Last month, city officials announced a new piece of legislation designed to discourage drug use by offering up to $100 a week to people who receive financial assistance through the county’s Adult Assistance Program and test negative on a regular basis.
Dubbed “Cash Not Drugs,” the policy was proposed by District 6 Supervisor Matt Dorsey, who has personal experience with addiction, and supported by Mayor London Breed, who framed the legislation as a crucial new tool in San Francisco’s existential fight over its drug crisis.
"I lost my sister to a drug overdose. She was down in the streets of the Tenderloin, and it was definitely very difficult to get her the help she needed. I want to make it easier. Just as easy to get treatment as it is to go out there and buy dope," Breed said at the July 29 press conference.
Meanwhile, what do actual people who live and cop narcotics on the street think? The answer is as complex as their individual struggles, but conversations with drug users from SoMa to the Castro suggest that, despite Dorsey and Breed’s best intentions, a program like Cash Not Drugs might not pan out as intended — at least not for the city’s most vulnerable people with addiction woes, who may not have the basic requirements to participate in the county program, like an address to receive mail or a safe place to keep paperwork.
“It sounds like in order to get money, you already have to figure out how to get money and benefits and stay in touch with the city,” said Jon Emm, who lives on the sidewalks of the Mission and uses fentanyl daily. “I’m just shit at it, man. I want the money, but if it’s anything like getting housing, I’m gonna screw up the paperwork again.”
Cash Not Drugs is intended to be a complement to Proposition F, a contentious drug-screening policy for county welfare recipients that passed in the March election and will go into effect in January. Prop. F affects people who currently receive general assistance from the San Francisco Human Services Agency, which offers a range, depending on a person’s situation, from $109 a month for unhoused clients to $712 a month for those who are housed. Currently, there are 6,189 recipients in total, up from about 4,700 in 2019.
Bureaucratic hurdles — and skepticism borne of experience
Starting in January, any county assistance recipient who is “reasonably suspected” of being dependent on illegal drugs will be screened for substance use disorder. If they are deemed to be dependent on illegal substances, they would need to consent to further evaluation and potentially a treatment program in order to receive additional cash, along with other benefits.
The Cash Not Drugs policy suggests sweetening the deal, adding $100 more for every week a recipient passes a urine test. Marijuana, alcohol and psychedelics would be exempt, according to Gary McCoy, the vice president of policy and public affairs for HealthRight 360, who also spoke at the July 29 press conference.
The exclusion of cannabis is a minor relief for Arthur Manning, a 49-year-old unhoused man who often hangs out and sleeps in on the streets of SoMa, not far from Mid-Market. He said that he used to receive cash through the county assistance program, but lost his eligibility after his paperwork was taken in a sweep of his tent last year. He works odd jobs for money and uses fentanyl, or fent, on a regular basis.
While Manning is intrigued by the thought of re-qualifying for general assistance and getting $400 extra a month for a clean urine test, he also wondered out loud whether it would help him much in the long term.
“So what comes after? Do I have to keep pissing clean for the rest of my life? Because fent is my one kind of peace. I mean I’ll take weed, but is this going to turn my thing around? Is it going to get me the place I want, or a job I can do?” he told me, visibly frustrated.
The proportion of adults receiving financial assistance through the HSA program who are also unhoused has risen, from 16% of recipients in 2019 to 20% today. That’s a small fraction of the estimated 7,000 adults experiencing homelessness in San Francisco, which may reflect the sometimes labyrinth-like nature of HSA’s bureaucracy.
A number of unhoused people I spoke to had struggled with filling out the documents to prove eligibility, traveling to and from the HSA office, and consistently accessing phones and navigating computer systems. Three people also told me they’d experienced dismissive treatment from program administrators.
“That shit makes me wanna do drugs,” scoffed Naysha J, a 29-year-old who moved to San Francisco from Sacramento in 2022 due to what she describes as an abusive family situation.
She started using meth and fentanyl last summer, after falling out with a friend who was housing her. J lost access to her prescription medications, she said, and now uses a combination of stimulants and opioids — a particularly deadly combination, according to experts — to “even out” her mood and anxiety problems.
“The money’s nice, but I feel like I’ve been screwed over before, like with housing applications. There’s gotta be more to it than just $400. I’m fine surviving as-is. But if I’m going to do all that work, there’s gotta be something more,” she said.
In addition to $109 a month offered to unhoused clients, county assistance also offers a “guaranteed” temporary shelter bed; the treatment offered to drug-dependent recipients under Prop F is supposed to be free of charge, according to the law, although the agency has yet to say who those providers will be, and how they will be paid for.
In a statement to Gazetteer SF, the HSA noted implementation will require “complex” planning between the agency, the city Department of Public Health, and third-party providers. “At this time, SFHSA intends to contract out the drug screening assessments,” HSA spokesperson Joe Molica wrote in an email. Dorsey did not respond to multiple requests for comment by Gazetteer.
The evidence base for Cash Not Drugs
There is evidence this type of abstinence reinforcement could work. Offering people with drug addiction positive reinforcement for not using is part of a clinical strategy known as “contingency management,” which has shown a lot of potential in trials over multiple decades around the country.
Research suggests that offering reinforcements like cash to achieve a “target behavior” are effective for a broad range of issues, especially when those reinforcements are consistent and quick. Twice-weekly reinforcements, or more, is ideal, especially when paired with bigger payoffs or personal coaching, according to research from Sterling McPherson, a professor at Washington State University.
People with severe mental illness, in addition to addiction issues, also seem to benefit from contingency management plans, seeing increased abstinence from drugs and improved quality of life, according to some research. But there’s a caveat: McPherson’s analysis of the research shows “no significant differences” in levels of depression, anxiety, stress, drug cravings, or coping ability between those in contingency management versus the control group.
In other words, Manning and J might be right to question whether an infusion of cash would really turn their bigger problems around.
Much of the fanfare around Cash Not Drugs seemed to be based on the assumption that the city’s poorest, most vulnerable people would jump at the prospect of hundreds in free cash, in exchange quitting the substance that’s killing them from the inside. But while most of the nearly dozen people I chatted to around SF admitted their drug use was a problem, many seem trapped by both the perception and reality of seeking help. Some have had poor prior experiences with social services; others are simply hyper-focused on making it from one day to the next.
Their responses encapsulate the frantic experience of living in unsheltered homelessness — and help explain why anti-drug policies, whether harsh requirements for abstinence or more reward-based programs like contingency management, only address part of the crisis.
The full Board of Supervisors are expected to vote on the legislation in September, with potential implementation in summer 2025.
