SAN FRANCISCO — After surging during the COVID pandemic into a crushing public health emergency, drug overdose deaths in San Francisco plummeted in 2024, according to preliminary data compiled by city health officials.
The chief medical examiner’s office recorded 586 fatal overdoses in San Francisco in the first 11 months of 2024. That represents a nearly 23% decrease, or 174 fewer deaths, compared with the first 11 months of 2023. In total, 810 people died from drug overdoses in 2023, the highest number in city records.
The development mirrors both national and statewide data showing overdose deaths on the decline. Provisional data from the federal Centers for Disease Control and Prevention indicate a 14.3% decrease in fatal overdoses across California when comparing the 12 months that ended in July 2023 with the 12 months that ended in July 2024. Fatal overdoses fell 16.9% nationwide during that period, according to CDC figures.
Los Angeles County health officials have not yet released fatal overdose figures for 2024. But the most recent data also showed progress: Deaths from drug overdoses and poisoning plateaued between 2022 and 2023, after years of historic increases, according to the L.A. County Department of Public Health. In 2023, the county recorded 3,092 fatal overdoses, down slightly from 3,220 deaths the year before.
San Francisco public health experts attributed the decline in fatal drug use in the city to the widespread availability of naloxone, a medication commonly sold under the brand name Narcan that can rapidly reverse the effects of opioid overdoses, as well as buprenorphine and methadone, prescription medications that treat opioid addiction long-term.
“We are cautiously optimistic that our public health interventions are starting to see results in terms of saving lives,” said Dr. Grant Colfax, director of the San Francisco Department of Public Health.
Methadone prescriptions issued by the health department increased by more than 30% and buprenorphine prescriptions by nearly 50% in the last year, Colfax said. The department recently partnered with a “night navigator team” that works after dark to offer treatment, including a telehealth program that quickly connects people who abuse opioids with healthcare providers who can prescribe medications. The department has logged more than 2,300 calls since the program launched in March.
San Francisco has added about 400 residential treatment beds to 2,200 existing spots in recent years and tripled the number of street care workers in the last two years, according to the public health department and Mayor London Breed’s office.
Dr. Christopher Colwell, chief of emergency medicine at Zuckerberg San Francisco General Hospital and Trauma Center, said he has seen a notable increase in the number of people open to accepting treatment in the last year.
“I think a lot of patients are recognizing, more so in the last year than I’ve ever seen, how dangerous opioid use disorder is, watching their friends and colleagues die,” Colwell said. “I’ve seen a lot more willingness to at least have that discussion, and consider it, than I did even just a couple years ago.”
Keith Humphreys, a Stanford University psychiatry professor who studies addiction, called the 2024 numbers a “big deal.”
“Both because of the lives that are saved, but also just for the morale of every front-line worker, every harm-reduction worker, every treatment professional, every police officer who has been despairing that this is never going to get better,” Humphreys said. “This is a big boost.”
San Francisco, like many urban areas, recorded a sharp rise in fatal overdoses in the early years of the COVID pandemic, when government shutdowns made it more difficult to directly address the introduction of fentanyl into the street drug scene. For example, San Francisco counted 259 deadly overdoses in 2018, when fentanyl first hit the streets, and 441 fatalities in 2019. A year later, as the city effectively shut down to slow the spread of COVID-19 and it became more difficult to do community outreach, overdose deaths skyrocketed to more than 720.
Humphreys said the pandemic’s wane has also made it easier to address some of the social factors underlying addiction.
“Everything about COVID was terrible from a drug viewpoint. You had more reasons to use drugs: sadness, isolation, bereavement, loneliness,” Humphreys said. “The kind of structures that help people get and stay in recovery, like work, accountability, daily routines, social obligations, all went down.”
Breed lost her November reelection bid to nonprofit executive and Levi Strauss heir Daniel Lurie, a result widely attributed to voter frustration over homelessness and street drugs. Still, Breed said the recent decline in overdose deaths is a testament to her administration’s decision to take a “harder stance” against illicit drug use, arresting dealers and mandating treatment for some users.
Last March, for example, she sponsored a successful ballot measure to require drug screening and treatment for people receiving county welfare benefits who are suspected of illicit drug use.
Colwell said that although last year’s numbers are a positive sign, opioid use remains a serious problem. He stressed the importance of adding treatment options such as buprenorphine and methadone, which are more effective long-term than overdose reversal medications. And although he appreciates the city’s efforts to invest in treatment beds and housing, he said, “I don’t go a day where I don’t feel like we need more.”
He and other experts said it is crucial that the city and Lurie continue investing in solutions, even as San Francisco faces a projected $876-million budget shortfall. Lurie has pledged to declare a fentanyl emergency when he takes office Jan. 8 and to “get tough” on drug dealers.
“We’ve seen what can be helpful,” Colwell said, “and we need to keep doing this.”