San Francisco’s Tenderloin neighborhood harbors the weight of the city’s ongoing drug and homelessness crisis, and the City and County of San Francisco has failed to deliver substantial and long-lasting government policies to address the neighborhood’s plight. From police sweeps to coordinated entry, harm reduction to interim shelters, the City of San Francisco has consistently failed to provide the necessary resources and funding to alleviate the drug and homelessness crisis plaguing the Tenderloin.
As I walked through the Tenderloin, past my uncle’s barbershop and my father’s old single room occupancy, past my favorite phở restaurant and my cousin’s old preschool, I stepped over human feces, urine streams, power wash suds, and people passed out on the sidewalk. The Tenderloin is home to the highest concentration of children in any San Francisco neighborhood, along with Vietnamese immigrants who fled their homeland after the fall of Saigon, and the largest Muslim community in the city. The famed bánh mì shops, local mosques, and small businesses mark the neighborhood for what it is today.
But San Francisco’s devastating fentanyl and homelessness crisis has shrouded this neighborhood in needles, burnt foil, and temporary tents.
Since the start of the COVID-19 pandemic, deaths by drug overdose have doubled in San Francisco — much of it happening on the streets of the Tenderloin, where the fentanyl market runs rampant. In August of 2025, of the 48 people who died of overdoses in San Francisco, 38 died from fentanyl use. In July of 2025, 79% of the 53 overdose deaths in the city involved fentanyl.
Despite former San Francisco Mayor London Breed’s crackdown on open-air drug markets in the Tenderloin, the fentanyl market ensues. Dealers clocked in ski masks greet crowds of swaying and screaming customers, completely indifferent to the police driving through the neighborhood.
The drug crisis in the Tenderloin is “so bad,” an anonymous Tenderloin resident and restaurant owner told me. They reported walking home in the street to avoid the crowds of drug users who line the sidewalks. Daily encounters with drug users are common in the Tenderloin. Harry, a first-year student at UC Berkeley who grew up in the neighborhood, has witnessed people doing drugs on the street ever since he was a child. “I didn’t really know what they were doing, but they [were] covered under blankets [and] lighting stuff,” he said.
San Francisco’s embrace of harm reduction strategy dates back to the Summer of Love in 1967. This strategy aims to minimize the dangerous consequences of drug use by providing resources to use safely, including clean needles or new strips and aluminum foil. Grassroots organizations in the Tenderloin have invested resources in promoting safe drug use, a methodology that has reduced overdose deaths in the United States and controlled the spread of HIV infections during the AIDS epidemic. While some unhoused people rely on substances to stay alert to guard their possessions through the night, others’ drug use fuels their struggles with homelessness.
Supporters of harm reduction also tout the benefits of the policy in alleviating housing insecurity. According to Marichelle Alcantara, director of the Housing Consortium of the East Bay, unhoused individuals who feel supported in their drug use and substance abuse disorder are more likely to accept housing services.
However, harm reduction has faced significant backlash. In September 2025, Tenderloin residents and small business owners sued the City and County of San Francisco for allowing the proliferation of drug use in the neighborhood through the distribution of drug paraphernalia. The lawsuit alleged that the city’s tolerance of harm reduction kit distribution is perpetuating the drug crisis by encouraging drug users to flock to Tenderloin streets in search of straws, foil, and needles.
In line with this backlash, Mayor Lurie scaled back the city’s harm reduction efforts. In May, he restricted the distribution of harm reduction kits to city-sanctioned indoor spaces, contrary to historical practices of pitching pop-up distribution sites outdoors where drug users reside. To get more insight into how the Mayor’s shifting policy impacts San Francisco’s unhoused population, I spoke with Siena Elvin, a UC Berkeley Master of Public Policy student focused on homelessness who worked as a housing case manager in Santa Cruz County. Elvin claims that pushing harm reduction distribution sites indoors is “not really aligned with best practices.” She emphasized the importance of accessible services, adding, “We don’t need to be adding more barriers to accessing harm reduction services.”
The Mayor has also attempted to nudge drug users toward treatment programs by requiring organizations handing out harm reduction kits to display brochures with information for rehabilitation programs. However, many of these nonprofit organizations fail to display these brochures in easily accessible places and neglect to hand them out with every harm reduction kit. Without a clear and informative roadmap regarding drug treatment programs, these brochures put the burden of seeking out treatment on the very people coming to the nonprofit tents with the intention of getting high.
But when harm reduction is not paired with concrete solutions to tackle homelessness, it’s simply a bandage on the larger drug crisis choking out the Tenderloin.
On March 17, 2025, Mayor Lurie signed Executive Order 25-02, titled “Breaking the Cycle,” which outlined a course of action to tackle the homelessness and behavioral health crisis in the Tenderloin head-on. Within six months, the government promised to add 1,500 beds, fulfilling the Mayor’s campaign promise.
To fund Lurie’s “Breaking the Cycle” plan, the Mayor dedicated $30 million from Proposition A, which allocates funding toward addressing San Francisco’s homelessness crisis, toward interim housing. Elvin stressed that interim housing is a temporary solution that “takes funds away from permanent housing,” leaving people stuck in a perpetual cycle of interim housing. Elvin believes that while expanding interim beds is a good initial step, it “disrupts the ultimate goal [of] permanently housing people.”
