SAN FRANCISCO – Reeling from drug overdose deaths and scenes of people smoking fentanyl on sidewalks, San Francisco moved closer Thursday to adopting a “recovery first” drug policy that sets abstinence from illicit drugs as its primary goal, a proposal that has prompted heated debate in the city that pioneered harm reduction.

Opponents of Supervisor Matt Dorsey’s proposal say its emphasis on stopping drug use alienates those who are not ready to quit, while proponents say the city has been far too permissive and making drug use safer does not help break the cycle of addiction.

Dorsey, himself recovering from alcohol and drug addiction, amended the proposal in his public safety committee to clarify that distributing safer-use paraphernalia and linking people to social services regardless of whether they are using remain critical to the city’s response.

But more than an hour of public comment with cheers and boos from both sides underscored just how touchy the issue remains.

“No one dies from harm reduction,” Patt Denning said. “People die from conventional abstinence-based treatments because they’re either left out or kicked out if they don’t comply with abstinence.”

Brendan Harris, who said he has been clean for six years, countered that harm reduction tactics cannot go on forever and people need a firm if compassionate push into treatment.

“We can’t just keep enabling drugs over and over again,” he said.

In recent years San Francisco’s public health department advised people who use drugs to do so with friends to try to prevent overdose deaths. Critics said that sent the wrong message.

Mayor Daniel Lurie, who took office in January, has vowed to solve the city’s fentanyl crisis. Last year more than 600 people died from accidental overdoses.

He ordered city-funded nonprofits to offer treatment or counseling options before giving out certain paraphernalia such as foil and pipes, and they will no longer be allowed to distribute those items in parks and on sidewalks.

As amended, Dorsey’s proposal states that the “long-term remission of substance use disorders for individuals, with the help of fully supported and staffed evidence-based recovery and behavioral health services, shall be the primary goal.”

It also defines recovery as “the process by which an individual suffering from substance use disorder strives to make positive changes that become part of a voluntarily adopted healthy lifestyle.”

Dorsey said abstention should not be a controversial goal and it can mean receiving methadone as part of a medication assisted treatment program. San Francisco offers an array of services to help people addicted to drugs, but many residents only see the free foil and pipes, he said.

“We’re losing the battle on harm reduction when people think that’s all we’re doing,” he said after the hearing.

The San Francisco Marin Medical Society, which represents more than 3,500 physicians, proposed the amendments.

The full Board of Supervisors votes on the proposal next month. It is expected to pass, with seven of the 11 members sponsoring or cosponsoring.