This story aired in the June 25, 2026 episode of Crosscurrents.
For more than 25 years, the City of San Francisco has used an approach called “harm reduction” to help people struggling with substance abuse. It’s common in California. The key tenet of harm reduction is: meet people where they’re at, so that they can manage their substance use and stay alive. That can involve giving people clean supplies to consume drugs.
But the harm reduction approach is at the heart of a conflict. On the one side are some San Francisco elected officials, business owners, and residents who associate it with open air drug use and crime. On the other side are nonprofit organizations that say harm reduction services save lives.
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Story Transcript:
REPORTER: It’s a beautiful, sunny spring day in San Francisco. Just south of Market Street, below the I-80 overpass, lies a converted former warehouse. A number of people have gathered along the sidewalks. They chat, eat, or dig around their belongings. Some guard the recycling they’ve collected. Others smoke from glass pipes or cigarettes.
Most of the buildings on this street are behind locked chainlink fences; the barbed-wire on top deters unwanted visitors. But at one place – the Harm Reduction Therapy Center, the doors are wide open for clients,
DANGER: This place is one of San Francisco’s gems.
REPORTER: I meet a man outside who tells me his name is Danger
DANGER: These guys, even if you're not fit to have an appointment, 'cause you got too much crystal in your body, the counselors will sit down with you. And um, in general, I think it's one of San Francisco's most healing, pragmatic things.
REPORTER: At the front door of the center, a staff member serves as gatekeeper.
Maurice Byrd, who is the Clinical Training Director here, takes me on a tour past the kitchen, art and music stations, and ping pong tables.
MAURICE BYRD: We really want people to just be able to float through here freely, um, kind of make their choices of what they want to do.
REPORTER: At the center of the warehouse are comfortable-looking brown leather couches, where people are talking or playing games.
BYRD: So some people are just kind of just hanging out. I see one of our counselors here talking with someone, and we have, um, a bunch of therapists on the floor. I can count 1, 2, 3, 4 of us on the floor right now. So what I think is really cool is that people get to come in, talk to a therapist immediately, if they want to.
REPORTER: The Harm Reduction Therapy Center–or HRTC–has almost 20 people that work here or at the mobile units they have in Bayview and the Mission. They provide therapy and other resources to people dealing with drug use, homelessness, or mental health issues. And, as the name of the organization indicates, they use a harm reduction approach.
Maurice says the idea of harm reduction is just common sense.
BYRD: We all are always practicing harm reduction. We're doing things in our life to reduce harm. Um, we brush our teeth, we wear shoes so our feet are not tore up.
REPORTER: Back in September 2000, San Francisco’s Public Health Department became one of the first in the nation to officially adopt a harm reduction approach.
BYRD: From a treatment perspective, it's really about helping people manage their disorders. Which means they could be in a full on substance use disorder or maybe experimenting with drugs, or they could be thinking about quitting drugs, moderating those drugs, using them safer.
REPORTER Harm reduction strategies focus on keeping people safe and healthy "where they're at." They don’t require abstinence in order to get support. And they involve things like syringe exchanges, overdose prevention kits, and safer use supplies like glass pipes.
BYRD: You know, it's really dedicated to this idea of keeping people healthy as possible, safe as possible, and alive.
REPORTER: Some folks hanging out in front of HRTC say they really feel this from the center.
DeMARIO ROBINSON: Um, it's a great, great place. Uh, find peace of mind again, I kind of re…re…recover, um reground and everything.
REPORTER: That’s Demario, who came to San Francisco from Santa Rosa. Zia, who also goes to HRTC, says it helps her build relationships with others trying to get clean.
ZIA: It's a…a fellowship. I…I talk to my friends, you know, who are in the community
REPORTER: Sitting next to Zia is Robin. She is a proud mother and hopes to see her son again one day soon.
ROBIN THOMPSON: I've been coming here for the last, I don't know, seven, eight years? And if, if it wasn't for this place, I probably would be locked up
REPORTER I see that man we met before, Danger, heading down the street.
REPORTER: What do you like to do when you get to the center?
DANGER: Steal lots of lollipops, get coffee and oatmeal. But in general, on Mondays I have a therapist and for me, I've never had therapy my whole life. I've only been homeless for like three years. And now when I'm finally getting it, I'm gonna get outta homelessness. And when I do, I'm likely not gonna go back into it.
REPORTER: Lollipops, clean needles, therapists–the staff at HRTC tell me each one of those provide what’s called a “point-of-contact” - a way for providers to interact with people needing services. Jason Brown, a licensed social worker with HRTC, tells me that lots of points of contact lead to trust.
