San Francisco Releases Roadmap to Reduce Drug Overdoses and Promote Wellness and Recovery of People With Substance Use Disorders

The 2022 Overdose Prevention Plan contains strategies aimed at reducing the overall overdose death rate and lessening disparities among Black/African Americans
September 28, 2022

San Francisco, CA – Mayor London N. Breed and the San Francisco Department of Public Health (SFDPH) today released a strategic roadmap to address drug overdose deaths in San Francisco, further building on the progress that has already been made in saving lives and promoting the recovery of people who use drugs.

“Overdose Deaths are Preventable: San Francisco’s Overdose Prevention Plan” introduces new and enhanced strategies to lower disparities and morbidity associated with drug use in San Francisco and includes measurable goals to reduce overdose deaths and increase treatment among people at high risk.

The plan sets ambitious goals of reducing overdoses in San Francisco by 15% by 2025; reducing racial disparities in overdose deaths by 30% by 2025; and increasing the number of people receiving medications for addiction treatment by 30% by 2025.

“We need to turn the corner on the crisis of overdose deaths and the high levels of addiction driven by the flood of fentanyl in San Francisco,” said Mayor Breed. “This strategic overdose plan has the right elements in place to save lives and create positive change in communities impacted by public drug use. The tools in this plan will help us make progress while we work with our partners at the state and federal governments to address an issue that impacts not only San Francisco, but our entire country.”

A cornerstone of the plan is to create multiple “wellness hubs” as drop-in locations for people who use drugs and people experiencing homelessness to come in off the streets and be connected to care and services. These wellness hubs will include the effective elements learned from the Tenderloin Center in new, community-centered locations across San Francisco. The wellness hubs are part of SFDPH’s broader goal to reduce public drug use by providing safe and trusted places for people to visit. It is part of other outreach efforts across the behavioral health system to engage with people who use drugs and provide pathways to improve wellness and receive substance use treatment.

During the next three years the plan will increase access to medication, add residential step-down beds, and double the distribution of naloxone, the life-saving antidote to opioid overdoses.

“In this strategic overdose plan we are applying tools that are proven to be effective, while also continuing to innovate on new solutions to our city’s behavioral health challenges,” said Director of Health, Dr. Grant Colfax. “San Francisco has long been a leader in our responses to public health crises, and we are confident that working together with a community-centered approach that is rooted in equity we will make progress and save lives together.”

Evidence and Equity-Based Approach

San Francisco’s four-part, strategic plan is evidence-based, equity-oriented, and will improve the health and wellbeing of people who use drugs and the communities in which drug use and overdoses occur. As the City works to reduce the overall overdose death rate, it is implementing strategies to lessen the disparities in overdose deaths among Black/African American San Franciscans, whose opioid overdose death rate is five times higher than the citywide rate.

To achieve these goals, the four strategies outlined in the report include expanding availability and accessibility of the continuum of substance use services; strengthening community engagement and support for at high-risk individuals; increasing coordination among City departments; and tracking overdose trends and related drug use data to inform ongoing public health responses.

In the past year, San Francisco served more than 4,500 people for specialty services for substance use disorders across 47 sites, with more than half of those enrolled in opioid treatment programs. SFDPH also treated more than a thousand people with buprenorphine in primary care clinics and through its health program for people experiencing homelessness, known as Whole Person Integrated Care. Thousands more people received substance use treatment outside of SFDPH’s safety net system.

“This strategic overdose plan builds upon the many successful efforts already underway in San Francisco, but with renewed focus, energy, and dedication to reducing racial disparities to reduce the tragic loss of life among San Franciscans,” said Dr. Hillary Kunins, Director of Behavioral Health Services. “We recognize that with the ever-changing nature of drug use and drug overdoses, our public health responses will also need to evolve and so we are taking a data-driven, outcomes-oriented approach to evaluating our programs to ensure that our responses are effective and tailored to the needs of the community.”

The Path Forward

In addition to opening the first wellness hub by the end of 2022, other actions include opening 70 new residential step-down beds in 2023. These overnight beds add to the City’s rapidly expanding residential care program for mental health and substance use disorders – now two-thirds of the way toward a goal of 400-new beds to provide timely and appropriate levels of care across the system. Meanwhile, as implementation of the overdose plan ramps up, SFDPH will coordinate overdose prevention efforts though a new Office of Overdose Prevention.

In 2023, San Francisco will open two more wellness hubs to co-locate services and improve the health of people who use drugs. Within three years SFDPH will have substantially expanded the distribution of naloxone to 100,000 kits annually citywide, putting this overdose reversal medicine into the hands of tens of thousands of San Franciscans, many of whom will also be trained to take immediate action to save lives.

By three years, the City will have placed naloxone kits in every supportive housing facility in the city, and will have increased the number of people receiving medication for addiction treatment for opioid use disorders, namely methadone and buprenorphine, by 30%. This will be done by making it easier for people to access medicines in settings such as urgent care clinics, shelters, and on the street.

“The Overdose Prevention Plan is the direct result of our close and long history of collaboration with the San Francisco Department of Public Health in developing harm reduction and other health-related interventions that are needed to meet the basic needs of people who use drugs,” said Laura Guzman, Senior Director of Capacity Building and Community Mobilization at the National Harm Reduction Coalition. “This plan incorporates a clear equity focus and invites our city to place overdose prevention efforts in communities most impacted by overdose deaths, asking for specificity in how to serve the needs of Black and Latino/x populations, unhoused people and those living in SROs hotels.”

This plan will be revised annually as new strategies are identified and lessons are learned and with ongoing input from stakeholders and community members across the city.

A complete copy of the report is available here: