Glide Harm Reduction supervisor Jason Norelli holds up a fresh pipe while packing bags with supplies such as alcohol wipes, foil, fresh smoking pipes and unused needles while preparing for an outreach walk at Glide Memorial Church in San Francisco in 2020.
Jessica Christian/The Chronicle
One year after San Francisco Mayor Daniel Lurie moved to restrict the distribution of free drug supplies such as foil and pipes, there’s little evidence that the shift has helped meaningfully ease the city’s drug crisis.
For decades, San Francisco has embraced a harm reduction strategy, providing free supplies intended to reduce the risks associated with illicit drug use. But last April, Lurie declared that the city had lost its way and needed to pivot as part of a new, tougher crackdown on open air drug use.
Under the new policy put in place then, officials prohibited city-funded nonprofits from handing out free smoking supplies — such as foil, pipes and straws — in public spaces. It also required any organization that hands out drug use supplies to first offer counseling and treatment referrals. The policy did not apply to outdoor distribution sites on private property, such as one run by the San Francisco AIDS Foundation in the Bayview and another operated by Glide Foundation in the Tenderloin.
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For Jessica, who is homeless and smokes methamphetamine, the policy change made no impact on how she got supplies nor whether she sought treatment. She drops by the parking lot of Glide Foundation in the Tenderloin twice a week to pick up new pipes.
“I’m not doing anything to hurt anybody,” she said. “People are only going to stop (using), if they’re ready to stop.”
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The ease with which people like Jessica can get free supplies, even amid the restrictions, has prompted some people to say the city didn’t go far enough.
Other critics argue the administration is trying to project a “tough love” approach at the expense of interventions that they say are effective in building trust and engaging people in need of care.
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“Folks are not necessarily getting housed or access to treatment or care. More often, they’re just moving from neighborhood to neighborhood,” said Anna Berg of the Harm Reduction Therapy Center. “It’s just making it harder to stay connected.”
Roger Boyd, 35, holds a piece of foil containing fentanyl while spending time on McAllister Street in the Tenderloin district of San Francisco.
Jessica Christian/The Chronicle
A year into the policy shift, the Lurie administration is continuing to cut further into the city’s harm reduction network, which aims to reduce some of the negative consequences of drug use rather than mandating abstinence or treatment.
City officials have identified roughly $1 million in proposed cuts in response to a mayoral directive targeting harm reduction contracts that “do not promote assertive pathways to treatment” or are negatively impacting the greater community.
The cuts would close three mobile sites that give out clean drug paraphernalia and offer drug treatment, scale back a syringe cleanup crew and reduce local funding for drug-use supplies, such as clean needles and pipes, though the city receives most of those supplies free from the state.
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The proposal marks the latest step in a broader shift by the Lurie administration to lean more heavily on law enforcement to address public drug use while pushing nonprofit providers to connect more people to treatment.
Public Health Director Daniel Tsai said the city remains committed to caring for its most vulnerable residents and that the policy shifts reflect a “more proactive view to how we address public drug use.”
“We have to think about how to help folks on their (recovery) journey, and also about the overall community and kids walking down the street,” Tsai said. “Those are all important and relevant factors.”
Gina McDonald, a recovering meth user who co-founded Mothers Against Drug Addiction and Deaths, said she supports any effort by city officials to make it “easier to get help and harder to get high.”
“It’s about making it a little bit more inconvenient,” she said. “Do we need to go further? Well, we’ll see.”
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The city’s public health department said last year that even with the new policy it remained committed to “evidence-based harm reduction strategies” and that it would evaluate the effectiveness of the policy based on overdose, HIV, and Hepatitis C rates.
But harm reduction advocates and addiction treatment providers warned that restricting smoking supplies make it more difficult to reach vulnerable people and force more drug users to share supplies or inject drugs, increasing the risk of overdose and disease transmission. Most providers said they already paired supply distribution with offers of counseling and treatment.
Since the policy took effect, Tsai said the city has “not seen any meaningful uptick” in HIV or Hepatitis C infections. He also pointed to preliminary figures suggesting San Francisco may be on track for a decline in fatal overdoses this year.
Still, San Francisco has the second-highest fatal overdose rate among large county-level U.S. jurisdictions, according to the latest reliable federal data. And while overdose deaths have fallen from their 2023 peak, they remain far above pre-pandemic levels.
Charles and Joni (right) show off their drug paraphernalia on Ellis Street in San Francisco.
Gabrielle Lurie/The Chronicle
More recent figures from the San Francisco medical examiner’s office show the city recorded roughly the same number of overdose deaths in 2025 as in 2024 — 625 compared with 635 — though fatalities may be on track to fall further this year. A decline could reflect a range of local and national factors, including supply disruptions, changes in drug-use patterns or policy shifts.
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Admissions to residential drug treatment rose modestly from 2024 to 2025, though completion rates are low. More people are receiving prescriptions for medications to treat opioid addiction but few are sticking with it.
Residents in neighborhoods long affected by open-air drug markets say they have seen only marginal improvements in street conditions.
“The city government still tolerates — and by tolerating, encourages — public drug use in poor neighborhoods like SoMa, Mission and Tenderloin,” said Alex Ludlum, executive director of the SoMa West Community Benefit District, adding that he has seen cops drive by groups of people using drugs and not stop to enforce the laws.
Meanwhile, harm reduction providers say the administration’s new policies make it more difficult to reach those struggling with addiction. One of the mobile sites slated for closure in the Duboce Triangle neighborhood, for example, provided not only drug-use supplies but also access to public health clinicians offering wound care and treatment connections.
“Reduced visibility in the city shouldn’t be mistaken for reduced need,” said San Francisco AIDS Foundation CEO Tyler TerMeer. “If access shrinks, engagement shrinks, and that has real consequences in our city.”