Amidst nationwide opioid epidemic, San Francisco’s accidental overdose deaths drop for second consecutive year


Hannah Saunders


As the nation continues to face challenges with the opioid epidemic, accidental overdose deaths in San Francisco dropped for the second year in a row, as reported by the San Francisco Department of Public Health (SFDPH). 

“The Centers for Disease Control reported that through August 2022, overdose death rates were on the rise in California, while they were down in San Francisco. This suggests that the city’s programs and policies, as well as the work of our community partners, are having a positive effect,” SFDPH told State of Reform. 

Preliminary data was provided by the Office of the Chief Medical Examiner, which shows that San Francisco recorded 620 accidental drug overdose deaths in the 2022 calendar year, while 640 accidental drug overdose deaths took place in 2021. For 2020, there were a total of 725 reported accidental overdose deaths.


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Despite this downward trend, Black individuals continue to be disproportionately impacted by overdoses. Data shows that overdose rates among Black individuals in 2022 is more than five times the citywide rate, which is on par with 2021 data. 

“SFDPH recognizes that there are profound racial disparities among people who die of overdoses both nationally and in San Francisco,” SFDPH told State of Reform. “It is important to support immediate overdose prevention activities, while also working to address the larger social factors, such as structural racism, that have compounded the impact experienced by Black communities.”

Data from last year shows a 14% decrease in reported overdoses, which is a 14% decrease from 2020—when overdose rates were at an all time high in the city, largely due to the COVID-19 pandemic and the growing presence of fentanyl, a deadly synthetic opioid.

“Fentanyl continues to disrupt and destroy lives in our City and while overdose numbers have gone down, they still remain far too high,” Mayor London Breed said. “San Francisco remains committed to finding innovative solutions to the ongoing opioid crisis while also focusing on the accountability work with our public safety agencies to get drugs off our streets.”

In San Francisco and throughout the country, fentanyl is the leading driver of drug overdose deaths. Of the 620 overdose deaths in 2022 in San Francisco, 72% were attributed to fentanyl. In comparison to other drugs, fentanyl is relatively cheap and is used to cut up drugs such as heroin, cocaine, and methamphetamine. As a result, individuals consuming substances may be unintentionally exposed to fentanyl, which is fatal in small amounts.

According to the CDC’s National Center for Health Statistics, there were 107,622 drug overdose deaths in the United States in 2021, which is an increase of nearly 15% from 2020, where the estimated overdoses were 93,655. Data for 2022 has not yet been made available. 

“Fentanyl has had a devastating impact on communities across the country, including San Francisco,” Director of Health Dr. Grant Colfax said. “We are addressing the crisis head on with a multitude of tactics, including growing our substance use treatment services and programs, expanding access to medication, and hiring more outreach staff to engage even more people suffering on our streets and in our neighborhoods.”

Fentanyl first became prevalent in local drug supplies in San Francisco in 2018, according to SFDPH, who has since been tackling the issue from numerous angles. Last year, Mayor Breed and SFDPH created the Office of Overdose Prevention, and implemented an Overdose Prevention Plan in 2022 to coordinate efforts to reduce overdose deaths and mitigate negative impacts of drug use on individuals and communities.

A peek into San Francisco’s Overdose Prevention Plan

“The decline in deaths is encouraging and shows that we can save lives with the programs and policies we are implementing in San Francisco,” said Dr. Jeffrey Hom, overseer of the Office of Overdose Prevention. “This is not about a single intervention, but a comprehensive public health approach to save more lives and to reduce the profound racial disparities that exist among those dying of overdoses across the City.”

SFDPH acknowledges how long standing and institutional factors such as poverty, racism, lack of housing, and unaddressed trauma contribute to overdose deaths, and that to reduce overdose deaths, prevention must be included in actions of all city departments and partners because opportunities to intervene exist in all settings. 

The city’s Overdose Prevention Plan consists of four strategic areas, some of which are already in place and undergoing expansion. Strategic Area 1 focuses on increasing availability and accessibility to the continuum of substance abuse services. While treatment for substance use and harm reduction have historically been viewed as separate and mutually exclusive approaches, SFDPH emphasizes how they exist on a continuum. 

Image: Zuckerberg San Francisco General Hospital.

Wellness hubs are the cornerstone of the city’s efforts to tackle substance use. The hubs provide overdose prevention services and resources, services to improve health, and linkages to treatment. SFDPH will also work to expand access and remove barriers to opioid use disorder treatment, including fentanyl addiction. An Addiction Care Team (ACT) provides addiction treatment care at Zuckerberg San Francisco General Hospital (ZSFG), where they offer harm reduction, medication and psychosocial treatment, and linkages to care.

