Proposition F — Illegal Substance Dependence Screening and Treatment for Recipients of City Public Assistance

See our March 2024 SF Election Guide for a nonpartisan analysis of measures and contests on the ballot in San Francisco for the election occurring March 5, 2024. Voters will consider the following proposition in that election.

Proposition F asks voters whether the city should be allowed to screen single adult welfare recipients for drug dependency and require those identified as suffering from substance use disorder to enter treatment to continue receiving cash assistance through the County Adult Assistance Program.

A “yes” vote supports requiring that single adults aged 65 and under with no dependent children who receive county public assistance benefits and are reasonably suspected to be dependent on illegal drugs participate in screening, evaluation and treatment to be eligible for cash benefits. A “no” vote opposes adding that requirement for County Adult Assistance Program participants. The measure requires more than 50% affirmative votes to pass.

If the ordinance is approved, county assistance recipients who decline drug screening, evaluation and treatment will be considered noncompliant and ineligible for benefits.Discontinued recipients would get 30 days of housing through guaranteed shelter access or rent paid directly to a landlord, with potential extensions for eviction prevention. State law requires every county to provide public assistance programs for poor, single adults aged 65 and under.

San Francisco currently distributes County Adult Assistance Program funds to about 5,200 single adults aged 65 and under — $109 a month to unhoused residents and $712 a month to housed residents. From 2018 to 2020, about 20% of recipients reported having a disabling substance use disorder, according to the city Human Services Agency, which administers the program. And the rate is likely higher among recipients who are experiencing homelessness.

What the screening process would entail is vague. The measure’s lead proponent, Mayor London Breed, has denied that recipients would be tested for drugs, but Trent Rhorer, Human Services Agency executive director, said at a press conference that screening could include drug testing.

The measure could have disproportionate consequences for the city’s Black residents, who account for 6% of the total population but make up the highest percentage of County Adult Assistance Program recipients whose race is known — 18% — as well as more than one-third of the city’s unhoused population and nearly one-third of overdose deaths so far this year. (Nearly half of county assistance recipients were listed as having unknown races or ethnicities in the latest Human Services Agency demographics report.)

The Department of Elections received an opponent argument submission from Roma Guy and Diane Jones, a celebrated San Francisco couple with a long history of social justice activism that was depicted in the 2017 television series “When We Rise.”

Jones, a registered nurse, and Guy, a medical social worker who served for 12 years on San Francisco’s Health Commission, argued that the measure would worsen homelessness and have “deadly results.”

“Research by public health experts shows indisputable evidence that proposals such as Prop F lead to increased rates of return to substance use, overdose deaths, and suicide,” they wrote.

Breed initially announced the proposal at a Sept. 26 press conference as a strategy to compel low-income residents with substance use disorder into treatment. “No more anything goes without accountability, no more handouts without accountability,” Breed said. “So, in order to get resources from our city, you will need to be in a substance use disorder program and consistently seeking treatment.”

Supervisor Matt Dorsey — a Breed collaborator who is open about his struggles with substance abuse — proposed the measure to the Board of Supervisors as legislation, arguing that it would inspire people at high risk for substance use disorder and overdose death to enter treatment. It had the support of Supervisors Rafael Mandelman and Catherine Stefani. But six supervisors rejected the idea.

A coalition of more than two dozen community advocacy groups responded by launching a “No on F” campaign. In a Nov. 30 letter addressed to the mayor and Board of Supervisors, they wrote that the measure would worsen homelessness, jeopardize the health and stability of Black, Latinx, Indigenous and low-income people, contribute to the stigma, and create discrepancies in treatment services and accessibility.

Board President Aaron Peskin also opposed the proposal, describing it as Breed “desperately grasping for a political lifeline.” He added that the city could not fund the routine drug testing of thousands of welfare recipients.

According to City Controller Ben Rosenfield, the measure would have a “moderate impact on the cost of government.” The annual cost of administering the program is estimated at between $500,000 and $1.4 million, which would be partially offset by discontinued public assistance funding. If the measure passes, savings from discontinued benefits could range from $200,000 to $4 million in the first year to $100,000 to $2 million in subsequent years, Rosenfield wrote. But, he added, the measure doesn’t account for additional residential treatment, withdrawal management, or residential step-down treatment programs — a cost that would depend on the number of assistance recipients who choose to participate.

For context, the city spends about $12,000 per person for a 90-day treatment stay. If all 20% of CAAP recipients who said they suffered from disabling drug dependency enrolled in such a program, it could cost the city about $12.5 million.

The measure has also been panned by several political groups including the San Francisco Democratic Party and the San Francisco Tenants Union.

“This is just another in a long line of bad faith stunts by desperate politicians leveraging our homelessness crisis in an election cycle,” Róisín Isner, director of activism and operations for the SF Tenants Union, wrote in a statement.

According to campaign finance filings, the measure has received $330,000 so far from supporters, including a $100,000 contribution from Chris Larsen, a tech billionaire best known for co-founding the peer-to-peer lending firm Ripple. Larsen also donated $250,000 toward Proposition E — Police Department Policies and Procedures.

Larsen has spent a small fortune influencing San Francisco’s trajectory over the last few years. He partnered with San Francisco’s police union to attract recruits to the Police Department, spending $600,000 on an advertising campaign that aired last year during college basketball’s March Madness Final Four. And in 2021, he gave $1.7 million in COVID-19 pandemic recovery aid to 50 neighborhood and small business groups across the city through his nonprofit, Avenue Greenlight.

The measure also has the support of Safer SF — a lobbying firm that successfully campaigned to recall former District Attorney Chesa Boudin over policies it deemed overly progressive. The Department of Elections lists Eric Kingsbury as the proponents’ measure’s primary contact. Kingsbury is a member of Safer SF and secretary of the Marina Community Association, a nonprofit neighborhood group in San Francisco’s Marina District.

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