Overview
Ban Deadly Drug Dealing
Our coalition started with a protest against fentanyl and open drug scenes, major factors in the rise of drug deaths from 18,000 in 2000 to 93,000 in 2020. Research shows that cities can break up open air drug scenes through a combination of social services and law enforcement. They should arrest drug dealers and offer them a chance to abandon their illicit activities or convict them. San Francisco should give addicts the care they need to recover, and cities must also prohibit the public use of hard drugs.
Cal-Psych
For decades, both liberal and conservative experts have said that homelessness can only be dealt at the state level. Rising drug deaths and homelessness are not entirely the fault of counties. The homeless and mentally ill are highly transient, making care and services for them difficult for counties to manage. A state-level solution is needed to best serve these populations. The state should offer more of everything: inpatient rehab, drug treatment on demand, psych beds, conservatorship, assisted outpatient treatment, mobile vans, and residential care facilities.
Shelter First, Housing Earned
Currently San Francisco is operating under a Housing First policy for assisting the homeless. That means the city gives out permanent supportive housing to the homeless unconditionally and refuses to build shelters. This policy is a failure. It is why our streets are lined with tents. It forces the homeless to sleep outside where they are more likely to be assaulted or addicted. Instead, the city should offer Shelter First, Housing Earned where the city would guarantee the homeless a bed every night and would give out housing based on preconditions like abstinence.
Shut down deadly drug markets
The Tenderloin of San Francisco, Skid Row and Venice Beach of Los Angeles, and the Blade in Seattle are what Europeans call “open air drug scenes.” They are places where drugs are sold and used openly. In these neighborhoods people inject and smoke meth, cocaine, heroin, and fentanyl on the sidewalks. Tents line the streets. In Venice Beach, tent fires are common as is assault and theft.
Ending these drug scenes would reduce crime, drug use, and homeless encampments. Fortunately, many cities have been able to do just that. In Amsterdam, police and social workers broke up the city’s open air drug scenes by offering social services and enforcing the law. Social workers provided methadone, drug and mental illness treatment, and shelter, while police ticketed users who used in groups publicly. For these public users, they were required to attend rehab or face jail time if they did not pay their tickets, which was often. This policy has the dual benefit of helping addicts beat their addiction while also ensuring public order. Today, Amsterdam’s former open air drug scenes are now thriving mixed-income neighborhoods. Lisbon, Frankfurt, Vienna, and Zurich all followed similar policies and reaped positive results.
New York used smarter policing to end the infamous open air drug scene in Times Square in the 1990s, which helped reduce drug-related killings by 90 percent. Increased police presence has been shown to reduce crime in a way that longer sentences have not. In High Point, North Carolina, police broke up three open air drug scenes by sitting down with dealers, showing them the extensive evidence they had gathered of their crimes, and offering services. The police presented the dealers job training, tattoo removal, and social services as a way to restart their lives and as an alternative to jail. These interventions broke up the market in ways previous arrests had not.
San Francisco needs to follow the leads of these cities and break up the open air drug scenes that plague the city and its residents.
Shelter First, Housing Earned
San Francisco currently gives out housing on a Housing First basis, meaning housing is distributed to the homeless without preconditions and shelter is not built. Housing First has made homelessness worse. Despite the city expanding its permanent supportive housing units from 6,000 in 2005 to 11,000 in 2019, San Francisco has seen its homeless population rise 50 percent and its unsheltered homeless population climb by 95 percent. San Francisco has the highest per capita permanent supportive housing units of any major city. It has twice as much as New York and three times as much as Chicago and Los Angeles, yet it still has the worst homelessness problem in the country.
Refusing to build shelters in favor of permanent supportive housing forces homeless Californians to sleep outside where they are more likely to suffer from violence, addiction, and overdose deaths. Large homeless encampments foster open air drug scenes and general disorder in our cities that hurt the homeless the most. In Venice Beach Los Angeles, fights and fires break out regularly, endangering the lives of the homeless there. And, contrary to what homeless advocates say, the homeless do want shelter. There are frequently long lines outside of shelters in San Francisco.
The evidence does not favor Housing First as the best way to end homelessness. In a groundbreaking 14-year study, a team of Harvard researchers found that just 12 percent of the homeless remained housed after ten years of unconditional housing. The strength of this study is its duration; Housing First advocates point to the success of 2-year studies showing that Housing First works to house the homeless, but the Harvard study demonstrates that Housing First doesn’t keep people housed in the long-run.
Housing First advocates point to a two-year study that showed 86 percent of recipients of unconditional housing remained housed, but there was a twist. The permanent supportive housing did not lower the rate of deaths compared to homeless people who didn't have access to Housing First. Additional evidence doesn’t support the policy. A study of 249 homeless people in San Francisco found the Housing First did not decrease the number of hospitalizations the homeless experienced. The National Academies of Sciences, Engineering, and Medicine published a review of the scientific literature of Housing First and found that there was little evidence that permanent supportive housing improves health outcomes, other than limited data suggesting it does so for people with HIV/AIDS.
