"I mean it's a hard drug to beat. It's fentanyl. It's crazy," said one drug user, outside a tent he calls home.
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From fentanyl to meth, "tranq" and more, the drug supply is becoming increasingly unpredictable.
A man named Michael, hanging out on Market Street, says he sells and uses.
TAKE ACTION SF: Mayor, city leaders to answer questions about future of city
TARA CAMPBELL: "Most people who are buying, what are they looking for?"
MICHAEL: "They looking for like fentanyl -- fentanyl gets you feeling good."
And, Michael says it's cheap and easy to get.
MICHAEL: "They might want something for five bucks."
TARA CAMPBELL: "How much do you get for $5?"
MlCHAEL: "You know, a nice amount."
MORE: Feds launch 'All Hands on Deck' operation to crack down on SF drug dealers, fentanyl
San Francisco is on pace for its deadliest year yet amid the drug overdose crisis. The Chief Medical Examiner has recorded 692 accidental overdose deaths so far this year, the majority caused by fentanyl.
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To combat the crisis, the city set aside nearly $600 million for behavioral health services in the past fiscal year, with the money going towards everything from more treatment beds to the street crisis team.
The city's also working to get life-saving Naloxone Spray, or Narcan into more hands, doling out more than 70,000 doses so far this year.
"I'm going to give you this, okay," said Sheriff's Deputy Barry Bloom, just a block away from City Hall, where he administered Narcan to a woman.
EXCLUSIVE: Video shows how Narcan is saving lives on streets of SF
EXCLUSIVE: Video shows how Narcan is saving lives on SF streets
And, back in the Tenderloin another life is saved, which is exactly why a group of activists set up a pop-up safe consumption site earlier this year.
"What we're doing here today is showing how easy it is to save a life," said Lydia Bransten, executive director of The Gubbio Project.
"We're not putting anyone at risk, including ourselves," said Richard, who is fighting addiction to fentanyl. "It would be nice if I could be here for more than just a day. I don't know what it's going to take."
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The city's been hesitant to green light safe consumption sites, citing legal concerns. But, the mayor has signaled support for the New York model, where a local nonprofit is funding and operating three sites.
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And, as local leaders look to New York City for solutions, Los Angeles is turning its eyes to San Francisco.
"One of the things I appreciate about what San Francisco's been doing in recent months, is that shift to focusing on especially the folks who are manufacturing this poison that's killing people on the streets," said Los Angeles Councilwoman Traci Park, who took to the streets of San Francisco.
The city is now more than six months into a multi-agency effort to shutter the open-air drug market. Gov. Gavin Newsom sent in California Highway Patrol and National Guard to support police.
But some say the city's gone too far -- from arresting drug users to the mayor's proposal to drug test welfare recipients -- moves the mayor defended in a recent interview with ABC's Martha Raddatz.
RELATED: LA councilmember tours San Francisco streets as both cities grapple with fentanyl crisis
LA councilmember tours San Francisco streets as both cities grapple with fentanyl crisis
"No, it's not always the popular thing to do and this is not about "left " or "right. " This is about saving lives," said Mayor London Breed.
And back on the streets, there is a stark reminder of the struggle to get sober.
"Myself, if you test me, I will be clean and might be dirty," said Denise, who was on the streets of the Mission District. "I go days and I do, and I go days that I don't."
And on one of those days when Denise did use, it was her last; just weeks after ABC7 News Reporter Tara Campbell spoke with her, Denise died of a fentanyl overdose.