Mayor Daniel Lurie of San Francisco is ending the practice of handing out paraphernalia to drug addicts for free unless the city staff and nonprofits first attempt to push those addicts into treatment and counseling plans.

“We can no longer accept the reality of two people dying a day from overdose,” the new mayor, a Democrat, said in a statement. “The status quo has failed to ensure the health and safety of our entire community, as well as those in the throes of addiction.”

“Fentanyl has changed the game, and we’ve been relying on strategies that preceded this new drug epidemic, which ends today,” he said.

The move marks a sharp pivot in San Francisco’s public health policy. For years, the city leaned into a “harm reduction” approach, offering sterile needles, foil, pipes, and plastic straws to drug users in an effort to reduce disease transmission and accidental overdoses.

Critics argued that those efforts only enabled continued addiction and did little to truly address the root problems. 

Under the newly announced policy, effective April 30, city-funded nonprofits and health officials can only distribute clean needles and supplies if they actively provide treatment counseling or immediately connect users to services.

The directive is simple — no more handing out drug equipment in public spaces like streets, parks, or sidewalks. Instead, distribution will be moved indoors or into city-controlled environments.

“We are responsible for the health of the individual on the street and the health of the community impacted by this crisis,” the director of San Francisco’s Department of Public Health, Daniel Tsai, said. “We are implementing strategic changes to build a more responsive system of care that moves people from the streets into effective treatment and sustained recovery.”

The city’s crackdown is part of the new mayor’s sweeping “Breaking the Cycle” plan — a strategy aimed at tackling homelessness, mental health crises, and opioid addiction head-on. Just weeks into his term, Mr. Lurie, who swept into office on a campaign promise to clean up the city’s fentanyl disaster, worked with the Board of Supervisors to slash red tape for shelter expansion and treatment programs.

“Connecting the distribution of safer use supplies to counseling and treatment is not a retreat from compassion — it’s an embrace of what actually helps people recover,” a professor of psychiatry at Stanford University, Keith Humphreys, said. “We know from decades of research and experience that addiction is rarely overcome without more proactive, assertive attempts to connect people to treatment and support.”

Not everyone is on board. The executive director of the National Harm Reduction Coalition, Laura Guzman, said the city does not have enough treatment available for addicts. “It’s mandating or putting as a condition for people to receive life-saving supplies, to actually have long conversations about treatment that may not be available,” Ms. Guzman said, according to Los Angeles Times. 

The chief executive of the San Francisco AIDS Foundation, Tyler TerMeer, also warned that banning free paraphernalia might force addicts to move from smoking drugs to injecting them, which is more dangerous.

“San Francisco AIDS Foundation stands firm in our knowledge that providing people with the information and resources they need to take care of themselves, including safer-use supplies and treatment and counseling services, is best for the health of people who use substances,” Mr. TerMeer told the Times.