The minute Sam was released from San Francisco’s County Jail No. 1 in January, he “ran to the dope dealer.”
Kimberly, who was booked in October 2025, also went “straight to the streets to get high.”
Star said she was arrested, booked, released, and arrested again on Sixth Street, a notorious drug corridor a few blocks away from the jail, enough times for a judge to issue her an order to stay away from that street.
Mayor Daniel Lurie made “breaking the cycle” of homelessness and addiction a priority of his first year in office. He told voters that visible drug use will not be tolerated, and promised to unite law enforcement and behavioral health professionals to get people into treatment.
San Francisco police subsequently increased enforcement against low-level crimes. Police made over 50 percent more arrests for drug offenses in 2025 than they did the previous year.
But many of the people arrested go in and out of jail. As the number of people locked up in San Francisco in 2025 reached a six-year high, individuals like Sam, Kimberly, and Star said the crackdown did not keep them off the street — and they weren’t the only ones.
Last year, the San Francisco sheriff’s department repeatedly booked hundreds of people, according to a Mission Local analysis of jail booking logs. Two out of every five people in logs from January 2025 were booked again later that year, our analysis found.
The records, along with dozens of interviews, offer a daily snapshot of individuals in custody. They also raise a question: How useful is a trip to jail when it becomes like a revolving door?
Of the approximately 1,000 people booked in January 2025, over 400 re-appeared in the sheriff’s records later that year. Over the course of 12 months, each was booked about three times, on average.
“We have a problem with repeat and chronic offenders in our city,” District Attorney Brooke Jenkins said in an April video, noting that eight percent of defendants are responsible for 25 percent of cases prosecuted by her office.
People arrested for public drug use, identified here only by their first names as they navigate ongoing criminal cases, said they have felt the pressure of law enforcement under Lurie. Police are “looking for people to bust,” Sam said. They’re “on us like white on rice,” Star said.
In some cases, police simply cite and release people on the street. Others get booked at County Jail No. 1.
“No matter what you think of all that ideologically, there’s no debate that it puts more people into the system,” said Judge Charles Crompton, who presides over the city’s Behavioral Health Court. “It creates more people being in custody,” and leaves jail healthcare providers “busier than ever.”
The jail has subsequently become a “triage point” overwhelmed by a flood of people with behavioral health disorders it was never designed to treat, said dozens of San Francisco jail staff, healthcare providers, outreach workers, legal professionals, and formerly incarcerated people interviewed by Mission Local.
As a result, many said they end up back on the street, using drugs, only to be arrested again.
Department of Public Health officials declined to be interviewed for this story. In a 2023 interview, Tyler Mains, the chief medical officer of Jail Health Services, told Mission Local that “the reasons people use substances are widely varied, and a lot of times have to do with underlying factors.”
“One day in jail is not going to change that,” he said.
Take, for example, the just over 1,000 people who were booked in January 2025.
Over the next 12 months, over 40% of them were booked again.
Over half of those booked again were booked at least once on charges related to the use or possession of a controlled substance.
Three out of every four were booked later in the year for the same charge they were booked for in January.
Booked again and again
Most people are booked for multiple charges each time they go to jail. Logs show that people were repeatedly booked for “possession of unlawful drug paraphernalia,” a misdemeanor, more than any other crime.
However, charges that appear in the booking logs aren’t always reflective of a new crime.
Sam, for instance, went to jail on a warrant for previous misdemeanor charges. Several formerly incarcerated people said in interviews that they were arrested after they failed to appear in court due to lack of access to a cell phone, transportation, or stable housing.
“Many of our unhoused neighbors are set up to fail by systems that ignore the realities of their lives,” said Anjuli Webb, a public defender for a man who went to jail 11 times in 2025.
A few names appear in the sheriff’s logs far more often than others. Four people, for example, were booked nine or more times in 2025. It’s unclear how long they spent in custody, what services they received, and whether they picked up new charges. The city denied public records requests for discharge logs.
Still, their records indicate just how many times it may be possible to return to jail.
For Webb’s client, the man who went to jail almost every month of 2025, nearly every time involved charges of possession of drug paraphernalia. He was also regularly booked for petty theft, assault with a deadly weapon, criminal threats, and “unauthorized lodging.”
“Unauthorized lodging” is a misdemeanor associated with homelessness, attorneys said. Records show that the number of people booked for that crime spiked from less than five to dozens a month after the Supreme Court in Grants Pass v. Johnson ruled cities could enforce bans against sleeping in public.
In some cases, people died of an overdose shortly after getting booked. Wesley Troupe, a man in his 50s, died just over three months after getting booked for petty theft while on parole, according to records from the San Francisco medical examiner. Another man also in his 50s, Ares Brown, died 19 days after getting booked on charges related to possession of a stolen vehicle.
