San Francisco Department of Public Health Launches New On Demand Long-acting Injectable Buprenorphine Pilot At Maria X Martinez Health Resource Center Made Possible By Breaking The Cycle Fund

San Francisco, CA – The San Francisco Department of Public Health (SFDPH) has launched a new pilot program at the Maria X Martinez Health Resource Center (MXM) that expands access to same- day treatment for opioid use disorder using a $500,000 grant from the Breaking the Cycle Fund.  MXM is one of the City’s largest low-barrier clinics serving people experiencing homelessness.  While same-day treatment is already available through SFDPH, the On Demand Direct-to-Inject Pilot enables patients to receive their first dose of long-acting injectable (LAI) buprenorphine directly at MXM for the first time, eliminating additional steps that can delay care. The pilot is funded through the public-private Breaking the Cycle Fund, part of the broader Breaking the Cycle initiative launched by Mayor Daniel Lurie, which aims to improve access, coordination, and outcomes across the city’s homelessness and behavioral health systems.

“As we’ve transformed San Francisco’s response to homelessness and behavioral health over the last year and a half, we’ve made clear that recovery is possible—and that our city has a responsibility to be there for people the moment they’re ready,” said Mayor Daniel Lurie. “When someone shows up for treatment, we should be able to provide it that day, and this pilot increases our capacity to meet that need. Keeping San Francisco safe and delivering better outcomes for our city’s most vulnerable residents requires an all-hands-on-deck approach, and through the Breaking the Cycle Fund, we’re bringing public and private partners together to move faster, test new approaches, and do more of what works.”

“At the Department of Public Health, we have prioritized expanding access to treatment and to making sure treatment is available quickly and easily for people in the streets. Immediate access to medication for addiction treatment is one of the most effective strategies for both preventing overdoses and helping people advance in their treatment and recovery journey,” said San Francisco Director of Health Daniel Tsai. This new initiative, supported through the Breaking the Cycle fund, does exactly that. This pilot will bring lifesaving treatment to patients when they need it most.”

The pilot expands access to LAI buprenorphine and allows MXM to store and administer these medications onsite for the first time. Clinicians say this is critical for meeting people in the exact moment they are ready to begin treatment, particularly when withdrawal symptoms make returning on another day extremely difficult. LAI buprenorphine is particularly helpful for individuals who face barriers to taking a daily medication, or experience side effects from sublingual buprenorphine.  LAI buprenorphine is currently available on demand at Zuckerberg San Francisco General Hospital, the SFDPH Sobering Center, the Behavioral Health Services Pharmacy, and the BEAM program at 1380 Howard Street.

“Getting treatment for clients experiencing opioid use disorder, especially when fentanyl is involved, has been extremely difficult for many patients. Withdrawal symptoms are often intolerable,” said Whole Person Integrated Care Chief Medical Officer Joanna Eveland. “By offering long-acting injectable buprenorphine on demand, we can meet people in the exact moment when they are ready for treatment.”

Over the past two years, SFDPH has shifted from a crisis response model toward a recovery-driven system centered on faster, lower-barrier, and more clinically intensive interventions. This includes significant investment to expand treatment on demand, which has enabled nearly 80% of clients interested in same- or next-day treatment to access it and increased the number of patients on medications for opioid use disorder (MOUD) by nearly 30%. The On Demand Direct-to-Inject Pilot builds on this progress by removing delays, expanding immediate access to evidence based treatment, and offering a pathway to long term recovery for people at highest risk of overdose.

A One-Stop Clinic Designed to Save Lives

MXM serves more than 21,000 patients annually, more than 75% of whom are experiencing homelessness. With the launch of the On Demand Direct-to-Inject Pilot, MXM becomes a true one-stop clinic where patients can receive evaluation, stabilization, medication, follow-up care, and connection to long-term treatment in a single location. This model reduces missed appointments, increases engagement, and helps prevent overdoses by ensuring treatment can begin without delay.

The SFDPH Street Team often meets people when they are ready for help with their substance use disorder yet are managing several urgent health concerns at the same time. In the past, getting someone into treatment could require multiple stops or return visits, which created delays, missed opportunities, and preventable overdoses. With this pilot, Street Team members can bring patients directly to MXM for same day treatment and stabilization, allowing clinicians to address opioid withdrawal alongside the other medical needs that often accompany homelessness.

“With this pilot, our Street Team staff can transition someone directly from street outreach into care in a single visit,” said DPH Ambulatory Services Division Chief Administrative Officer Aman Lail. “That change will save lives by making treatment faster, simpler, and more accessible for people who need it most.”

The total cost of implementing the On Demand Direct-to-Inject Pilot is approximately $500,000. Most of this investment supports the purchase of 460 starting doses and 500 follow up doses of the medication over two years. Additional costs include the installation of secure narcotics safes at pilot sites and auditing software that ensures safe storage, tracking, and compliance.

A Key Strategy in Breaking the Cycle

The Breaking the Cycle Fund is a groundbreaking public-private partnership that provides critical resources to pilot programs and projects that realize Mayor Lurie’s vision for transforming the city’s behavioral health and homelessness response.  The Breaking the Cycle Fund invests in pilots and demonstration projects that are scalable and if successful, can be replicated so that more people can benefit.  In addition to the LAI pilot, examples include a grant program that has supported critical repairs and vacant unit reactivation in more than 60 permanent supportive housing buildings. The Breaking the Cycle Fund is managed by the Housing Accelerator Fund, in partnership with Tipping Point Community and the San Francisco Foundation.

Breaking the Cycle philanthropic funding covers nearly all of the pilot expenses. SFDPH contributes staffing, facilities, and operational oversight to support successful rollout and long-term sustainability. This shared investment allows the city to expand lifesaving access to medication while maintaining responsible financial stewardship.

“When someone is ready for treatment, every barrier is a missed opportunity. The Breaking the Cycle Fund invests in innovative solutions that remove those barriers, save lives, and create models the City can scale,” said Rebecca Foster, CEO of the Housing Accelerator Fund.

Expansion Plans

The pilot begins at MXM and is designed to expand to up to five additional SFDPH clinics in 2027. This phased expansion allows the department to refine workflows, evaluate safety and effectiveness, and strengthen the model before determining whether it can be adopted citywide.

The pilot will run through April 2028. SFDPH will evaluate impacts on overdose events, emergency room use, hospitalizations, treatment retention, and overall engagement in care to help determine the long-term role of same-day initiation across the SFDPH primary care system.

About Maria X Martinez Health Resource Center

Located at 555 Stevenson Street, MXM is the city’s central low-barrier clinic for adults experiencing homelessness. The center provides urgent care, wound care, primary and behavioral health services, TB testing, HIV treatment and prevention, dental services, and medications for addiction treatment.  MXM is part of SFDPH’s Whole Person Integrated Care (WPIC) section which consists of non-traditional primary care, urgent care, and behavioral health clinical services primarily serving people experiencing homelessness.

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