Those images tend to swell in number as discussion of the Tenderloin and public drug use grows, like the public debate surrounding the supervised injection site bill recently vetoed by Gov. Gavin Newsom. Recent videos of people living on the streets shared by Michael Shellenberger, a frequent critic of the city, who wrote a book called "San Fransicko," racked up millions of views.
But sharing videos and photos of people who may be living in poverty, struggling with mental illness, or dealing with addiction has also raised ethical and privacy concerns with some advocates. After being seen on social media living on the streets and using drugs, people risk added difficulties getting jobs, or being seen by people they're trying to escape.
Tracey Helton Mitchell knows what it’s like to be shown on film in her worst moments. In the late '90s, Mitchell was living in San Francisco and deep in the throes of a heroin addiction.
She agreed to participate in the film because she was convinced she was going to die of an overdose anonymously in a hotel or an alleyway somewhere in San Francisco. "I was on heroin the whole time, really on heroin. There's a part of the film where [the filmmaker] shows me doing laundry and I'd asked him, like, 'Why was I doing laundry?' Because I never did laundry," Mitchell said. "And he said, 'Because you always shot heroin. We had to film you doing something else.'"
Mitchell was sober by the time the film premiered in 1999. But she did not expect how popular it would be, or that she would lose her privacy.
"People were offering me drugs. People fell in love with this [person], you know, they had this relationship with this person that was in this movie," she said. "And I do mean fall in love. I had weird stalkers, like I'm not exaggerating. And it has sort of a cult following now, people contact me every week about it still."
Now more than two decades after the premiere of the documentary that changed Mitchell's life, images, photos and videos of San Franciscans using drugs, or passed out, are regularly shared on social media.
Mitchell can understand why people want to capture what they see on the streets of San Francisco, because those images are one way to get the attention of political leaders.
But she's also troubled that people seem to be using images for their own political gain without considering the person's humanity.
"The pictures that you really see a lot of are people just suffering, just suffering. If you really cared about them, you could black out their faces," Mitchell said. "It very simply boils down to, 'Are we dehumanizing people by highlighting them at the worst moments of their life?'"
Navigating issues around social media and informed consent can also be complicated, Mitchell said. Someone might agree to be photographed one day, go into rehab, and no longer want the image online for the public to see. Family members might want the photos taken down.
People in the images could be fleeing domestic violence or other dangerous situations, said Jennifer Friedenbach, executive director of the Coalition on Homelessness.
Friedenbach said the way images are used to call for more criminalization of people who use drugs feels exploitative, like trolling.
"That could negatively impact them as they walk through life having better moments or [when they] are trying to get work," Friedenbach said. "I just don't think it's ethical to do that to people."
Ricci Wynne, who describes himself as in recovery, shared a video on Twitter in July showing kids getting off a bus amid a scene of apparent drug use in the Tenderloin. He said in an interview with CBS Bay Area that he was angered by what he saw and wants city leaders to take action.
The video garnered over 10,000 likes, and was featured in the Daily Mail tabloid in the U.K. and TMZ. Other accounts that regularly post videos showing despair on San Francisco streets focus on specific blocks or neighborhoods.
Adam Mesnick, who runs a controversial Twitter account called @bettersoma, said images are a way to bring attention to an ongoing problem.
He's posted or shared videos of people using drugs, and people lying on the streets and suffering. Mesnick said he understands the criticism but his Twitter account is not the problem.
"It is a very valid opinion that you have a problem with the photo. But I have a bigger problem with the way the situation is being handled now," he said.
Mesnick said the images he photographs are what he sees every day in San Francisco, and he gives people 10 dollars to take their photos and often tries to have conversations with them.
He said that personal interaction is more than what he’s seen a lot of the public do.
"I probably check on every single person underneath a blanket that I've ever seen in San Francisco since as far as I can remember backwards. And the reality is people just walk right by," he said.
There are ways to ethically photograph or film people who use drugs, said Graham MacIndoe, a photographer and teacher who documented his own active heroin addiction in a series of self-portraits entitled "Coming Clean." He said when asking for consent, it's important to use plain language explaining how the photograph will be used and what it is for.
"I do think we should show all sides of the war on drugs and the crisis that's happening right now," he said, adding that that should include giving agency to people who use drugs or who are in treatment, and asking them what the solutions are.
"We've all seen those pictures, we've all seen people ... in the Tenderloin or wherever, lying in corners, homeless, using drugs, whatever," he said. "You add another picture to that pile of pictures and what does it do? Nothing. It just reinforces that there's a problem. But it doesn't bring us closer to a solution."
He said too few photographs focus on solutions, particularly given that the country is far past the point of needing photos to raise awareness about the epidemic.
After the premiere of "Black Tar Heroin," Tracey Helton Mitchell focused on caring for and treating people who use drugs. She went on to write a memoir, "The Big Fix: Hope After Heroin," and said she doesn't regret being in the film because it helped so many people.
And she also doesn't have many photos to remember that time in her life, which is why it's also important to ask people being photographed if they'd like copies of their own images. People who are homeless often get their belongings stolen or thrown away, and lose everything.
The people Mitchell knew who took photos of her during that time in her life are no longer alive.
"The only pictures I have from the age of 18 to the age of 27 are mug shots and [photos from] 'Black Tar Heroin.' That's it," she said. "If I didn't have that, it would be almost like I didn't exist for 10 years."
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