Responding to a dramatic increase in overdose deaths, San Francisco’s Department of Public Healthhas unveiled an ambitious plan to reduce fatalities by focusing on both harm reduction and drug treatment. Acknowledging that overdose is now a public health crisis in the city—which reported 625 deaths in 2021, involving opioids, cocaine, and methamphetamines, and driven by a dramatic increase in the presence of the synthetic opioid fentanyl—the plan calls for establishing “wellness hubs” as a cornerstone of a continuum of sevices. Treatment and harm reduction exist side by side on this continuum, the health department states, and will therefore couple overdose prevention services such as safe syringe sites with the expansion of treatment availability. While the hubs will offer overdose reversal medications, drug testing strips, and spaces for safe consumption of drugs, the plan calls for removing barriers to treatment and adding 70 new beds for residential treatment, and increasing the number of people receiving medication-assusted treatment (MAT) by 20 percent. The overall goal is to reduce fatal overdoses by 15 percent by 2025. Yet while the plan as outlined has many positive components, it falls short by decoupling harm reduction as a pathway to treatment services. It says that “treatment must be made available to people who seek it, whereas other services incouidng harm reduction and supplies, should be accessible to individuals NOT seeking treatment.” We must find ways to link these two elements with incentives that encourage and motivate users to enter treatment, rather than returning to a life of drugs.
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Rosenthal Center for AddictIon Studies