San Francisco’s Substance-Abuse Crisis

The most important walk you can take in San Francisco is not to the grand Golden Gate bridge, down crooked Lombard Street, or to the brightly painted Victorians in Alamo Square. It’s to the city’s large and gritty sixth district, which contains the Tenderloin, Civic Center, and South of Market neighborhoods. What you’ll find there will shatter any preconceived notions about homelessness you might have heard from activists, city departments, and elected officials. You’ll realize that San Francisco doesn’t have a homeless problem—it has a substance-abuse crisis. And Project Roomkey, California governor Gavin Newsom’s hotels-for-homeless plan that he’s touting as a model for the rest of the country, won’t help any more than a band-aid will cure a cancer patient.

Block after block, you’ll see thousands of people who are barely alive. Some are alone; others are piled on top of one another, running into traffic, or standing slumped over, unconscious. They’ll be injecting or smoking heroin, fentanyl, and methamphetamine in front of you, unaware or unfazed by your presence. Scabs cover their faces and bodies, limbs are swollen red and blue, often bloody and oozing pus. You’ll notice the garbage, rotting food, discarded drug detritus, and feces surrounding them. A shocking number are mere teenagers, but many are old or have aged well before their time.

Your immediate reaction will probably be grief and horror. How can we treat our fellow human beings so cruelly, and how did we, as a society, allow things to get this bad? If we can’t admit these individuals into hospitals today, we should at least erect mobile hospitals to deliver critical medical, psychiatric, and addiction treatment before it’s too late.

Yet Newsom has declared that with programs like Project Roomkey, the United States can solve homelessness. To see the results of the program is to know what a bizarre claim this is. While a small portion of the unhoused are healthy enough to shift into and benefit from such housing, the vast majority are not—and their troubles won’t be alleviated by a hotel room.

San Francisco launched Project Roomkey last year, ostensibly as a way to thwart the spread of Covid-19. At last count, approximately 8,000 people live on San Francisco’s streets, and starting in April 2020, a few thousand were routed to leased “shelter-in-place” (SIP) hotels and motels. However, since so many were living outside as a direct result of substance use (or mental illnesses associated with or exacerbated by it), lethal drug activity flourished in and around the buildings.

Then came the body count. In 2020, San Francisco saw 713 fatal drug overdoses, mostly from fentanyl. Nearly three-quarters perished while isolated inside the hotel rooms and supportive housing provided by the city. Six died in the Hotel Whitcomb, a designated SIP hotel, in a single month.

The reason: Project Roomkey hotels offer no addiction-recovery treatment or mental health care. Nor is there a sobriety requirement. Residents do, however, get plenty of fresh needles, fentanyl foil, and other drug supplies, courtesy of the harm-reduction teams. As Dr. Hali Hammer of San Francisco’s Department of Public Health admitted in an April 2021 New York Times story on the city’s epidemic of drug fatalities, “What we as the public health department are responsible for is preventing death by giving people the resources they need to use safely.” The entire system erodes the desire and willpower to accept detox and rehab. It’s easier and less painful, at least in the short term, to use in a hotel.

Crime has also surged around the SIP motels and hotels, as people score from dealers just outside the lobbies. Shootings, robberies, and car break-ins have become commonplace, as have open-air drug use and sexual acts performed in broad daylight—an alarming change for neighborhoods like the Marina, which not long ago did not have a high population of unhoused, addicted people.

Now Project Roomkey is transitioning from leasing rooms in hotels and motels to purchasing buildings and converting them into permanent housing for unsheltered individuals. Funds are suddenly flowing for the program. FEMA offered partial funding, but earlier this year President Biden signed an executive order directing the federal government to reimburse program costs fully.

Newsom and San Francisco officials are aware that Project Roomkey does nothing to heal homelessness because the absence of a home isn’t the real sickness. The self-described experts will continue to blame income inequality, lack of affordable housing, or class and racial disparities. They won’t admit—at least not publicly—that the problem is almost entirely driven by addiction.

Meantime, the tide of people coming into the city, drawn by easy access to cheap, potent narcotics, will continue unabated. Some may get a hotel room, but most will become fixtures on the streets. Few, if any, will get better. Based on current projections, more than 1,000 people will die from overdose in 2021. Their descent will be both agonizing and inhumane.

It doesn’t have to be this way in San Francisco, in California generally, or across the United States. Funds allocated to programs like Project Roomkey should go toward providing vital medical, psychological, and addiction treatment to those in desperate need. Go ahead. Call it a pipe dream.

Erica Sandberg is a widely published consumer-finance reporter based in San Francisco. As a community advocate, she focuses on homelessness and crime and safety issues.

This article was originally published by City Journal Online.


  1. Rick Womack says

    This is spot on. It seems that the “harm reduction” strategies are only making it worse. I can’t say that misgovernment or maladministration caused the addiction but they certainly are making it worse.

  2. The Federal HUD “Housing First” policy is a big issue here. It directs the largest source of funding for the homeless, about $13 billion, to be spent only for shelters that are “low” to “no barrier.” Meaning that homeless shelters, if they get HUD funding, cannot require that their clients try to stay sober or enroll in treatment programs. In other words, 3 meals a day and a roof over their heads, paid for by taxpayers, until they die of an overdose, or, rarely, recover.

  3. When you encourage and reinforce a problem it will not only persist but it will grow exponentially.
    San Francisco and other Democrat led cities, and states, let’s not forget the feds, seem to think they can feed the tiger so it won’t eat them. Guess what, it will, without hesitation, eat them also! And, we see that in cities and states that have unbelievable debt. Debt that they ignore. And the voters keep electing these incompetents because they don’t do their homework and continue to vote stupid. It is what Democrat voters do.
    That tiger has a twin and they are Debt and Diversity (employment and position appointments based on sex, skin color, and other stupid ideas) will destroy America and every state and city within.
    This homeless problem is a result of that encouragement and reinforcement of drugs and debt by our elected leaders, from the school boards to the president of the U.S.!
    Fire every teacher and public school administrator, impeach every democrat mayor, councilman, governor, and president for two things; a violation of failing their oath of office and for absolute incompetence. Begin the next day to rehire, appoint replacements beginning with character qualities first, ability to perform, and then qualification – you can always hire for character and train for the position. These idiots they hire today based on a four year term of smoking weed and drinking beer has not done us to well.
    I’m through…………………………

  4. Take the homeless down to the border, take away any ID, pay the coyotes $4,000 each and have them bring them to our immigration detention facilities. The Biden plan will care for them as long as they promise to vote democrat. The bonus is that they speak English.

  5. Patricia Whalen says


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