This is the second part of a series on people who cycle through San Francisco’s jails. Read Mission Local’s analysis of thousands of jail booking logs here.
A fight broke out during Sam’s January stint in San Francisco County Jail No.1.
The jail’s intake cell is like a “jungle,” Sam recounted. “You have to act like an animal … If you’re weak, you’re going to get stomped on by everyone.”
Did he see how it started?
Well, Sam had started it.
Immediately after, he said, he had a sinking fear that he’d ruined his life.
But no one reprimanded him, and he kept moving through the system. Sam was booked for failing to appear in court for a prior misdemeanor charge. During intake, a nurse offered him opioid addiction medication, which he declined. Then, 24 hours after being arrested, he was back on the street, buying drugs.
Often, the San Francisco Department of Public Health said, people are released within a day or two of arrest, limiting the ability of healthcare workers to treat their substance abuse within the justice system.
There are in-custody recovery programs in the jail, and a few people are incarcerated there for years before being sentenced to prison. Still, roughly half of patients in custody are released within 2 days, according to health department data. Over 90 percent are released within a week.
Two weeks after the fight, Sam was walking around the Mission District with a wounded arm. He ran into a nurse in the St. John the Evangelist Episcopal Church courtyard, home to the non-profit Gubbio Project, and met this reporter.
He told the story of his time in jail and the fight he started, then paused to look down at the skin cracked open on his hands. “This isn’t me,” he said.
Maybe he’d get “the shot”, Sam ventured, referring to a long-acting injection the city now offers to treat opioid addiction. It only has to be taken once a month.
First, he would have to figure out how to get it.
Did he mind company? Sam shrugged. “Let’s go.”
Release and return
Sam’s return to the streets after being jailed was not unusual. Many formerly incarcerated people described little follow-up from outreach workers after their release.
But according to several social workers, legal professionals, and doctors, San Francisco’s jail health and reentry services are among the most comprehensive in the state; a “gold standard.”
After four to seven days in custody, about 50 people a month receive discharge medication, an individualized treatment plan, and a referral to a substance-abuse program in the community, then director Dr. Lisa Pratt wrote in a July 2025 presentation.
In 2025, on average, half of the people given medication in custody for opioid addiction attended a follow-up appointment within 30 days of release, a significant improvement from years prior, health department data shows.
The challenge is accessing their services before getting released and arrested again. According to the 2025 presentation, someone only in custody for a day may leave with just a handout describing community resources and a supply of naloxone, which is used to reverse overdoses.
Jail Health Services can tell people who have been arrested “that’s what you need,” said Dr. David Smith, an addiction expert who has treated patients in custody.
However, said Jennifer Esteen, a nurse who has worked in the jail, “there’s not a lot of outreach” if you’re not willing to be “your own advocate.”
Sam steps forward
Wary of anyone affiliated with the criminal justice system, Sam has had trouble advocating for himself. He acknowledged he wasn’t the most sympathetic character.
The 45-year-old man has been charged with crimes in multiple California counties and is estranged from his family. He instructed this reporter to interrupt his rants, because if he got too worked up we’d never get anywhere.
“I’ve been abused all my life,” he said. At nine years old he began to cycle between group homes and juvenile halls. Homelessness and the criminal justice system taught him his current prerogative: “You come close to me, I’ll bite you.”
With a mission in mind, though, he became kinetic.
There’s a clinic further down Mission Street, Sam mused, barreling ahead without stopping to ask for advice from a group of outreach workers a few feet away from him. Spry for a man with one arm wrapped in gauze, he walked to the 16th Street transit plaza and paid for the bus with rarely-used tokens. He chatted the entire time, undeterred by the lurching that sent him stumbling back and forth, then disembarked eight blocks later.
Last week, outreach workers were handing out free food at a vacant lot near 24th Street, he said. They “caught me like a fish.” While he ate, a provider had talked about opioid-use disorder medications. It stuck with him.
When we got there, however, the lot was empty.
Such an obstacle would usually cause him to throw in the towel, Sam said, but he wanted his story to have an interesting ending. He wandered over to the Calle 24 Latino Cultural District building, another nonprofit, and knocked. An amiable employee named Jorge Arguello answered the door.
