“Recovery First Drug Policy” is on the San Francisco table

So why are harm reduction activists trying to push it off?

It’s indisputable that San Francisco has been and remains in a drug fueled crisis. From 2020 to 2024, over 3,000 human beings lost their lives to overdose, mainly from fentanyl. 2025 is already a rough year. The death toll for January was 59, February was 68, and March was 65. That’s 192 individuals who suffered and perished in this city.

Clearly what San Francisco has been doing to stem the destruction has not worked. A predominant reason is the city’s over reliance on a bastardized version of harm reduction. It went from rational - accessible needle exchanges to offset the spread of blood borne diseases - to pure lunacy, with free pipes for meth and crack to fentanyl foil and straws, all delivered to the addicts.

Harm reduction has become a trashcan overflowing with garbage ideology. It has led to mental and physical problems, chaos in neighborhoods, increased property crime, and more deaths, not fewer. It completely de-emphasizes sobriety. Somewhere along the way, helping people to kick a habit and live free of the substances that are killing them stopped being the goal.

Enter “Recovery First Drug Policy”

Despite the winging fringe, the vast majority of the city’s residents are disgusted with the status quo. For too long San Francisco has been associated with appalling street conditions and people in varying stages of personal destruction.

When Supervisor Matt Dorsey introduced his “Recovery First Drug Policy” ordinance in April 2025, it was met with hope and praise. Though it has no legal teeth, it would signal a fresh, new approach. Dorsey, who has been in recovery from methamphetamine addiction for years, defines recovery as being abstinent from illicit drugs.

Therefore the aim of the legislation, should it be passed, is to make recovering from addiction a city-wide goal. During the meeting, held at the Board of Supervisors chambers, the recovery community came out in force, holding yellow and black signs that read, “Drug Enableism KILLS.” One by one they stood and spoke passionately about finally getting clean and sober.

And that is what infuriated people in the harm reduction industry. They don’t get paid to help people off the toxic substances, but to keep them on. And on, and on, and on…

The activists reaction

Alarmed by what might happen should the city actually take a cessation of illegal drug use approach, the activists applied pressure.

Grey Gardner, California state director Drug Policy Alliance, Jennifer Friedenbach, executive director Coalition on Homelessness, Celestina Pearl, director of outreach/harm reduction Lyon-Martin Community Health Services, Laura Guzman, executive director, National Harm Reduction Coalition, Calder Lorenz, operations director The Gubbio Project and Jes Distad board member, Harvey Milk LGBTQ Democratic Club penned a letter in response to Dorsey’s original ordinance.

Here are a few key excerpts (complete letter at the end of this story) and my comments to each:

“The proposed measure presents a very narrow view of recovery.”

Well, recovery is overcoming an addiction. So yes. It’s narrow because that’s the definition.

“…the language of this ordinance could exacerbate the existing stigma against substance use disorders and substance users…”

Don’t be daft. There is nothing stigmatizing in helping people recover from drug addiction.

“Alarmingly, this policy could redirect funding for abstinence-based models only, stripping harm reduction-based programs from critical funding necessary to distribute overdose prevention medication and life-saving harm reduction supplies, offer drug and treatment-related education, and facilitate connections to social services and treatment.”

Ah. You’re afraid that your funding will dry up. That’s what this is about.

“San Francisco must also deliver on the promise to establish wellness hubs…”

These are city sanctioned and funded drug use sites. San Franciscans don’t want them because they would only make the problem worse.

Last minute revisions to mollify the mob?

Shortly before the meeting where Dorsey rolled out his Recovery First Drug Policy, he amended some of the legislation’s language to satisfy the S.F. Marin Medical Society. Suddenly “recovery” (remember, defined as abstaining from illegal drugs) was neutered.

Dorsey’s original version:

"Recovery" means abstinence from illicit drugs, and shall include participation in a Medication-Assisted-Treatment program administered by a qualified healthcare provider in accordance with applicable laws and medical guidance.”

Short, sweet, perfect.

Now it’s gobbledygook:

“Recovery" means the process by which an individual suffering from Substance Use Disorder strives to make positive changes that become part of a voluntarily adopted healthy lifestyle. Recovery may include participation in a Medical Assisted Treatment program administered be a licensed healthcare provider in accordance with applicable laws and medical guidance; an outpatient or residential substance use treatment program; a contingency management program or other program determined by the program participant to support their efforts to be in Remission.

Readers, you can’t make this up. However, this drivel expired a long time ago and needs to be tossed in the trash then incinerated. San Francisco isn’t interested in “remission.” We want real, lasting recovery for individuals and our communities.

What now?

The Voice of San Francisco held a Spaces meeting on X, and Matt Dorsey came on to explain the changes to his ordinance. It was spicy. Have a listen.

