San Francisco Overdose Deaths Are At Nearly 2-Year Low. What’s Behind the Decline?

San Francisco saw its lowest monthly number of fatal overdoses in nearly two years in June, officials announced Monday, offering slight good news as the city battles a severe overdose crisis.

According to preliminary data from the medical examiner’s office, 48 people died of accidental overdoses last month. That’s down more than 15% from 57 deaths in June of last year, and it represents the lowest monthly total since July 2022, when the city reported 43 overdose deaths.

The data also show a decrease in overdose deaths in the first half of the year compared to 2023. While public health officials say the “heartening” numbers could result from citywide programs, a policy expert said wider drug use trends are likely making the difference.

Dr. Hillary Kunins, the director of behavioral health at the San Francisco Department of Public Health, spoke about the city’s increased access in recent months to the overdose-reversing medicine Narcan, as well as more street care teams and both telehealth and in-person treatment while announcing the June overdose data on Monday.

However, Keith Humphreys, a drug policy expert and professor at Stanford University, believes that the downward trend likely has little to do with citywide policies.

“There’s certainly some sensible things going on — the biggest one: making anti-overdose medication widely available to as many people as possible,” he told KQED. “We’ve been doing that for years at a pretty high level — the good that did was baked in already, so I don’t think that would explain a change like this.”

Instead, Humphreys said, the trajectory mirrors national data and likely suggests that more people who are using fentanyl are doing so knowingly rather than suffering “surprise overdoses” when they thought they were using another drug.

He pointed to a spike in overdose deaths that began around the time of the COVID-19 pandemic. In 2020, the city saw a then-record 726 deaths, according to data from the office of the medical examiner. That number dipped a bit in 2021 and 2022, though overdoses remained above pre-pandemic levels, and last year surpassed 2020 as the city’s deadliest year on record with 810 deaths.

So far, there have been 374 overdose-related deaths in 2024. The figure is slightly lower than the number of deaths recorded during the same period in 2023, but it is still on track to come close to the year’s staggering total.

Humphreys said that the small reduction was not surprising, given that pandemic restrictions — though not COVID-19 infections — have all but completely wound down. Nationwide, annual overdose deaths decreased last year for the first time since 2018.

“During the pandemic, we had increases [in overdoses] beyond anything we’ve had in the history of our country,” he said. “Which I think said a lot about the impact of isolation, stress, the destruction of social opportunities, the loss of jobs, all those kinds of things. Now, we’re getting the other side of it … the restoration of all those things is going to be good for human health,” including drug use and overdose.

Kunins agreed that the pandemic led to a spike in overdose deaths and “worsened health outcomes.”

The hopeful trajectory is also likely a reflection of heroin’s diminished presence in the illicit drug market, according to Humphreys. High numbers of heroin users suffered accidental fentanyl overdoses in recent years, according to Humphreys.

“When heroin is completely gone, people will know that what is being bought and sold is fentanyl,” he told KQED, noting that San Francisco is not at that point yet.

“We had a lot of surprise overdoses three years ago in San Francisco, a lot of people who didn’t think they were going to be exposed but were. Now we’re getting to a point where almost no one is surprised, and that should reduce overdoses.”

Fentanyl entered the drug market on the West Coast just before the pandemic, Kunins said. In the following years, heroin has made up a shrinking portion of overall overdose deaths. In 2020, 93 of the overdoses reported by the city involved heroin, nearly 12%. So far, in 2024, 20 overdoses included opioids, making up only about 5% of the total.

Despite the slight downturn in overall deaths, Kunins said overdose “is very much a crisis in our city and our country.”

How officials want to handle the crisis is expected to play a large role in city elections this fall. Three leading mayoral candidates — Mayor London Breed, former Mayor Mark Farrell and Levi Strauss heir Daniel Lurie — have all supported tougher policies surrounding drug use.

Farrell previously called for California National Guard members to be deployed in highly trafficked areas, like the Tenderloin and SoMa neighborhoods, and Lurie has expressed support for compelling drug users to enter treatment. In March, Breed placed two measures on citywide ballots expanding police powers and increasing screening and treatment requirements for drug users receiving welfare and touted increased drug-related arrests in May.

Both Humphreys and Kunins cautioned against implementing harsher policies. Humphreys said bringing in outside law enforcement likely wouldn’t be effective, while Kunins said that DPH’s priority is expanding treatment, not limiting it.

“Many of the regulations and structures surrounding access to medications for addiction treatment that are at the federal and state level really serve to limit access to treatments,” Kunins said. “Our goal is to decrease barriers into care, make it easier and more appealing for people to get into treatment, and to reach our overall goal of saving lives and supporting people to get into recovery.”