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San Francisco has at once become home to some of the wealthiest people in the US rubbing shoulders with the president and a burgeoning population in poverty — and a narcotics epidemic that has made it a flashpoint in America's debate on drugs.

In parts of the city, a fleet of high-tech driverless high-end taxis roam the streets, a nod to the city’s tech industry and proximity to Silicon Valley.

Yet just blocks away, the skyscrapers, designer brands and exclusive bars give way to homeless shelters and rehabilitation centres of the Tenderloin.

Tents and tarpaulins line the streets, which often lack even basic amenities of grocery shops and pharmacies, let alone cafes or parks. Drug use in the open remains commonplace, namely of the highly addictive narcotic fentanyl.

Narcotics use has spiralled, with overdoses reaching nearly three times the US national average, according to the Centers for Disease Control and Prevention. After a record 806 deaths in 2023, overdoses declined by 21% in 2024 to 635 deaths, though rates began creeping back up again.

This has become a public bugbear in recent years for many of the super-wealthy, including tech billionaire Elon Musk, who until recently owned a mansion in the Bay Area.

An aerial view of the downtown San Francisco skyline, 10 July, 2025 AP Photo

US President Donald Trump’s former top ally called the city “a disaster,” posting on his platform X in May 2023, “once beautiful and thriving, now a derelict zombie apocalypse."

Musk also moved X's headquarters from San Francisco to Austin in 2024 despite promises that he would stay in the city, stating that he did so because he "had enough of dodging gangs of violent drug addicts just to get in and out of the building.”

Trump himself