Response to Today’s San Francisco Board of Supervisor’s Treatment on Demand Hearing

San Francisco – HealthRIGHT 360 has been dedicated to providing care for people who use drugs for over 50 years. The challenges facing the people we serve have grown more dire over the past 20 years. Housing insecurity, economic and racial inequity, the “War on Drugs,” and now, most pressingly, the increasing toxicity of the drug supply have all contributed to placing people with substance use disorders in increasingly precarious and desperate positions.

Facing these challenges, it is unconscionable to allow the ruthlessness of overdose fatalities to continue to impact the lives of our most vulnerable community members, and it is our moral responsibility to implement any and every effective program possible to save the lives of those who need our help. Last year, three times more people died due to an accidental overdose in San Francisco than of COVID-19, Our city undertook drastic, yet necessary, actions to stop the spread of COVID-19 by implementing emergency policies and relief to protect people from the spread of the virus. The largely successful COVID-19 response can serve as a model for an appropriately scaled and integrated public health response to address the even more lethal overdose crisis. 

To make change, we need to create and expand low-barrier services that have been proven to save lives – we must increase availability of Medication Assisted Treatment (MAT), and we need to increase our city’s capacity to provide timely access to residential substance use detox and treatment services. We also need to adopt innovative interventions which include contingency management, drug sobering centers, and overdose prevention programs. We must also address the impacts of stigma on people with substance use disorders, as this contributes to isolation, shame, secrecy, increased risk of an overdose, and disconnects people from the very care that they need when they need it. We must recognize that there are many paths to health for people who struggle with their substance use. It is a false dichotomy to pose “abstinence-based” treatment as standing in opposition to a range of services to care for and treat people who struggle with substance use. And in the face of the enormous risk of overdose death, it is indefensible to consider discharging individuals from treatment because they have had a return of the very same symptom that brought them into treatment in the first place. Kicking people out of treatment that need it the most will only result in more deaths.

Today, during the Treatment on Demand Hearing, we heard opinions based on anecdotes or individual experiences. Individual experiences of recovery are meaningful, but not at the expense of discarding what decades of research has taught us about what works in responding to problematic drug use, and what doesn’t work. While we all ramp up our efforts to end this overdose crisis, we cannot allow knee-jerk-reaction policymaking. We must refrain from the increasing rhetoric around expanding the role of law enforcement as a solution to treatment, and we need to avoid advocating for treatment that is not evidence-based and has been historically proven to have negative and unsuccessful outcomes. The “war on drugs” and criminalizing drug use and drug users is not the answer. Sending people to jail and/or forcing them into treatment is a demonstrably failed public policy, damaging and disenfranchising Black and Brown communities by militarizing police and deploying them against people of color. In fact, these failed policies have not stopped the rise in overdose deaths across the United States over the past 20 years. It is critical that our response to the overdose epidemic takes a new approach. We must ensure that our public health responses are evidence-based practices/practice-based evidence, equality, and compassion.

HealthRIGHT 360 supports solutions for the overdose crisis that are currently in operation, or proposed, by the San Francisco Department of Public Health – such as low barrier services, contingency management, Drug Sobering Centers, Overdose Prevention Programs, housing, and ultimately moving towards safe supply. These are all proven methods that can dramatically reduce the number of overdoses.

It is critically important for us to address the unrelenting rise in overdose deaths while also dismantling the structural racism that has been directly tied to substance use disorder for so many decades that have exposed vast inequities and disparities in our Black and Brown communities. 

The lives of people who use drugs are no less valuable than those that are at risk of dying from COVID-19. The overdose crisis can end if we take immediate and appropriate action – lives depend on it.

About HealthRIGHT 360:

HealthRIGHT 360 is a non-profit provider of substance use disorder treatment, mental health services, and primary care to over 45,000 Californians annually, including more than 15,000 San Franciscans. HealthRIGHT 360 provides care that is compassionate, non-judgmental, and science-based. We provide services, regardless of one’s ability to pay; inspired by our belief that healthcare is a right, not a privilege. Learn more about HealthRIGHT 360 and our programs at

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