Challenging Proposition F: A Medical Perspective on San Francisco’s Approach to Welfare and Addiction

By Jen Nossokoff

San Francisco’s Proposition F, slated for a vote in March 2024, brings forth a crucial conversation about the intersection of welfare, drug use and addiction treatment. This proposition mandates drug screening for certain recipients of the County Adult Assistance Program, tying continued welfare benefits to participation in drug treatment for those who test positive. While this approach integrates treatment, it also threatens to withhold benefits from those who decline it, raising a spectrum of ethical, practical and policy-related concerns. As the only candidate for local office with a license to practice medicine, I have a unique responsibility to speak out on the dangers that Prop. F will have on some of the most vulnerable members of our community. 

At the core of this debate is the treatment of addiction. The medical community widely recognizes addiction as a complex brain disorder, not a moral failing. Effective management of addiction typically requires a nuanced blend of medical, psychological and social support. By mandating treatment as a condition for welfare, Prop. F oversimplifies this complex issue at the expense of people who need care, not punishment. The requirement to accept treatment or face the loss of benefits places undue pressure on individuals who are not ready for treatment, which often leads to less effective outcomes or avoidance of support systems altogether.

In the broader context of Prop. F and similar legislative efforts, it is imperative for legislators to recognize the boundaries between policy making and providing health care. Lawmakers, while instrumental in shaping policies that impact public health, are not health care providers. Their role should be to create an environment where medical professionals can effectively address health issues, including addiction, rather than attempting to dictate specific medical interventions. This is particularly relevant in light of complex and sensitive issues like addiction treatment, where individualized care and voluntary participation are often key to successful outcomes.

The overturn of Roe v. Wade underscores the delicate balance between legislation and personal health autonomy, a balance Prop. F disrupts by mandating drug treatment for welfare recipients without considering individual health needs or readiness. As a health care provider, it is my responsibility to advocate for legislative measures that respect individual autonomy and informed health decisions, guided by medical expertise rather than rigid legislative mandates. This approach is crucial for policies like Prop. F, where respecting personal circumstances and professional medical guidance should be paramount.

Legally, mandatory drug testing for welfare recipients has faced challenges on the grounds of constitutional rights. The Fourth Amendment’s protection against unreasonable searches has been cited in cases where similar policies were struck down or reconsidered. This legal backdrop suggests that Prop. F might also encounter judicial scrutiny​​.

More broadly speaking, Prop. F reflects a broader policy debate within San Francisco, over differing views on addressing public safety, drug addiction and homelessness. While supporters view this proposition as a step toward responsible use of taxpayer dollars and addressing drug abuse, the clear counter to this is that it adds harmful hurdles for those who are already struggling, doesn’t effectively address the underlying issues of addiction​​​​ and is poised to make the problems worse. 

Prop. F’s mandatory treatment approach starkly contrasts with San Francisco’s 2022 Drug Overdose Prevention Plan, which emphasizes a more inclusive and voluntary strategy for managing addiction. Given the City’s limited treatment facilities and housing resources, Prop. F could inadvertently heighten the overdose and homelessness crises, moving us in the opposite direction from the plan’s goals of accessible and varied substance use services. This highlights the need for approaches that support rather than mandate treatment, respecting individual needs and city resources.

Voluntary treatment allows individuals to engage in their recovery process actively, enhancing the likelihood of successful outcomes. This approach respects personal autonomy and readiness for change, key factors in effective addiction management. It stands in stark contrast to Prop. F’s mandatory treatment model, which may not align with the individual’s readiness or willingness to seek help, potentially reducing the effectiveness of treatment. A more compassionate and proven effective alternative to reducing overdose deaths is voluntary, personalized treatment.

Ultimately, addiction should be understood as a medical condition, rather than a reflection of one’s character or morality, and managed in an evidence-based and holistic manner. Offering someone treatment and forcing someone into treatment are two very different things. To create effective, compassionate and ethical policies that genuinely support public health and welfare, legislators must acknowledge the expertise of health care professionals and respect individual autonomy. Compulsory treatment for addiction has repeatedly been shown to be an ineffective and improper method for addressing substance abuse issues. Denying access to essential resources, like stable housing, to individuals battling addiction unless they comply with treatment demands is an inappropriate and counterproductive approach. For these reasons I strongly oppose Prop. F and recommend the City reject this measure. 

Jen Nossokoff is a physician assistant, licensed to practice medicine in California. She is a candidate for Supervisor in District 1 in November as well as a candidate for a seat on the Democratic County Central Committee AD-19 in March. Her focus is on community safety, transportation and health equity. To learn more visit www.Jen2024.vote. This piece was written by Jen with the use of generative AI and a writing tool in compliance with the guidelines set by the City and County of San Francisco.