SAN FRANCISCO, CA – At a San Francisco Board of Supervisors hearing held earlier this week, the San Francisco Police Department (SFPD) acknowledged that displacement is a deliberate component of its current drug enforcement strategy, even as community leaders, public health experts, and city officials questioned its effectiveness and urged a more holistic approach.
The hearing, convened by District 9 Supervisor Jackie Fielder and co-sponsored by Supervisors Matt Dorsey, Shamann Walton, Connie Chan, and Joel Engardio Mahmood, focused on the City’s partial implementation of the “Four Pillars Strategy,” a model that transformed Zurich’s response to public drug use and overdose deaths in the 1990s. The Four Pillars framework integrates prevention, treatment, harm reduction, and enforcement.
SFPD Commander Derrick Lew, representing the Department’s Drug Market Agency Coordination Center (DMACC), confirmed during testimony that displacement of people who use drugs is an expected and accepted result of their enforcement efforts. “It’s a known symptom,” Lew said, referencing DMACC operations that relocate drug activity from one neighborhood to another—most recently into the Mission District, which logged over 900 9-1-1 calls in March, the highest number in a decade.
Supervisor Fielder pressed Lew on whether arresting and releasing individuals without connecting them to care is an effective use of resources. Lew responded affirmatively, stating, “I do.” When asked about strategies to mitigate displacement, Lew offered no clear solutions.
The Budget and Legislative Analyst’s Office (BLA), which recently collaborated with Zurich city officials to evaluate the transferability of the Four Pillars to San Francisco, concluded that the model is applicable and potentially transformative. Fred Brousseau, Policy Analysis Director with the BLA, noted that Zurich’s success hinged on a coordinated effort: “Arresting people wasn’t solving the problem… their approach is to threaten people with arrest if they’re using in public but to point out and direct people to the safe consumption sites.” He added that strong public support in Zurich was critical to adoption of the strategy.
Despite some elements of the Four Pillars model being in place in San Francisco, the hearing revealed that no city department could point to unified metrics for measuring success—such as treatment completion rates, reductions in overdoses, or call volumes to emergency services. Several agencies referenced “unprecedented” interdepartmental collaboration, but without clear benchmarks, oversight and accountability remain limited.
In contrast to Zurich, where enforcement is matched with robust harm reduction and treatment infrastructure, San Francisco’s approach may be undermining its own goals. UCSF addiction specialists Dr. Dan Ciccarone and Dr. Leslie Appa testified that building trust with people who use drugs is essential to connecting them with treatment. Aggressive enforcement, they warned, can destabilize lives and reduce opportunities for engagement.
Supervisor Fielder echoed this concern: “We conduct sweeps, we disrupt, but that also means that we’re destabilizing people… We are reducing that amount of trust, those opportunities to have someone be that lifeline. As our doctors were talking about, trust is so critical to getting people into treatment, and very much keeping them alive.”
Zurich, by comparison, implemented safe consumption sites as a cornerstone of their strategy. These centers serve as entry points for comprehensive services, including Medication Assisted Treatment (MAT). Today, approximately 75% of Zurich site users are enrolled in MAT—three times the rate seen in San Francisco, according to testimony.
Public Defender Alexandra Pray also highlighted systemic issues in relying on incarceration as a path to treatment. “Clients are released sometimes before they can access treatment,” she testified. “There are all sorts of legal barriers that don’t make it practical to expect that somebody who is arrested for drug use will be connected to treatment and services as a result of that arrest… instead, it just increases the jail population.”
Supervisor Fielder concluded the hearing by reaffirming her commitment to reform. “Since assuming office, we’ve met with small businesses, community-based organizations, constituents, and many others in District 9 who want to see a cessation of fatal drug overdoses and of public drug use,” she said. “This is about saving lives. Neither displacement nor dispersal is a strategy. This is responding to the reality on our streets and about restoring dignity. My constituents are demanding an end to the chaos, and I stand with them.”
She expressed her intent to work with the Mayor, fellow Supervisors, and city departments to implement a full and effective Four Pillars strategy to address the ongoing fentanyl and overdose crisis.
