16-05-2025
San Francisco leaders inspired by European city to end fentanyl crisis
SAN FRANCISCO - A city in Switzerland is the latest inspiration for San Francisco leaders working towards tackling the drug crisis.
The backstory
In the 1980s and 1990s, Zurich was a hotspot for the HIV/AIDS crisis and rampant public drug use. The city created the Four Pillars approach, a strategy aimed at tackling the issues, and was largely successful.
San Francisco leaders think the Four Pillars strategy could pave the way for a safer future for the city.
Overdose deaths in San Francisco climbed between January and March 2025, increasing by 50%. A report by the Coroner's Office found nearly 200 drug-related deaths, with fentanyl being the most-used drug.
In a report initiated by former Supervisor Dean Preston, the four pillars are identified as prevention, harm reduction, treatment, and law enforcement.
"All of these pillars are integral to their strategy of reducing public drug use, reducing overdose rates, getting people connected to the help that they need," said Supervisor Jackie Fielder.
She said there are already steps being made towards the goal, but there are areas to improve.
San Francisco police officers are part of the outreach teams on the streets. Narcan is used to save drug users from overdosing, and there are some shelter beds, but it's not enough.
"There is not enough capacity with our limited resources either in our public safety system, criminal justice system, or treatment system, so we need to figure out what to do with those people in the meantime," she said.
Fielder said the hearing brought to light the fact that drug users are often arrested, cited, and released instead of being brought to shelters or treatment.
Along with stricter enforcement, an addiction expert at the University of California San Francisco, Dr. Daniel Ciccarone, said the city should provide supervised consumption spaces, a method tried and abandoned in the past.
"There are 200 around the world. No one has ever died in one, and people can consume drugs there safely under medical supervision," he said. "Overdoses go down, hospitalization utilization goes down, arrests go down, public nuisance goes down, and health goes up."
The approach also calls for sobering centers and access to safe supplies and syringes.
However, there is one pillar Fielder said San Francisco is missing: prevention, which includes identifying risk factors and education.
"What can we do about childhood trauma? What can we do about adverse childhood experiences?" Ciccarone asked.
Homelessness advocate and business owner Christin Evans, who is also part of the Homeless Oversight Commission, said to address the drug crisis, the city needs to provide more affordable housing and mental health services.
"When they go into a shelter placement, a lot of times what happens is they are exited to the street because of behavioral issue," she said.
What's next
Dr. Ciccarone said it could take a few years to coordinate existing programs and implement the approach.
"It took the Zurich folks months, perhaps even a couple years, to come together across the different philosophies so that public safety really worked with the doctors and public health," he said.
Fielder said this is just the start of an ongoing conversation to coordinate city efforts.
Earlier this week, Mayor Daniel Lurie announced that more than $27 million will go towards mental health and addiction treatment.
KTVU reached out to his office for a comment about the Four Pillars strategy, but did not immediately hear back.
