Why Democrats say drug screening welfare recipients isn’t a GOP wish come true

SAN FRANCISCO — Drug-policy reformers were stunned this month when voters in deep-blue San Francisco overwhelmingly passed a ballot measure that reads like a Republican talking point from Richard Nixon's War on Drugs.

The initiative requires people on government assistance to submit to regular drug screening and mandatory treatment, if they show signs of addiction.

But Democratic officials who’ve embraced the concept — in San Francisco and beyond — say their rationale has nothing to do with GOP-led efforts of decades past or racially charged tropes about “welfare queens” abusing taxpayer dollars.

Democrats argue the shift is about preserving lives as overdose deaths, mostly from the synthetic opioid fentanyl, skyrocket. It’s also in response to concerns from voters who want officials to get drug users out of public spaces — especially as San Francisco has become ground zero for deteriorating street conditions.

The effort by Democratic politicians is striking because it’s a sharp change of course after years of liberal cities embracing harm-reduction drug policies like clean needle exchanges and safe-injection sites. It comes amid a larger shift toward tough-on-drugs and crime policies in blue cities, where Democrats are exasperated by urban challenges in the wake of the pandemic.

Among those favorable to the pivot is President Joe Biden’s Health and Human Services Secretary Xavier Becerra, a California Democrat whose department oversees much of the administration’s addiction-response efforts.

“Knowing San Francisco well, we should be willing to consider anything that helps us tackle this drug addiction crisis because so many people are dying today,” Becerra said at POLITICO’s Health Care Summit in Washington this month. “We need to get a grip on this.”

Many Republican-leaning states require federal welfare applicants to complete a questionnaire on their substance use and, depending on their answers, pass a drug test as a condition of eligibility. There are at least 13 states with such requirements including Missouri, North Carolina, Arizona and Georgia. A few purple and blue-leaning states also have the requirement, including Wisconsin and Maine.

San Francisco Mayor London Breed’s decision to repurpose the traditionally conservative welfare policy into a ballot measure, known as Proposition F, is derived from a growing frustration among Democratic voters in cities with progressive drug policies. Now, many liberal lawmakers are embracing more coercive approaches.

In Oregon, backlash to a decriminalization policy approved by voters in 2020 spurred the majority Democratic legislature to reinstate penalties for drug possession earlier this month. Democratic Gov. Tina Kotek said she plans to sign the bill into law.

And in Philadelphia, where the hard-hit neighborhood of Kensington has been called the East Coast’s largest open-air drug market, city lawmakers recently proposed creating a “triage center” where drug users would be forced to enter treatment or face arrest.

Breed, who’s running for reelection in November, proposed Prop F as she faces plummeting approval ratings and tries to win back an electorate that has grown angry over the city’s trifecta of urban epidemics: addiction, crime and homelessness.

Critics, both to Breed’s right and left, have in turn framed the policy as an act of political expediency on the part of an embattled mayor and establishment Democrats.

“This is a desperate attempt by California Democrats to inch their way back toward the middle of the spectrum,” said Republican lawyer Harmeet Dhillon, a longtime San Franciscan and close ally of former President Donald Trump. “It’s like cheap clicks, as opposed to systematic problem-solving.”

But Breed and her moderate Democratic allies on the Board of Supervisors successfully convinced the city’s notoriously liberal voters to approve the measure by a wide margin of 58 percent during the state’s March 5 primary.

In Breed’s hands, the mayor argued, the policy is not a way to prevent drug users from receiving public assistance — it’s a funnel to mandatory addiction treatment. Welfare recipients would only be subjected to testing if a city worker “reasonably suspects” they are addicted to illicit drugs.

“People talk about ‘Oh, tough-on-crime, soft-on-crime.’ It's not about that,” Breed told POLITICO as she campaigned for the measure earlier this month. “I want people to survive.”

San Francisco’s program isn’t as stringent as drug-testing welfare requirements in GOP states, which often tie eligibility to sobriety. Participants in the city’s program won’t be required to stay clean to obtain cash assistance, as long as they continue to seek treatment. About 5,800 people are enrolled in San Francisco’s welfare program for single adults, and can receive up to $712 per month.

It’s unclear how often welfare recipients might be required to undergo drug screening. The city’s Human Services Agency will spend the coming months drafting detailed rules, before the measure takes effect Jan. 1, 2025.

But many public health experts — and one of Breed’s closest political allies — say they worry it will fail because drug-screening policies are not shown to be effective in decreasing addiction and could perpetuate inaccurate stereotypes about welfare recipients. Between 5 and 10 percent of welfare recipients struggle with substance abuse, a slightly higher rate than among the general population, according to an issue brief by the U.S. Department of Health and Human Services.

In San Francisco, roughly 20 percent of people on the city’s government assistance program for single adults voluntarily disclose that they have a substance use problem. The actual number could be higher given the data is self-reported.

Keith Humphreys, a behavioral sciences professor and addiction policy expert at Stanford University, told POLITICO he was asked to endorse Breed’s policy but declined because of concerns about treatment capacity and the county’s ability to accurately monitor compliance.

He instead favors bolstering drug courts, which involve court-supervised treatment as an alternative to incarceration for people struggling with substance abuse who are charged with certain crimes. In California, participation in drug courts has plummeted since recent drug-sentencing reforms, according to a 2020 study.

“If we’re waiting for truly voluntary treatment,” Humphreys said, “we’re going to have a whole lot of deaths.”

State Sen. Scott Wiener, a moderate Democrat from San Francisco who backs Breed for reelection, broke from her and opposed Prop F. When asked whether he thought the mayor’s approach would succeed, Wiener said, “I don’t think so, but I hope I’m wrong.” He said tying public benefits to abstinence-based treatment could further harm vulnerable people.

Wiener said the city should focus on policies that data shows are likely to save lives. For instance, he’s long advocated for legalizing safe-injection sites (a policy vetoed by Gov. Gavin Newsom), noting that New York City and other countries have reported preventing many overdose deaths after opening such centers.

He said San Francisco can employ tough-on-drug policies that work, such as using law enforcement to shut down open-air drug markets, without abandoning compassionate harm-reduction policies, which he lamented have become a “political football.”

Harold Pollack, a public health professor at the University of Chicago who has studied drug use among welfare recipients and the impact of screening policies, said such a policy could ultimately backfire. Treatment availability is severely limited in San Francisco, so a mandate would effectively deprive many people living with addiction of access to the cash they depend on to meet basic needs like food and shelter, Pollack said. What’s more, the loss of cash assistance is associated with a substantial rise in charges for income-generating crimes like robbery, a 2022 study of Supplemental Security Income recipients found.

“I have a lot of sympathy for where this is coming from, but I do not think this is a wise thing to do,” Pollack said.

But Trent Rhorer, executive director of the San Francisco Human Services Agency, argues that Breed’s measure is being unfairly compared to drug-testing programs in largely red states that are designed to reduce the welfare rolls. The city, he said, isn’t trying to cut benefits.

“They could still be actively using drugs, and many in treatment programs do,” Rohr told POLITICO last fall, when Breed proposed the idea.

Still, many frontline addiction providers reject mandates entirely, noting studies that show rapid recurrence of drug use and a higher risk of fatal overdose among patients nudged into treatment.

“Tough love doesn’t work,” said Melissa Moore, civil systems reform director at the liberal-leaning Drug Policy Alliance in New York City. “If these types of Drug War policies were successful, we wouldn’t be experiencing record-breaking overdose deaths across the country.”