In San Francisco, the so-called “harm-reduction” method of dealing with drug addiction is on the way out — and thank goodness. The lenient approach, which coddled drug addicts, only made the problem worse.

The National Harm Reduction Coalition defines “harm reduction” as “reducing negative consequences associated with drug use,” rather than fighting drug use itself. It is also “a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.”

Harm reduction activists were once the darlings of City Hall. They began with noble intentions in the 1980s, when the HIV/AIDS crisis led the activists to propose meeting drug addicts “where they’re at.”

The problem was that letting addicts be addicts also meant leaving them on the streets to deteriorate and die. 

Today harm reduction is in a public-relations free fall. Politicians don’t want to support it; Residents hate it.

Of course, the philosophy sounded appealing on paper. Don’t be judgmental. The word “addict” is stigmatizing; use “substance use disorder” instead. Wait, did you say someone is getting “clean”? That implies users are dirty. Everyone is fine. That guy face-down on the sidewalk just needs Narcan and a free home.

And don’t you dare introduce such concepts as recovery, sobriety, and abstinence. That girl on a three-day meth binge will come to that conclusion on her own, if she chooses and when she’s good and ready. Which may be never, but whatever. Pharmaceutical-grade drugs, aka “safer supply,” will help too. Users just need to know where the drugs come from, how to test them, how to keep their drug tools to themselves, and how to party with friends.

When put into action, harm reduction principles failed miserably. They certainly didn’t “reduce harm.” It turns out practices like dispensing drug-supply paraphernalia by the vanful — from fentanyl foil to crack pipes — made lives and communities worse, not better.

San Franciscans witnessed the ruinous effect of such policies in real time. Harm reduction created massive and intractable open-air drug scenes; lured thousands of homeless drug tourists into the city; and intensified addiction. Already troubled areas like the Tenderloin and the Mission were brought to their knees with almost unimaginable crime and squalor.

Locally, harm reduction peaked in 2023. That was the year we had the most overdose deaths on record, at 810 fatalities. Enough was too much.

Then-Mayor London Breed — an ardent harm-reduction proponent who wanted to set up formal drug-use sites (even having a de facto one in the Civic Center, which was a total disaster) — lost the election to Daniel Lurie in 2024.

Lurie’s administration marked the beginning of the end of harm reduction culture. His Breaking the Cycle plan, unveiled in March 2025, eroded what was once a stronghold: City-funded nonprofit organizations giving drug supplies to drug addicts in the places where they congregate. Now such items can only be provided at sanctioned brick-and-mortar sites and must be paired with information about counseling and recovery.

The suffering carries on, though. Between 2020 and 2025 alone, 4,090 people died of accidental drug overdoses in San Francisco. Nearly one in four of those deaths occurred inside the city’s network of approximately 9,000 “Permanent Supportive Housing” units, nearly all of which are drug-tolerant buildings. The deadly fentanyl scourge continues to rage. Dealers keep flooding the city, as even when arrested they face little to no repercussions.

The hellish drama playing out in full view has its roots in the harm-reduction movement. Its adherents believe that criminalizing public drug activity is wrong.

Although evidence of such severe negative outcomes hasn’t swayed the most ardent harm-reduction promoters, they know it’s under attack. Financial support has dried up, and proponents no longer have a guaranteed seat at the table. 

In 2025 the Trump administration issued “Ending Crime and Disorder on America’s Streets,” an executive order that directed Health and Human Services agencies to stop funding harm reduction and safe-consumption efforts. The Substance Abuse and Mental Health Services Administration (SAMHSA) followed, barring federal grant funds from going toward syringes for illicit drug injection, pipes, and safer-smoking kits.

On July 29, Mayor Lurie signed Supervisor Matt Dorsey’s legislation to ensure drug-free housing units are available. Groups like the Coalition on Homelessness fought the ordinance, but could only whimper when it passed.

This doesn’t mean the activists will go extinct. Instead, they will simply switch to another radical, yet more welcoming environment — perhaps LA.

My prediction is that most will redirect their frenetic energy into the latest trend: socialism. The majority are already on the hard left anyway, so the fit is natural.

Expect less rhetoric about “loving drug users” and waning passion for distributing baggies of foil and pipes, and more fervent participation in organizations like the Democratic Socialists of America (DSA).

Socialism, too, seems like a hard habit to break.

Erica Sandberg is an independent journalist covering personal finance and current affairs.