SF to Expand Combination Shelter-Opioid Treatment Program for Homeless Residents

As part of efforts to treat the city’s drug crisis, San Francisco’s Department of Public Health is expanding a program for unhoused people that combines a shelter bed with opioid addiction treatment under one roof.

RESTORE — which stands for Rapid Engagement Shelter and Treatment for Opioid Recovery — currently operates 35 beds at the Adante Hotel on Geary Street in Lower Nob Hill. Officials will soon double the number of beds, with the hope of operating up to 200 across the city.

The expansion comes as the Office of the Chief Medical Examiner released its latest data showing 65 accidental overdose deaths in March 2025, including 52 cases involving fentanyl. Public Health Director Daniel Tsai said the goal of RESTORE is to initiate treatment as soon as someone is off the streets to better transition them to long-term care.

“I can think of very few interventions that we have from a public health standpoint where we’re getting people plugged into a bed and initiating treatment literally immediately,” Tsai said at a press conference on Wednesday. “We will do telehealth prescribing to start someone on medications for opioid use disorder that same day.”

Potential clients will be required to engage with a case manager daily and agree to an opioid or mental health treatment plan to secure their stay.

RESTORE started as a pilot program over the past 12 months and saw success rates “unlike anything we have ever seen,” Tsai added, although he did not disclose the specific numbers.

“When you talk to our teams on the street, they will tell you that the availability of a RESTORE bed completely changes the type of discussion they can have with a client,” Tsai said.

The shelter beds offered in the program are non-congregate and stays are short-term: usually between one and two weeks. These factors lower the barrier of entry for unhoused people, Tsai said. Additionally, the combination of a bed and treatment plan means that clients don’t have to coordinate the two themselves.

The brief stay is meant to stabilize clients and put them on the path to recovery, which varies significantly from person to person.

Keith Humphreys, a Stanford University professor and addiction policy researcher, said even one or two weeks could provide a “time-out” that is long enough to get people back on their feet.

“It is a period of stability where they can stop taking any substances that they’re taking, start taking any medications they should be taking for their mental illness or for their addiction and have a sort of headspace to make good decisions about their future,” he said.

Tsai said the biggest problem is capacity.

“One of our biggest barriers is we only have 35 beds, and there are people on the street who are willing to start treatment in this sort of setting,” he said.

But in light of the upcoming expansion, Humphreys noted that scaling services like those offered through RESTORE can quickly run into quality issues, too.

He pointed to HealthRIGHT 360, the city’s largest, publicly-funded addiction treatment provider, which saw five fatal overdoses in 13 months. Wesley Saver, director of policy & public affairs for HealthRIGHT 360, said in a statement that it is “encouraging” to see the Department of Public Health scale programs like RESTORE.

“A lot of life, particularly street life, is lived in five-minute intervals,” Humphreys said. “Just to have the time-out to say, OK, you’re stable, you’re safe, you don’t have to survive, you’ve got food, you’ve got shelter. Let’s talk about where you want to be in a month or six months, as opposed to where you want to be in five minutes.”

The expansion of RESTORE follows a slight decrease in accidental overdose deaths, down from 68 overdose deaths in February, breaking a trend of monthly increases since October. Of the 192 total deaths from January through March of this year, the vast majority are fentanyl-related.

That translates to an average of at least two deaths per day, Tsai noted.

“Every overdose death we have here in the city and county of San Francisco is preventable, and it’s unacceptable, and it’s tragic,” Tsai said. “The current approach of what we’ve done historically here has not delivered the results that we need.”