Prop F
Drug Screening and Treatment for Benefits Recipients
Substance Abuse Screening, Evaluation, and Treatment Requirements for CAAP Assistance

Requires County Adult Assistance Program recipients suspected of using illegal drugs to submit to drug testing and substance abuse treatment in order to receive program benefits.

Vote NO

Jump to SPUR’s Recommendation

The County Adult Assistance Program (CAAP) is a state-mandated, city-funded public benefit program that provides cash assistance to people living in poverty who are ineligible for Social Security benefits or other public assistance programs. Proposition F would require people receiving CAAP benefits who are suspected of using illegal drugs to submit to drug testing and, if they test positive, to participate in substance abuse treatment in order to receive CAAP benefits. Those who do not comply would be denied cash assistance and other public benefits under the program but would be provided with housing assistance for 30 days, with potential for an extension to prevent eviction, through direct payments to the landlord or shelter access.

The Backstory

Mayor London Breed introduced this measure in response to the ongoing drug crisis in San Francisco with two goals in mind: incentivizing people with a substance abuse condition to accept treatment in order to reduce drug-related deaths and improving accountability for the use of public funds. While the city offers and is actively expanding services for people with a substance use condition, it lacks authority to require anyone to accept treatment when it is offered to them.

CAAP currently serves fewer than 5,000 San Franciscans. Eligibility for the program is limited to low-income San Franciscans with no dependent children, including those who cannot work, immigrants, and refugees. For housed residents who qualify, CAAP provides a cash benefit of up to $712 per month.

This measure was placed on the ballot by the mayor. It requires a simple majority (50% plus one vote) to pass.

Equity Impacts

CAAP exists to serve extremely low-income San Franciscans who lack access to any other resources. CAAP helps the poorest people in the city, who are disproportionately people of color and immigrants. Making it more difficult to access CAAP benefits by requiring drug screening and treatment would likely discourage people from participating in the program and receiving public benefits that could support them in becoming economically secure. Prop. F could have negative equity impacts by dissuading people in poverty from joining this program.


  • The measure could provide the city with a tool to move people suffering from addiction into treatment outside of law enforcement action, since the city lacks tools to incentivize people with substance abuse disorders to accept treatment.


  • This measure would make it more difficult for people who need public benefits the most to access them and would discourage people from seeking these benefits, increasing financial insecurity and housing insecurity for individuals who rely on CAAP.
  • This policy step is based on the unproven assumption that people who are receiving public benefits are more likely to use drugs than people who are not. It is not known how many people enrolled in the program have a substance abuse condition.
  • This ordinance is unlikely to meaningfully improve the lives of low-income people with substance abuse conditions. Drug testing for public benefits has not had a measurable impact on substance use since it was instituted in the late 1990s.[1]
  • Free treatment programs and beds are scarce in the city, which makes it unlikely that the policy would have the intended effect of helping people with a substance abuse condition receive treatment. It might have the unintended effect of increasing housing insecurity and homelessness.
  • Forced drug treatment does not improve health outcomes for drug users or people with substance use conditions.[2]
  • The ordinance could raise the administrative costs for CAAP through drug testing, assessment, and case management costs, as well as any costs that result from insufficient treatment capacity. The financial impact is dependent on future actions of the Human Services Agency, the mayor, and the Board of Supervisors.
SPUR's Recommendation

While SPUR understands the immense personal and public toll of this public health crisis, we do not think that this ordinance would achieve its intended goals. Compulsory drug testing for public benefits has not had a measurable impact on substance use or substance use disorders.[3],[4] Requiring recipients of public benefits to submit to drug testing and substance use disorder treatment could increase poverty and exacerbate harms to the city’s most vulnerable populations. Research has shown that any barrier to public benefits can discourage enrollment, reducing access to much-needed benefits, and that drug testing is no different.[5] It can have the unintended consequence of stigmatizing people experiencing poverty, rather than helping people who are experiencing addiction. Medical experts, public health experts, mental health experts, and direct service providers all oppose drug testing and treatment requirements as a condition of receiving public benefits.[6] Drug testing and treatment are also expensive and would likely cost the county much more than the existing program, as many states found when they tried requiring public benefits recipients to undergo drug testing.[7],[8]

Vote NO on Prop F - Drug Screening and Treatment for Benefits Recipients

[1] S.R. Hogan et al., “Social Welfare Policy and Public Assistance for Low-Income Substance Abusers: The Impact of 1996 Welfare Reform Legislation on the Economic Security of Former Supplemental Security Income Drug Addiction and Alcoholism Beneficiaries,” Journal of Sociology & Social Welfare, 2008, 35(1): 221–245, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2854403/.

[2] D. Werb et al., “The Effectiveness of Compulsory Drug Treatment: A Systematic Review,” International Journal of Drug Policy, February 2016, 28: 1–9, https://doi.org/10.1016/j.drugpo.2015.12.005.

[3] M.J. Walker and J. Franklin, “An Argument Against Drug Testing Welfare Recipients,” Kennedy Institute of Ethics Journal, 2018, 28(3): 309–340, https://pubmed.ncbi.nlm.nih.gov/30369508/.

[4] See note 1.

[5] V. Palacio, “Drug Testing SNAP Applicants Is Ineffective and Perpetuates Stereotypes,” Center for Law and Social Policy, July 2017, https://www.clasp.org/sites/default/files/publications/2017/08/Drug-testing-SNAP-Applicants-is-Ineffective-Perpetuates-Stereotypes.pdf.

[6] ACLU, “Drug Testing of Public Assistance Recipients as a Condition of Eligibility,” April 8, 2008, https://www.aclu.org/documents/drug-testing-public-assistance-recipients-condition-eligibility.

[7] M. Gomez and J. Israel, “What 13 States Discovered After Spending Hundreds of Thousands Drug Testing the Poor,” ThinkProgress, April 26, 2019, https://archive.thinkprogress.org/states-cost-drug-screening-testing-tanf-applicants-welfare-2018-results-data-0fe9649fa0f8/.

[8] See note 5.