Requiring Treatment Can Save Lives

London Breed
4 min readSep 27, 2023


Fentanyl has hit San Francisco — like cities across this country — and it’s like nothing we’ve ever seen before. More people are getting addicted, and tragically more people are dying.

We are offering services and enforcing our laws to shut down open-air drug markets. But we need to do more. The failed policies of simply offering services and walking away when they are rejected again and again are not working.

We are going to have to get comfortable with being uncomfortable. We have to do something different.

That’s why I announced new legislation to require anyone who has a substance use disorder and wants to participate in our general assistance program to receive cash to be in treatment. In San Francisco, the program is called County Adult Assistance Program (CAAP), and anyone applying would be screened for a substance use disorder. If they are identified as having one, they have to enter treatment to receive the benefit.

Simply put, if you want cash from this taxpayer funded program, you need to participate in treatment.

Mayor’s Press Conference on the New Treatment Initiative — YouTube

This treatment could be a range of interventions from residential treatment, medical detox, medically assisted to outpatient options. There is no one answer. And this isn’t about requiring sobriety to get cash. It’s about getting into treatment and trying. We know people aren’t perfect and they will slip up. But they have to try.

Now, the critics are already saying that we shouldn’t try. But this crisis is too severe not to try. And frankly, I’m frustrated and tired of those who criticize our efforts to improve street conditions and save lives without offering any solutions or ideas of their own but would rather obstruct for their own political ends. This includes members of the Board of Supervisors who are saying no, once again, to finding ways to get people to accept care. Enough of the opposition and obstruction. Enough of the excuses.

President Peskin, in his opposition, said we should focus on arresting drug dealers. We are doing that. Our work to disrupt the open-air drug markets has focused on enforcement. Arresting those dealing drugs and detaining those who are using drugs, while offering them access to services upon release. Our Police officers have made a significant increase in arrests compared to last year, and federal and state law enforcement agencies are also out doing the same.

In just the last 100 days, SFPD has made 548 arrests for narcotic sales and 266 warrant arrests, seizing 44 kilos of fentanyl. This is about holding people accountable for the harm they are causing when they refuse help and continue to deal or use in public. We will continue to enforce these laws to shut down these drug markets.

But that can’t be the only solution. We also need more tools to compel people into treatment. We need to pull every lever we have because too many people are sick and dying in our City and too many people think the only answer is to just let people do drugs on the street and die.

As I said, the failed policies of the past aren’t working with fentanyl and where we are today. Thankfully there are members of the Board who are supporting these efforts, including Supervisors Matt Dorsey, who is in recovery himself, Rafael Mandelman, and Catherine Stefani.

Let’s talk about the services we are offering. We spend over $700 million a year in behavioral health services. That doesn’t include all the money we spend to shelter and house homeless people. It includes the 350 treatment beds we’ve added — on top of the 2200 we already had — and the over 4,000 people who are helping with medication like buprenorphine or methadone.

But our outreach workers, despite all of this, cannot force people to accept help. Let me give one example. Just last week, our SF Department of Health Street Care Team encountered 80 people who they offered substance use services to. One accepted.

That’s just one team in one week, but it’s what we are facing. We are not going to make a difference on what we are seeing on our street if this is our only answer. We have to do everything we can to reduce the deaths occurring on our sidewalks every single day.

Now, this is not the only solution we are pursuing. Right now, Senate Bill 43 to expand our conservatorship laws, is on the Governor’s desk, as are two bills to put forward state ballot measures to expand the number of treatment beds and resources for those who have mental illness and addiction issues. I’m grateful for the legislators who passed these measures, and I’m hopeful the Governor signs them. If conservatorship reform passes, we will aggressively implement those policies to compel more people into care.

The answer has to be all of the above. We need to try new solutions, not just lob criticisms. We have to try. We have to try for those who need treatment, for those who are at risk of dying, and for our neighborhoods and residents who are frustrated with the lack of accountability for all the funding we provide.

Change has to come.