The problem with Housing First is that it misunderstands the causes of homelessness. It is based on the belief that homelessness is caused by poverty when much of homelessness is caused by addiction and untreated severe mental illness. Policies that don’t address addiction and mental illness are bound to fail. Several studies have found that people in Housing First-type housing showed no improvement in drug use from when they were first housed. A literature review in 2009 suggested that Housing First’s harm reduction approach may actually worsen addiction. A study in Ottawa found that, while the Housing First group kept people in housing longer, the comparison group saw greater reductions in alcohol consumption, problematic drug use, and greater improvements to mental health, after two years.
Housing shouldn’t be given out unconditionally. Instead it should be offered with conditions - usually sobriety or following a treatment plan for severe mental illness. This is called the“contingency” approach.
This policy has shown success. Between 1990 and 2006, researchers in Birmingham, Alabama conducted clinical trials of abstinence-contingent housing with 644 homeless people with crack-cocaine addictions. Two-thirds of participants remained abstinent after six months, a very high rate of abstinence compared to other treatment programs. Other studies found that around 40 percent of homeless people in abstinence-contingent housing maintained their abstinence, housing, and jobs. In a randomized controlled trial, homeless people were given furnished apartments and allowed to keep them unless they failed a drug test, at which point they were sent to stay in a shelter. Sixty-five percent of participants completed the program.
Instead of attempting to guarantee Californians a right to housing, which will likely never be realized, Californians should instead be guaranteed a right to shelter. New York City, a city with over 77,000 homeless people, has sheltered 95 percent of its homeless population. It does not suffer from the same problems of open air drug scenes and homeless encampments. California should also require the homeless to sleep in a shelter bed if they have nowhere else inside to sleep. Cities should not permit the breakdown of public order and adverse health effects of unsheltered homelessness.
Cal-Psych
California needs a new, statewide agency to tackle the problems of homelessness, drug addiction, and untreated severe mental illness. Call it Cal-Psych. Cal-Psych would be built around case workers with “whatever it takes” mandates who have access to evidence-based treatments and policies like contingency housing, mandatory drug treatment, and assisted outpatient treatment.
One-third of the homeless have a severe mental illness and the severely mentally ill are ten times more likely to be in prison than in state mental hospitals. This is a humanitarian crisis. Cal-Psych would be responsible for procuring the psychiatric beds needed for the severely mentally ill to get treatment. Cal-Psych would also be responsible for implementing an expanded use of assisted outpatient treatment and conservatorship, which mandate medical treatment. Many severely mentally ill individuals require mandatory treatment to be healthy. Cal-Psych caseworkers would have enough funding to provide the support that their clients need. They would know if their clients had stopped taking medication, were back on the street, or had committed a crime. Cal-Psych would have mobile units capable of performing on-the-spot psychiatric evaluations and enrollment in treatment programs.
Because a large number of the homeless are addicted to drugs, Cal-Psych social workers would coordinate with law enforcement to break up open air drug scenes like those in the Tenderloin and Skid Row. Cal-Psych would secure and manage expanded, on-demand drug treatment. Every time someone has overdosed and survived, Cal-Psych workers would be able to connect that person to treatment. And residential drug treatment would be longer so that people in recovery are not released back into the world right when their cravings are peaking. Addicts who have committed nuisance crimes or crimes to feed their addictions would be offered drug treatment as an alternative to jail, and Cal-Psych would provide case workers who can support people in treatment.
There are models of effective and humane responses to the mentally ill and street addicts in the U.S. Arizona and Texas have police officers trained to handle mental health calls. They track down people who have violated court orders for treatment. They check in on people. They often have social workers with them. Crucially, their status allows them to handle people who might be in a violent, psychotic state, which social workers are usually not equipped to handle.
Cal-Psych would also manage housing for the homeless. It would be responsible for ensuring every Californian has a right to shelter by buying and building the shelters and housing necessary to get the homeless inside. As part of treatment programs for the severely mentally ill and the drug-addicted, Cal-Psych case workers would be able to offer housing on a contingency basis to their clients, meaning that clients would only receive housing if they met preconditions like taking medication or sobriety. This approach has been shown to be effective at housing individuals and improving their health outcomes. Purchasing residential homes and converting Project Roomkey hotels into contingent housing would be a first step. The governor could issue state-of-emergency declarations to acquire shelters and housing for Cal-Psych.
Cal-Psych would be statewide because many of the homeless are mobile and move across counties. When this happens, they shouldn’t lose their case workers or access to programs. Localities have also widely failed to address the homelessness crisis and the state has more buying power and capacity to implement the needed changes. Californians themselves are so fed up that they now believe that state officials are responsible for solving homelessness as opposed to localities by a 62 to 38 percent margin. However, we would not abandon the current system overnight. We should not repeat the mistakes of the community health advocates of the 50s and 60s who closed mental hospitals without having suitable replacements. Cal-Psych would begin in just a few counties and would expand once it is successful.
