October 2026

GRACE SF: Randomized trial and system transformation initiative

GRACE SF is a joint initiative of the City and County of San Francisco, San Francisco Public Health, HealthRIGHT 360, California Policy Lab, and the Center for Addiction Science, Policy, and Research (CASPR).

GRACE SF is a planned randomized trial of GLP‑1 medication for substance use disorders within San Francisco’s housing and treatment services. Implementation and adoption will be designed in coordination with patients and frontline treatment providers, guided by clinical outcomes, service-use data, and economic research.

Addiction services in San Francisco

San Francisco’s Department of Public Health reported the following service use in fiscal year 2024–25:

16,804
unique people received DPH substance-use services, up 15.3% from the prior year.
5,711
people received specialty substance-use disorder treatment.
71%
of specialty treatment clients were experiencing homelessness.

Sources: SF Controller (FY2024–25); SFDPH (2025, slide 23). DPH counts overlap and exclude some programs; they are not complete citywide totals.

Implementation design

The planned trial will evaluate GLP‑1 treatment within existing housing and addiction services. Delivery models and participant supports are being developed in coordination with patients and frontline treatment providers.

Implementation research will examine treatment engagement and continuity of care to guide refinements.

Cost-effectiveness

The planned evaluation will examine treatment outcomes, costs, and use of public services, with California Policy Lab contributing expertise in administrative data and policy evaluation.

This research will inform estimates of cost-effectiveness and the resources needed for sustained delivery.

Policy adoption

Adoption plans will be developed in coordination with patients and frontline treatment providers, using clinical outcomes, implementation findings, and cost data. Planning will consider service capacity, workforce needs, and options for sustained coverage.

Broader adoption would depend on the evidence, service capacity, and relevant approvals.

Program updates

Thanks. We'll keep you posted.