In September, San Francisco Supervisor Matt Dorsey introduced his “Recovery First Drug Policy” that states “The cessation of illicit drug use and attainment of long-term Recovery from Substance Use Disorders shall be the primary objective of the City’s drug policy.” The policy allows for other steps, including harm reduction, as part of a comprehensive approach to achieve this goal.
The policy is opposed by the Drug Policy Alliance. Here is Supervisor Dorsey’s defense of the ordinance against the Drug Policy Alliance.
I see this approach as mirroring the goal of a smoke-free society, which transformed tobacco control.
The Board of Supervisors is the legislative body for the City and County of San Francisco. They are hearing the proposal this week, on Thursday April 24 at 10:00am in the Board’s chambers at San Francisco City Hall. It is the second item on the agenda.
Here is my letter to the Board of Supervisors supporting the ordinance:
emailed to: Board.of.Supervisors@sfgov.org cc Matt.Dorsey@sfgov.org.
Re: Administrative Code – “Recovery First Drug Policy,” File No. 250190 — SUPPORT
I am a retired UCSF professor of medicine and founding director of the UCSF Center for Tobacco Control Research and Education where, among other things, I conducted research on the health effects of secondhand tobacco smoke and tobacco control policies including smoke-free policies. I have testified for every tobacco control Laws introduced at the Board of Supervisors since the 1980s and assisted in the implementation of some of those laws. I served as treasurer for the 1983 Proposition P campaign, which successfully dedended San Francisco’s new workplace smoking law against a referendum by the tobacco industry, handing the industry its first electoral defeat.
The original meaning of “smoke-free” was “free from secondhand tobacco smoke.” We were not urging smokers to quit smoking, viewing that is a matter for their personal choice; all we wanted was for them to exercise that choice in a way which did not hurt bystanders who chose not to smoke. We now know in hindsight that by creating smoke-free environments, we fundamentally change the social norms around smoking in a way to create an environment that supported smokers in their decisions to stop smoking and undermined decades of tobacco industry efforts to create a social support system which made smoking the norm.
In particular, we now know that the creation of smoke-free environments (including workplaces and homes) help smokers quit by…
- Encouraging and facilitating quit attempts
- Longer duration of quit attempts
- Greater use of smoking cessation medications and increase medication effectiveness
- Reduced cigarette consumption
The combined effect of these factors is increased number of smokers who were freed themselves from nicotine addiction.[1]
In addition, smoke-free environments are associated with less smoking initiation by young people.
Over time, as a result of these changes, the definition of “smoke-free” came to apply to individual smokers, meaning “free from giving money to the tobacco industry,” i.e., no longer smoking or using other tobacco products.
While I am not an expert on illicit drug use and its treatment, this experience with tobacco suggests a comparable change in the way we think about illicit drug use leads me to support the “Recovery First Drug Policy” because it clearly establishes freedom from giving money to the organizations that sell drugs as the desired norm. It also could lead to the encouragement of facilities, including housing, for people who are committed to becoming drug-free. Providing drug-free environments for these people would likely facilitate their efforts to become drug-free by removing visual and behavioral cues created by other people using drugs.
While the proposed legislation still allows for intermediate steps, particularly harm reduction efforts operated independently of organizations that sell drugs, clearly stating that the long-term goal is a drug-free society would reflect what we have learned in the progress against tobacco.
Thank you for your consideration.
[1] An excellent summary of the research supporting these conclusions can be found in the following publication: Office on Smoking and Health (US). The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2006; pages 609-628. Available from: https://www.ncbi.nlm.nih.gov/books/NBK44324/
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