San Francisco, CA - Mayor London N. Breed today will sign onto the ballot her measure that would allow the City to require single adults with substance use disorder to participate in treatment in order to continue receiving financial support from the City and County of San Francisco. Under the new initiative that was announced last month by the Mayor, single adults who receive benefits from the County Adult Assistance Programs (CAAP) would undergo screening for substance use disorder and participate in a substance use disorder treatment program when the screening reveals that they have a substance abuse dependency on illegal drugs, such as Fentanyl and other opioids.
The ballot measure is scheduled to appear on the March 2024 ballot. It would require a simple majority to pass.
“This ballot measure will allow San Franciscans to add another tool to our efforts to address the drug use that is creating serious public safety hazards and fueling an overdose crisis on our streets,” said Mayor London Breed. “We want to help people, but we also need people to be trying to enter into the various treatment and services options we offer in this City. We will continue to fund a wide range of services to help people struggling with substance use disorder, but we also need to add accountability as part of the equation.”
Under the new proposal, as a condition of maintaining their CAAP benefit, recipients suspected of a substance use disorder (SUD) would be required to participate in a substance abuse assessment and treatment program, if SUD dependency on illegal drugs is confirmed. Funded by the San Francisco Human Services Agency (SFHSA), these treatment programs would include a range of interventions from residential treatment, medical detox, medically assisted treatment, outpatient options, and abstinence-based treatment, among others depending on the needs of the client.
Individuals who refuse or do not engage in the SUD assessment and treatment would no longer receive CAAP cash assistance. Those who are discontinued from CAAP cash assistance for not complying with the treatment mandate will receive housing assistance for 30 days. Individuals may be considered for an extension of housing assistance if necessary to prevent eviction.
“We must do all that we can do to ensure that substance use disorder treatment is accepted more often than it is declined. As policymakers, our challenge is to strike a balance between compassion and accountability,” said Supervisor Catherine Stefani. “This proposal is a strong response to the opioid crisis – which is taking more lives per month than ever in 2023. San Francisco must be a city where individuals do not face addiction alone but can actively seek sobriety and rebuild their lives.”
“In recent years, San Francisco has earned a reputation as a destination for people who use the most toxic drugs to come, and eventually die,” said Supervisor Rafael Mandelman. “I support this effort to make San Francisco the City where people are able to get sober and build a better life.”
“We’re facing down the deadliest street drug in history, and the more we can do to incentivize recovery from substance-use disorders related to fentanyl, the more lives we can help save,” said Supervisor Matt Dorsey. “Mayor Breed’s proposal draws on a key principle from the National Institute on Drug Abuse that drug treatment doesn’t need to be voluntary to be effective. To the contrary, sanctions and incentives ‘can significantly increase treatment entry, retention rates, and the ultimate success of drug treatment interventions.’”
According to the SFHSA, from 2018 to 2020, approximately 20% of CAAP recipients self-disclosed in an initial interview with SFHSA staff that they have a disabling substance abuse issue. The incidence of substance use disorder among CAAP recipients who are experiencing homelessness is likely higher than the CAAP population as a whole.
In 2022, the San Francisco Homeless Count and Survey released by the Department of Homelessness and Supportive Housing (HSH) found that 52% of individuals experiencing homelessness reported their drug or alcohol use as a disabling health condition, representing a 10% increase from 2019. In its Accidental Drug Overdose Reports for 2020 through 2022, the Office of the Chief Medical Examiner has determined that at least 25% of drug overdose decedents have no fixed address.
SFHSA estimates that among the 700 accidental overdose deaths that occurred in San Francisco between September 1, 2022 and August 31, 2023, about 94 individuals – or 13% of the total deaths—were recent CAAP participants and 9%, or 62 individuals, were participating in CAAP in the month of their death. Of those CAAP participants who died of an overdose during this time period, 82% had Fentanyl as a primary cause of death, and 89% had any opioid as a primary cause.
"In my almost three decades of working in the human services field in San Francisco, I have not seen the drug crisis as dire as it is today,” said Trent Rhorer, SFHSA Executive Director. “Our goal with this initiative is to reduce drug-related addiction and overdose deaths amongst those who come to our Agency for help. We want to look at all potential solutions and do everything we can to support clients who have substance use disorders by motivating them to get the help they desperately need, which we hope will lead to them addressing their substance use and achieving stability and well-being in their lives.”
California state law requires all 58 counties to provide aid and support in the form of cash and other services to very low-income adults without dependents through locally funded "General Assistance" Programs. In San Francisco, the state mandated General Assistance is implemented through SFHSA's County Adult Assistance Programs.
The initiative is part of Mayor Breed’s commitment to prioritizing treatment, offering support to people with substance use disorder in crisis, and holding them accountable when they refuse help.
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