S.F. plan needs more than police
For almost a decade, my younger sister has faced opioid addiction, and for nearly as long, I’ve tortured myself with the illusion of control. If only I said the exact right words or found the perfect treatment option, I thought, then she would be safe.
Power is what I craved.
I wanted her addiction to be within my control, subject to my shortcomings, because maybe then I could work hard enough to make it stop.
“I hate this,” she sobbed to me one day over the phone after her landlord issued an eviction notice and called the police. “I want my life to be different.”
I booked a flight for the next day from California to Colorado to see her, sure I could leverage the crisis for lasting change.
But once I arrived, my sister’s phone went straight to voicemail. I knocked and knocked, and no one answered her door. On day three, I left a bouquet of grocery store flowers on the front seat of her car, its windows down despite the falling snow.
Each time my interventions didn’t go as planned, we both suffered. I felt like I’d failed; she felt she’d let me down. It wasn’t until I accepted the limits of my control, until I was honest about my own needs alongside hers, that my efforts became effective and sustainable.
Last month, San Francisco Mayor London Breed declared a state of emergency regarding drug use and crime in the Tenderloin, naming these issues as her top priorities.
While I am glad to see broader attention and resources devoted to the Tenderloin, my caution is against reinforcing the age-old savior narrative. In light of my family’s experience and as a volunteer with syringe access and overdose prevention programs in San Francisco, I know how counterproductive this frame can be. This myth of control over people who use drugs harkens back to stubborn, paternalistic ideas of codependence, enablement and tough love.
Early into my experience with my sister, a therapist recommended a book published in the early 2000s on a well-regarded approach, Community Reinforcement and Family Training. The book was called “Get Your Loved One Sober.” Although it contained helpful insights, I was offended by the title’s dismissal of my sister’s agency and its implication that the onus of her recovery was on me.
Nonetheless, it took me years to untangle myself from this way of thinking.
The savior frame leaves out the staggering scale of support needed to assist people who use drugs.
As a volunteer with the Drug Overdose Prevention and Education Project, San Francisco’ biggest naloxone distribution program, I have participated in the effort to train and equip community members to reverse overdoses. In 2021 alone, the use of naloxone — largely within this grassroots network — accounted for the reversal of over 6,000 overdoses in San Francisco. If you consider the tragic number of lives lost to accidental overdose in the city, 711 in 2020 and 592 in 2021, the effectiveness of this work speaks for itself.
In November 2020, I traveled from San Francisco to Phoenix to support my sister. After years of relative stability on medication-assisted therapy, she had lost her job in the COVID-19 shutdowns, reconnected with an exboyfriend and moved from our native Colorado to Arizona. Without income, housing or existing support in the area, her drug use increased. By the time I flew out to meet her, she was living alone in a motel and using fentanyl every day.
By this point, however, my sister was motivated to get help. She did the legwork to gather and print the materials needed to board a plane without her ID and messaged a friend for intel on detox facilities back in Denver. She stuck it out through lengthy waits in multiple intake rooms as dope sickness and fear of the unknown set in.
We hit obstacles along a frustrating path. There was no clear entry point or information center for accessing systemic help.
We tried the emergency room first, but unlike coming off alcohol or benzodiazepines, opiate withdrawal is not life-threatening, so the wellmeaning staff turned us away. Many of the treatment programs we called had months-long waiting lists. We learned that public health insurance does not cover in-patient drug treatment in many states, including Colorado.
What happens if someone doesn’t have a place to stay while they wait for a bed in a treatment center? What if, even though you intend to stop using, it’s far easier to get and use the substances your body is dependent on than it is to access genuine support?
If the exclusive outcome of the fentanyl crisis is a heightened police presence in the Tenderloin, we are missing the point. San Francisco needs safe consumption sites with medical supervision and clear onramps to treatment. The city needs more permanent supportive housing — and case managers, health educators and other frontline staff need better pay.
My job is not and has never been to save my sister. My job is to be honest, to act in integrity with my values, to believe in her, trust her, love her.
Our job as a city is not to pluck people out of the proverbial dark basement one by one; it is to recognize our shared responsibility to renovate our whole house — to make it bright, integrated and livable for all.