Photo by Marco Verch
Information released by the Chief Medical Examiner for the City and County of San Francisco on 16 January 2026 indicated a decline in deaths from overdoses of such drugs as fentanyl, heroin, prescription opioids, methamphetamine, powder cocaine and crack.
Accounting for the period from 2017 to 2025, fatal overdoses began to creep up in 2018 and dramatically increased during 2019 and 2020, owing to the proliferation of fentanyl, a relatively inexpensive and highly addictive synthetic opioid up to 50 times more potent than heroin and 100 times stronger than morphine. Certain dealers began mixing it into cocaine, heroin, and methamphetamine to sell a more powerful and addictive product at a reduced cost, but the consequence of that, inevitably, was more deaths by overdose.
These fatalities hit a peak in 2023 with 810 deaths, but in 2024 the total declined to 635, and again decreased to 621 in 2025. Public health officials attribute the decline in overdose deaths to expanded distribution of naloxone (also known as Narcan), a medication used to reverse the effects of opioids, as well as increased access to medication-assisted treatment.
Mayor Daniel Lurie and his administration inherited this problem upon his inauguration in 2025, and responded by declaring a state of emergency in San Francisco, opening more shelter beds, consolidating street outreach teams, and enabling drug users access to telehealth appointments through which they can be prescribed medications used to treat addiction.
Photo by James Conrad
In the period from October 2023 to the end of June 2025, the outreach teams conducted 3,000 telehealth appointments, and roughly half of them successfully encouraged addicts to begin treatment.
However, despite the overall success of the above measures and the resultant reduction in overdose deaths as a result thereof, unfortunately, not all demographic communities are equally enjoying the benefits. While White people have made up between roughly 40 percent and 50 percent of overdose deaths during the period from 2020 to 2025, Black people, who account for five percent of San Francisco's population, have made up at least 25 percent of overdose deaths during that same timeframe. By comparison, the overdose rate for Asians in San Francisco, who make up more than a third of the City's population, was only 10 percent.
An article in the San Francisco Standard published on 20 December 2024 notes that researchers tracking the overdose crisis in San Francisco point to several factors in the disproportionate number of Black people overdosing on drugs. These components, decades in the making, include the physical destruction of Black neighborhoods as part of racist urban redevelopment policies during the 1950s, ‘60s and ‘70s, the proliferation of crack cocaine and heroin throughout the 1980s, the concurrent disappearance of blue-collar jobs in the wake of the personal computer revolution, and Black people being generally shut out of this particular radical economic shift due to deeply entrenched unfair societal prejudices.
In 2025 alone, the data from the Chief Medical Examiner’s Office showed that nearly eighty percent of the fatal overdoses occurred in four adjoining zip codes – 94109 (Nob Hill), 94102 (the Tenderloin), 94103 (South of Market) and 94110 (the Mission District). According to this data, over the course of the whole year, the Tenderloin saw the highest number of overdose deaths, with nearly one fourth occurring in that neighborhood, of which Black people make up nearly one tenth of its population.
