The crowd, which skews on the older end of Gen Z, gives natural-wine natty: mustaches and dad caps, ironic T-shirts (Barefoot Contessa), band totes (The National), dogs in striped sweaters, a flutter of butterfly hand tattoos. It could be Bushwick, but it’s Balboa Street, and Rampant owners Charlie O’Leary and Jack Pain, who live in the neighborhood, fit right in themselves.

On top of a carefully curated selection of bottles, the duo offer 16 natural wines (i.e., “clean and not flawed”) by the glass — specifically those they hope will convert the haters. “People say natural wine is funky, cloudy, and tastes like kombucha,” says O’Leary, who admits that “there is an ocean of horrible natural wine out there.”

But this is not the case with the Albariño — nor, they hope, a new orange wine that O’Leary describes as “approachable, delicious, complex” from Kelley Fox, a female producer based in Oregon. Soon they’ll have in SF-based Isabella Morano to do a tasting of her Isa Wines in person. The little food menu has wine-bar go-tos like bresaola and tinned fish, but also hummus made by the woman who owns Al-Masri, the longtime Egyptian and belly dancing restaurant down the street.

Just a couple of blocks up, there’s more natural wine to be had at Slake, a year-old shop that specializes in clean drinking — “frankly, an exhausting conversation, but it’s also an important one,” says owner Daniel Lovett. Lovett did his time working everywhere from Nopa to Saison before starting a family and wanting to ditch the restaurant grind. Natural wine, he says, isn’t just a millennial affectation. “It’s about drinking the way we’ve learned to eat here in the Bay. Keep it clean and small and local.” 

In the last year, admissions to substance use residential treatment admissions have increased 35%, and both methadone starts and buprenorphine prescriptions are up 39% and 52%, respectively, in 2024 compared with 2023, according to the Department of Public Health.

More issues arose when San Francisco had to nearly close its largest public hospital, Laguna Honda, after on-site overdoses triggered inspections that the facility failed to pass. City leaders, including those in Washington, D.C., like Speaker Emerita Nancy Pelosi, rallied alongside Colfax to get the hospital, which has since been recertified, back on track.

“Dr. Colfax is an extraordinary public health leader,” Pelosi said in a statement. “From our city’s COVID response, to saving Laguna Honda hospital, to expanding primary care and treatment for substance use disorders, Dr. Colfax has led with a data driven, community-centered focus that benefits all San Franciscans.”

Despite those efforts, San Franciscans continued to see tragedy in their streets stemming from the overdose epidemic, though there were roughly 20% fewer overdose deaths last year than in 2023.

In November, voters elected Lurie after he campaigned on a message to bring change and accountability to City Hall. Now in office, Lurie has started releasing plans for how the city can more quickly set up emergency shelters and behavioral health beds.

So far, that’s involved asking the Board of Supervisors to remove certain bureaucratic requirements to speed up city contracts and permitting, and to waive rules around accepting private donations for services directly responding to overdoses, drug dealing and homelessness.

“We have accomplished much in the past six years, and there is no doubt that the dedicated, hard-working and compassionate staff at DPH will continue to deliver for San Francisco,” Colfax said.

San Francisco has plummeted in the rankings of America’s best cities as its soaring cost of living, rampant crime, homelessness and an exodus of companies takes a major toll.

The once shining City by the Bay fell from 27th last year to 126th in the most recent study by the Milken Institute, which rates metro areas nationwide.

The precipitous fall from grace comes after San Francisco was ranked No. 1 as recently as 2020 — the year that set off its COVID-induced struggles.

The Milken Institute’s annual report gauges the best cities based on metrics including job and wage growth, affordable housing, economic equality and other factors.

At the top of the list was Raleigh, NC, followed by Ogden, Utah and Salt Lake City. Huntsville, Ala. and Colorado Springs, Colo. rounded out the top five.

Since 2020, several major companies, including X, Oracle, Tesla, Hewlett Packard, Charles Schwab and Palantir have relocated their headquarters from the San Francisco Bay Area to states like Texas and Colorado. The companies cited California’s high costs and regulatory challenges, and a more business-friendly climate in the other states.

This trend reflects a broader shift as corporations seek lower taxes, reduced operational expenses, and better economic conditions, impacting the Bay Area’s commercial real estate and job market.

Since the pandemic, the Bay Area also has faced significant challenges related to crime.

Oakland has experienced a surge in homicides, with 114 reported in 2023, marking the fourth consecutive year with over 100 homicides.

Meanwhile, a brazen wave of shoplifting prompted California Gov. Gavin Newsom to sign legislation in August aimed at combating organized retail crime.

The San Francisco Police Department has deployed high-tech drones equipped with surveillance capabilities to enhance crime-fighting efforts, leading to numerous arrests and improved response times.

San Francisco is also consistently ranked among the most expensive cities in the US alongside New York, San Jose, Calif., and Honolulu.

The deterioration in San Francisco’s quality of life has had political repercussions.

In the Nov. 5 mayoral election, billionaire philanthropist and Levi Strauss heir Daniel Lurie defeated incumbent Mayor London Breed, winning approximately 56% of the vote to Breed’s 44%.

Lurie, founder of the non-profit Tipping Point Community, is the first political outsider to be elected as San Francisco’s mayor since 1911.

His campaign focused on addressing crime, homelessness and housing affordability.

During the race, Lurie pledged to secure 1,500 shelter units within his first six months in office and to prioritize public safety by increasing police staffing.