San Francisco’s compassion crisis

Thomas Wolf was in a pickle. His doctor no longer prescribed him the narcotic pain reliever oxycodone for his foot injury, but his supply had run out. Wolf didn’t think he could live without his pills anymore. So he searched on YouTube: “Where can I buy drugs in San Francisco?” YouTube directed him to Golden Gate Avenue and Leavenworth Street in San Francisco’s Tenderloin district.

Wolf drove to that block, tense and nervous. He had never hit the streets looking for drugs before. How does it even work? He didn’t wonder for long. Within minutes, a man sidled up to him: “Yo, wassup, wassup, you need something?” Wolf handed him some cash, the man plopped white pills into his palm, and that was it—his first illegal drug transaction. It was that easy, that quick.

Wolf drove back to that block, again and again. He found a Vietnam veteran who sold him 80-milligram oxycodone pills at about $30 per pill. He soon needed eight pills a day to achieve his usual high. He was brazenly spending $240 a day on pills, because here on these streets, it doesn’t matter if police officers are present: The open-air, free-for-all drug den continues all day, all night, with almost no legal repercussions.

From billboards to policies, San Francisco trumpets an image of a progressive, social-justice-minded, and compassion-flowing city. Help is aplenty, given without judgment. Within the Tenderloin district, nonprofits offer all kinds of services. Volunteer groups hand out neatly packaged sandwiches. Multiple organizations, partnering with the San Francisco Department of Public Health, provide free drug-use supplies such as needles and metal cookers in the name of “harm reduction.”

But San Francisco also faces a severe drug and homelessness crisis, which the COVID-19 pandemic has exacerbated. Pre-pandemic, the drug-addled and homeless easily blended into the crowds. Now, with city streets eerily empty, San Francisco’s sickest and poorest are more visible: Up to 448 tents occupied the Tenderloin district at one point. Feces, urine, rotting food, and needles littered the streets, prompting the UC Hastings College of Law to sue the city and county on May 4: “What has long been suffered in the Tenderloin has become insufferable.”

The city settled the lawsuit by moving about 600 people into hotels, safe sleeping sites, and shelters. But the drug crisis continues unabated. In 2019, 441 people in San Francisco died of an overdose—a 70 percent spike from 259 overdose deaths in 2018. More than half of those deaths were related to fentanyl, a synthetic opioid that’s about 50 to 100 times more potent than morphine. Because it’s cheaper and stronger, fentanyl use has increased nationwide, but in San Francisco, people use it openly in public. Under harm reduction principles, the city’s health department has widely distributed naloxone (a drug that rapidly reverses opioid overdose), which reversed more than 2,600 overdoses last year. But city officials have faced even more overdose deaths this year due to pandemic-driven isolation and easier accessibility to fentanyl. Through August, 468 people—about two per day—died of drug overdoses in the city.

I VISITED SAN FRANCISCO IN MID-SEPTEMBER when the city choked under wildfire ashes. In the dark orange haze, I saw young men and women leaning against graffitied walls, sticking needles into their arms or torching crumply pieces of aluminum foil so they could smoke fentanyl or crack cocaine. I watched a man desperately sift through burnt pieces of foil, hoping to find one more hit of fentanyl in the residue. I also saw Hondurans, most who looked as young as teenagers, standing watch on street corners. They’re part of organized gangs who commute to downtown from Oakland to sell drugs.

Not everyone buying drugs in the Tenderloin is homeless: I saw a middle-aged man swerve into a no-parking spot in a gleaming black Lincoln MKS and call out, “Hey, mama!” to an elderly Asian woman with a stooped back and red-checkered Vans. The man popped out of his car with a fistful of cash. The woman pocketed the money, dropped several white pills into his cupped palm, and within minutes, the man and his Lincoln were gone. Two blocks away, I saw a similar exchange between a fresh-faced yuppie and an older, hoodie-wearing man—a quick flash of hands, and they calmly walked on like nothing had happened. All these incidents happened less than two blocks away from City Hall and the FBI office.