Mothers Against Drug Addition and Deaths, a Bay Area group of mothers who have children suffering with substance use/at risk teenagers penned a letter withdrawing their support for the amended version of the Recovery First ordinance. Definitely worth a read.

As for me, I believe this well-meaning and potentially powerful city ordinance can and should be fixed.

Complete letter from the harm reductionists

We write in respectful opposition to the Ordinance NO. 250190, also known as the ‘Recovery First Drug Policy,’ amending our city’s drug policy to singularly focus on the abstention and cessation of drug use. As advocates working on policies that prioritize social support and community well- being, we believe that San Francisco’s drug policies should be grounded in scientific evidence, health, and equity.

We share in the vision and the urgency that individuals with substance use disorders (SUD) receive the urgent treatment that they desire and need, limiting or preventing the adverse consequences associated with SUD.

However, we are deeply concerned with the introduction of the Recovery First Ordinance, which, as written, signifies a drastic departure from San Francisco’s long-established data-driven drug and harm reduction policies. The proposed measure presents a very narrow view of recovery, obscuring the different pathways toward recovery. Recovery is not a one-size fits-all, rather, it exists on a spectrum. The federal Substance Abuse and Mental Health Service Administration crafted a consensus definition to capture the nuance of recovery as, “a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential”.

For over thirty years, San Francisco has been at the forefront of adopting innovative strategies that reduce health risks associated with drug use and that improve the recovery of people who use drugs (PWUD). A critical component of such measures has been the implementation of harm reduction policies and practices, driven by community public health strategies that engage directly with people who use drugs to prevent overdose and infectious disease transmission, improve physical, mental, and social well-being, and offer low-barrier options for accessing healthcare services, including substance use and mental health treatment.

In 2000, San Francisco’s Health Commission passed a resolution adopting a Harm Reduction Policy for Substance Use, sexually transmitted disease, and HIV treatment and prevention services, and/or programs that serve people who use drugs in their programs. The adoption of this policy followed a community-led building of programming and services to support people who used drugs impacted by AIDS. It signaled San Francisco’s openness to embed an evidence- based approach into their system of care and support services to meet people where they are and build trusting relationships that will connect people to health and social services. Moreover, it represented a commitment to ensure that drug policies and services to people impacted by drug use were guided by a public health approach, recognizing that cessation of all drug use is not necessary to receive supportive services.

The Recovery First Ordinance will undermine a well- developed drug user health framework that maximizes the wellbeing of our communities by focusing the city’s drug policy solely on one approach. The abstinence only model ignores the fact that recovery from substance use is not a linear nor rigid path and forecloses on the continuum of approaches available to support individuals in their recovery journey.

The reality is that recovery from substance use is a complex and often unpredictable process influenced by each individual’s circumstances, and cessation of drug use is one part of the many components of recovery. Returning to drug use, or relapsing into substance use, is a component of the recovery change process, and for this reason it is critical to implement strategies to improve the retention of non-abstinent patients in the continuum of care.

We are deeply concerned about San Francisco adopting a definition of recovery that is severely limited. This definition is not aligned with best treatment practices, but rather places abstinence-based models as the only standard for treatment when people need access to a variety of treatment options beyond medication-assisted treatment, such as contingency management, behavioral health treatment, and trauma-recovery services.

We also believe that the language of this ordinance could exacerbate the existing stigma against substance use disorders and substance users and thus, inhibit successful outreach and connection of PWUD to services. Having a policy defining recovery as being “abstinent from drug use” will discourage people from seeking overdose prevention and other critical resources, knowing that any indication of their substance use could prevent access or remove them from shelter, housing or treatment.

Alarmingly, this policy could redirect funding for abstinence-based models only, stripping harm reduction-based programs from critical funding necessary to distribute overdose prevention medication and life-saving harm reduction supplies, offer drug and treatment-related education, and facilitate connections to social services and treatment. We risk isolating individuals away from services when San Francisco should address this from both angles and incorporate harm reduction principles into treatment models to match people's experiences better.

Investing in public health approaches will help people stay on their path towards recovery, which include but are not limited to shelter and housing options that meet their needs before and after exiting treatment; having access to low-barrier and effective treatment services, naloxone and overdose response training and education, and drug checking services. These low barrier treatment options still lack adequate funding to meet the scale of need - we must build up the spectrum of effective programs, not narrow our scope of care. San Francisco must also deliver on the promise to establish wellness hubs, a key cornerstone of the 2022 Overdose Prevention Plan to provide linkages to care, which will strengthen our current system of services.

We must prioritize the adoption of evidence-based and health-centered solutions to increase the opportunities for people struggling with substance use to seek and get treatment. This ordinance has the potential to hinder the long and established progress the City of San Francisco has developed to address the overdose crisis. We urge your “No” vote on this ordinance.