4Pillars4Success: Supervisor Preston Releases First Comprehensive Roadmap to Tackling the City’s Drug Crisis

Modeled on Zurich’s Successful Four Pillars Strategy, the detailed 118-page report maps out a proven path to addressing addiction, public drug use, and associated crime.

District 5 Supervisor Dean Preston announced on Tuesday 4Pillars4Success : a groundbreaking and comprehensive roadmap to tackle San Francisco’s drug crisis. Per Supervisor Preston’s request in January,  a 118-page analysis was researched and written by the city’s independent Budget and Legislative Analyst, who worked with local, national, and international experts and departments, including officials from San Francisco, New York, and Zurich, Switzerland to explore successful strategies and flag potential improvements to our local response. This model has reduced overdose deaths by over 60% in Zurich, while also dramatically improving street conditions, and crime related to drug dealing and use, including a 98% reduction in theft.

“Cities like Zurich have shown that we don’t have to choose between addressing street conditions and saving lives,” stated Preston. “This report offers a roadmap to solving the most pressing conditions on our streets.” 4Pillars4Success is one in a string of big-picture projects proposed by Preston including social housing to end housing insecurity, the residential vacancy tax to open more homes, and a public bank to fund green infrastructure across the city. 

San Francisco has taken a reactive approach to its drug crisis, launching short-term efforts that have yielded mixed results and have often contradicted each other. There has been no comprehensive approach among the relevant departments and stakeholders that includes both short-term and long-term strategies. Fortunately, San Francisco’s sister city Zurich, Switzerland, has created a blueprint and solved a similar crisis using their “Four Pillars” strategy, which is based on comprehensive strategic planning and coordination among various Zurich departments.  

“It is time we listen to and follow the wisdom of our sister city. Its four-pillar approach decreased public drug consumption by utilizing a carrot-and-stick approach. The Safe Consumption Site  was the carrot, and the stick came from street-level enforcement. This approach also decreased HIV transmission and reduced overdose. Academic research has shown SCS to be effective at reducing the medical consequences of drug use, reducing public nuisance from drug use, and being cost-effective, i.e., while the intervention costs money, more is saved by the city as hospitalization and emergency department utilization goes down.” Dr. Daniel Ciccarone, Addiction Specialist at the University of California San Francisco.

"A key success factor in Zurich, is the city's joint strategy and the close cooperation between the police department and health and social services. The City of Zurich stands united behind the four-pillar policy." Captain Beat Rhyner, Zurich City Police Department. 
 
"This policy analysis report on Zurich's drug and addiction policy is a great example of how cities can learn from each other. We are glad to see that the sharing of good practices between the City of Zurich and San Francisco has led to this important policy paper." Anna Schindler, Director, Office for Urban Development, City of Zurich.

“This is exactly what has been missing: a comprehensive plan that's been proven to work." David Elliott Lewis, Co-chair of the Tenderloin People’s Congress.


Key Findings and Recommendations
The report provides a sweeping overview of the overdose crisis in San Francisco, as well as data and metrics on the City’s current response. Of note, the report found that: 

• San Francisco’s overdose crisis remains at high levels (542 so far this year) despite the decrease from 810 fatal overdoses in 2023– the highest recorded number in San Francisco history. 

• Only an estimated 25 percent of San Franciscans with opioid use disorder receive medications to treat it, in contrast to Zurich where more than 75 percent of residents addicted to opioids are taking medications for their opioid use disorder. 

• An overwhelming majority of people who are arrested for drug use in San Francisco do not access treatment, calling into question our increasing reliance on arresting drug users. 

• More than 40 percent of non-fatal opioid overdoses in San Francisco appear to  be from unintentional consumption of fentanyl, suggesting the need for easily accessible drug checking.

The Budget and Legislative Analyst also makes several recommendations to improve San Francisco’s response to the overdose crisis. The major recommendations include: 

• Adoption of a comprehensive Citywide drug policy along the lines of Zurich’s Four Pillars, incorporating input from key stakeholders such as the Departments of Public Health and Homelessness and Supportive Housing, the Police and Fire Departments, experts in the field, consumers of City services, community-based organizations that provide substance use treatment and related services, community members, and others.

• Establishment of one or more safe consumption sites to reduce fatalities and ensure that people using in public can be redirected elsewhere.

• Establishment of City-operated Wellness Hubs, with or without safe consumption sites attached, to provide hubs for people who use drugs to receive services and get referrals to treatment, housing, and other assistance. 

• Changing the culture of our local drug policy approach by implementing cross-departmental exchanges and site visits between Police Department academy participants, patrol officers, Drug Market Agency Coordination Center (DMACC) team members, Department of Public Health Behavioral Health staff and substance use disorder treatment providers, staff of the Homelessness and Supportive Housing Department, street teams representatives, and if one or more are opened, safe consumption site staff.

• Improving data tracking and information about the number of people accessing treatment for substance use disorder; data about police arrests for drug use and drug dealing for the Drug Market Agency Coordination Center and Citywide; and data about the number of drug use and drug dealing cases charged/dismissed, as well as case outcomes. 

After the Tenderloin was redistricted into District 5 in 2022, Supervisor Preston and his team worked with the Department of Public Health to create the city’s first Overdose Prevention Plan which called for overdose prevention sites and expanded treatment. Where it’s been implemented, lives have been saved.  With the 4Pillars4Success, Supervisor Preston has taken the next big step: teeing up a bold roadmap with a track record of great success for City leaders to unite around. 

“This new report evaluates the city’s progress and analyzes how the successful Four Pillars strategy to reduce overdoses and improve street conditions could be implemented here,” said Supervisor Preston. “My hope is that 4Pillars4Success, a product of extensive research over the last year, provides the roadmap our city has been missing for the incoming mayor, board, and departments to finally get this crisis under control.”