San Francisco’s strategy of pairing permanent housing with harm-reduction services is under renewed scrutiny after fresh data showed 3,772 people have died of drug overdoses city-wide since 2020, with more than half of this year’s fatalities occurring indoors. Roughly 60 percent of the deaths inside permanent supportive housing have been traced to five nonprofit operators, led by Episcopal Community Services (ECS). Despite that record, the Board of Supervisors on 3 June unanimously extended ECS’s contract for another two years, adding more than US$25 million and lifting the total value of the grant to about US$72 million. The city has steered nearly US$720 million to the five largest providers over the past five years. Public frustration is rising. More than 100 residents rallied in the South of Market district this week demanding a clamp-down on open-air drug use and expansion of sobriety-based rehabilitation centers. Supervisor Matt Dorsey, whose district includes SoMa, backed a “zero-tolerance” stance on public drug consumption while calling for additional treatment capacity. Staffing those services remains a hurdle. City College of San Francisco—the city’s only free, in-person program that trains state-certified substance-use counselors—reports wait-lists for nearly every required course. The program expects to award 45 certificates this year, a record, but administrators say limited funding prevents them from adding classes needed to meet demand.