Several people stand in front of an evergreen tree covered in small white lights. They are holding vertical white banners displaying lists of people's names in colorful letters. Other banners are spread on the ground in front of them. A woman with shoulder-length gray hair wearing a black coat addresses the crowd speaking into a microphone on a stand.

2023 Is San Francisco’s Deadliest Year on Record for Drug Overdoses

Last Thursday San Francisco’s chief medical examiner released the city’s updated overdose death count — 752 so far — making 2023 the worst year on record for drug-related fatalities. One-third of those people were listed as having no fixed address. Later that day, a crowd gathered at Civic Center Plaza to remember more than 420 who died in the city while experiencing homelessness this year.

A man in his eighties sits on his bed in a small single-room occupancy residence in Chinatown. Behind him is a window where he hangs his clothes. There are assorted items beside him, including a desk fan, a television, newspapers and cardboard boxes.

Protecting Chinatown’s Older Adults From Climate Disasters Requires More Funding, Nonprofits Say

Community organizations say the systems in Chinatown to protect older populations during extreme weather are not enough to meet the needs that could arise. Without sufficient financial backing, the health of many older residents in the neighborhood could be threatened during extreme weather disasters. Similar scenarios could transpire in San Francisco’s other climate-vulnerable areas.

Red lanterns and flags are strung across the roadway on a block in San Francisco's Chinatown. Most of the three and four-story buildings have shops on the ground floor and apartments or offices above. Many of them have wrought iron balconies that are painted green.

For Chinatown’s Older Residents in SROs, Climate Disasters Pose Greater Risks

Chinatown faces higher threats during periods of extreme weather due to a range of socio-economic factors as well as the built environment. Within the neighborhood, older adults living in single-room occupancy buildings are among the populations at heightened risk. Reasons for this include physiological changes related to aging and financial barriers associated with making climate-resiliency adaptations to older buildings.

A young Latina with straight, long dark hair wears a lilac top and a jean jacket. She is smiling standing on a sidewalk near the intersection of a city street.

SF Students, SRO Residents Train to Reverse Drug Overdoses

Experts in overdose prevention say many teen and adult lives could be saved if more people know how to identify and respond to overdoses. In San Francisco, an array of programs are providing overdose response training to teenagers, college and medical-school students, and residents in neighborhoods that have a high rate of overdose deaths.

Two women are speaking to each other at a protest rally on a plaza outside of San Francisco City Hall. They are Supervisor Hillery Ronen, who holds a pink sign that reads "We Love Marginalized Communities," and Vitka Eisen, CEO of HealthRight 360, who holds a sign that reads "Harm Reduction Works." They are both wearing jeans and black T-shirts. Many of the people standing around them are similarly dressed.

City Officials Lack Urgency to Prevent Overdose Deaths, Say Safe Consumption Proponents

Several weeks after a crucial legal hurdle blocking safe consumption sites in San Francisco was seemingly resolved, proponents said they were dismayed that city leaders and public health officials were still not greenlighting centers that could reduce deaths related to drug use.

Overdose deaths have reached 620 this year — on track to have the highest annual tally since counting began, with fentanyl causing the vast majority of fatalities, according to the chief medical examiner’s latest report.

A San Francisco Sheriff's Department prisoner transport bus arrives at the San Francisco County Jail in San Bruno. The cream-colored bus is driving through the entrance, which is flanked by two brown brick walls. A series of tall, narrow traffic cones appear on the left side of the frame. District Attorney Brooke Jenkins criticizes the use of pretrial diversion programs offering defendants accused of selling drugs rehabilitation, counseling and training rather than jail sentences. Many such suspects are held at the San Francisco County Jail in San Bruno.

DA’s Opposition to Drug Diversion Programs Undermines Public Safety, Say Legal Advocates

San Francisco District Attorney Brooke Jenkins has criticized and diminished the use of diversion programs that offer criminal defendants accused of selling drugs rehabilitation, counseling and training rather than jail sentences.

Since taking office 15 months ago, Jenkins has reduced the number of referrals to the San Francisco Pretrial Diversion Project by 70%, according to its CEO David Mauroff.

And as San Francisco’s rate of overdose fatalities reaches more than two deaths a day, Jenkins is pushing for defendants accused of selling drugs to remain in jail. But some legal experts say that’s a bad strategy both for the defendants and for public safety.

A rally at City Hall with a sign reading "Every Overdose Death Is a Policy Failure" #fundharmreduction

Drug Crackdown Has Sparked Violent Turf Warfare in Central San Francisco, Supervisor Says

A drug crackdown in the Tenderloin and South of Market has resulted in more than 600 arrests, with authorities seizing more than 200 pounds of fentanyl since the initiative launched in May, Mayor London Breed said.

But the coordinated effort, involving city and state law enforcement agents, appears to be leading to violent clashes, said Supervisor Dean Preston, whose district includes the Tenderloin. “They’re poking a hornet’s nest,” he said in an interview.

Three people wearing vests and jackets with city logos speak with a man standing in the entrance of a tent covered with plastic tarps on a city sidewalk.

SF ‘Failing’ on Housing as Overdose Solution, Health Expert Says

Sarah Evans has spent decades advancing drug overdose prevention initiatives around the world. As a division director for Open Society Foundations — a grantmaking network founded and chaired by business magnate George Soros — Evans promotes one surefire way to help abate San Francisco’s homelessness and fatal overdose crisis: housing.

“The way that people get off the street is by getting into housing, where people can get support and stay there even while they are continuing to struggle with substance use disorders of all kinds and mental health issues,” said Evans, who leads the organization’s drug policy programs globally. “It literally is the only way.”

San Francisco isn’t doing enough to meet this housing need, according to health experts.

Susan Lefever, wearing a black jacket and crossbody purse, stands in front of the glass windows of a storefront. There are flyers posted on the glass behind her.

San Francisco’s Fatal Overdose Crisis Was Decades in the Making

As San Francisco continues to search for solutions, our team at “Civic” is exploring the origins of the city’s opioid overdose crisis, what has been done to help and what might be making things worse. After six months of research involving hundreds of studies, reports and archival news clippings, and three dozen interviews with people with lived experience and professional expertise in homelessness, addiction, medicine, criminal justice, housing, social work, street outreach, business, education, harm reduction, policymaking and advocacy, we’re launching the series, “San Francisco and the Overdose Crisis.”

Over six episodes, the series will explore what influenced rampant opioid addiction and its connection to homelessness, the 150-year history of policing and prosecuting drugs in San Francisco, the long battle to open a safe consumption site in the city, and grassroots efforts to stem the tide of drug-related fatalities.