Programs like needle exchanges and safe-consumption sites can lead to fewer deaths and help connect users to treatment. Without harm reduction, experts said, the city’s fentanyl crisis might well be far deadlier.

Isaias Lopez was dying, but he didn’t know it.

Lopez was slumped against a wall in the Tenderloin district of San Francisco, where the concentration of homelessness and drug use have divided this city politically.

A baby blue baseball cap and a white hoodie covered his head, making him just another human lump to be avoided by passersby. He had begun to nod off from the fentanyl that minutes ago was in a scrap of tin foil that now lay nearly empty on his legs

“Three thousand deaths is an inconvenient truth. This highlights 3,000 failures and highlights how we are not listening to policy experts and doctors,” said Dr. Dan Ciccarone, who specializes in addiction medicine at the University of California, San Francisco, outside the medical examiner’s office near the Hunters Point neighborhood.

Amid what feels like an ever-worsening drug crisis here, locals and politicians alike are fed up. Overdose death rates remain near all-time highs. The Tenderloin, a historic downtown neighborhood, remains rife with open-air substance use and drug dealing. Public health officials are increasingly at a loss.

But the solution is not a return to the ‘war on drugs’…