A decade. That's how long San Francisco has been grappling with fentanyl — and after ten years of task forces, emergency declarations, Narcan distributions, safe sleeping sites, and a whole alphabet soup of city programs, the scorecard for 2025 looks like this: more people died than last year.

Let that sink in.

The city has spent enormous energy — and enormous money — telling itself it's making progress. And to be fair, some harm reduction measures have pulled people back from the edge. Naloxone saves lives. That's real. But when overdose deaths are still climbing after a decade of intervention, you have to ask whether the overall strategy is working or whether we're just getting better at managing a catastrophe we've quietly accepted as permanent.

San Francisco has a habit of confusing activity with results. We fund the programs, hold the press conferences, and declare the initiatives — and then move on before anyone checks whether any of it actually moved the needle. Fentanyl is the brutal proof of concept for that failure loop.

The drug arrived, it stayed, it killed, and it kept killing. Meanwhile, the political will to do anything genuinely disruptive — whether that's serious enforcement against open-air dealing, mandatory treatment pathways, or an honest accounting of which programs have failed — has been perpetually deferred in favor of ideological comfort.

This isn't a left or right issue. It's a basic governance issue. If a city spends a decade and hundreds of millions of dollars on a crisis and the death toll goes up, someone needs to be held accountable. Not shamed — accountable. What worked? What didn't? What do we stop funding?

San Franciscans deserve an honest audit, not another ribbon-cutting on a program that sounds good in a press release.

The people dying in the Tenderloin and SoMa aren't abstractions. They're neighbors. And they deserved better than ten years of the same cycle.

We can do better. We just have to actually want to.