Five years, five nonprofits, 594 drug overdose deaths
3,772 people have died of drug overdoses in San Francisco since 2020 — the top five providers account for nearly 70 percent of fatalities inside permanent supportive housing
“HSH enters into agreements with vendors to run homeless facilities, but doesn’t have total control over the agreements because the nonprofits that operate the sites have their own, like, are their own entities.”
— Emily Cohen, deputy director for Communications & Legislative Affairs, San Francisco Department of Homelessness and Supportive Housing, during Roe v. CCSF motion for preliminary injunction deposition, Aug. 25, 2025
While monthly drug overdose deaths in San Francisco are tracked regularly, The Voice of San Francisco wanted to do a deeper dive by tracking the numbers over the past five years. In this series, we will explore not only how many people have lost their lives to drugs (over 70 percent involved the deadly opioid fentanyl) but also where those deaths occurred. Here, we will examine the nonprofit providers contracted by the city’s Department of Homelessness and Supportive Housing.
We worked with Gina McDonald, cofounder of Mothers Against Drug Addiction & Deaths, who, over two years researching overdose deaths, noticed a pattern of repeat addresses. The Voice took those findings to our data expert, who crunched and sorted the numbers into a database. The results shocked even a seasoned, boots-on-the-ground veteran of the overdose crisis like McDonald.
Established by the late Mayor Edwin M. Lee in December 2015, the Department of Homelessness and Supportive Housing (HSH) was hailed as a “bold goal to help at least 8,000 people out of homelessness by the end of his second term,” committing to funding for homeless prevention and solutions of at least $250 million per year.
Lee passed away in 2017, and HSH has definitely not lived up to his expectations. In a critical 2020 performance audit of HSH by the budget and legislative analyst, the department’s coffers had $364 million — an 80 percent increase since its inception.
The budget wasn’t the only thing that increased: between 2017 and 2019, the number of people without permanent housing climbed by 30 percent. As of that March 2020 audit (the most recent by the city), HSH had contracts with 59 nonprofit providers for 350 programs with total funding in the 2019–20 fiscal year of $240.6 million. In the five years since that audit, the number of homeless individuals has grown, primarily due to an influx of “drug tourists” — those who arrive from other places that won’t tolerate public drug use — for the cheap drugs and abundant services.
“Even in the era of COVID-19, the opioid crisis stands out as one of the most devastating public health disasters of the 21st century in the USA and Canada,” stated a 2022 report by the Stanford Lancet Commission. The report went on to blame the crisis on “unrestrained profit seeking and multi-level, multi-system regulatory failure.” In San Francisco, however, much of the blame falls on the nonprofit providers and their unwavering allegiance to harm reduction and Housing First Policy.
Between 2020 and 2025, 1,398 people died from COVID-19 in San Francisco. During that same five-year period, 3,772 people have died of an accidental drug overdose. Eight hundred seventy-five of those deaths occurred inside the 122 Permanent Supportive Housing (PSH) locations managed by 30 different service providers. Of those 875 PSH deaths, 594 occurred in buildings operated by the top five providers (a tie for fifth place resulted in six providers in total). That means nearly 70 percent of the overdose deaths in PSH locations can be attributed to just six providers.
The top providers are Episcopal Community Services (162 deaths), Tenderloin Housing Clinic (156 deaths), Tenderloin Neighborhood Development Corporation (93 deaths), Conard House (67 deaths), HomeRise (58 deaths), and, tied for fifth place, HSH itself (also 58 deaths).
The buildings with the most deaths over five years were Kelly Cullen Community (220 Golden Gate Avenue, TNDC, 26 deaths), Rene Cazenave Apartments (25 Essex Street, UCSF Citywide, 23 deaths), Arlington Residence (480 Ellis Street, Bayview Hunters Point Foundation for Community Improvement, 23 deaths), Dalt Hotel (34 Turk Street, TNDC, 22 deaths), Mission Hotel (520 South Van Ness Avenue, THC, 20 deaths), Seneca Hotel (34 Sixth Street, THC, 19 deaths), and Jefferson Hotel (440 Eddy Street, THC, 17 deaths).
On Aug. 21, The Voice reached out via email to Beth Stokes, CEO of Episcopal Community Services (ECS), Randy Shaw, head of Tenderloin Housing Clinic (THC), Jennifer Dolin of Tenderloin Neighborhood Development Corporation (TNDC), Anne Quaintance, CEO/executive director of Conard House, Janea Jackson, CEO of HomeRise, and Shireen McSpadden, executive director of HSH, to ask if they knew how many people had died of drug overdoses in their buildings over the past five years. As of press time, not a single one had responded.
$720 million to the top five providers over five years
The amount of money handed to the top nonprofit PSH providers over the past five years is nearly $720 million. For fiscal years 2020 to 2025, ECS received $265,964,288. THC took in $277,531,024, TNDC $49,156,983, Conard $82,411,363, and HomeRise $44,659,677.
Despite the overdose deaths occurring at these PSH locations under the watch of the top providers, the city of San Francisco continues to renew their contracts.
On June 3, 2025, the San Francisco Board of Supervisors unanimously approved a grant agreement between ECS, the leader in overdose deaths over the past five years, for support services, property management, and master lease stewardship at the Alder, Crosby, Elm, Hillsdale, and Mentone Hotels for permanent supportive housing for formerly homeless adults, extending the grant term by 24 months from June 30, 2025, through June 30, 2027, increasing the contract by over $25 million for a new total “not to exceed $72,297,684.”
Lest you think Daniel Lurie is off the hook, he’s not: as mayor, he signed off on the contract extension for ECS and has a longstanding relationship with the organization through his nonprofit Tipping Point Community.
For Tipping Point’s Chronic Homelessness Initiative, the $100 million effort from 2017 to 2022 to reduce chronic homelessness by half in five years, Lurie chose Chris Block — founding director of coordinated entry at ECS — as his director (the initiative failed spectacularly). On the campaign trail, Lurie described 833 Bryant, which he developed with Tipping Point and a $65 million gift from Charles and Helen Schwab, as his crowning achievement for providing permanent supportive housing (he “built it faster and cheaper than City Hall could”). As of 2025, ECS still provides client services at 833 Bryant, where the medical examiner said more than a dozen people have died from drug overdoses inside since 2021.
Over the past five years, 3,772 people have died of drug overdoses in San Francisco, the majority of them from fentanyl. Nearly 25 percent of those deaths, or 875, occurred in what the city calls “Permanent Supportive Housing.” Five hundred seventeen deaths (14 percent) happened in hospitals, while 63 percent took place in other locations, including in vehicles and outdoors. Next, we’ll examine the proximity of deaths occurring outdoors to PSH locations.