For some San Franciscans, a drug crisis is just part of city living. They see people shooting up in front of their homes and businesses. They often find someone dozing on a sidewalk, high. Sometimes, they check for a pulse. “That’s how I found my first dead body,” said Adam Mesnick, owner of a local deli.
But the city’s drug crisis is relatively new. In 2018, San Francisco’s overdose death rate roughly matched the national average. Last year, its death rate was more than double the national level.
I recently spent time in San Francisco to understand what is going on. In today’s newsletter, I want to explain one of the factors that has contributed to the city’s crisis: culture.
Culture can sound like an abstract concept, but it matters for drug policy. Consider smoking. In 1965, more than 42 percent of American adults smoked cigarettes. In 2021, less than 12 percent did. The country did not criminalize tobacco. And while policy changes like higher taxes played a role, much of the drop happened through a sustained public health campaign that led most Americans to reject smoking.
In San Francisco and other liberal cities, the opposite shift has happened with hard drug use. The culture has become more tolerant of people using drugs. When I asked people living on the streets why they are in San Francisco, the most common response was that they knew they could avoid the legal and social penalties that often follow addiction. Some came from as close as Oakland, believing that San Francisco was more permissive. As Keith Humphreys, a drug policy expert at Stanford University, told me, San Francisco “is on the extreme of a pro-drug culture.”
Destigmatizing drug use
San Francisco’s change is rooted in a broader effort to destigmatize addiction. Some experts and activists have argued that a less punitive and judgmental approach to drug use would help users get treatment — a “love the sinner, hate the sin” attitude.
Over time, though, these efforts in liberal cities have expanded from users to drug use itself. Activists in San Francisco now refer to “body autonomy” — arguing that people have the right to put whatever they choose into their veins and lungs. They no longer want to hate the sin. They say it’s no one’s business but the drug user’s.
One example of this shift: In early 2020, an advocacy group put up a billboard downtown to promote the use of naloxone, an overdose antidote. It showed happy young people seeming to enjoy a high together. “Know overdose,” the billboard said. “Use with people and take turns.” Here, drug use wasn’t dangerous as long as users had someone to check on them while high.
The shift is also present in drug-related service providers in San Francisco. Michael Discepola, director of health access at the program GLIDE, said that his organization wants people to use drugs more safely. Abstinence is not always the correct goal, he argued. When one client declared that he wanted to quit drugs, Discepola explained, GLIDE suggested “more realistic goals.”
Stigma without criminalization
Other countries’ experiences show it is possible to relax drug laws, as many liberals want to do, without relaxing attitudes. In 2000, Portugal removed the threat of prison time for drug use. But it’s still a predominantly Catholic, socially conservative country that largely looks down on the practice.
Portugal’s system reflects those attitudes by pushing people to stop using drugs. Even its harm-reduction programs, which aim to keep people alive over getting them to quit drugs, work with the country’s treatment system to help people stop using.
In San Francisco, harm-reduction programs such as GLIDE do not require staff to guide people toward treatment. They argue that such pushiness could scare away clients who are not interested in quitting drugs. They often cite the drug policies of British Columbia, a global leader in harm reduction. But British Columbia set a record for overdose death rates last year.
I go into more detail about the differences between San Francisco and Portugal in this new story for The Times’s Upshot section, including a chart that compares overdose death rates across Europe.
Related: Oregon officials declared a 90-day state of emergency over fentanyl in Portland, part of an effort to reduce public drug use.
THE LATEST NEWS
A House committee approved articles of impeachment accusing Alejandro Mayorkas, Biden’s homeland security secretary, of refusing to enforce immigration law. There is no evidence that Mayorkas committed impeachable offenses.
The Justice Department is investigating whether Representative Cori Bush, a Missouri progressive, mishandled campaign funds.
Fair Fight, the voting rights group that Stacey Abrams founded, is laying off most of its staff after incurring debts through prolonged court battles.
Jean Carnahan, who in 2001 became the first woman to represent Missouri in the Senate, died at 90.
The chief executives of TikTok, Meta, X and other tech companies will testify to Congress today about children’s online safety.
Ahead of the testimony, lawmakers released internal Meta documents that show how it rejected efforts to address the issue.
A tech industry group that represents Google and Meta among others is trying to block state laws that seek to protect young people online.
A.I. will help perpetrators create more images of children being sexually abused, law enforcement officials said.
Other Big Stories
E. Jean Carroll’s defamation trial against Trump represents an older woman’s declaration that she still has value, Jessica Bennett argues.
Americans recovered from the pandemic’s social isolation. But they still don’t trust the institutions that abandoned them, Eric Klinenberg writes.
The U.N.’s Palestinian refugee agency perpetuates conflict and needs to be abolished, Bret Stephens argues.
394 hot dog ice sculptures: The artist Sunday Nobody has found millions of viewers with his elaborate absurdist projects.
St. Moritz: Rich people wanted to watch polo on a frozen lake. But Switzerland was too hot for the “hottest ticket in town.”
Ask Well: Is my lip balm making things worse?
Lives Lived: Chita Rivera dazzled Broadway audiences for nearly six decades, including as Anita in “West Side Story” and Velma Kelly in “Chicago.” In 2005, Newsweek called her “the greatest musical-theater dancer ever.” She died at 91.
Birds of a feather: The producer Ryan Murphy spent years searching for the perfect rivalry to dramatize in the second season of his TV series “Feud.” He considered Prince Charles and Princess Diana, and William F. Buckley and Gore Vidal, and a half-dozen others. Then he discovered the story of Truman Capote and his “swans” — New York society women whom the writer befriended, then betrayed in a tell-all magazine article. “It’s very easy to do a show where people are just nasty to each other,” Murphy told The Times. “But feuds are never about hate. They’re about love.”
For more: Maureen Dowd profiled Calista Flockhart, the former “Ally McBeal” star who plays one of the swans.