SF drug overdoses decline for first time in three years as City overdose prevention efforts intensify

Strategies for 2022 build on the implementation of the Street Overdose Response Team and low-barrier access to treatment and overdose prevention resources.
January 19, 2022

Today, the SF Department of Public Health (SFDPH) announced preliminary findings showing that accidental overdose deaths in 2021 were 7% lower than 2020, representing the first decline since 2018. The preliminary findings are based on data from the Office of the Chief Medical Examiner (OCME) and conclude a year’s worth of monthly reports on accidental overdoses in the City.  

The year-over-year decline from 700 deaths in 2020 to 650 deaths in 2021 are a sign that the City’s record high number of overdoses in recent years may be leveling off with the support of new City investments in substance use treatment, mental health, housing and other services, among additional factors. The City’s overdose prevention efforts are designed to have impact by lowering the barriers to treatments and services and encouraging safer use practices that are proven to reduce the risk associated with drug use. The data from 2021 and 2020 categorize overdoses slightly differently, which is why there are variations in annual overdose numbers.   

The 2021 preliminary data from OCME has been released alongside a new, detailed report on Substance Use Trends in SF through 2020, analyzing the impacts of drug overdoses in SF in 2020. The findings of the 2020 report points to fentanyl as the main driver of overdose mortality, especially among younger people and Black/African Americans. Efforts like the distribution of naloxone, the opioid overdose-reversing medication, through community organizations like the Drug Overdose Prevention and Education (DOPE) Project and City services reversed more than 4,300 overdose deaths in 2020. Between January 1 and September 30, 2021, community partners and City services distributed 28,000 naloxone kits, reversing more than 6,800 overdoses. The City will continue to meet distribution demands in 2022. 

“As we continue to implement Mental Health SF and invest in critical services like our Street Overdose Response Team, we must look ahead and build on the progress we have,” said Mayor London N. Breed. “We know that every overdose death is preventable, and we know that we still have a long way to go, but we must act aggressively to ensure that every resident receives the support and services they so desperately need.” 

On Tuesday, the City opened a new services-focused Linkage Center at 1172 Market Street as part of a broader intervention to address the overdose crisis in the Tenderloin. As a place where people who use drugs can voluntarily find respite from the streets and access resources, the Linkage Center is one of the key initiatives of the local Emergency Declaration issued by Mayor Breed and approved by the Board of Supervisors in December. The Emergency Declaration allows the City to waive certain laws to quickly address the crisis of people dying of drug overdoses in the Tenderloin.  

SF will also open a drug sobering center, called SoMa RISE, this year as a safe space for people who are intoxicated to come inside and be connected to services. Additional overdose prevention efforts planned for 2022 include an expansion of the Street Overdose Response Team, which provides an immediate response and then follow-up care to people who have recently survived an overdose and are most at risk of another one, and opening California’s first safe consumption site.  

“We grieve the many lives lost to overdose in 2021 and commit ourselves to employ the tools, resources, and support that we know are effective to save lives. We also show our gratitude for the many people who saved a life this past year, reversing an overdose, connecting someone to treatment, or being a steadying hand in a friend’s path to wellness,” said Dr. Grant Colfax, Director of Health. “We look to 2022 with optimism and hope given the many efforts and resources being deployed at a rapid pace and the commitment of our communities and partners throughout the City to save lives.” 

Overdose deaths in SF began a rapid rise in 2018 due to the arrival of fentanyl in the illicit drug supply, an opioid that is 50 times more potent than heroin. The COVID-19 pandemic added to the dangers of drug use because people were more often using alone. In response, the City intensified its overdose prevention response, adding new resources that specifically target people experiencing homelessness, who are among those at highest risk.  

In 2020 and 2021, the City and community partners launched and expanded overdose prevention efforts, including:  

  • Expanded hours and services at the Community Behavioral Health Services Pharmacy at 1380 Howard Street, including delivering treatment to Shelter in Place (SIP) sites and telemedicine. 
  • Added 88 new drug and mental health treatment beds as part of Mayor Breed’s plan to add 400 new spaces through Mental Health SF. 
  • Launched the Street Overdose Response (SORT) team in August 2021 to provide care and support for people at high risk of overdose. SORT has already responded to over 750 calls to date. 
  • Launched the SRO Overdose Prevention Program, providing targeted outreach and intervention for individuals living in SROs. 
  • Set up over 150 low-barrier naloxone stations in over 30 shelter in place sites. 
  • Launched the SFDPH Clearing House to distribute naloxone both to community partners and directly to individuals with the plan to distribute 28,000 naloxone kits annually. 
  • Passed legislation requiring frontline City employees with SFDPH, the Department of Emergency Response (DEM), the SF Department of Homelessness and Supportive Housing (HSH), and the SF Human Services Agency (HAS) to receive training in naloxone use and overdose reversal. 

Mayor Breed and SFDPH are committed to further decreasing overdose deaths in 2022 by completing the implementation of Mental Health SF, overhauling SF’s mental health system for all San Franciscans who lack insurance or who are experiencing homelessness, expanding access to treatment, including medication treatment and contingency management, expanding proven overdose prevention methods, and increasing community engagement and education.  

The following overdose prevention initiatives are underway and will launch or expand in 2022:  

  • Expansion of new beds and treatment facilitates, including opening the drug sobering center, SoMa RISE.  
  • Expansion of the Street Overdose Response Team to include peer specialists and additional teams so that the Street Overdose Response Team can maintain a caseload of 700 individuals. 
  • Opening California’s first safe consumption site. 
  • Launching initiatives so that SF Fire Department paramedics can provide the addiction medicine treatment buprenorphine in the field. 
  • Launching a fentanyl test strip program, which will be accessible through syringe access programs. 
  • Launching a five-year project to support the health of SF’s Black/African American residents called the Culturally Congruent and Innovative Practice for Black/African American Communities, serving Black/African American residents with mental health needs. 

SFDPH and the OCME will continue to collect and analyze substance use data throughout the City to better allocate resources and invest in overdose prevention and treatment programming that reflects the needs of each community. 

Key findings from the 2020 Substance Trends Report

  • Overdose deaths continue to be driven by the powerful opioid fentanyl and related analogs, often in combination with cocaine or methamphetamine.  
  • 89 percent of opioid overdose deaths in 2020 were attributed to fentanyl. Deaths involving fentanyl tend to occur more among younger persons than deaths not involving fentanyl.  
  • Admissions to substance use disorder (SUD) treatment programs for fentanyl increased substantially in 2020, as did the overall number of people treated for opioid use disorder with buprenorphine. SF did see a further decline in the overall number of admissions and unique persons admitted to SUD treatment programs. The most recent decline is likely due to the COVID-19 pandemic but is also likely made up by increasing numbers of people receiving buprenorphine outside SUD treatment programs.  
  • Males, persons aged 50 to 59 years, and Black/African Americans had the highest rates of overdose mortality related to opioids, methamphetamine, and cocaine/crack. SUD treatment program admissions were highest among males and Black/African Americans for all substances. 
  • Drug overdose mortality tends to be concentrated in the Tenderloin, South of Market, and Mission neighborhoods of SF 

Safety Tips  

If you use drugs or if you know people who use drugs, it is recommended that you carry naloxone for your safety and the safety of others. Naloxone is covered by Medi-Cal, Healthy San Francisco, and most health plans. It can be obtained from the Community Behavioral Health Services (CBHS) Pharmacy at 1380 Howard Street on a walk-in basis with no prescription required, Monday-Friday 9 a.m. to 7 p.m. and Saturday-Sunday 9 a.m. to 4 p.m.