Mayor Lurie Ends Distribution of Fentanyl Smoking Supplies Without Counseling and Treatment

SAN FRANCISCO – Mayor Daniel Lurie today announced a major policy shift in San Francisco’s response to the fentanyl crisis, focused on getting people off the streets and quickly into treatment and care. Under new guidelines issued by Department of Public Health (DPH) Director Dan Tsai, individuals must now receive treatment counseling or be connected to services to receive safer drug use supplies. 

“We can no longer accept the reality of two people dying a day from overdose. The status quo has failed to ensure the health and safety of our entire community, as well as those in the throes of addiction. Fentanyl has changed the game, and we’ve been relying on strategies that preceded this new drug epidemic, which ends today,” said Mayor Daniel Lurie. “Our new policy will connect individuals to treatment quickly, and that is a big step toward reclaiming our public spaces. I thank Director Dan Tsai for meeting the moment with this evidence-based approach.”

This policy goes into effect April 30 and applies to all city-funded public health programs distributing drug use supplies, including sterile syringes and smoking kits. The new approach mandates that any distribution of supplies be paired with proactive treatment counseling and connections to care, requiring distribution programs to provide treatment referrals and on-site engagement to enable entry into services. The policy also prohibits the distribution of smoking supplies in public spaces.

“As public health, we are responsible for the health of the individual on the street and the health of the community impacted by this crisis. We are implementing strategic changes to build a more responsive system of care that moves people from the streets into effective treatment and sustained recovery,” said Department of Public Health Director Dan Tsai. “We are committed to proven, evidence-based health interventions and safer use supplies are most effective when paired with counseling, healthcare, and access to treatment and recovery services to create meaningful change for an individual.”

As part of this policy pivot, DPH will closely monitor overdose rates, HIV/Hepatitis C transmission to ensure this policy aligns with overall public health goals. This shift is part of broader DPH roadmap for tackling the fentanyl epidemic, which includes expanding treatment beds and services, more quickly connecting individuals to stabilization and treatment services, reducing barriers that prevent people from progressing in treatment, and rapid connections to medications for opioid use disorder (MOUD) including buprenorphine and methadone. 

“Connecting the distribution of safer use supplies to counseling and treatment is not a retreat from compassion—it’s an embrace of what actually helps people recover,” said Keith Humphreys, Professor of Psychiatry at Stanford University. “We know from decades of research and experience that addiction is rarely overcome without more proactive, assertive attempts to connect people to treatment and supports. This policy gives San Francisco a stronger hand in saving lives by ensuring that every encounter is also an opportunity to guide someone toward care and recovery.”

As part of this policy pivot, DPH will closely monitor overdose rates, HIV/Hepatitis C transmission to ensure this policy aligns with overall public health goals. This shift is part of broader DPH roadmap for tackling the fentanyl epidemic, which includes expanding treatment beds and services, more quickly connecting individuals to stabilization and treatment services, reducing barriers that prevent people from progressing in treatment and rapid connections to medications for opioid use disorder (MOUD) including buprenorphine and methadone. 

The new DPH policy follows Mayor Lurie’s “Breaking the Cycle” executive directive, which laid out his vision for tackling San Francisco’s homelessness and behavioral health crisis. That executive directive listed both immediate and long-term reforms needed to fundamentally transform the City’s health and homelessness response with a focus on coordination, accountability, and outcomes. 

One of the 100-day actions included a directive to reassess policies for distribution of fentanyl smoking supplies and re-focus on access to longstanding evidence-based public health interventions alongside strategies to connect individuals to treatment and recovery.

Today’s policy announcement delivers on that goal.  Key elements of DPH’s new policy include: 

• Beginning April 30, individuals must engage with counseling that encourages and connects them to treatment options in order toreceive any safer use supplies from any city staff or DPH-funded contractor or subcontractor.
• In addition to the treatment counseling requirement, all city-funded programs can no longer distribute smoking supplies outdoors in public spaces.
• DPH-funded programs that currently distribute smoking supplies in public spaces must shift to doing indoors or DPH-approved controlled spaces.
• DPH will be working with partners to transition the majority of distribution programs indoors or away from public spaces by April 30, and all programs by May 30.

This policy is one of many tools the City is now using to address the fentanyl crisis, which also include increased enforcement, building more interim housing and treatment beds, and reforming street outreach teams into a more accountable and neighborhood-based model. The new unified street teams launched last week, with the Department of Emergency Management and San Francisco Police Department co-leading the new neighborhood-based operational model that coordinates law enforcement and services across multiple partner agencies to get people off the streets.

The new policy also marks a significant shift in the City’s public health approach—grounded in evidence, focused on outcomes, and aligned with Mayor Lurie’s broader commitment to connect more individuals to treatment, consider the wellbeing of the entire community, and restore public trust in the City’s response.

It builds on work the Lurie administration has been doing since day one to get people off the street and connected to the services they need. After announcing the Fentanyl State of Emergency Ordinance on his first day in office, Mayor Lurie partnered with the Board of Supervisors to pass it 10-1 and then signed it into law, unlocking critical tools to treat this crisis as the emergency it is. He also announced plans for a 24/7 police-friendly stabilization center that will open at 822 Geary Street this spring on an expedited timeline thanks to the ordinance.