San Francisco Drug Overdoses Decline by 11% in 2021 but Remain at Crisis Levels as City Urgently Focuses and Expands Overdose Prevention Efforts

Report shows continued inequities in overdose rates among Black/African Americans, and the need for a citywide approach to lower the risks for people who use drugs.
October 07, 2022

San Francisco, CA — The San Francisco Department of Public Health (SFDPH) released the “Substance Use Trends in San Francisco Through 2021” report today with data showing the first decline in overdose deaths in three years. Even with this encouraging decline, the annual count of people dying of overdoses last year remained at crisis levels. 

In 2021, 625 people died from drug overdoses involving opioids, cocaine or methamphetamine, an 11% decrease compared to 2020, but still 41% above pre-pandemic 2019 levels. The pandemic likely contributed to the especially high number of deaths seen in 2020. 

“The Substance Use Trends report compels us to do more citywide to alleviate the overdose crisis in San Francisco’s communities and save more lives,” said Director of Health, Dr. Grant Colfax. “Our new strategic overdose plan builds on the progress that’s been made and pushes our public health response forward by defining our goals and public health strategies that will make the most impact. This also requires a ‘whole city’ approach to working together to support people who use drugs and lower their risks in every way possible.” 

Fentanyl remained the primary driver of overdose deaths in the city with 75% of overdose cases involving this powerful, synthetic opioid, whether taken alone or in combination with cocaine or methamphetamines. The report also highlighted the deep and profound inequities that persist as Black/African Americans in San Francisco experience an overdose death rate that is five times higher than the citywide total. 

Last week, SFDPH released “Overdose Deaths are Preventable: San Francisco’s Overdose Prevention Plan,” a four-point strategic roadmap with new and enhanced strategies to reduce the number of deaths and eliminate disparities associated with drug use in San Francisco. The report includes measurable goals to reduce overdose deaths and increase treatment among people at high risk. 

San Francisco has the highest overdose death rate among large California counties, a rate that is similar to other major cities across the United States due to the 2018 arrival of fentanyl in local drug supplies. Data show that overdoses continue to be highly concentrated in the Tenderloin and South of Market neighborhoods but are present in many other areas of the City as well. 

The racial disparity in overdose deaths underscores the need for tailored and focused approaches toward overdose deaths and substance use disorders that is informed by the community and supported with sufficient resources to make meaningful change. 

“This report underscores the seriousness of the crisis of overdose deaths in San Francisco,” said Dr. Hillary Kunins, Director of Behavioral Health Services. “The data tell us where we need to focus our efforts to make meaningful change, especially in BIPOC communities that have been unjustly impacted by overdoses and drug use. We can make more progress, and we will.” 

In 2021, SFDPH advanced a number of efforts to save lives and improve the wellness and recovery of people who use drugs. Working with community partners, San Francisco substantially expanded the distribution of naloxone, a life-saving opioid reversal medicine, to more than 33,000 kits. The effort saved lives – distribution sites reported 9,492 overdose reversals in 2021, more than doubling the 4,307 reversals in 2020. 

Innovative new programs were also launched last year, including the Street Overdose Response Team, which responded to more than 1,670 calls involving people who had survived a known or suspected overdose. SoMa RISE opened as a drug sobering center, bringing people who are intoxicated on drugs off the streets to sober up safely, receive basic care, and be connected to services. 

Meanwhile, SFDPH offered low-threshold outpatient medications for addiction treatments, such as buprenorphine, at more sites including urgent care, homeless shelters, and on the street, while continuing to expand residential treatment programs to deliver timely and appropriate level of care for people ready to enter overnight programs. San Francisco is now two-thirds of the way toward a goal of expanding its behavioral health bed count by 400 beds. 

Under the overdose prevention plan, new efforts are underway to create safe, welcoming “wellness hubs” in multiple neighborhoods for people who use drugs and people experiencing homelessness. The first wellness hub is expected to open this year, with several more to follow in 2023 and will build on the successful elements of the Tenderloin Center in community-centered, drop-in locations that provide overdose prevention services, access to treatment, housing, and other benefits. 

A copy of the “Substance Use Trends in San Francisco Through 2021” report can be found here