Has compassion run amok in San Francisco? Though police officers still arrest drug dealers—mostly targeting people with outstanding felony warrants, large amounts of illegal drugs, and/or court-mandated “stay away” orders—the court regularly releases suspects even as their cases are still pending. District Attorney Chesa Boudin, an open socialist who ran his campaign on restorative justice over imprisonment, has been pressuring the mayor and city supervisors to stop policing drug-related offenses, saying jail is an ineffective solution.

But the city has not decided on a better alternative, and the result is a public health and humanitarian disaster that affects everyone. One Tenderloin resident told me she wears her headphones every time she walks outside so she can shut out the drug dealers and panhandlers. Yet she, like many San Franciscans, says that’s better than jailing people: They point to the failed War on Drugs that did little to address the human despair behind addiction, and they point to the racial and socioeconomic disparities of mass incarceration. They also speak of civil liberties.

“We want to respect people’s decisions to live their own lives, even if we find their choices distasteful,” she told me. “At what point do we stop putting our privileged sensibilities above their desires to just be free and do their thing?” Yet she’s also become desensitized, she admitted: “You have to—otherwise, you can’t function.”

THOMAS WOLF WAS RUNNING OUT OF MONEY. To pay for his drug addiction, he had stopped paying his mortgage and bills, blown entire paychecks on drugs, and stolen his wife’s debit card. He soon turned to heroin, a cheaper drug, and snorted it in the bathroom at work, then passed out on his desk. One day, he stopped showing up to work. Eventually, the utility company shut off the electricity in his house. He then went on an 11-day bender in Tenderloin until a police officer told him to go home. His wife had filed a missing person report.

Back home, his wife was waiting for him with a packed bag: Either go to rehab, or get out. Wolf was already experiencing withdrawal symptoms at that time—aching, shaking, nauseous, and dying for his next hit. So he walked away from his wife and two young kids. He spent the next six months on the streets injecting, snorting, and smoking any drugs he could find. He spent all $520 of his monthly general assistance on drugs—and when that ran out, he became a “mule”—basically, he held drugs for dealers in exchange for drugs.

When he wasn’t holding drugs, he was high, drooping with hanging arms while he drifted in and out of consciousness. He lay next to people scratching themselves raw from abscesses and woke up to them dead from drug overdose. At times, while injecting, he missed his veins and contracted sepsis. He spent six days in the hospital, intubated under intensive care. “And that still wasn’t enough for me to stop,” Wolf recalled. “That’s addiction.”

After police arrested him several times for drug possession, dealers stopped using him as a mule. Desperate, he shoplifted in pharmacy stores and peddled the merchandise. It was a high-incentive, low-risk way of making extra bucks: In 2014, California passed Proposition 47, a state ballot initiative that reclassified various drug and property felonies as misdemeanors. Under Prop 47, all thefts under $950 are classified as misdemeanors, which don’t consistently lead to jail time.

One day, a group of harm reduction volunteers handed Wolf a free drug kit from a cart. The kit contained clean needles, cotton balls, a cooker, a tourniquet, and a Brillo pad, which is used to inhale drugs. Wolf was ecstatic—that was about $10 worth of stuff. Not one person asked if he was interested in treatment.

“At what point do we stop putting our privileged sensibilities above their desires to just be free and do their thing?”

That’s because of San Francisco’s “harm reduction” philosophy, which advocates say is a more pragmatic and humanistic approach to drug use. The idea is to neither support nor condemn drug use, but help people “use with dignity” and reduce deaths and transmittable diseases instead. Through local nonprofits such as Drug Users Union, the health department distributes 4.45 million needles each year to reduce risk of diseases such as HIV and hepatitis C. Any person can walk into one of the city’s many harm reduction service providers and walk out with bags of metal cookers and foil (for cooking), straws (for snorting), tourniquets, and alcohol pads—all free.

Wolf learned very quickly where to get cash assistance, hot meals, and pipes, but he had no idea where to turn for recovery. Harm reduction advocates tell me that’s because they don’t want to turn people off. Instead they want to provide a safer environment to use drugs or offer clean drug supplies—and maybe, one day, addicts will ask for treatment.

