Overdose is a public health emergency in San Francisco, and a disproportionate number of overdose deaths occur in the city’s permanent supportive housing (PSH) buildings. Prior assessments of the city’s PSH sites indicate a strong interest in peer-based overdose prevention strategies, as well as strong interest among residents in contributing to peer-based overdose prevention programs. The city has implemented several peer-based overdose prevention efforts at housing sites in collaboration with its partners, including programs in single residency occupancy (SRO) buildings, and permanent supportive housing sites.
In 2025, the San Francisco Department of Public Health hired End Hep C SF and Facente Consulting to translate learnings from previous peer-based overdose prevention programs at housing sites into evidence-based implementation guidance that could be scaled citywide. This project involves (i) review of findings from previous peer-led programs in San Francisco housing sites, and (ii) translation of findings into an implementation toolkit for PSH sites. The toolkit will include materials such as curriculum and training modules, guides for peer compensation structure, and overdose response protocols. The health department plans to share the toolkit while implementing a community of practice that allows PSH sites to engage in group learning before, during, and after program implementation.