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2023 Was San Francisco's Deadliest Year for Drug Overdoses, New Data Confirms

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Names written in chalk appear on the sidewalk in memorial. Candles are also placed on a mat. Packs of chalk are scattered on the ground. The names "Bobby," Connor," and "Steven" can be seen.
A street memorial for people who recently died of drug overdoses is displayed outside of a supervised drug use pop-up site in San Francisco on Aug. 31, 2023. (Martin do Nascimento/KQED)

San Francisco recorded 806 drug overdose deaths in 2023, more than in any other year on record, a tragic milestone that experts have predicted for months.

“Every 4 1/2 minutes, someone dies of overdose,” said Dr. Grant Colfax, director of the San Francisco Department of Public Health, at a press conference on Wednesday, detailing new preliminary data from the city’s medical examiner’s office.

“This local and national crisis is driven by multiple factors,” he added, pointing to a combination of pharmaceutical marketing, poverty, limited drug-treatment options and “decades of under-investment in behavioral health care.”

Nearly 80% of all overdose deaths in the city last year involved fentanyl, a synthetic opioid about 50 times stronger than heroin, the new data shows. Commonly used in medical settings to treat pain, fentanyl first appeared in the illicit drug supply on the East Coast around 2013 and began wreaking havoc in San Francisco and other West Coast cities about five years later.

The data also shows a slight uptick in the presence of xylazine, also known as tranq, in overdose deaths.

Previously, San Francisco’s worst overdose year on record had been in 2020 — with 726 recorded deaths — as overdoses spiked after the city went under a strict COVID-19 shelter-in-place order, severely limiting many medical services and prevention options.

The following two years saw a slight drop in overdose deaths, a change that medical experts say is hard to attribute to any single factor.

However, one tool that San Francisco employed in 2022 — a supervised consumption site — was found to have prevented more than 300 overdose deaths, according to city data and independent research. People struggling with addiction could come to the facility near Civic Center to use illicit drugs in a sterile environment, with medically-trained staff on-site to reverse overdoses and, ideally, connect participants to other crucial resources, like housing, drug treatment and basic health services.

The city ran a single supervised consumption site, called the Tenderloin Center, for 11 months in 2022 and reported no overdose deaths at the facility during that time.

But the site’s high-visibility location in United Nations Plaza drew sharp criticism, particularly from local business owners, and it was shuttered by the end of that year.

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Dr. Colfax on Wednesday said supervised consumption sites could be an important tool to help the city get a grasp on its compounding overdose crisis. But the city has so far refrained from relaunching that model, largely due to Gov. Gavin Newsom’s veto of a 2022 bill that would have allowed San Francisco, Oakland and Los Angeles to legally operate such sites.

“We call on our legislators to make greater investments in behavioral health care, both mental health and substance-use treatment,” Colfax said. “We call on them to eliminate barriers to safe consumption sites, to access methadone and make all treatment more accessible.”

He also implored lawmakers to better support the country’s behavioral health workforce.

“We can’t deliver services needed if we can’t hire and train a workforce,” Colfax said, noting that over 25,000 people are currently receiving care for behavioral health disorders in the city’s overwhelmed public health network.

Meanwhile, San Francisco is working to increase access to treatment facilities and medications like buprenorphine that help reduce opioid cravings, he said. And just last year, it distributed more than 125,000 kits of naloxone, the fast-acting medication that can reverse opioid overdoses, directly to health workers and people who use drugs.


“Saving a life is the first priority, then we can connect you to treatment,” Colfax said.

Meanwhile, the city’s street response crews that directly respond to reported overdoses increased by nearly a third last year, according to Hillary Kunins, the city’s director of behavioral health and the head of the Mental Health SF program.

The city’s street teams, she said Wednesday, “have expanded to include a multidisciplinary approach with team members out and about in the highest-need areas, and we are following people over time with consistency and persistence.”

Mayor London Breed has also called on law enforcement to crack down harder on public drug use and dealing and pushed for more arrests of both users and dealers.

Despite those efforts, overdose deaths have continued to climb as highly potent synthetic substances like fentanyl continue to flood the illicit drug market, and federal funding for behavioral health care support dwindles.

Health workers on the ground, like Britt Rubin, a substance-use counselor on the city’s street response team, said a key part of her work is keeping up with the ever-changing drug landscape and understanding what people need to know to stay safe.

“I just have real talk with people in the substance-using community about what’s going on. Have the drugs changed? Is this what you expected and what you were seeking?” Rubin said at Wednesday’s press conference.

The latest overdose report shows that men accounted for the vast majority of San Francisco's overdose deaths last year (nearly 83%). It also finds that the city's Black residents were disproportionately impacted.

Black people in San Francisco accounted for roughly 31% of all overdose deaths in 2023 — second only to white people — despite making up less than 5% of the city’s total population, the data shows.

Tyrone Martin, a peer supervisor with the public health department, who helps people in the Tenderloin struggling with substance use, said his journey from addiction to recovery was supported by family and outreach teams similar to the one he works with now.

“I experienced compassion, and I want to give that back,” Martin said. “It’s not linear what we do … but one thing I will say is that when there is genuine authentic outreach going on in the TL [Tenderloin], there is success.”

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