San Francisco is facing a persistent and deadly drug overdose epidemic that continues to claim hundreds of lives each year. Although 2024 may see a slightly lower death toll compared to the record-breaking year of 2023, the number of fatalities remains alarmingly high. Tracking data from local agencies like the Medical Examiner’s Office sheds crucial light on this evolving crisis, particularly the role of fentanyl and its devastating impacts on vulnerable populations.

Overview of Overdose Deaths

Yearly Fatalities and Recent Trends

By November 2024, San Francisco reported 589 deaths attributed to accidental overdoses, with 46 of those occurring in November alone. Of these, 31 deaths involved fentanyl. The prior month saw 35 fatalities, with fentanyl implicated in 26 cases. These numbers highlight the ongoing dominance of fentanyl in the drug market and its significant contribution to overdose deaths.

Comparison to Previous Years

2023 surpassed 2020 as the deadliest year on record for overdose deaths in San Francisco. While 2024 appears less fatal in comparison, more deaths have already been recorded than in any year prior to 2020.

The overdose epidemic first began to escalate in the mid-to-late 2010s, coinciding with the infiltration of fentanyl into the city’s drug supply. Fentanyl, a synthetic opioid up to 50 times more potent than heroin, is deadly even in extremely small amounts—just 2 milligrams can be fatal.

Fentanyl and Its Role in the Epidemic

Potency and Risks

Fentanyl is a synthetic opioid that is frequently added to other substances due to its potency. Its extreme strength makes it cheaper and more addictive, but also vastly more dangerous. Fentanyl was involved in 73% of accidental overdoses in the city in 2020, and its prevalence has only increased since then.

Fentanyl is often found mixed with stimulants such as methamphetamine, which can further complicate its dangers. Many users are unaware that they are consuming fentanyl, as it is commonly used to enhance other drugs.

Geographic Impact

The epidemic has been particularly severe in neighbourhoods like the Tenderloin and South of Market (SOMA), where many of the fatalities occur. For instance, in 2020 and 2021, approximately 23% of overdose deaths were concentrated in Tenderloin, while SOMA accounted for 18%. Notably, these deaths disproportionately happened outdoors, including on pavements and in front of buildings.

Single Room Occupancy (SRO) housing was another hotspot for fatalities. A Chronicle investigation uncovered that at least 166 overdose deaths occurred within city-funded hotels in 2020 and 2021.

The COVID-19 pandemic greatly exacerbated the crisis. Lockdowns and social distancing measures isolated individuals, often leading to an increase in drug and alcohol consumption. Further, treatment programmes either shut down or reduced their capacities, leaving many without the support they needed. This confluence of factors contributed to a significant spike in overdoses during the summer of 2020 and into 2021.

Demographics and Disparities

Gender and Age

Men have been disproportionately affected by overdoses in San Francisco. Data from 2020 shows that 70% of overdose victims were men, primarily between the ages of 35 and 64.

Unsheltered Populations

Among the most vulnerable are unsheltered individuals, who are disproportionately affected by the epidemic. Over half of the people receiving services from the city’s Street Overdose Response Team (SORT) are unsheltered.

Efforts to Address the Crisis

Harm Reduction Initiatives

San Francisco has invested considerable resources in harm reduction measures. The $11.4 million SORT programme is a key example. The team operates directly in the streets, providing harm reduction supplies and connecting individuals to long-term treatment services where possible.

Naloxone Interventions

Emergency Medical Services (EMS) personnel have been at the forefront of overdose reversals, administering naloxone to prevent fatalities. More than 2,700 overdose reversals were recorded citywide in 2022, with a significant portion occurring in the Tenderloin.

Misinformation and stigma around drug use remain significant barriers to effective intervention. Public education campaigns are crucial, particularly concerning fentanyl’s dangers and naloxone’s life-saving potential.

Source: SF Chronicle