San Francisco housed 16,000 chronically homeless people. The most expensive city on the planet, housing 16,000 people in permanent supportive housing. And 25% of all overdose deaths in the city happened inside that housing. That’s the San Francisco drug policy failure in a single statistic.

On this episode of the Unnecessary Harm Podcast, I spoke with Tom Wolf, director of West Coast Initiatives at the Foundation for Drug Policy Solutions, senior fellow at the Discovery Institute’s Center on Wealth & Poverty working on homeless policy, and director of partnerships at Sunflower Sober, a recovery app blending telehealth, peer support and AI that already has 100,000 active subscribers. Tom lived the San Francisco drug policy failure from the inside. He spent years homeless on the streets, addicted to heroin and then fentanyl. He emerged to become one of the most credible voices in American drug policy reform. He’s been to the White House six times in the last seven months, advising the Office of National Drug Control Policy, the Department of Housing and Urban Development, and SAMHSA on what actually works.

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When Harm Reduction Becomes the Hill of Unnecessary Hurt: A Conversation with Tom Wolf

Tom didn’t start homeless. Middle class family man. Married with two kids. Owned a home. Got addicted to opioids after foot surgery in 2015. They sent him home with a 30-day supply of oxycodone. At his peak, he was taking 560mg a day just to stay well. If one of your listeners took that amount today, they would die of an overdose. But addiction is progressive. You build tolerance. You need more.

He blew through $100,000 on pills. Bankrupted himself and his family. When he could no longer afford the pills, he switched to heroin because it was cheaper. His wife gave him a choice: rehab or leave. He wasn’t ready. He walked out. Ended up homeless on the streets of San Francisco, then into fentanyl addiction. Got arrested six times. Finally got clean in jail. Went to a six-month faith-based 12-step rehab. Reconciled with his wife and kids. Eight years sober as of June 24th.

The United States now has 48 million people addicted to drugs. Not including alcohol. Over 10% of the population. The highest it’s ever been. California, Oregon, and Washington hold over 50% of all unsheltered homeless in the country. At least 75% are struggling with drug addiction. Last year, those three states had nearly 20,000 overdose deaths. Over 20 metric tons of fentanyl came across the border into California and Arizona from the cartels.

Oregon’s decriminalisation experiment saw overdose deaths spike 400% between 2020 and early 2025, when it was rolled back. The San Francisco drug policy failure looked similar. The city gave out over 700,000 syringes last year. Less than half were collected. The rest flowed into the bay. The harm reduction answer to homelessness has been: here’s a crack pipe, here’s a meth pipe, here’s some foil and straws, here’s a clean needle, have at it. And when you’re ready, let us know. But you’re never going to be ready if they keep making it comfortable.

That’s changing. After years of San Francisco drug policy failure, the city passed an ordinance making it recovery-first. Prop 36 passed in California in 2024, giving teeth back to the courts for repeat offending drug dealers and users. The drug czar, Sara Carter, publicly stated that the harm reduction ethos is not what the Office of National Drug Control Policy is practising now. California is about to pass a bill funding drug-free recovery housing for the first time. The state never paid for that before. It had to be harm reduction housing where drugs were allowed.

Tom’s message: accountability is a cornerstone of recovery. Radical harm reduction is on the way out. We are ushering in a new era of recovery as a solution to our drug and homeless crisis.

🗝️ Key Takeaways From This Episode

• 48 Million Americans Addicted: Over 10% of the US population struggles with substance use disorder. Add alcohol and it’s nearly a quarter of the country.
  
• The Housing Myth: The San Francisco drug policy failure proved that housing without recovery doesn’t work. The city housed 16,000 chronically homeless people. 25% of overdose deaths happened in that housing.
  
• Oregon’s 400% Spike: Decriminalisation without infrastructure saw overdose deaths quadruple. It was rolled back in early 2025.
  
• Recovery First Is Policy Now: After the San Francisco drug policy failure became undeniable, the city passed a recovery-first ordinance. The federal drug czar has publicly moved away from harm reduction ethos.
  
• Accountability Is the Cornerstone: Tom got clean in jail. He was given a choice: keep sitting there, go back to the street, or go to a six-month rehab. He chose rehab. That accountability piece saved his life.
  

👇 Watch Now

YouTube | Spotify

Essential Resources:
Tom Wolf Recovery
Foundation for Drug Policy Solutions
Discovery Institute – Wealth & Poverty Center
Sunflower Sober App – Available on Apple and Google Play ($8.95 USD/month)

P.S. Have a story of resilience or hope to share? We’d love to hear from you! Contact listen@unnecessaryharm.com.au or connect with us directly on LinkedIn.

Shane Varcoe
Executive Director
June 2026