It’s unclear how long they were held in jail, and if they were treated for a substance-use disorder. They were among the 17 people who were booked in 2025 and later died of an overdose that same year.
Public health meets public safety
Not everyone who is arrested for a drug offense needs or wants to be treated for addiction, and misdemeanor drug possession charges are rarely the reason people remain in custody. The majority of people incarcerated in San Francisco county jails in 2025 were charged with a serious and violent felony, according to the sheriff’s annual report.
That said, around two-thirds of the approximately 1,200 people in the county’s jails on any given day have a stimulant-use, opioid-use, and/or alcohol-use disorder, according to San Francisco Department of Public Health data.
Multiple jail and court staff said the proportion of people with a substance-use disorder is now closer to 85 percent, a marked increase from two years ago.
“Jails have effectively become one of the largest settings in the country where people with untreated behavioral health conditions cycle through repeatedly,” the Department of Public Health wrote in a statement to Mission Local.
Court and jail staff told Mission Local that jail healthcare providers must respond to acute medical crises while also being “inundated” with thousands of patients. Some are known “frequent flyers” of the system who may arrive “gravely disabled and suicidal.” Others still need to be diagnosed. Many fall through the cracks.
Eight people interviewed over the last six months about being booked and released from jail said all they received by way of support when they left was a phone number to call about social services, a list of clinics, or a bus token.
After eight days in custody, Michaio said, the attitude was “get out of here” and “get sober on your own.”
After three days, Shawn was “told to hit the road,” he said. “You have to be your own advocate to be referred” to outside social services.
“Just bye and I hope we don’t see you again,” recalled Henry, a born-and-bred San Franciscan who said he’d been to jail four times in his 50 years, most recently for possession of drugs.
“It never helped me,” Henry said. “I’m still homeless.”
“The amount of people with substance-use disorders, impoverished, and unhoused in the jail are systemic issues,” said Jennifer Esteen, who’s been a registered nurse in San Francisco for 16 years and started working in the jail last August. They are “running through a cycle they can never break free from.”
Jailed and triaged
The root causes of a crime are complex. They’re best addressed in the community, where someone can build relationships with providers without fear of punishment, said several doctors, attorneys, and advocates.
At the same, some felt that the justice system can at least give people an opportunity to access behavioral health services they wouldn’t otherwise.
In 2025, the sheriff’s department expanded its jail capacity and added a dorm specifically for people with substance-use disorders. Local politicians suggested that detaining drug users in “mass arrests” could present an opportunity for addiction treatment in custody.
“We have to make sure that we are keeping in custody those who require more time to figure out a better plan for their lives,” the DA said in her April video.
Jenkins told Mission Local she was speaking of detaining people like “fentanyl dealers,” not low-level offenders who commit quality of life crimes that the criminal justice system is unable to effectively assist.
The city’s jails should not be relied on for medical care, Jenkins said. “But, unfortunately, that is sometimes where we can have people spend a significant time getting the treatment that they need that they wouldn’t otherwise take advantage of outside the system.”
“The only reason why I ended up getting help is because I got picked up for a criminal record,” said Elijah Donaldson, a former Behavioral Health Court participant who recalled his personal cycle of drug use.
But Donaldson wasn’t just sitting in a cell. After his arrest, he spent years completing a court-approved treatment plan with a case manager through a diversion program. He had an incentive: If he was released to treatment, he’d avoid prison time.
Jails, by their nature, are not set up to provide care for chronic behavioral health disorders, said doctors and academics at Stanford University, UC Berkeley, and UCSF.
“It is hard, even with the best of intentions, to operate a therapeutic program inside a facility whose larger purpose is focused around danger and control,” said Keith Humphreys, a professor of psychiatry and behavioral sciences at Stanford University.
Moreover, Humphreys added, “people come in and out of jail fast.” When a person arrives in jail intoxicated, “it’s pretty hard to do much beyond watch over them” and “make sure they don’t die during withdrawal.”
“Each booking represents a point of contact with the healthcare system, but the episodic, short-stay nature of most jail admissions makes it difficult to provide the sustained treatment that substance use disorders require,” wrote a spokesperson for the health department.
Judges refer the majority defendants to out-of-custody case management services. They can also release people to mental health diversion programs. Still, hundreds of people are released only on the condition that they get themselves back to court, or have the charges against them dismissed after being brought to jail.
Social workers said they simply didn’t have the bandwidth to offer in-depth case management to everyone. The only chance some of these people may have to get connected to healthcare will be during a few hours of booking.
24 hours for a change of heart
Upon arrival, everyone brought into custody by police is briefly assessed by a triage nurse, who determines if they are too sick or injured to sit in jail. Those deemed healthy enough typically spend up to 24 hours waiting in an intake room before being released or housed in the jail, the nurse, Esteen, said.