“Is this the place that gives out the vending permits?” Sam asked. Yes, Arguello said. The men had a conversation about the ins-and-outs of the permitting process.
Sam covers his drug costs by selling clothing he gets for free from Goodwill, he explained later. Business has been tough recently, he said, with prices getting driven down by buyers “squeezing” sellers they know are desperate for drug money.
That, Sam added, was “morally wrong.” Stealing from a corporation, on the other hand, was not. Sam noted that he only stole from the grocery store when he was hungry.
Regardless, Sam’s line of questioning had nothing to do with his entrepreneurial ambitions. He simply wanted to establish that Arguello knew about permits because, he whispered to this reporter in an aside, he heard the permit people knew about the van people.
So, what happened to the van? Sam asked, getting around to it.
Arguello knew exactly what van he was talking about. On Fridays, he said, a mobile clinic operated by HealthRIGHT 360, a substance use treatment provider the city contracts with, is parked nearby. As it was not Friday, Arguello called to make Sam an appointment at their physical location.
No one-time fix
Theoretically, Sam could have connected to HealthRIGHT 360, or another organization like it, directly from the jail if he was deemed medically suitable.
Each month, HealthRIGHT 360 schedules intakes for about 20 people referred from the criminal justice system by the court, attorneys, Jail Health, or probation officers, said MaryAnn Swift, the director of residential treatment services.
The program receives more referrals each month than the 20 it is able to accommodate. In mid-April, there were beds reserved for people being released from jail out into June.
Residential addiction treatment capacity across the city is still limited. If everyone in the San Francisco justice system were released to a program, attorneys and healthcare workers said, there would not be enough specialized beds or clinicians.
Even defendants in custody with treatment plans from the court are waiting between one and four months to get into a program that fits their specific needs.
The public defender’s misdemeanor unit represents 3,000 people a year and has three social workers in the jail. “We’re not able to reach most folks,” said Andrea Lindsay, the managing attorney. “What you can offer is only as good as the resources that exist.”
To break the cycle of addiction, San Francisco has added more than 600 treatment-focused beds and stood up a crisis stabilization center, wrote Kunal Modi, the mayor’s Chief of Health and Human Services, in a statement to Mission Local. In May, the city will launch the RESET center near the jail as an alternative location for law enforcement to bring intoxicated people.
City workers like Esteen, the nurse, said resources were still scarce: “If we tried to move 1,000 people,” from jail to residential treatment programs, she said, they’d “flood the system.”
Even if someone gets a spot in a program, they may decide they no longer want what’s being offered, or realize barriers get in the way. Many drug users Mission Local interviewed, for example, asked what would become of their beloved pets.
Neither healthcare workers nor law enforcement can force medication and counseling upon people who say they aren’t ready.
“Substance use disorders are chronic both in the justice system and outside of it,” Swift said. “None of it is a one-time fix-all solution, because of the nature of the disease.”
Sam still wanted to try. He took the phone from Arguello and spoke to a provider. When Sam was finished, he lit a celebratory cigarette with a pocket-sized butane torch. “I’m going to get the shot!” he yelled at passersby.
He’d secured an appointment and had an hour to spare. An attempt at a pit stop to purchase a couple of bags of cashews from an illegal fencing operation nearby were foiled when the vendor realized he had a journalist in tow and refused to sell.
“I’m tired of living like this, bro,” he announced to a friend before hustling away from the scene to an oncoming bus. “I gotta make different choices.”
Outside the HealthRIGHT 360 building on 1563 Mission St., Sam confirmed the plan: If he came back downstairs from the private patient intake area in 30 minutes, it was a bust. If not, he was being seen by a doctor.
Half an hour passed. Sam didn’t come back out. It seemed he’d gotten “the shot” he wanted.
Over the coming weeks, however, messages to his email address bounced. There was no way to know if he’d found the treatment he was looking for, stuck with it, and broken his cycle of addiction and arrest.
That is until three months later, when his name reappeared in the jail booking logs. The charges: drug possession.
Abigail Vân Neely reported this story while participating in the USC Annenberg Center for Health Journalism’s 2025 Data Fellowship.