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Overdose deaths at SF’s city-funded facilities totaled 246 over two years

Needle drop location on Mission and 16th streets in the Mission District. | Camille Cohen

More than 10 people per month on average died of drug overdoses in the city’s supportive housing facilities and shelter-in-place hotels during 2020 and 2021, an indicator of how a flood of cheap, powerful fentanyl kills users even as city programs have rescued them from homelessness.

The data, obtained from the office of San Francisco’s medical examiner in response to a public records request, shows that during the first two years of the pandemic, at least 246 people died of drug overdoses in city-funded facilities aimed at keeping very low-income adults and families from having to live on the streets. 

Forty-three of the deaths were in the shelter-in-place hotels pressed into service during the pandemic, while the other 203 were in long-term single-room occupancy residences.

The city’s Department of Homelessness and Supportive Housing had a budget of $1.2 billion for the fiscal years 2021 to 2022 and 2022 to 2023, focusing on a model where residents are given independent rooms and the on-site services of a social worker, building manager, and periodic visits for physical and mental healthcare and job counseling.

The facilities are mostly operated by nonprofit service providers. The medical examiner data obtained by The Standard describes the location where a person died, though that isn’t necessarily where they called home. The data does not identify the specific facilities involved.

“How horrifying, looking at all those deaths is just horrifying–miserable deaths, deaths of isolation,” said Stanford professor Keith Humphreys, who reviewed data obtained by The Standard. 

San Francisco’s long-term-care medical facility Laguna Honda Hospital has received recent scrutiny for drug problems after reports that two patients suffered nonfatal overdoses, triggering an investigation that is threatening the facility’s Medicare and Medicaid funding.

But the overdose problem is vastly worse in independent living facilities for the indigent.

Neither the city’s Department of Public Health, nor the Department of Homelessness and Supportive Housing, had provided comment by press time.

In San Francisco, publicly-funded indigent housing in general does not prohibit drug use, based on the fact that some users will not accept services that keep them from satisfying their need for fentanyl or other drugs. City programs focus on preventing deaths and disease by providing clean syringes and medications that help curb addiction, in some cases without passing judgment on drug use.

For Humphreys, a well-known critic of policies that focus only on harm reduction, the data obtained by The Standard is evidence that the city needs to do much more than provide homeless addicts with a room plus nominal services, sometimes referred to as a “housing first” model.

At the center of the overdose epidemic is fentanyl, as much as 100 times stronger than heroin, which first hit San Francisco in 2015. Eleven people died of overdoses of the drug that year, a number that ballooned to 502 deaths by 2020, according to the San Francisco Department of Public Health. 

The medical examiner data shows that more than two-thirds of the deaths in city-funded hotel rooms for the indigent involved fentanyl alone or combined with other drugs.

Staffers at city-funded supportive housing facilities are not equipped to prohibit drug use among clients who live independently in separate units, and building managers are often loath to confront residents or drug dealers. 

According to Humphreys, data shows that communal-living facilities that prohibit drug use show better recovery rates for those willing to go down that road. Without enough housing that also offers intensive treatment and a drug-free environment, city-funded facilities will remain charnel houses.

“Now we know that those are your outcomes, then this is on you,” he said of the city, “and you need to explain why this is so good you couldn’t try creating alternatives for some of these people so they would be alive.”