The money for Cal-Psych could come from three sources: California’s failed Mental Health Services Act, Medicaid, and, over time, city and county funding currently sent to unaccountable nonprofit service providers.
Cal-Psych’s care for the homeless that truly meets their needs represents a moral, human, and technological frontier for California. If enacted, it would be arguably the most comprehensive and effective homelessness program in the country. Californians would no longer feel the shame that accompanies seeing someone in a psychotic state on the street, living in tents along the highway, or shooting up fentanyl on the sidewalk, because the people who previously struggled under those conditions now have the care, incentives, and resources they need.
Fund the Police
A strong police presence is good for communities — it is proven to prevent homicide and crime. Efforts to defund the police are demoralizing to police officers and, when combined with civil unrest and anti-institutionalist rhetoric, contribute to rising homicide, inequality, and disorder.
At the same time, we need to do more to reduce police abuse and discrimination against communities of color. Officers must be held accountable and take responsibility for their actions, and lethal force must be a last resort. We need law enforcement to coordinate with empowered social workers and humanely direct the mentally ill to the care they need.
Police reform that ensures safety, equity, and lawfulness will require funding, accountability, and dedication to better our existing institutions. As California pursues a third way between mass incarceration and lawlessness, it must both create Cal-Psych and develop the capacity of our police to deal with addiction and mental illness effectively.
Enforce the Law - Fairly and Impartially
Many California cities have reduced enforcement of laws against public drug use, defecation, theft and other supposedly “victimless” crimes. To some extent this is because laws like Proposition 47, passed in 2014, decriminalized shoplifting of items valued under $950 and possession of three grams of even hard drugs. But the hesitancy of city leaders to prosecute suspects has also contributed to weak enforcement of laws. And that means the supposedly “victimless crimes” do, in fact, have victims.
These trends are rooted in fears of returning to the tragedy of mass incarceration, but laws must be enforced if we are to have livable and walkable cities, and to get people the care they need. Law enforcement should not go after people who are using drugs peacefully in their own homes. Laws can be enforced without the massive monetary and human cost of mass incarceration and curtailed civil liberties.
Warn Dealers of Deadly Drugs They Could Face Homicide Charges
Fentanyl has radically altered drug use. It is many times more potent than other opioids. Sometimes drug dealers deliberately or accidentally poison their victims with counterfeit drugs. The buyer believes they’re getting one drug, but in reality what they purchased is laced with fentanyl.
In order to prosecute drug dealers for murder in the case of a fatal poisoning by real or counterfeit drugs, prosecutors need to prove implied malice — that dealers knew their actions could kill. “Alexandra’s Admonishment,” Senate Bill 350 in the 2020-2021 legislative year, would have given District Attorneys the discretion to give dealers a formal warning informing them that their actions could prove fatal. If the dealer is caught selling drugs that kill someone, then they can be charged with voluntary manslaughter or murder. This is a necessary deterrent to save our communities from the scourge of fentanyl poisonings.
Redevelop Skid Row, Tenderloin, and Other Devastated Neighborhoods
Neighborhoods like the Tenderloin that are struggling with crime, open drug scenes, and decay are not locked into their sorrowful state. Equity-focused redevelopment can reduce crime, end open drug scenes, and revitalize neighborhoods. Housing vouchers and rent-controlled housing can prevent displacement of current residents. Redevelopment creates large quantities of new housing which ensures that developers can build a large amount of affordable housing.
Such redevelopment turned Amsterdam’s Zeedijk neighborhood from an open drug scene into a thriving community for residents of many income levels. A similar transformation took place in the Alphabet City neighborhood in New York. Neighborhoods that attract crime and drug use are not an inevitable part of cities.
Crack Down on Crimes on Snapchat and Social Media
Social media companies are exercising extraordinary powers over our minds and over our children. Some, like Snapchat, are where young people are buying drugs, including ones that kill them. Others, like Instagram, appear to be contributing to anxiety and depression among adolescents.
We need to hold social media companies accountable. Snapchat must be forced to improve its process for taking drug dealers off its platform. Additionally, parents and families need greater insight into how social media companies are manipulating the emotions of their children. And social media companies must be turned into tools for improving well-being, resiliency, and mental health.
Sound the Alarm
We need to sound the alarm, and educate parents and kids that they could die from fentanyl poisoning and drug overdose.
The U.S. and California failed to prepare our children for a world of abundant and easily-accessible hard drugs. As a result, tens of thousands of our loved ones are succumbing to addiction, poisonings, and overdoses every year.
We are developing a drug education platform based on what is proven to work. We are searching for partners with experience in this field. We are seeking to understand past successes such as the “Truth” campaign led by young people targeting tobacco companies for trying to convince children that smoking was cool.