Project HOUDINI Link currently provides enrolled patients with six months of targeted patient navigation, contingency management and linkage to community-based opioid use disorder treatments, primary care, and mental health care for individuals taking one of three FDA approved medications for opioid use disorder. Patients are started on buprenorphine, methadone, or extended-release naltrexone and are assigned navigators to assist with insurance enrollment, and community-based treatment providers.

The Treatment Access Program (TAP) in the Behavioral Health Access Center assesses and matches individuals seeking care with treatment providers. TAP assesses clients who are referred by various providers in the city, and staff provide support to ZSFG social workers, and facilitate placement for discharged patients from triage and inpatient settings to community based programs.

Supporting and broadening overdose prevention services, such as naloxone, fentanyl test strips, drug checking, and safe consumption will prevent overdoses from being fatal. Enhancing targeted overdose response teams and connecting people to care will improve post overdose outcomes.

Medications for Addiction Treatment (MAT) are currently available in multiple Department of Health funded settings. Seven Opioid Treatment Programs (OTPs) offer methadone and buprenorphine, and four Federally Qualified Health Centers (FQHCs) participate in office-based methadone treatment. All FQHCs in the city have physicians who can prescribe buprenorphine.

Strategic Area 2 focuses on strengthening community engagement and social support for people who are at high risk of an overdose. Communication to the public about substance use and the availability of services will continue through public messaging campaigns. Contingency Management is a treatment approach for individuals with stimulant use disorders, and is available at the San Francisco AIDS Foundation, where patients receive tangible incentives to reinforce positive behaviors, like abstinence. 

Drug sobering centers, like SoMA RISE, offer a trauma informed safe space to be while intoxicated. SoMA RISE initially opened in June last year, and by September, the center was operating 24/7. Services at the facility include medical care and observation, linkages to services and housing supports, referrals to providers, and individual and group counseling.

Using a citywide and data-driven approach, the department will provide public overdose response trainings and naloxone distribution. Collaborating with community-based organizations and developing partnerships to support populations most affected by overdoses will also be a focus.

Strategic Area 3 will implement a whole-city approach to overdose prevention by establishing protocols for first responders to refer and quickly connect individuals who use drugs to health resources, overdose prevention services, and drug treatment. Additional goals include making overdose prevention training and naloxone available in all city-run housing facilities, and embed overdose prevention resources in a range of settings, such as social services, healthcare, and higher education, among others.

San Francisco has already implemented harm reduction policies in Shelter-in-Place hotels for individuals experiencing homelessness. Overdose prevention policies are being implemented across several city departments, including the Department of Homelessness and Supportive Housing, the Human Services Agency, and the Department of Emergency Management. The policies provide procedures for a suspected overdose on site, the development and distribution of harm reduction training, and substance use treatment resources.

Image: Delaware County Prevention Council.

SFDPH currently funds naloxone distribution through the department’s Clearinghouse and the Drug Overdose Prevention and Education (DOPE) Project. Last year, there were 23 DOPE distribution sites. SFDPH is continuing to expand naloxone distribution in harm reduction sites, medical settings, behavioral health settings, social service settings, pre-release at the San Francisco County Jail, and community outreach settings, such as street fairs, sex clubs, and bookstores.

In 2021, SFDPH and partners distributed over 33,000 kits of naloxone. In 2022, the San Francisco AIDS Foundation distributed over 40,000 doses of naloxone and reported 5,127 overdose reversals. In the last three months of 2022, SFDPH trained over 2,000 individuals on how to recognize and respond to overdoses.

Strategic Area 4 will track overdose trends and related drug use metrics to measure success and to inform program development. 

Goals going forward

While already implementing parts of the Overdose Prevention Plan, SFDPH is striving to meet benchmarks. Within one to two years, SFDPH hopes to increase the number of people receiving MAT by 20%, and increase the number of programs offering contingency management from three to five.

Other short term goals include increasing citywide naloxone distribution from 47,000 kits to 75,000 annually, while having naloxone available in 50% of supportive housing facilities.

Goals for the next three to four years consist of establishing wellness hubs in priority neighborhoods, increasing the number of people receiving MAT by 30%, and increasing citywide naloxone distribution to 100,000 kits annually. 

Additional long-term goals include having naloxone available in 100% of supportive housing facilities, and training 250 people in overdose recognition and naloxone use in educational settings and entertainment venues each year.

This year, SFDPH will continue implementing strategies from the Overdose Prevention Plan while scaling up efforts.

“Every new or expanded program is another opportunity to make an impact on individuals and families affected by the overdose crisis,” SFDPH’s Director of Behavioral Health Services  Dr. Hillary Kunins said. “Making sure that we reach people most at need and provide the most effective treatment possible will continue to be a priority for as long as drug-related deaths remain pervasive in our communities.”