JASON BROWN: So being able to offer on-demand therapy–on-demand treatment–has been a really useful part of what HRTC does at our mobile sites.
REPORTER: Mobile sites are vans with supplies and therapists. Jason runs the units for HRTC in Bayview and the Mission.
BROWN: That's where the process of change actually happens.
REPORTER: He also says the act of providing clean supplies - which is sometimes controversial - can do three things: prevent overdose deaths, reduce the spread of infectious disease, and act as a bridge to long-term treatment.
BROWN: So giving somebody supplies to help them not overdose speaks to: I want you to live long enough to be able to think about what you're doing.
REPORTER: Harm reduction always had its detractors. Critics didn’t believe it could be useful as a gateway to recovery.
But Zia tells me: when COVID hit, the debate went on the back burner, at least in San Francisco.
ZIA: I remember when Mayor Breed was, London Breed was here, and they had the whole, um, you know, on, uh, Market Street, like the, the, they had like the, um, it was almost like a drug legalization, you know?
REPORTER: After the COVID pandemic, however, the number of fentanyl overdose deaths kept rising. In 2023, the City lost more than 800 people to overdose deaths, up from 649 the year before. These deaths became a lightning rod throughout the nation. In my conversation with Zia, she remembers that national news outlets cast San Francisco as the City of permissiveness and excess.
ZIA: You know, you could come and do your drugs out in the open on Market Street, you know.
REPORTER: In 2024, voters opted for a change in leadership. Mayor Daniel Lurie launched a program called Breaking the Cycle, which amended the city’s harm reduction policy after a quarter century. And after one year in office, he touted the changes as a success in his State of the City address in January 2026.
DANIEL LURIE: We stopped freely handing out drug supplies and letting people kill themselves on our streets. It is not a basic right to use drugs openly in front of our kids. We made San Francisco a recovery-first city and launched Breaking the Cycle to bring together health services, social services, law enforcement, and emergency responders.
REPORTER: With Breaking the Cycle, Mayor Lurie wasn’t outright rejecting harm reduction. But he was telling addicts and agencies things had to change. The new policy still allows nonprofits that receive funding from the City to distribute syringes on the streets to prevent the transmission of diseases.
But the agencies cannot hand out clean smoking supplies from mobile units anymore. They can only provide clean glassware, straws, and foils indoors, or at “City-approved” controlled spaces known as Supervised Injection Facilities. And all supplies–both syringes and for smoking–must be paired with immediate referrals to treatment, and connections to additional care.
Jason Brown tells me that in practice, the Lurie policy change deters clients from engaging with staff. It interferes with the trust building process by diminishing the points-of-contact.
BROWN: And it can turn somebody off in their moment of motivation to try to engage or get more information or learn what their options are, and to feel like they've hit an immediate barrier or too many intrusive questions when really what they're wanting is information and to know what they could do next. And so every kind of piece of the process that gets added to trying to get help slows it down. It shifts away from that moment of motivation when now you've got to make somewhere else. You've gotta get somewhere else. You've gotta, you're on hold for 10 minutes. That’s all it takes to see something else and move on to something else.
REPORTER: The SF Department of Public Health declined my request for an interview, but they did send an email saying that the city has recorded 26% fewer fatal overdoses in the first quarter of 2026 compared to the same period last year. And that the Department of Public Health hasn’t seen a shift to more syringe use because of the policy change.
But what changes have people on the streets noticed? When I was talking to Robin, she told me about a greater police presence and a lot of hassle.
THOMPSON: But there's always like, cops are always bugging around and bothering people. There's a lot of 'em standing around out here for nothing.
REPORTER: When I leave The Center in the afternoon, I’m disappointed to see no one left on the sidewalk. But I do see the SFPD and the Department of Public Works conducting a “sweep.”
A sweep is when folks are asked to clear the sidewalk, and anything they can’t take with them is put on the Department of Public Works truck for disposal.
Then the sidewalks are doused in a pungent chemical that smells like an ammonia-drenched fruit bowl. The power washers come next.
REPORTER: On the sidewalk just outside HRTC, I run into Anna Berg, the Clinical Program Director.
ANNA BERG: I think what happens a lot for us as an agency is folks are connecting with us and engaging with us or meeting with a particular treatment provider here and a lot of uniforms and a lot of uh, uh, uh, you know, trucks and cars and police vehicles or other city vehicles here actually discourage some folks from wanting to come and connect.
REPORTER: She remains hopeful, though.
BERG: We'll see most everybody who was here again tomorrow.
REPORTER: And like today, the doors will be open to those clients who come back for coffee, maybe some therapy, perhaps a lollipop, and definitely a break from the streets.
You can find more information about this by visiting www.harmreductiontherapy.org
