The problem with San Francisco, according to Stanford University psychologist* Keith Humphreys, is too much "libertarianism." Since the City by the Bay is not exactly known for light governance, that may seem counterintuitive. But Humphreys, who was a senior White House adviser on drug policy during the Obama administration, has in mind something closer to libertinism, which he says has long characterized San Francisco's culture. In a San Francisco Chronicle op-ed piece published on Tuesday, he blames excessive tolerance of vice, which he equates with libertarianism, for "fueling San Francisco's drug crisis."
That analysis is doubly wrong. Humphreys misconstrues libertarianism while ignoring its critique of drug prohibition, which is essential in understanding why drug-related deaths have reached record levels across the United States not just despite but largely because of the government's efforts to prevent them.
Humphreys thinks the root of "San Francisco's drug crisis" is "a libertarian, individualistic culture" that since the 19th century has attracted people who yearn "to be free of traditional constraints back East, to reinvent themselves, to escape the small-mindedness of small towns and to find themselves." While that culture "underlies the city's entrepreneurialism, artistic energy and tolerance for diversity in all forms," he says, it "has a downside when it comes to addiction, which thrives in such a cultural milieu." San Francisco "has long been one of the booziest cities in the country," he writes, and "heavy use of substances has always been part of how San Francisco defines freedom and the good life."
Conflating "heavy use of substances" with libertarianism is more than a little strange. Libertarianism focuses on the proper role of government; it does not tell people how they should conduct their private lives, except insofar as their actions impinge on the rights of others. Although the idea that the government should not dictate recreational choices (an idea that San Franciscans do not consistently endorse) is obviously appealing to people whose choices politicians do not like, there is nothing paradoxical about a libertarian teetotaler.
Humphreys is keen to rebut "conservative commentators" who blame "soft-on-crime liberalism" for San Francisco's "drug crisis." To the contrary, he says, "San Franciscans' liberalism is why the government offers generous health and social care services, without which overdose deaths would be higher, not lower." The actual cause of ever-escalating drug deaths, he avers, is "the libertarian assumption that given freedom and tolerance, everyone will rationally and productively pursue their self-interest," which "cannot explain why a starving person would, for example, forgo food in exchange for fentanyl or cocaine."
The assumption that Humphreys describes as "libertarian" is plainly at odds with reality. But libertarianism does not assume that people never make mistakes, never develop bad habits, or never engage in behavior they ultimately regret. It simply argues, for moral and pragmatic reasons, that the possibility of error is not enough to justify using force, which should be reserved for conduct that violates other people's rights.
Humphreys suggests that decisions regarding psychoactive drugs are a special case because those substances negate the ability to choose. As I explain in Saying Yes, this belief is a tenet of voodoo pharmacology, which posits that drugs take control of people and compel them to act against their own interests.
Survey data, which show that people can and generally do use both legal and illegal drugs without developing life-disrupting habits, contradict that theory. Observational and laboratory research confirms that the way people react to drugs is not pharmacologically determined but highly contingent on the circumstances and incentives they face, as psychologists such as Stanton Peele, Bruce Alexander, and Carl Hart have been pointing out for many years.
Contrary to Humphreys' scenario of "a starving person" who chooses drugs over food, even heavy users will delay gratification in exchange for small financial rewards. The animal experiments that lent credence to Humphreys' depiction of compulsive drug use turned out quite differently when rats were placed in stimulating environments in the company of other rats. Since humans are a lot more complicated than rats, it is not surprising that their patterns of drug use vary widely across situations.
The same person who uses a drug heavily in one context (at war in Vietnam, for instance) will use it moderately or not at all in another. That point was vividly illustrated by the spike in drug-related deaths during the pandemic, which was plausibly attributed to social, economic, and psychological factors such as financial insecurity, emotional stress, isolation, and disengagement from meaningful activities. As Hart observes, those same factors explain why addiction, contrary to government propaganda, "is not an equal-opportunity disorder."
There is plenty of room for argument about what the government can or should do about the conditions that drive addiction. But one thing is clear: What the government is doing now makes matters worse by creating a black market where the composition of drugs is uncertain, unpredictable, and highly variable. Prohibition compounds that hazard by pushing traffickers toward more potent products, which are easier to smuggle, and by reducing access to less dangerous options.
The ongoing surge in fentanyl-related deaths illustrates all of those phenomena. Black-market drugs were already iffy because of prohibition; the prohibition-driven rise of fentanyl has made them even more of a crapshoot. And these are the substitutes that nonmedical opioid users resorted to after drug warriors succeeded in reducing the supply of pain pills. Instead of legally produced, reliably dosed pharmaceuticals, they are consuming mystery pills and powders that are far more dangerous because it is impossible to know what they contain. The upshot of recent restrictions on prescription opioids, in addition to the scandalous undertreatment of pain, is more drug-related deaths, exactly the opposite of what the government ostensibly was trying to achieve.
Humphreys has nothing to say about any of this. Instead he blames San Francisco's supposedly "libertarian" culture, which cannot possibly explain why drug-related deaths have been rising across the country, a trend that accelerated after the crackdown on pain medication. His solution is less tolerance, along the lines of Portugal's drug policy.
"Portugal is in no way a libertarian country," Humphreys writes. "Rather, it's a cohesive, communal society in which drug use is culturally frowned upon rather than celebrated as a sign of freedom. When drug-addicted people commit crimes in Portugal, they are sent to a 'dissuasion committee' that can apply penalties to those who refuse to seek and stay in addiction treatment. Informally, this is backed up by pressure from family and community for addicted individuals to enter recovery."
Humphreys is right that Portugal's approach is not libertarian. While "dissuading" drug users is preferable to arresting, prosecuting, and incarcerating them, it shows little respect for individual autonomy. Humphreys is comfortable with that because he thinks individual autonomy is meaningless in the context of drug use. Hence he thinks San Francisco should "use court authority to mandate addiction treatment more broadly than it currently does."
In principle, that court authority, backed by the threat of punishment, could be deployed against heavy drinkers as well as illegal drug users. In practice, that generally does not happen, but only because of the arbitrary line that the government has drawn between alcohol and currently prohibited drugs. If you use the latter, that in itself is a criminal offense that can trigger coercive "treatment." But you are free to destroy your liver and your life by drinking too much unless you commit a crime, such as driving while intoxicated.
Humphreys does not bother to justify that distinction, which he takes for granted. He likewise takes for granted the lethal impact that the war on drugs has on the people he is keen to help.
*CORRECTION: This article originally misidentified Humphreys as a psychiatrist.