In part two of our series Housing First, Morgue Second, we revealed that 4,090 people have died from accidental drug overdose in San Francisco between 2020 and 2025, and that nearly one in four of those deaths occurred inside Permanent Supportive Housing (PSH). For part three we broke down the 99 locations where the majority of those deaths occurred and discovered a disturbing trend — of 1,081 overdose deaths at those 99 locations, 73 percent happened inside just 68 PSH sites run by a few key providers.
A detailed review of individual facilities by the Voice and Gina McDonald, cofounder of Mothers Against Drug Addiction And Deaths (MADAAD), revealed that overdose deaths are not randomly distributed across supportive housing — they are heavily concentrated in a relatively small number of buildings run by just a few providers. According to data from the San Francisco Office of the Chief Medical Examiner, the buildings with the highest number of overdose deaths occurred at the following locations:
– Kelly Cullen Community (Tenderloin Neighborhood Development Corporation): 28 deaths.
– Arlington Residence (Mercy Housing Corporation) 25 deaths.
– Rene Cazenave Apartments (UCSF) 24 deaths.
– Dalt Hotel (Tenderloin Neighborhood Development Corporation): 22 deaths.
– Mission Hotel (Tenderloin Housing Clinic): 21 deaths.
Multiple buildings have recorded over 20 overdose deaths during that time period. Several others sit in the mid-to-high teens.
Episcopal Community Services (ECS), Tenderloin Housing Clinic (THC), and Tenderloin Neighborhood Development Corporation (TNDC) dominate the grim leaderboard. These organizations manage many of the buildings with the highest body counts. This is not a scattered tragedy. This is a systemic pattern repeated year after year inside the very facilities taxpayers fund to help those struggling with opioid addiction.
Overdose deaths are not randomly distributed across supportive housing — they are heavily concentrated in a relatively small number of buildings run by just a few providers.
While the sites with the most overdose deaths are overwhelmingly PSH buildings, all but 11 of the others are Single Room Occupancy- (SRO) style hotels converted to supportive housing and operated by PSH providers, or Project Roomkey, which Gavin Newsom launched in April 2020 in an attempt to leverage Federal Emergency Management Agency (FEMA) funding to house the homeless.
Eight of the locations in the top 99 were shelters, and one was a navigation center. Five Keys Charter Schools and Programs ran two shelters plus the navigation center, accounting for 25 deaths combined.
Three locations were not listed with the city, but did offer supportive or Section 8 housing. The 57 Taylor apartments are privately owned and accounted for seven deaths. Sunset Hotel is also privately run and had six deaths. Soma Studio and Family Apartments is operated by TDNC and accounted for seven deaths (as we wrote in part one of this series, TDNC had the third most deaths in PSH at 93).
San Francisco’s PSH overdose rate averages 1,392 per 100,000 — 17 times higher than the citywide rate and roughly 50 times higher than the national average over the same period. Now we see that within PSH itself, deaths are clustered in specific buildings in specific neighborhoods. Unsurprisingly, drug overdose deaths are heavily concentrated in the Tenderloin, South of Market, and Mission District areas, where the majority of PSH sites are found, along with drug dealers brazenly plying their trade.
The fact that 73 percent of drug overdose deaths in the top 99 locations occurred in PSH should shock policymakers out of complacency. When individual supportive housing sites are recording 20 to 30 overdose deaths over a five-year period, we aren’t talking complex challenges, we’re talking policy malpractice.
Defenders of the current model will again say these residents are “high risk.” That is no longer an acceptable answer. We are not merely housing high-risk individuals — we are repeatedly placing them in environments where they continue to die at horrifying rates with no intervention or accountability. For example, Mayor Daniel Lurie said on the campaign trail that he would audit PSH providers, and a number of supervisors over the years have made the same promise, but it has yet to happen.
Meanwhile, the amount of taxpayer money handed to those PSH providers over the past five years is nearly $720 million. For the 2020–25 fiscal years, ECS received $265,964,288. THC took in $277,531,024, TNDC $49,156,983, Conard $82,411,363, and HomeRise $44,659,677. The data shows us exactly where much of that investment has led: to buildings with double-digit body counts operated by the city’s largest contractors as overdose deaths inside PSH remain stubbornly, catastrophically high. Despite all of this, San Francisco lawmakers continue to renew those big contracts. It’s hard to call it housing, never mind supportive housing, when the medical examiner’s van is full of body bags before most San Francisco residents have had their first cup of coffee.
The evidence is irrefutable. The only question left is whether San Francisco leaders have the courage to face it and to make the big, bold changes necessary to end San Francisco’s opioid mass destruction.
Gina McDonald, cofounder, Mothers Against Drug Addiction and Deaths contributed to this story.
