We face an escalating addiction epidemic, with more than 100,000 people dying of drug-related overdoses in the US in 2021—the highest number of deaths ever recorded. San Francisco has the highest overdose death rate in California. At SFGH, more than 1/3 of hospitalized patients have a substance use disorder (SUD). Our patients with SUD have longer lengths of stay (3 v 5 days), 1.5x higher 30-day readmission rates, and 5x higher self-discharges than those without SUD. At SFGH, addiction affects Black and Latinx individuals (50%), people experiencing homelessness (50%), and those with psychiatric conditions (50%). In 2019, with grants/philanthropy funding, I co-founded the SFGH Addiction Care Team (ACT) to improve hospital-based addiction care for patients. ACT provides evidence-based addiction care, harm reduction, and linkage to care for patients while educating the healthcare workforce and reducing addiction inequities.