Nurses can check people’s vitals and pass pain medication through the intake cell door. While “all access to patients is controlled” by sheriff’s deputies, according to a 2023 Jail Health Services presentation, nurses can and do conduct follow-up interviews in private rooms away from law enforcement. This, healthcare workers said, is when patients may be more inclined to speak honestly about their drug use and medical history.
“Most folks who are struggling with addiction aren’t interested in self-reporting their substance use to people who they perceive to be enforcement,” said Andrea Lindsay, an attorney who oversees the public defender’s misdemeanor unit. “A lot of them never make it up to the regular part of the jail,” where they would have a chance to access more services.
Sam’s early January day in the jail intake facility was bleak.
When a deputy handed him a phone, he didn’t know who to call. The 45-year-old sat on one of the two benches on either side of a windowless room alongside a dozen other people, many of whom he said were vomiting because they were “dopesick.” There was just one toilet.
Sam had forgotten how painful withdrawal was, like someone “drilling into your spine.” That, he said, made him scared to quit.
According to Department of Public Health data, about a quarter of people booked into jail report recently using opioids. Each month, about 40 percent of people who remain in custody are taking some form of opioid addiction medication.
Jail Health Services “operates the largest medical withdrawal management unit in San Francisco” according to a July 2025 presentation by then director Dr. Lisa Pratt.
In April 2025, it expanded further, opening a pharmacy inside the jail and adding services through the statewide Justice-Involved Reentry Initiative.
San Francisco has one of the few jails in the United States where patients can choose any form of opioid-use disorder medication, a health department spokesperson wrote.
Still, there are limitations.
People taking controlled opioid addiction medication for the first time, for example, must get a prescription from a doctor or nurse practitioner. While a doctor is always on-call, they typically see patients in custody only by appointment, Esteen said. That appointment is hard to get when the jail is understaffed, there may be lockdowns, and doctors must prioritize acute health crises, she said.
Nurses can offer Suboxone, Esteen added, but they’re instructed to only give that opioid addiction medication 48-hours after an individual’s last drug use. By then, many patients may already be back on the street.
In 2024, San Francisco’s jail became the first in the country to offer longer-lasting injections that can be given as early as eight hours after arrest. Healthcare workers said they have been effective because they do not require patients to return to a provider right away. Even this convenience, though, isn’t enough for some who are on the fence about accepting treatment.
Sam, for example, said that when he’d committed crimes in the past, it was because he “wanted someone to know I needed help.” But when he’s been offered opioid addiction medication while in custody, he said, he turned it down. His reasons:
- “You don’t ask the cops for anything.”
- He had an open wound and worried about feeling the pain if he continued to detox.
- He wanted to see a therapist first, and there was not one immediately available during intake.
“Once I fix my head, then my heart will change,” Sam thought. 24 hours later, he was out, buying drugs, and risking getting arrested again.
This is one part of a series on people who cycle through San Francisco’s jails. Read about Sam’s search for treatment here.
Abigail Vân Neely reported this story while participating in the USC Annenberg Center for Health Journalism’s 2025 Data Fellowship.
Graphics and additional data analysis by Kelly Waldron. Illustrations by Neil Ballard.
Methodology
The 2025 San Francisco county jail booking log data used in this analysis was compiled from thousands of emails provided by the San Francisco sheriff’s department listing the individuals booked each day, and what those people were charged with. Each booking log is a snapshot of a person in custody on a given day, and does not reflect their entire criminal history, time in custody, or recidivism.
Booking logs are subject to human error, and Mission Local could not verify that every city department that works with people in the justice system has an identical data set.
“Individuals may appear multiple times in booking logs for reasons that are not indicative of new criminal behavior, including bench warrants, court-ordered returns, or administrative updates,” wrote a spokesperson for the sheriff.
To avoid the possibility of over-counting, in this analysis individuals’ bookings within three days of each other were removed to account for administrative rebookings that do not reflect someone leaving and returning to jail. Logs that showed a change in what someone was booked for, rather than a new charge against that individual, were also removed from the data set. It is, however, possible for an individual to be released and re-booked into jail for multiple alleged crimes within a few days.
The graphics in this story were created using booking logs from Jan. 1 to Dec. 31, 2025.
Mission Local compiled a list of all the charges people were booked for in 2025, which included charges like “possession of unlawful drug paraphernalia.” If someone was booked on charges related to the sale or manufacture of controlled substances, it was not considered a booking related to merely drug use or possession. If a description of the charges against someone included an aggravating factor, like possession of a controlled substance with a firearm, that booking was also not considered an example of a booking for merely drug use or possession.
The findings of this analysis were shared with multiple city departments and independent researchers before publication.