Swanky hotels, wagyu steakhouses and gourmet brunch spots line Lower Nob Hill’s Post Street corridor. But city data show San Francisco's drug overdose crisis is creeping into this posh pocket of the city—and into a number of other neighborhoods that had been relatively unscathed in the past.
The San Francisco Fire Department responded to 51 overdose calls in Nob Hill in all of 2022. But by the end of September this year, the 2023 total had already hit 84, a nearly 40% year-over-year increase with three months left to go, according to department data.
The same holds true along the Embarcadero, between Piers 28 and 38, where the number of overdose calls in the first nine months of 2023 was three times the entire 2022 total. And in subsections of the Western Addition, Bayview-Hunters Point and the Mission, call figures also far exceeded their 2022 full-year totals by the end of September 2023.
San Francisco is on track to lose more lives to drug overdoses in 2023 than any year on record.
Overdoses killed 620 people in the city in 2023 through the end of September. As the fatalities climb, overdose calls are increasingly bringing medics farther afield from the city’s historic epicenter of the drug crisis: the southwestern corner of the Tenderloin.
While the southwest Tenderloin remains a hotbed of overdose response, it has represented a far smaller share of overdose calls in 2023 than in previous years. That’s in part because neighboring sections of the Tenderloin and South of Market neighborhoods have seen a climbing portion of calls. But significantly, the largest relative increases in overdose calls have come in pockets of neighborhoods like Nob Hill, areas that previously accounted for few overdose calls and now see an average of multiple a month.
The factors behind the trend are somewhat elusive.
University of California San Francisco Professor Ayesha Appa, a physician and addiction expert, said she has heard from patients who fear being arrested and prosecuted for drug use, so they have increasingly migrated to indoor spaces. Those indoor spaces may be far removed from the outdoor spots where people often use drugs in the southwest Tenderloin, offering a possible explanation as to why overdose calls are fanning out across the city.
This year, the city’s leadership vowed to crack down on public drug use in the Tenderloin, making hundreds of public intoxication arrests and filling local jails. Few of the arrestees ended up in drug treatment.
Appa said people using drugs alone are at higher risk of a deadly overdose because fellow drug users are often able to reverse overdoses using the life-saving drug naloxone.
“Being pushed into the shadows leads to less safe use and increased risk of overdose,” she said.
The San Francisco Department of Public Health declined The Standard’s request to interview the experts leading the city’s overdose response.
“Trends in both unintentional overdoses as well as overdose-related 911 calls can vary over time due to a number of factors, including, but not limited to, a changing drug supply and different patterns in drug sales and drug use,” a department spokesperson wrote in a statement.
The Standard analyzed a San Francisco Fire Department database of every potential overdose call that the department responded to from Jan. 1, 2019, through Sept. 30, 2023. The data was filtered by the fire department to only include calls with a high likelihood of being overdoses based on the information entered on the patient care report filed by medics. Private ambulance company responses were not included in the data. Since the fire department responds to the vast majority of emergency calls in San Francisco, the database is a strong indication of overdose trends, but does not include all overdoses.
To see detail on the block-to-block level, The Standard broke the figures down by U.S. census tracts, small micro-neighborhoods used to analyze government data.
A Quiet Climb in Overdoses
In some of the neighborhoods where overdose rates have quietly climbed this year, the unfolding problem is not apparent from the street.
That’s the case in Lower Nob Hill’s southeastern census tract, an eight-block area bordered by Post, Leavenworth, Bush and Powell Streets. The fire department responded to 24 overdose calls in that area in the first nine months of 2023, up from the six calls it fielded in all of 2022. That 300% jump was the largest increase of any San Francisco census tract that received at least 20 calls through September 2023.
Some business owners along Post Street said they were surprised by the data, noting they haven’t seen a rise in drug activity on the street. That being said, several people told The Standard they have noticed an uptick in ambulances visiting the area.
Poppy Cho, a server at iThai Bangkok Street Food on Post Street, said the Ansonia Hotel at 711 Post St., which opened as a homeless shelter in late July 2022 and is run by the nonprofit Urban Alchemy, is visited by ambulances almost daily.
“I notice more ambulances passing by, but I don’t really know what’s going on,” Cho said.
The fire department’s publicly available data shows that it responded to over 570 medical incidents on the 700 block of Post Street between Jan. 1 and Oct. 21. The data does not specify which address on the block ambulances deployed to.
An Urban Alchemy worker at the shelter, who declined to give his name because of the company’s media policy, said many of those ambulance calls are not drug-related. The Standard confirmed two overdose deaths occurred in the building this year through July 31, according to data from the San Francisco Chief Medical Examiner’s Office.
A spokesperson for Urban Alchemy declined to comment.
Issam Askndafi, the longtime owner of Town & Country Market on Post Street, complained of shoplifting but said he hasn’t noticed an increase in drug activity on the street.
“Maybe it’s happening inside the homes? But not outside,” Askndafi said.
Other people working nearby said the Post Hotel, which the city converted into permanent supportive housing for formerly homeless people, also draws regular visits from ambulances.
Residents of city-funded housing for formerly homeless people account for nearly one-fifth of the city’s total overdose deaths, an average of three fatalities a week, according to data from the Chief Medical Examiner’s Office. But nobody died of a drug overdose at the Post Hotel in the first seven months of 2023, according to the latest data reviewed by The Standard.
Supervisor Aaron Peskin, who represents Lower Nob Hill, speculated that city-sponsored efforts to clean up the adjacent Tenderloin neighborhood by deploying street ambassadors could be pushing drug users uphill into his district. But while he’s heard some grumbles about people hanging outside the 711 Post St. shelter, constituents haven’t raised concerns about ballooning overdoses to his office, Peskin told The Standard.
In fact, business owners and employees in Lower Nob Hill told The Standard they’ve recently noticed a decrease in drug activity.
Timothy Denson, who’s been living on San Francisco’s streets for roughly eight years and was injecting crystal methamphetamine in a nearby alleyway, said he wandered up to Nob Hill from his encampment in the Tenderloin because a nonprofit worker on Ellis Street asked him not to shoot up in front of their building.
“I just came here because it’s a quiet place to be,” Denson said.
A Growing Crisis
This year, the San Francisco Fire Department logged 2,472 overdose calls through the end of September. That’s about 30 calls short of the entire 2022 calendar year total, which previously set the record for the past five years. In 2019, overdose calls were significantly lower, at 1,608.
More and more of those calls have brought medics to SoMa.
There were 623 overdose calls in that neighborhood in the first nine months of 2023, an explosive growth over the 514 calls in all of 2022 and 377 in 2021. SoMa residents have made their concerns heard over visible drug use and sales.
Meanwhile, the area around U.N. Plaza, a bustling transit hub just a few blocks from City Hall, has had the most overdose calls of any block in the city for five years straight.
The Department of Public Health recently launched an initiative called the Bridge & Engagement Services Team, which focuses on neighborhoods where people are at high risk of overdosing. In a statement, the department said it monitors the city’s 911 data along with drug testing data to send outreach teams to clusters of overdoses occurring across the city.
The city’s budget for behavioral health services sits at $592 million. This year, that money has paid for over 73,000 doses of naloxone while providing addiction and mental health care to 25,000 people annually.
Despite the city’s efforts, more and more people in San Francisco are dying from drug overdoses.
One of them was Grover Hunter.
In April, the 37-year-old died from the effects of fentanyl, methamphetamine and cocaine in a communal bathroom at the 711 Post St. shelter, according to the Medical Examiner's Office.
He grew up in Mendocino County and loved going to concerts and growing tomatoes, according to his obituary. He left behind two sons.