SF Department of Public Health Treatment on Demand Report Shows Gains in People Accessing Drug Treatment as Fatal Overdoses Decline

San Francisco, CA — The San Francisco Department of Public Health (SFDPH)’s annual Treatment on Demand Report shows the city is making progress in combatting the fentanyl crisis by getting more people quickly into treatment. In addition, the FY 24-25 report includes new, improved measurement of how quickly people are able to access substance use treatment. This analysis provides greater insight into where SFDPH must improve services to realize treatment on demand.

Overall, the number of people in drug treatment has increased significantly (by 30% over three years when including more recent data through mid-2026) as a result of the city adding new treatment beds, increasing treatment capacity, and pioneering new ways of helping people access medication for their substance use in the streets and outside of traditional health clinics. Fatal overdoses are declining and more people than ever before are accessing effective drug addiction treatment.

The newly released data in the report show that overall, 78% of SFDPH clients were offered same- or next-day access to addiction treatment services. However, 41% of the time individuals wanted to enter residential withdrawal management (detox), they were not able to gain same day or next day access. Access to withdrawal management is critical as it is often the first step for an individual to enter residential drug treatment.

“For the first time, we can quantify our ability to provide treatment on demand in San Francisco,” said SFDPH Director Dan Tsai. “The data show we are succeeding in significantly increasing the number of people getting treatment. But the data in the new report also show where there are barriers to people quickly accessing care. This insight is critical in removing roadblocks so that people who raise their hand for help can receive treatment on demand, quickly and without having to jump through hoops. We will use this data as we bring on new beds and resources to improve access to treatment on demand.”

“Treatment on demand is still far from what voters were promised, but this is the most honest DPH has been about where the system falls short," said Board of Supervisors President Rafael Mandelman. "For the first time, we have the data to work toward closing the gaps and to track outcomes. I've called for a hearing on this report, scheduled for December 10 at the Public Safety and Neighborhood Services Committee, so the Board can dig into the data and push for solutions."

“People are not getting timely access to treatment and that’s unacceptable,” said Dr. Hillary Kunins, Director of SFDPH Behavioral Health Services. “The data in this report gives us a fresh perspective on the challenges we face so that we can improve our efforts to provide timely access to treatment, and support people on their path to recovery.”

Importantly, the report sheds light on common reasons why individuals were not able to access withdrawal management on the same or next day. Common reasons for an inability to immediately access withdrawal management services included a need for more medically intensive or psychiatric support, or because the individual had mobility needs that could not be addressed in available rooms. For example, 30% of cases where individuals did not receive same or next day access to withdrawal management were due to a different or greater clinical need than could be served at existing sites.

SFDPH is using better measures of timely access to help identify and remove barriers to treatment entry at the critical moments when individuals are seeking help. SFDPH and contracted providers can and will make many improvements under their control. However, current state licensing requirements and policies also pose barriers to treatment on demand. For example, state requirements limit the ability of licensed residential treatment providers to care for people with medically complex conditions. SFDPH has requested common sense waivers and flexibilities from the state to better be able to get treatment to people.

SFDPH has opened more than 200 new residential treatment and care beds since January 2025, including additional respite, withdrawal management, residential treatment, and recovery housing beds. Another 200 beds are on track to open in the next few years, including psychiatric emergency and acute mental health beds, residential substance use treatment beds, dual diagnosis, sobering, and recovery housing.

An estimated 37,500 people in San Francisco are at risk of substance use-related harm. Among these, an estimated 15,000-19,500 may be eligible for SFDPH services, including many already in SFDPH care. SFDPH specialty substance use treatment served approximately 6,000 unique clients in FY25-26 and the number of unique clients in specialty substance use treatment has risen by 30% over the past three years, including programs at every step of the recovery continuum. Across SFDPH’s greater system of care, more 17,000 unique individuals received some kind of substance use treatment or care in FY 24-25.

Opioids, followed by stimulants, are the main drivers of overdoses in San Francisco. Fatal overdoses in San Francisco this year are down 24% over the previous year, and 38% lower than the height of the fentanyl crisis in 2023. Over the same period, SFDPH has seen a steady rise in people in people receiving medications for opioid use disorder (up 29% from FY 24-25) and has grown the number of programs offering contingency management, the most effective intervention for people who use stimulants such as methamphetamine and cocaine.

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