SF Overdose Deaths Keep Climbing in Recent Months as Fentanyl Remains a Major Threat

Updated 1:20 p.m. Wednesday

San Francisco recorded 118 accidental drug overdose deaths in the first two months of 2025, a nearly 12% decrease compared to deaths during the same period last year, but a steady increase over recent months, according to preliminary data released by city health officials on Tuesday.

The tally — 61 deaths in February and 57 in January — marks a notable uptick over the last four months, after falling to a low of 37 in October.

“It’s unacceptable. It’s preventable. And we as a department are going to be doing everything possible to tackle this epidemic,” said Daniel Tsai, director of San Francisco’s Department of Public Health, who replaced Dr. Grant Colfax just over two weeks ago.

Fatal overdoses in the city reached a record high in 2023, with 810 deaths reported. Fatalities fell last year to 635, an almost 22% decrease.

Nearly 75% of the overdose deaths recorded so far this year were fentanyl-related, according to the Office of the Chief Medical Examiner’s latest report. Three out of every four people who died were identified as male.

The latest snapshot was delivered a day after Mayor Daniel Lurie signed an executive order outlining immediate and long-term plans to address the city’s drug and homelessness response.

The executive order builds on a fentanyl ordinance approved by city supervisors last month, granting the mayor expanded authority to quickly hire homelessness and drug treatment service providers. Lurie’s push sidesteps the board’s oversight of roughly $1 billion in contracts and lease agreements, according to the city’s Budget and Legislative Analyst.

The new directive also reassesses the city’s policies on distributing fentanyl smoking supplies — particularly foil, pipes and straws — in public spaces.

“We will be working through that policy rapidly, on the ground with our clinical folks, with our providers, with our communities and stakeholders over the next very short period of time,” Tsai said during a press briefing, underscoring the department’s support for sterile syringe access as an effective strategy to reduce disease transmission.

On Tuesday, Tsai outlined his department’s multi-pronged approach to addressing the overdose crisis. The plan includes increasing the availability of treatment beds citywide, streamlining the process to quickly connect people to treatment when they’re ready and expanding resources to help them complete treatment. Tsai said the strategy also focuses on moving people off the streets and into supportive housing, where they can continue receiving critical services.

“The mayor’s directive to us is to build a more responsive behavioral health treatment system,” Tsai said, noting that it’s critical to identify what is currently working and what’s not. “That can help as many people as possible be off the streets, the conditions in the streets and into effective treatment and sustained recovery.

“That’s our true north.”