As the number of overdose deaths in San Francisco surpasses previous years, city officials are expanding wastewater testing for fentanyl and other substances to better inform public health responses.
The Department of Public Health on Thursday announced its wastewater analysis plan, the same day that the Office of the Medical Examiner released its latest dataset showing that there have been more overdose deaths in San Francisco this year than in previous years.
There were 752 overdose deaths in San Francisco from January to November 2023, preliminary data from the medical examiner shows. In 2020, the worst year on record previously, there were 726 overdose deaths.
“We need all the tools available to identify the presence of substances that may be used to halt and reverse this deadly epidemic,” said Dr. Hillary Kunins, director of behavioral health services at SFDPH. “Data from wastewater testing will help provide information about the presence of risky substances in San Francisco and prompt more strategic interventions aimed at saving lives.”
Fentanyl, an opioid about 50 times stronger than heroin, is the most common substance associated with the recent spike in overdose deaths in San Francisco and across other major West Coast cities. It is commonly used in surgical settings under medical supervision.
The city will also be monitoring wastewater for levels of methamphetamine, amphetamine, cocaine and xylazine, which have been used in combination with fentanyl in some overdoses and also naloxone, a fast-acting opioid overdose reversal medicine.
San Francisco is among 70 different U.S. regions working with the National Institute on Drug Abuse to measure the presence of the substances through wastewater testing.
The idea is to have better foresight into what substances are present in the illicit drug supply and to direct public health resources in response.
“There is no other way for us to understand, at a population level, what all the different drugs being consumed are,” said Jeffrey Hom, director of population behavioral health for San Francisco, at a press conference on Thursday. “Elevated levels of drugs and drug metabolites could be used to predict higher risk periods of overdose and could prompt interventions by the city.”
Research from other jurisdictions already monitoring wastewater for opioids and other substances has shown some correlation between rising levels of risky substances and increased overdose deaths as well as calls to 911 for overdose response.
“This can help us explain other trends we are seeing and that can help guide our response,” Hom said.
Today’s grim milestone was projected months ago by experts tracking the evolution of the opioid crisis across the country. Before fentanyl arrived in California’s illicit drug supply, roughly around 2019, several East Coast cities saw overdoses skyrocket just a few years earlier, also largely due to fentanyl.
In San Francisco, overdose deaths are concentrated in the Tenderloin and South of Market neighborhoods, medical examiner data shows. The majority of overdose deaths in 2023 were among white San Franciscans. However, rates among Black and Latinx residents are increasing much faster than for white residents.
At Thursday’s press conference, health officials called on the federal government to fund more public health responses to the crisis.
“The fentanyl crisis is a national one, and it’s affecting cities like San Francisco,” Kunins said. “We need the support and resources of the federal government, and this program is an example.”
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