San Francisco’s District 6 Supervisor Matt Dorsey’s ‘recovery first’ ordinance has garnered momentum, advancing to the full 11-member Board of Supervisors after a 3-0 vote by the Public Safety and Neighborhood Services Committee.
However, the ordinance, which serves as an aspirational policy outlining the city’s approach to drug-addiction recovery, faced significant changes before its advancement. The original focus on an ‘abstinence-first’ model has been amended to emphasize ‘long-term remission’, following concerns voiced by harm-reduction advocates.
Advocacy groups criticized Dorsey’s earlier definition of recovery as too narrow, prompting the San Francisco Marin Medical Society, an association representing over 3,000 medical professionals, to recommend the change. Adam Francis, the organization’s senior advocacy and policy director, emphasized that this amendment mitigates conflicts between harm reduction and abstinence models.
San Francisco has been embroiled in an ongoing discussion regarding the most effective strategies to combat the rise in drug overdoses. Harm reduction prioritizes safer drug use and aims to protect individuals from overdose risks and infections by implementing initiatives like safe-consumption sites and needle exchanges. Proponents argue that this method meets people where they currently are in their addiction journey, recognizing that recovery can involve relapses.
In contrast, the ‘abstinence-first’ advocates maintain that their approach, which centers on total substance cessation, can prevent a slippery slope into further use. Critics of harm reduction contend that such policies have contributed to a culture of permissiveness surrounding open drug use in San Francisco.
Most medical experts agree that both methods have merits and play crucial roles in addressing substance reliance.
Dorsey’s ordinance sets a directional policy for city contractors and future legislation on drug recovery while signaling the city’s intended tone towards recovery efforts. However, it remains largely symbolic, lacking immediate enforcement mechanisms.
The newly amended ordinance characterizes any program identified by participants as contributing to their efforts in achieving long-term remission as aiding ‘recovery’. This encompasses outpatient and residential substance-use treatment, medication-assisted therapies provided by licensed healthcare professionals, and programs offering financial incentives to individuals working to reduce or cease drug use.
Despite Dorsey’s emphasis on encouraging a recovery-focused mindset, he acknowledges a growing frustration among San Franciscans regarding the harm-reduction model. Dorsey stated, “We are losing the hearts and minds of San Franciscans.” Medical professionals caution that an overt shift towards an abstinence-only framework could have fatal consequences.
Recent statistics indicate that after a decline in drug overdose deaths for 14 months, fatalities are on the rise once again. The Office of the Chief Medical Examiner recorded 65 accidental overdose deaths in March 2025 alone, marking four consecutive months of increases. The average number of overdose deaths in 2024 had been reported as 53.
Amidst these alarming figures, Mayor Daniel Lurie has initiated efforts to retract some of the harm-reduction policies. This includes halting city-funded nonprofits from distributing smoking supplies unless they also provide counseling or connect users to supportive services. Advocates warn that such changes may lead to individuals who smoke fentanyl switching to injection, which could increase overdose occurrences and infections.
Dorsey, a former alcoholic and meth addict, firmly aligns with the abstinence-first philosophy, often citing his own need for tough love during recovery. Nonetheless, he has acknowledged the importance of diverse recovery methods. “To the contrary,” Dorsey remarked, “we must include all approaches to accommodate a multitude of pathways taken by those of us who face problems with addiction.”
At the committee hearing, which drew an audience of around 71 attendees, public comments reflected various recovery experiences. One individual described Dorsey’s ordinance as ‘common-sense legislation’ that could deter illicit drug use; he reflected on his own struggles, stating, “I’m grateful that the page is finally turning in the city, and we’re going to start having accountability and recovery first.” Many supporters cheered, holding signs that expressed their stance with slogans like ‘Drug enablism kills.’
Harm-reduction advocates voiced cautious optimism regarding the amendments. Laura Thomas, of the San Francisco AIDS Foundation, expressed appreciation, noting, “The pathway to recovery can start in any number of places.” Laura Guzman, leading the National Harm Reduction Coalition, also called for overdose prevention and intervention measures to be incorporated into the ordinance as it progresses to the full board.
Support for Dorsey’s ordinance within the committee came as no surprise, as both Supervisors Danny Sauter and Bilal Mahmood are co-sponsors. Given the support, the ordinance is expected to pass smoothly at the full board meeting, scheduled for May 6, where it will need just six votes to be enacted, with seven co-sponsors already in place.
image source from：https://missionlocal.org/2025/04/sf-recovery-drug-law-harm-reduction-matt-dorsey/
