The Morning: San Francisco’s “pro-drug culture”

Plus, Donald Trump's legal bills, the West Bank and Truman Capote.

View in browser|nytimes.com Continue reading the main story January 31, 2024 By German Lopez Good morning. We're covering San Francisco's addiction crisis — plus Donald Trump's legal bills, the West Bank and Truman Capote. Needle exchange in San Francisco. Aaron Wojack for The New York Times Cultural shift For some San Franciscans, a drug crisis is just part of city living. They see people shooting up in front of their homes and businesses. They often find someone dozing on a sidewalk, high. Sometimes, they check for a pulse. "That's how I found my first dead body," said Adam Mesnick, owner of a local deli. But the city's drug crisis is relatively new. In 2018, San Francisco's overdose death rate roughly matched the national average. Last year, its death rate was more than double the national level. Source: CDC WONDER | Chart shows 12-month rolling averages. Death rates for 2023 are provisional. | By The New York Times I recently spent time in San Francisco to understand what is going on. In today's newsletter, I want to explain one of the factors that has contributed to the city's crisis: culture. Culture can sound like an abstract concept, but it matters for drug policy. Consider smoking. In 1965, more than 42 percent of American adults smoked cigarettes. In 2021, less than 12 percent did. The country did not criminalize tobacco. And while policy changes like higher taxes played a role, much of the drop happened through a sustained public health campaign that led most Americans to reject smoking. In San Francisco and other liberal cities, the opposite shift has happened with hard drug use. The culture has become more tolerant of people using drugs. When I asked people living on the streets why they are in San Francisco, the most common response was that they knew they could avoid the legal and social penalties that often follow addiction. Some came from as close as Oakland, believing that San Francisco was more permissive. As Keith Humphreys, a drug policy expert at Stanford University, told me, San Francisco "is on the extreme of a pro-drug culture." Destigmatizing drug use San Francisco's change is rooted in a broader effort to destigmatize addiction. Some experts and activists have argued that a less punitive and judgmental approach to drug use would help users get treatment — a "love the sinner, hate the sin" attitude. Over time, though, these efforts in liberal cities have expanded from users to drug use itself. Activists in San Francisco now refer to "body autonomy" — arguing that people have the right to put whatever they choose into their veins and lungs. They no longer want to hate the sin. They say it's no one's business but the drug user's. One example of this shift: In early 2020, an advocacy group put up a billboard downtown to promote the use of naloxone, an overdose antidote. It showed happy young people seeming to enjoy a high together. "Know overdose," the billboard said. "Use with people and take turns." Here, drug use wasn't dangerous as long as users had someone to check on them while high. The shift is also present in drug-related service providers in San Francisco. Michael Discepola, director of health access at the program GLIDE, said that his organization wants people to use drugs more safely. Abstinence is not always the correct goal, he argued. When one client declared that he wanted to quit drugs, Discepola explained, GLIDE suggested "more realistic goals." Stigma without criminalization Other countries' experiences show it is possible to relax drug laws, as many liberals want to do, without relaxing attitudes. In 2000, Portugal removed the threat of prison time for drug use. But it's still a predominantly Catholic, socially conservative country that largely looks down on the practice. Portugal's system reflects those attitudes by pushing people to stop using drugs. Even its harm-reduction programs, which aim to keep people alive over getting them to quit drugs, work with the country's treatment system to help people stop using. In San Francisco, harm-reduction programs such as GLIDE do not require staff to guide people toward treatment. They argue that such pushiness could scare away clients who are not interested in quitting drugs. They often cite the drug policies of British Columbia, a global leader in harm reduction. But British Columbia set a record for overdose death rates last year. I go into more detail about the differences between San Francisco and Portugal in this new story for The Times's Upshot section, including a chart that compares overdose death rates across Europe. Related: Oregon officials declared a 90-day state of emergency over fentanyl in Portland, part of an effort to reduce public drug use. Continue reading the main story ADVERTISEMENT THE LATEST NEWS Israel-Hamas War Israeli forces dressed in civilian clothes inside a hospital.   Israeli forces stormed a Palestinian hospital in the occupied West Bank and killed three militants, including a Hamas commander. "We are not very far from an explosion": Anger and resentment is mounting in the West Bank. Israel said its military had begun flooding Hamas tunnels under Gaza. More on the Middle East The militia that the Pentagon said was likely responsible for killing three U.S. soldiers in Jordan — a group based in Iraq but linked to Iran — said it was suspending military operations. Biden said he had decided on a response to the attack. International China is censoring criticism of its struggling economy. 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Here are columns by Ross Douthat on Taylor Swift and Thomas Edsall on Biden and immigration. Discover more of the insight you value in The Morning. The Times is filled with information and inspiration every day. So gain unlimited access to everything we offer — and save with this introductory offer. MORNING READS Sunday Nobody Meron Tekie Menghistab for The New York Times 394 hot dog ice sculptures: The artist Sunday Nobody has found millions of viewers with his elaborate absurdist projects. St. Moritz: Rich people wanted to watch polo on a frozen lake. But Switzerland was too hot for the "hottest ticket in town." Ask Well: Is my lip balm making things worse? Lives Lived: Chita Rivera dazzled Broadway audiences for nearly six decades, including as Anita in "West Side Story" and Velma Kelly in "Chicago." In 2005, Newsweek called her "the greatest musical-theater dancer ever." She died at 91. SPORTS College football: The N.C.A.A. is investigating the University of Tennessee over claims of recruiting violations, including whether boosters funded a private jet flight. M.L.B.: The Angelos family agreed to sell the Baltimore Orioles to two private equity billionaires, pending the league's approval, a source told The Athletic. Continue reading the main story ADVERTISEMENT ARTS AND IDEAS The cast of Feud: Capote vs. The Swans. Thea Traff for The New York Times Birds of a feather: The producer Ryan Murphy spent years searching for the perfect rivalry to dramatize in the second season of his TV series "Feud." He considered Prince Charles and Princess Diana, and William F. Buckley and Gore Vidal, and a half-dozen others. Then he discovered the story of Truman Capote and his "swans" — New York society women whom the writer befriended, then betrayed in a tell-all magazine article. "It's very easy to do a show where people are just nasty to each other," Murphy told The Times. 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THE MORNING RECOMMENDS … Johnny Miller for The New York Times Make Pierre Franey's chicken breasts with lemon, which first appeared in The Times in 1992. Deep clean your remote control. Turn on a new iPhone feature that makes it harder for thieves to ruin your life. GAMES Here is today's Spelling Bee. Yesterday's pangram was diffract. And here are today's Mini Crossword, Wordle, Sudoku and Connections. Thanks for spending part of your morning with The Times. See you tomorrow. — German Sign up here to get this newsletter in your inbox. Reach our team at themorning@nytimes.com. Continue reading the main story Editor: David Leonhardt Deputy Editor: Adam B. Kushner News Editor: Tom Wright-Piersanti News Staff: Desiree Ibekwe, Lauren Jackson, Sean Kawasaki-Culligan, Brent Lewis, German Lopez, Ian Prasad Philbrick, Ashley Wu News Assistant: Lyna Bentahar Saturday Writer: Melissa Kirsch Need help? Review our newsletter help page or contact us for assistance. 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