Angelina Schaffet, an unhoused individual, told Mission Local that she refused to stay in a shelter, emphasizing how prevalent theft and sexual assault are in these confined shelter spaces. According to Cal Matters’ investigation into homeless shelters in California, shelters are plastered with black mold and bedbugs, and a scene for violence of all kinds. Shelter layouts also tend to lack privacy, with cots lined up in an open warehouse space. Despite the danger posed by shelters, they are often full, forcing unhoused individuals onto a waitlist.
Not only does interim housing without a feasible roadmap to permanent housing fail to address homelessness in the long term, but it also structurally inhibits unhoused individuals from independently attaining employment and permanent housing.
Take the Dolores Shelter Program in the Mission, which provides case managers, hot meals, and a bed. The shelter only allows overnight stays from 6 p.m. to 8 a.m., requiring individuals to take their things and leave by early morning. The Dolores Shelter Program serves people on a first-come, first-served basis, seeing people line up at 5:30 p.m. while others are turned away when beds are full. When unhoused individuals have no place to leave their possessions, they are inhibited from finding work, achieving financial independence, and securing permanent housing.
Other shelters in the city only offer a bed for a limited period of time. Rather than waiting for individuals to land a secure job and make the transition to living in permanent housing, shelters like Hospitality House restrict beds to 90 days. According to Elvin, when shelter stays impose strict stay limits, unhoused individuals shift their focus toward a “crisis of avoiding getting kicked out of where they are currently staying.”
Since July, Lurie has pivoted from his 1,500-bed promise, having only delivered 400. Even if Lurie created 1,500 shelter beds, which he emphasized consistently during his mayoral campaign, optimizing for interim shelter beds fails to address the mental health and substance abuse disorders many unhoused individuals face.
In an op-ed written for the San Francisco Standard, Chief of San Francisco’s Health and Human Services Kunal Modi stressed that “someone hooked on fentanyl needs more than a place to sleep.” Despite the city investing over $1 billion every year on over 25,000 shelter beds, Modi noted that San Francisco failed to see a significant decrease in the number of unhoused individuals living within San Francisco “because the system lacks flow.” The lack of treatment access and medical support has left San Francisco’s unhoused population stagnant in their interim shelter beds, or bouncing from emergency rooms, back to the streets, and back in temporary shelters that lack the resources to address their clinical needs.
At the end of September, just six months after Lurie signed the executive order, I asked the restaurant owner on Jones Street if she’d noticed any improvements in the Tenderloin. She shrugged and asked, “What’s changed?” After living in the neighborhood his entire life, Harry says he “hasn’t seen improvements.”
To truly address the homelessness and drug crisis in the Tenderloin, the City and County of San Francisco must significantly reform their coordinated entry system, which relies on government partnerships with local, grassroots organizations, and word of mouth to get unhoused individuals and drug users access to resources. By visiting access points around San Francisco, unhoused individuals can connect with temporary shelters, financial assistance, and employment opportunities. While access points are listed on the San Francisco government website, many unhoused individuals lack access to the internet and rely on word-of-mouth contact from an outreach worker to get information about services.
Reforming the coordinated entry system requires a staff of “well-trained, informed outreach workers.” Elvin stressed that interactions between outreach workers and people experiencing homelessness are essential to build trust and promote existing services. “The solution to homelessness is…funding,” a former Compass case manager told me. Speaking on her experience working as a case manager, “everyone was bone-tired.” Social services is a “stressful, emotionally taxing job,” she said, highlighting how more staff are needed to provide quality service and resources to those seeking them. While Lurie has centralized outreach efforts through “Breaking the Cycle,” this effort must continue in the long term before substantial changes can be made to the homeless and drug rehabilitation services system.
Rather than focusing their attention on adding more interim shelter beds, the City and County of San Francisco must instead focus on accommodating what unhoused and substance-using individuals actually need. According to District 5 Supervisor Bilal Mahmood, who oversees the Tenderloin, less than 50 beds are available at any time of day. “It’s almost like a race between each ad hoc team in every neighborhood to get to the bed as fast as possible,” he said.
Without sufficient funding and programs to direct unhoused individuals into permanent housing, less than 25% of people living in interim housing ever get placed in permanent housing. Unhoused individuals who have lived on the street for long periods of time are often “not accustomed to being indoors,” Elvin told me. According to Elvin, it can take unhoused individuals several tries to feel comfortable in indoor shelters.
Even in permanent housing, the city fails to address formerly unhoused individuals’ substance use disorders and clinical needs. Modi stressed that over a quarter of San Francisco’s recorded overdose deaths in 2024 occurred in city-funded permanent supportive housing.
San Francisco is currently working toward a systemic reform that prioritizes clinical care and permanent housing, creating a “coordinated system of care” that challenges the former “pathwork of nonprofit partners,” according to Modi. If San Francisco truly wants to eliminate homelessness and reduce death by drug overdose, the city must invest in hiring more case managers, developing mental health treatment plans, funding medical care, promoting employment opportunities, and providing a foundational pathway toward permanent housing to properly support the needs of unhoused individuals.
Featured Image Source: Wikimedia Commons
