San Francisco voters head to the polls on March 5 to weigh in on Proposition F, which would require people to be drug-tested in order to receive public benefits. Mayor London Breed (D) has proposed the measure as a way to compel more people to receive substance use disorder treatment. Harm reductionists and other opponents say it would punish people experiencing poverty, and cause other harms.
County Adult Assistance Program (CAAP) benefits, according to the mayor’s office, assist people with finding a job, housing and paying for food or utilities. The office states that people in housing receive $712 a month, while people who are unhoused can access city shelter and a cash grant of $109 a month.
Under Proposition F, any single adult with no dependent children who is receiving CAAP benefits could be drug-tested. They could then be required to participate in “substance abuse treatment,” if recommended by an evaluator.
The situation, according to Mayor Breed’s office, “calls for more tools to incentivize people into treatment, rather than blindly following the status quo.”
Anyone who refused to cooperate with either testing or treatment would become ineligible for cash benefits. They could instead receive a “housing stipend or access to in-kind shelter” for up to 30 days. The city could choose to extend any assistance, or cut it off.
In support of Proposition F, Mayor Breed’s office cites the increase in overdose deaths in San Francisco and the prevalence of synthetic opioids like fentanyl—a situation, it states, which “calls for more tools to incentivize people into treatment, rather than blindly following the status quo.”
Mayor Breed has conducted crackdowns against people who use or sell drugs, especially in the city’s downtown Tenderloin neighborhood. She has also scapegoated immigrants for fentanyl sales, while a city-and-state joint task force has been empowered to charge people who sell fentanyl with murder.
Yet in proposing Proposition F, which she announced in September 2023, Breed admitted that her goal of forcing more people into treatment through law enforcement wasn’t working.
“The arrests that we’re making for public intoxication, people are not accepting help,” she said. “And so now it’s time to make sure that we are cutting off resources that continue to allow this behavior to occur without the accountability, without someone involved in a treatment program that could lead to a better life.”
“It’s going to increase homelessness, and it will further decrease access to treatment for people.”
Dr. Marlene Martin, an associate professor at the University of California San Francisco School of Medicine, is among those opposed to Proposition F. In February, she joined a press conference, with Laura Thomas of the San Francisco AIDS Foundation and others, to speak out against the measure.
Dr. Martin disputes Mayor Breed’s assertion that Proposition F will increase treatment uptake among those most in need, when simply identifying drug use doesn’t demonstrate substance use disorder.
“It’s going to increase homelessness, [and] it will further decrease access to treatment for people,” she told Filter. “If you’re forcing people who potentially don’t have a substance use disorder or are not interested in treatment, you’re taking up very limited spaces for people who may be ready to get into the same programs.”
As well as undermining the city’s stressed treatment system, Martin and her colleagues believe Proposition F would punish poverty and unfairly target Black and Latinx residents.
Martin was among those who helped put together the city’s official Overdose Prevention Plan, released in October 2022. It outlined a very different approach to the issues of addiction and overdose in San Francisco.
“[It includes] overdose prevention centers, having a place where people can be safe and not overdose, as we’ve seen in many other countries that have put these in place,” she said. “[And] increased access to treatment, that’s both medication treatment as well as the spectrum of community programs so people don’t get turned away the day they are ready.”
The treatment described is voluntary, not coerced—which to harm reductionists is a critical distinction, both ethically and because of the relative ineffectiveness and potential harms of forced treatment.
There’s broad agreement that San Francisco has far too little low-barrier treatment and support available to people with substance use disorder. The issue is statewide, as California voters simultanenously weigh in on Proposition 1, another deeply controversial measure relating to housing, mental health and treatment.
A further criticism of Proposition F is the difficulty of implementing it without proper training and hiring of workers to conduct the drug screenings and substance use disorder evaluations. The union representing city workers—Service Employees International Union No. 1021—alleged in a February letter that Mayor Breed had violated labor laws by putting Proposition F on the ballot. Laws require employers to “meet and confer” with workers to negotiate “wages, hours and other terms and conditions of employment.”
“I don’t know who they think they’ll get to do the assessments—there’s not enough mental health professionals.”
Dr. Patt Denning, cofounder of the Harm Reduction Therapy Center in San Francisco, explained the challenge around this.
“There’s two levels, one is a screening that supposedly will be done by the [city],” she told Filter. “If that screening shows the possibility for a problem, then they go to an evaluation by a mental health professional. The screening is going to be hard enough in terms of workload. I don’t know who they think they’ll get to do the assessments—there’s not enough mental health professionals to do these assessments, and most are not trained to do a substance use assessment.”
The city workers union similarly maintains that there is a shortage of drug treatment employees working for the city, too many people who would have to be drug tested if Proposition F is adopted, and too little treatment space. Its February letter stated that there were 46 beds then available in treatment centers run by the city’s Human Services Agency. Around 5,200 people are currently receiving county benefits, it noted, about one third of whom are estimated to have substance use disorder.
The idea of requiring drug testing for people on welfare has a long history in the United States. President Bill Clinton’s federal welfare bill in 1996 allowed states to require mandatory drug testing for public benefits.
In 2014, the issue reached a federal court in Florida, which struck down the state’s law requiring drug tests for anyone on Temporary Assistance for Needy Families, a federal assistance program. The court described it as an unreasonable search.
But more states have passed requirements for drug tests in cases where there is a “reasonable suspicion” of drug use. In 2018, the Center for Law and Social Policy estimated that 13 states were drug-testing people for TANF benefits. It found that they had spent nearly half a billion dollars to test 2,541 people—and turned up 301 positive tests.
Photograph by Cambodia, P.I. Network via Flickr/Creative Commons 2.0
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