With 2023 marking the deadliest year for overdoses, we must declare a citywide emergency to address the mental health and substance use crises. Just as we did during COVID, we need a coordinated, government-wide response to cut through red tape and mobilize resources. Implement the remaining steps of the City’s 2022 Overdose Prevention Plan, which involved experts and community leaders. Establish “Wellness Hubs” to provide prevention services, healthcare, and treatment connections. Ensure True Treatment on Demand so that anyone can access effective, affordable care immediately. Reduce wait times, expand entry points, and increase behavioral health staffing to remove barriers to treatment.

Treat substance use disorder as a public health crisis, not a moral failing. Use evidence-based strategies to address root causes like poverty, homelessness, and stigma. Support recovery with stable housing, education, job training, and comprehensive services. Make life-saving medication widely available, expand mobile clinics, and push for policy changes like extending Medi-Cal coverage for long-term treatment. Address racial disparities—Black residents are five times more likely to die from overdoses, Native Americans report the highest substance use, and Latinos face access barriers. Invest in culturally competent, data-driven programs with multilingual resources. Adapt treatment to evolving drug trends and co-occurring conditions, recognizing that many affected individuals also struggle with trauma, mental illness, and systemic oppression. A holistic, research-driven approach is essential.

Support individuals with dual diagnoses by providing integrated, intensive treatment. Work with the state to secure funding for community-based behavioral health housing and treatment facilities, ensuring Prop 1 funds benefit San Francisco. Develop regional behavioral health centers so all Bay Area residents have access to care. Expand housing options beyond Permanent Supportive Housing (PSH) to include mental health co-ops, step-down housing, shared housing, and respite care like Hummingbird. People with high-acuity needs require more clinical care to prevent them from losing housing and ending up back on the streets.

Establish a unified and publicly transparent system to track all services and funding streams. Collaborate with the state to create metrics for evaluating program effectiveness. Improve accountability by tracking key indicators such as rates of incarceration, recidivism, homelessness exits, employment, overdose reversals, and fatal overdoses. Ensure accountability for drug dealers, from kingpins to street-level dealers, with a primary focus on rehabilitation rather than incarceration. Norway's experience in the 1990s, where a shift toward rehabilitation led to a 50% reduction in recidivism rates, serves as a promising model. San Francisco should allocate resources to prioritize rehabilitation, especially for first-time offenders.

Partner with local research institutions to conduct research on substance use disorder and mental health. More research is needed in these intersecting fields, which are often treated separately, and the city should partner with local public research institutions where possible to innovate its approaches. Encourage innovation in treatment and recovery programs. Shifts in attitudes towards harmful substance use are what gave us the research to create life-saving medication such as Narcan, as well as withdrawal management, and medication-assisted therapies. More breakthroughs are possible.

Increase Overdose Prevention and Treatment Centers beyond the city’s single sobering center. More Wellness Hubs are needed to provide stable spaces, reduce overdoses, and connect people to treatment. Trained professionals can intervene in crises and guide individuals toward recovery. Expand free fentanyl testing to more locations. Fentanyl is increasingly mixed into street drugs, posing a high overdose risk. While test strips and naloxone are available in SOMA and some nightlife venues, more community access points are essential. Provide Narcan and naloxone training to the public, including people who use drugs, ensuring more San Franciscans can recognize and respond to overdoses. Partner with cultural affinity groups and CBOs to expand training and distribution. Make treatment centers low-barrier and accessible during evenings and weekends. Many individuals seek help outside regular hours, requiring 24/7 staffing to ensure treatment is available whenever needed.

We need to address our city-wide staffing shortage of medics, behavioral outreach workers, 9-1-1 dispatchers, licensed clinical therapists, and emergency room nurses. To combat this crisis, we must offer competitive wages and benefits to city employees while ensuring our city’s HR department is taking measures to reduce the hiring and onboarding timeline. Endowment for social, behavioral, and public health workers. We can source talent among local graduates and support their college finances through an endowment, so long as they serve in these careers in the city afterward. Provide housing subsidies for students to attract talent and support the next generation of San Francisco’s frontline workers. Expand workforce housing options and resource programs to offer competitive salaries to attract and retain substance use and mental health treatment professionals

Implement mobile clinics and street outreach teams to reach individuals suffering from homelessness, mental illness, and substance use disorder. When Portugal reduced the number of people who harmfully used heroin in their country by 75%, they staffed up mobile teams who distributed clean syringes, life-saving medications, information about treatment, and primary care. San Francisco can take inspiration from this model. Distribute clean syringes, life-saving medications, treatment information, and primary care. We need to meet individuals where they are and ensure they have access to vital resources