Supervisor Preston Calls For Implementation of Zurich’s Four Pillars Strategy to Address Overdose Crisis
The Four Pillars Strategy— founded on close interdepartmental collaboration— is proven to save lives, improve street conditions, prevent addiction, and connect people to treatment
District 5 Supervisor Dean Preston is calling on the City to implement a comprehensive anti-addiction, anti-overdose drug strategy that has been operating successfully in Zurich, Switzerland, for decades. The Four Pillars Strategy includes four main areas of focus— or pillars— that are meant to address addiction and its short and long-term consequences: prevention, treatment, harm reduction, and enforcement.
Preston’s call comes on the heels of the latest report by the Office of the Medical Examiner, which reported earlier this month that the total number of overdose deaths reached 806 through last year– the highest level the city has ever seen by triple digits. In addition to the increase in total deaths, racial disparities also increased for Latinx and Black residents, who saw an increase in overdose deaths by 45% and 38%, respectively. The increase occurred despite significant investments and ramp-up of arrests by the San Francisco Police Department, San Francisco Sheriff’s Office, and state and local law enforcement, which began aggressively targeting and arresting drug users in May 2023.
“It could not be clearer that what we are doing is not working and we need to hit the reset button,” stated Preston. “City leaders need to stop chasing headlines and start implementing successful, evidence-based solutions like Zurich’s Four Pillars Strategy.”
Before the implementation of the Four Pillars Strategy in the 1990s, Zurich faced deplorable street conditions, high rates of addiction, and overdose fatalities. The implementation of the Four Pillars transformed the City and has since become an international success story and model. The Four Pillars Strategy ultimately recognizes that addressing the drug crisis requires cities to address harmful street conditions, provide support to people who use drugs to ensure they do not die from overdose, and also invest in programs that will help prevent and treat addiction through a collaborative approach that includes Public Health, housing agencies, social services, and law enforcement as equal partners in planning and coordination. The concept of “stadtverträglichkeit,” or city compatibility, emerged as a guiding principle by finding an equilibrium where a certain level of police enforcement is needed to maintain public order and quality of life, without impeding the accessibility of harm reduction facilities for drug users.
The Four Pillars Strategy was presented locally late in 2023 after Zurich sent a delegation of public officials, police officers, and public health and harm reduction workers to San Francisco as part of the Sister City Program. The delegation met with various departments, members of the Board of Supervisors, and participated in a public panel to share their knowledge and experience with San Franciscans. Feedback from these meetings was overwhelmingly positive, with participants feeling inspired by the model. Despite the delegation’s visit, however, the City’s response appears to remain overwhelmingly led by a law enforcement response that includes arresting hundreds of people with drug dependency for their drug use.
“While San Francisco is not Zurich, I do not accept for a minute that we cannot do this here. Our constituents are tired of the failed strategies, false promises, and over-reliance on strategies shown over and over again not to work,” stated Preston. “We can take a successful model and implement a real plan to save lives, help people, and improve street conditions.”
Preston has directed the city’s Budget and Legislative Analyst to prepare, on an expedited basis, a road map for San Francisco to implement the Four Pillars Strategy. The BLA report is expected to be completed within two months.
