Payam Javan: The San Francisco Department of Public Health is intensifying its efforts to tackle the city’s escalating overdose crisis by targeting the underlying causes such as addiction, mental illness, and homelessness. In the first quarter of 2025 alone, 192 people died from accidental overdoses — an average of more than two deaths per day, primarily due to fentanyl. Public Health Director Daniel Tsai, who assumed the role recently, emphasized the urgency of shifting to treatment-based approaches over traditional harm reduction tactics.

A key initiative being expanded is the RESTORE program — Rapid Engagement Shelter and Treatment for Opioid Recovery — which provides immediate access to medication-assisted treatment along with short-term shelter and pathways to long-term care. Although RESTORE has shown unprecedented success, it currently operates with only 35 beds, and Tsai plans to expand it to 75 in the short term, with a long-term goal of 150–200 beds. City outreach teams actively engage individuals with addiction and offer them immediate support through RESTORE.

At the same time, the department is moving away from certain harm-reduction measures deemed ineffective. This includes discontinuing safe consumption sites and banning public distribution of safe smoking kits by April 30. Instead, nonprofits will be required to offer treatment referrals along with supplies. Tsai and Mayor Daniel Lurie hope that reorienting the city’s strategy toward proactive, treatment-based interventions will lead to a lasting reduction in overdose fatalities.