“We’re just happy that someone came in, and we engage them at that point,” said Kenneth Kim, senior director at GLIDE Foundation, a nonprofit that operates out of the historical Glide Memorial Church in Tenderloin. “We don’t see this as a moral issue. It’s a health issue.” Among other programs, GLIDE provides free drug supplies, naloxone training, and fentanyl test strips to the hundreds of people who walk in each day. Kim said every drug user he’s met has tried quitting: “If it was really just about their will, I think they would have quit, but they need something different. … The truth of the matter is, we don’t have a system that says, ‘We will love you unconditionally.’ Instead it’s, ‘We’ll take care of you as long as you behave.’”

I asked several drug users on the streets if they’ve tried rehab. “Been there, done that,” one 51-year-old named Chris told me. He shared a meth pipe with his friend, Junior. “I’m high!” Junior told me, giggling as smoke whooshed out of his mouth. Junior, 55, said he’s tried rehab multiple times: “They treat us like a [obscenity]child.” He’s no longer interested in sobriety: “The Lord and I are on hold.”

The streets are filled with people whom the broken system has failed. San Francisco has more than 500 treatment beds, but that’s not enough for the tens of thousands of drug users in the city—nor is access to treatment easy for those who are uninsured or mentally ill. Even if someone is willing to go to treatment, city officials don’t connect people with abstinence-based programs, and it might take weeks before a treatment bed opens. By then, the painful withdrawals would have propelled that person back to drugs. Even if someone graduates from a rehab program, he’ll still need help building credit, seeking a job, and finding housing. Yet there isn’t enough transitional housing that mandates sobriety, and even if someone procures such a place, it’s almost impossible to stay sober when dealers hawk drugs at the doorway.

That’s what’s happening to Eric, 57, who told me he’s six months sober. He said he quit cold turkey after 40 years of smoking “anything combustible.” A father of two, he now has a job and lives in a single-room occupancy hotel in Tenderloin, where dozens of dealers offer drugs on every block. “It’s so tempting, so frustrating,” he told me. “I need to get out of here.” But with his limited resources and the city’s lack of affordable housing, his options are slim. Every day, Eric fights the demons on his doorstep.

THE LAST TIME WOLF GOT ARRESTED, in June 2018, he had lied to his son about going to an AA meeting. Instead, he smoked crack, weeping with shame and hating himself. By then, he had already been arrested five times—the last time for possessing 103 bindles of heroin and cocaine—and had an ankle monitor with a court order to stay away from Tenderloin. The police arrested him for violating that order.

For the first time, Wolf went to county jail. He spent three months there—five days on medically assisted detox, the rest sober. While in jail, he fished a Bible out of a trash bin. God had been silent for a long time, until he cracked the Bible open and found someone had highlighted Romans 5:5: “And hope does not put us to shame, because God’s love has been poured into our hearts through the Holy Spirit who has been given to us.”

Hope. How foreign yet sweet the word hope sounded to him. That was the beginning of a long spiritual awakening for Wolf, a soft blossoming of hope—not in his willpower or morality, but in the love of God. The system might not show unconditional love, but Wolf found someone who does. He called his brother and agreed to go to rehab if he bailed him out. The next day, his brother dropped him off at the Salvation Army’s Adult Rehabilitation Center, and Wolf spent six months in an inpatient recovery program.

Today, Wolf is 28 months sober. He’s currently staying with his parents while working on reconciling with his wife and kids. But he also lost job opportunities because of his criminal background and has zero credit due to debt. Had he not had housing stability or social support, it would have been too easy to return to the streets and drugs like many others, cycling in and out through the painfully complex, woefully inadequate system.

I met Wolf in Tenderloin one afternoon. He now advocates for people like him, but he’s brutally honest about the cost of addiction: “There’s no such thing as using drugs with dignity. The nature of addiction itself is undignified. It’s a life filled with desperation—everything you do is all about furthering your addiction.” During our two-hour walk, he pointed out familiar spots: where he used to sleep on cardboard, where he got high.

As we walked, a woman in a wheelchair called out to us, “Hey, hey, hey!” She was trying to sell us drugs. “No, I’m good,” Wolf told her. Across the street, a police cruiser slid up next to a drug market and honked. People hastily dispersed with their needles and pipes and plastic baggies. The police drove on. Within 10 minutes, people crammed the sidewalks again with their glazed eyes and scarred arms. The drug market bustled again.