The Upside-Down World Of San Francisco Policies: Outlawed Cocktail Swords And Subsidized IV Drug Use

Tuesday, August 21, 2018
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The priorities of successful governments are public safety, policies that broadly enhance economic opportunity, and policies that provide a sensible safety net. Alas, I suspect it is hard to find any example of public policies that deviate more sharply from these principles than recent San Francisco policies involving two very different types of sharp objects.

One sharp object is the “cocktail sword.” Remember your last mai tai at Trader Vic’s? The cocktail sword is the plastic implement that holds together the pineapple chunk and the maraschino cherry. It is essentially a plastic toothpick with a tiny swashbuckler “sword handle” fashioned onto one end. The ordinance calls for fines that range between $100 and $500 per plastic sword offense, depending on whether the offending establishment is a first-timer or a serial offender. The law, which also covers plastic straws and plastic toothpicks, does call for flexibility for medical purposes, which puts a whole new spin on the old saw “Just what the doctor ordered.”

City Supervisor Katy Tang, who sponsored the Bill, argued that the ban is needed because plastic implements are littering the streets of San Francisco. To support her argument that the environmental cost of plastic is “astronomical,” Tang cited an estimate that 500 million disposable plastic straws are used every day in the United States. If 500 million straws per day seems a bit high to you, then you are not alone. There are good reasons to be skeptical of this number, as the estimate was produced by one nine-year old who conducted a brief phone survey on plastic straw use.

The other sharp object involved is the hypodermic needle. San Francisco provides IV drug users with clean hypodermic needles in exchange for used needles. This is no small task, as the city’s Health Department estimates that roughly one out of every thirty eight San Francisco residents is an IV drug user. However, many of the used needles are not returned to the exchange. The city’s health department estimates that close to 2,000,000 needles each year are not returned. If you are like San Francisco Supervisor Tang and are worried about the littering of San Francisco’s streets, then you really should be worried about hypodermic needles. Many needles are winding up in city streets. One woman reported being stuck by a discarded needle while riding public transportation, and a girl is reported to have inserted a used needle in her mouth, thinking it was a thermometer. The Health Department is now spending about $750,000 per year to clean up needles that are littering the city.

Since many of the city’s IV drug users are homeless and mentally ill, garbage and human feces, as well as used hypodermic needles, are in city streets. This has become such a major issue within San Francisco that a UC Berkeley infectious disease specialist has concluded that San Francisco streets are dirtier than those in poor countries such as Kenya and India. This problem is significantly impacting tourism and business travel to San Francisco. According to Fortune magazine, one large medical association cancelled plans to hold its annual convention in San Francisco due to concerns about safety. The convention would have generated about $40 million in income for San Francisco businesses.

The needle exchange program has the important and laudable goal of reducing blood-borne disease transmission. But the simple economics of San Francisco’s drug use policy, which also includes a very tolerant view of IV drug use, means that IV drug users have become a disproportionately large share of San Francisco’s population compared to the rest of the country. The United Nations estimates that roughly 0.2 percent of the US population ages twelve and older uses heroin each year. This national share is more than ten times smaller than San Francisco’s population share of IV drug users.

San Francisco policies that implicitly support IV drug use have swelled the number of IV drug users far beyond what the city can ever hope to deal with. Because many of these users are homeless and mentally ill, solving San Francisco’s IV drug problem fundamentally means jointly dealing with all three issues. The city’s current policies—ranging from handing out free needles, to planned spending of nearly $38,000 per homeless San Francisco resident in the next budget—are ineffective; and one reason for this is that implicitly supporting drug use is fundamentally at odds with helping mentally ill drug users recover.  

There is a better way. Rather than tacitly accepting IV drug use and its extremely costly consequences, additional treatment facilities should be built but should be built in much lower cost areas than San Francisco. Policies should also recognize the combination of issues that affect drug users. This would improve upon current policies, as it would allow resources to be reallocated from the very expensive and chronic problems resulting from drug use within the city, to provide drug users with more efficient treatment. This in turn would increase the economic vibrancy of one of the highest productivity cities in the world.

Reasonable changes in policy priorities will significantly improve the quality of life in San Francisco and help those who are most in need. In the meantime, watch where you step if you are walking the streets of San Francisco. Plastic cocktail swords won’t be underfoot, but used hypodermic needles will be.