Lieutenant firefighter and PIO Jonathan Baxter work to save man named Ryan during a fentanyl overdose on Olive Street in San Francisco, California.
Gabrielle Lurie/The Chronicle
In 2021, 650 people died of drug overdoses in San Francisco, a 9% dip over the prior year, according to new data released Wednesday by the Office of the Chief Medical Examiner.
It’s the first time the number of lives lost to drugs in the city dipped year-over-year in a decade, but it follows an unprecedented spike in deaths the year before - from 441 in 2019 to 711 in 2020. Officials, advocates and residents agree the death toll is an unacceptable public health crisis and that the city needs more strategies to address it, including treatment and prevention.
The unfolding crisis — driven by a rise in the super-poweful opioid fentanyl — pushed Mayor London Breed to declare an emergency last month in the Tenderloin, the hardest-hit neighborhood.
That year-end toll amounts to nearly two people a day - each with their own stories, histories, families and friends - dying a day in San Francisco because of overdoses. By contrast, 430 people in the city died of COVID-19 in 2021.
The number of overdose deaths could change: Last year, the death toll rose after the medical examiner closed more case investigations.
Many overdose deaths occured in dense neighborhoods downtown. In 2020 and 2021, about 23% of the overdose deaths occurred in the Tenderloin and about 18% in SoMa.
Experts say the pandemic exacerbated the overdose crisis, isolating people and reducing access to treatment and social and emotional support. The easing of restrictions might have helped cut the death toll in 2021.
The number of fatal overdoses in the city has skyrocketed over the last decade, fueled by fentanyl, which can be up to 50 times more powerful than heroin. Fentanyl was a factor in nearly three in four overdose deaths in 2021, most often mixed in with other drugs.
While slightly less people may have died of overdoses, that doesn’t necessarily mean the number of overdoses has gone down - instead, overdose-reversing medication Narcan could be saving more lives.
From January through the end of September 2021, the latest data available, the city tracked more than 6,800 overdose reversals. That’s up from about 4,300 in 2020. The health department says that amount is an undercount and only accounts for the Narcan it distributes, since different organizations get their supply from other sources. It’s unknown whether every person given a dose of Narcan would have died of an overdose without it, but it undoubtedly helps.
Breed is pushing forward initiatives to tackle the crisis. In addition to the Tenderloin emergency declaration, she plans to crack down on drug dealing and use.
Some advocates and officials have criticized the mayor’s rhetoric and approach, arguing that including law enforcement as part of her response to a public health crisis will be ineffective and counterproductive. Others say the city needs to do more to tackle the drug supply and hold dealers accountable.
Breed’s emergency does include public health interventions such as opening a linkage center where people on the streets can drop-in to get help and filling 200 vacant positions in substance use and mental health treatment.
The city is also working on adding more treatment beds for mental health and substance use. As of Wednesday, 88 out of 400 additional beds planned under behavioral health reform legislation have opened.
Breed also plans to open a drug sobering center and a site where people can use drugs under medical supervision later this year. Advocates have been pushing for years to create a supervised space where the chances of people using drugs dying of overdoses will be reduced.
Mallory Moench is a San Francisco Chronicle staff writer. Email: [email protected] Twitter:@mallorymoench
