for Daniel Lurie and is grateful that the mayor and the police are turning their attention to the neighborhood. But he likened the approach so far to “kicking an ant hill.” Joe Wilson, a formerly homeless man who is now the executive director of homeless services nonprofit Hospitality House, said that “efforts like this are largely focused on what the neighborhood looks like, rather than permanent solutions, so they’re bound to fail.”
But the situation on Sixth Street, always dire, has devolved. Something must be done. And this is definitely something.
“I’ve been in the neighborhood for 38 years, and I ain’t never seen anything like this. This has got to be a movie. It cannot be real,” says Del Seymour, a former drug dealer and addict who now leads the jobs training nonprofit Code Tenderloin. “It is so far out of the realm of normalcy. I can’t take it no more. People are killing themselves and we are letting them do that. What kind of folks are we? We can’t let them do that no more, and I am willing to try anything right now. Anything.”
And this is definitely anything.
Sixth Street has, for generations, evaded solutions, and has been the most distressed corridor in San Francisco. For Lurie to stake his early reputation on cleaning it up could be a nigh-insurmountable challenge.
San Francisco’s crime rates are at near-historic lows. But residents have voted as if the city is undergoing a 1970s-era crime wave, in large part because of disorder, chaos and overt misery on the streets. So it will be interesting to see if deftly applied statistics, even accurate statistics, convince people that things are improving on Sixth Street, where disorder, chaos and overt misery are generational conditions.
Because, in the end, there is no magical tent. Only magical thinking.
Additional reporting by Abigail Vân Neely.
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JOE ESKENAZI
Managing Editor/Columnist. Joe was born in San Francisco, raised in the Bay Area, and attended U.C. Berkeley. He never left.
“Your humble narrator” was a writer and columnist for SF Weekly from 2007 to 2015, and a senior editor at San Francisco Magazine from 2015 to 2017. You may also have read his work in the Guardian (U.S. and U.K.); San Francisco Public Press; San Francisco Chronicle; San Francisco Examiner; Dallas Morning News; and elsewhere.
He resides in the Excelsior with his wife and three (!) kids, 4.3 miles from his birthplace and 5,474 from hers.
The Northern California branch of the Society of Professional Journalists named Eskenazi the 2019 Journalist of the Year.More by Joe Eskenazi
