Public safety, houselessness and affordability rank high among San Francisco voters for social issues. 

Yet, fentanyl has created an ongoing public health emergency in San Francisco and the Bay Area, especially within the Tenderloin District. Nationally, fentanyl remains a significant threat, coupled with inflation and a recession. The walls are closing in for people in San Francisco struggling with addiction and those in recovery. These current issues increase the risk of overdose for people addicted to drugs and relapse while maintaining sobriety.

Fentanyl is not going away

It is estimated that around three-quarters of all overdose deaths in San Francisco involve fentanyl, which is generally mixed with other drugs. Representatives in the Tenderloin District point out the city is averaging two overdose deaths per day. 

If you struggle with substance abuse, the risk is high. Fentanyl is found in methamphetamine and cocaine and is commonly made to look like pain medication. 

Overdose prevention remains at the forefront and has had some success with Narcan. Yet organizations struggle to keep up with the increasing number of individuals who use drugs, which is estimated at more than 25,000. 

Clearly, the problem is not going away and is a significant issue facing substance misusers today, especially among unhoused people. UCSF found that deaths of houseless people doubled in the city during the first year of the COVID-19 pandemic, primarily because of drug overdoses. 

The risk of houselessness increases with substance use

Year after year, the number of unhoused individuals in the city has generally increased. In 2022, the city counted more than 7,700 sheltered and unsheltered houseless people, a total which could increase to 20,000. The current situation is worsening, and addiction and mental health issues fuel much of the problem. It is estimated that alcoholism affects 30-40% of unhoused people, while drug addiction impacts 10-15%. Additionally, it is estimated that about 30-40% of unhoused people suffer from mental illness and/or substance use. 

It is a horrible situation to be in as it becomes almost impossible to stop the cycle. Drug dealers prey on the vulnerable, while untreated mental health problems and addiction take a vicious hold. Finding help becomes difficult because access to affordable care is a significant barrier. 

The city continues to focus on harm reduction and the usual plans to solve houselessness, but it fails to address the core issues of substance misuse and the lack of accessible mental-health treatment. Increasing inflation, job loss and recession are forcing more people into poverty and toward houselessness. San Francisco continues to be an expensive city to live in as well. If an individual manages to escape these difficulties, they face another struggle: maintaining recovery and sobriety in a costly world. 

Staying sober and the cost of living

Significant increases in the cost of living have occurred with transportation, food and housing, which impacts everyone. Being in recovery is not easy — add the struggle of affordable living, and it is incredible that anyone in recovery achieves lifelong sobriety. 

However, this is one barrier among many, and people make it work. While inflation and recession are unavoidable at this point, every individual recovering from substance misuse knows it is a marathon, not a sprint, to lifelong sobriety. Yet it is clear that affordability is a significant concern for people in recovery.  

Transitional housing and recovery homes or sober housing in San Francisco become valuable resources to combat the initial struggles with affordability. While this is not an option for everyone, it is an excellent place to begin. Individuals who are not experiencing houselessness can also downsize or move to the suburbs, or even turn to family and friends who are willing to help. Other individuals work multiple jobs and save every last penny. It is not easy and takes discipline, but the payoff can be enormous. 

But it will not get easier with the surging costs of goods and services. Unfortunately, thousands of people remain stuck despite some finding a way out. 

Facing the challenges head-on

With every wall that closes in, there may be a way out, but it is not always possible for everyone. Fentanyl continues to be a public health threat. The combined issues of cost of living and houselessness create many other social problems. The city faces a growing problem with addiction and mental health among those experiencing houselessness. Families struggle with job loss and the rising cost of living.  

These current issues are the underlying problem for millions of Americans. They are not only affecting San Francisco, but other major cities and small communities across the nation. Facing the challenges head-on takes discipline, help from others and access to resources — but not everyone readily has these. More is needed at the state and community level to meet a growing need. 

San Francisco has a strong community with a history of coming together. While the current issues surrounding substance use and addiction recovery change slightly with each decade, the community’s determination to overcome the problems and face them head-on remains strong.