In California, I would tend to expect that these street urchin drug users are on MediCal - which is federally funded to the extent of as much as 90%. If CA wants to facilitate this reckless recreational drug use, they are doing so with other people's money. So, no news here.
Many myths foisted on us in this opioid epidemic. Such as "It can happen to anyone!" Er, no, it will not happen to those who never use opioids. And that is a lot of us. Educated, prudent, responsible citizens.
Back to the essential question. Now that the annual OD fatalities due opioids are in the low 70K range - are these people who would ultimately commit suicide by other means at some other time, or who would spend decades institutionalized (in prison or perhaps psychiatric hospitals) or otherwise riding the backs of taxpayers?
From what I understand, you might be mixing two fairly distinct things. For the most part, the street-level addicts and dealers in San Francisco are using cocaine, heroin, and meth, and the scene is not that much different than it has been for decades, maybe just a bit bigger, more concentrated and tolerated.
There has also been an explosion of people who are prescribed opiates because of various kinds of medical issues, but become addicted. If you are poor and addicted to prescription opiates, there’s a good chance that you’ll end up on heroin because the dose is a tenth of the cost. Add to that, fentanyl from China is being cut and sold as heroin or black market prescription drugs, because the same high can be achieved for again, one tenth the cost. It’s also like 100 times more dangerous, because the amount needed to overdose is very low.
The increase in overdoses mostly has to do with that second trend of prescription opiates -—> heroin and/or black market drugs -—> fentanyl overdoses. Take that out of the equation, and the illegal drug overdose level would probably be not much different than the average over the last several decades.