If it came to anyone’s surprise that San Francisco has been running an open bar for the homeless, it’s only because this very San Francisco program somehow went under the radar. The NGO outfit was recently discovered by a local entrepreneur and chair of the Salvation Army Advisory San Francisco Metro Board, Adam Nathan.  

Nathan posted his observations on what he discovered hidden away at Hotel 587, in an old SOMA hotel: 

It’s set up so people in the program just walk in and grab a beer, and then another one. All day.… Inside the lobby, they had kegs set up to taps where they were basically giving out free beer to the homeless who’ve been identified with [Alcohol Use Disorder]. 

Nathan reported that the program costs $2 million a year. He voiced his concerns about its efficacy as well as the fact that it’s not known to the public—it’s unclear who runs it and who approved it.  

Turns out, the project is worse than initially reported. According to the San Francisco Chronicle, it currently serves 20 individuals at the cost of $5 million a year: 

Program officials said that nurses assess patients and typically dispense the equivalent of one to two drinks three to four times per day—doling out either 1.7 ounces of vodka or liquor, 5 ounces of wine, or 12 ounces of beer. 

In other words, enough to keep everyone enrolled happily inebriated. The New York Post reported that over its four years of existence, it has served a total of 65 clients. It’s not clear what happened to the 45 addicts who transitioned out of it. 

San Francisco writer Erica Sandberg pointed out that the city did something similar during COVID closures, when it provided secluded rooms for the homeless in chic hotels. The Department of Public Health partially funded the deliveries of alcohol, cannabis, and tobacco, all administered by staffers. Deadly fentanyl poisonings skyrocketed during this period, likely because sequestered addicts had little to do aside from partying solo.  

The Managed Alcohol Program (MAP) that Nathan spotted in the hotel was also born at the onset of the shelter in place, when a San Francisco sobering center decided to put its frequent flyers into a facility where they could be confined to a single building. It was one of the temporary government programs that became permanent once the emergency measures expired. In this case, a sobering center switched sides in the topsy-turvy world of health emergency.  

In a promotional video posted by UCSF School of Medicine, Program Director Alice Moughamian admitted that MAP’s goal is not to decrease the volume of alcohol consumed, but to mediate the social, health, and legal fallout, like the use of acute care units and interactions with the police. Each alcohol dose “is personalized [to the participant’s] own need and his own desire,” Moughamian explained. In other words, the cops don’t interact with the drunks to bring them to a sobering center; they are already at a sobering center, and they get all they wish on the taxpayer’s dime.  

From what Moughamian says, it doesn’t sound like any doctors are involved in prescribing the alcohol or drugs that are administered. Instead, they ask the alcoholics how much they drink and, with their input, figure out what the dosage should be.  

As Moughamian openly admits, the officials running MAP take the hard harm reduction approach favored by San Francisco’s Department of Public Health. The department once plastered ads across the city showing happy partiers, urging addicts to do drugs with their friends because, in their opinion, it’s safer that way. The only abstinence-based rehab program in San Francisco is the Salvation Army.  

Bryce Bridge, another MAP employee, revealed that cannabis consumption at the hotel is rampant and that despite running a closed campus, they catch enrollees with outside alcohol about once a week. And there’s no telling if other substances are being consumed there. He also hinted that there are incidents of violence, and it doesn’t sound like the police are called to deal with them.  

The ethicist Tanya Majumder described how MAP conducted a death panel for Mr. G, a 38-year-old patient with severe AUD, psychotic disorder, and a host of physical ailments, including pancreatitis. It sounded like his physician told him he needed to quit. But MAP decided to take another approach. Although drug maintenance remains highly controversial, Majumder nevertheless reasoned, “Autonomy is prioritized in the U.S. and the Global North.” Since they are dealing with limited resources, MAP asked Mr. G to choose between a longer life without alcohol and a shorter life with alcohol. To no one’s surprise, he chose the latter. After getting that answer out of a vulnerable man, they went on with enabling his addiction.  

This is not to suggest that MAP has not had financial success. Bryce Bridge showcased two enrollees who were able to drastically reduce their use of emergency services in the six months following completion of the program. The center figured that the former sobering center saved the city $1.7 million by reducing hospital visits. It’s worth noting that San Francisco drug poisoning deaths fell slightly over the period following the COVID closures—that covers most of the time when Hotel 587 was operating. So the drop doesn’t appear to be inconsistent with the city’s overall trajectory.  

Most of San Francisco’s homeless do not appear to be using alcohol only. Currently, synthetic opiates like fentanyl dominate the scene. There are no known attempts to successfully manage opiate addiction via harm reduction. As Adam Nathan noted, British Columbia is currently going through harm reduction motions with not much to show for it. San Francisco citizen journalist Adam Mesnick, who watched many homeless wither away before his eyes, calls the city’s approach a hospice service. Abstinence advocate and recovering addict Tom Wolf asked, “Are we just going to manage people’s addictions with our taxpayer dollars in perpetuity forever? It seems like that’s basically what we’re saying.” Quite. 

The basic problem with San Francisco non-profits is a clear lack of accountability—and that goes for all of them, not only the ones involved with the homeless populations. They are funded generously by the city and corporate donors, but rarely does anyone take a hard look at what they are doing. Mayor London Breed in fact has had her own corruption woes to worry about, and was once fined $2,500 for ethics violations. 

National politics are following San Francisco’s failures. With both the president and vice president issuing statements in support of cannabis legalization, it seems likely that Democrats will make it a part of their platform. Cannabis harm reduction will likely become the default strategy nationwide. From there, it will expend to other drugs. In the Global North, addicts will be given the choice to not so slowly kill themselves. It will save money for some—and enrich others in the process.