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San Francisco Fentanyl Deaths Up Almost 150%

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A staff member at San Francisco's 6th Street Harm Reduction Center demonstrates how to test a drug for the presence of fentanyl using a fentanyl test strip. (Laura Klivans/KQED)

Deaths from the powerful synthetic opioid fentanyl skyrocketed in San Francisco in 2018,  increasing by 147% since the previous year.

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That's according to the San Francisco Department of Public Health, which released data this week showing that 89 people died from accidental overdoses of fentanyl last year, compared to 36 fentanyl-related deaths in 2017.

Fentanyl is up to 50 times more powerful than heroin and can be 100 times more potent than morphine. It's often added to other street drugs, and can overwhelm and kill someone with limited tolerance to opioids.

For years, fentanyl had not infiltrated California to the degree it did in the eastern U.S., where the drug has long been responsible for staggering rates of opioid deaths. These new figures, however, show a stark rise in deaths from fentanyl, the largest the city has ever seen.


UCSF Professor of Family and Community Medicine Dr. Daniel Ciccarone said the U.S. opioid epidemic has unfolded in "three waves."

"Wave one: pills. Wave two: heroin. Wave three: fentanyl," he said.

Dr. Phillip Coffin, Director of Substance Use Research at SFDPH, said that the increase is most likely due to supply and cost: More people are choosing fentanyl because it costs less than heroin, and the available fentanyl may be of a higher quality than available heroin.

"Fentanyl started entering San Francisco in 2015, and we managed to avoid significant increases in mortality really until this year," he said. "We all expected that this other shoe would drop. We're of course disappointed but not surprised to see the increase in mortality with the increased prevalence of fentanyl use in the city."

Coffin attributed part of the initial delay in fentanyl overdose deaths to what he described as San Francisco's "culture of overdose prevention" among people who use drugs. "They're the ones who are reversing overdoses. They're the ones who are saving each other's lives," he said.

There were 259 overdose deaths in San Francisco last year resulting from all street drugs, including opioids, cocaine and methamphetamine, a 17% increase over 2017, and the highest number recorded since 2006, when the department began tracking data through its current system.

Methamphetamine-related deaths also jumped significantly, from 99 in 2017 to 126 in 2018, the data show.

The city is employing several measures to combat opioid overdoses, including overdose education, treatment for opioid addiction, use of fentanyl test strips, and distribution of naloxone, a drug used to reverse opioid overdoses.

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