San Francisco continues to grapple with a staggering number of fatal drug overdoses. The latest Centers for Disease Control and Prevention (CDC) data puts the city second on the list, trailing behind only Baltimore.
Even as the opioid crisis drags on, federal figures show a modest shift: overall overdose deaths in San Francisco have begun to decline.
In 2025, fatalities fell to their lowest level in five years.
Still, the city remains near the top nationally in per-capita overdose deaths.
City Supervisor Matt Dorsey acknowledged the grim ranking and uneven progress.
“What we are seeing right now is other counties are improving faster than San Francisco is,” he told ABC7. “What I’m hoping is that we have to do everything we can to turn off the magnet and stop being a destination city for drug related lawlessness,” he added.
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Officials say a new strategy is taking shape, with public health leaders pointing to expanded treatment programs and intervention efforts aimed at getting people off the streets and into care.
Steve Adami, executive director of a Salvation Army homeless initiative, says one abstinence-based shelter program is showing strong results.
“The program is full, we’ve had no overdose deaths, no overdoses, 80% success rate,” Adami told ABC. “I feel like we are opening the right types of programs that will help people overcome addiction, overcome homelessness and reclaim their lives.”
The facility houses 58 people, who must follow strict rules: passing a breathalyzer on entry, adhering to a 9 p.m. curfew, undergoing security checks, and attending required meetings with onsite managers, all part of maintaining a drug-free environment.
“For years, we were very enabling,” Adami said. “We were approaching the drug and homeless crisis as if it was only a housing crisis. We weren’t really addressing why people were on the streets. That is what has changed now.”
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Meanwhile, the Department of Public Health says its upcoming budget will focus on expanding treatment capacity, even as the city faces a projected $643 million deficit that could balloon to $1 billion within five years, raising questions about long-term funding for overdose response efforts.
A new initiative, the RESET center, is set to open next month. Under the program, police will be able to take people found intoxicated or using drugs in public to the facility instead of jail, where they will receive treatment and support.
Despite recent improvements in totals, the crisis has reached staggering levels in recent years.
In August 2023 alone, San Francisco recorded 84 overdose deaths, with 66 tied to fentanyl, matching January as the deadliest month since tracking began in 2020.
That year saw a record 725 deaths. More than 560 people died that year, with another 300 projected by year’s end.
Residents have described conditions in parts of the city as resembling a “zombie apocalypse.”
City data shows overdose deaths have climbed steadily since 2017, peaking in 2020.
After a brief decline in 2021, fatalities rose again in 2022.
According to a September 2023 report from San Francisco city officials, law enforcement crackdowns on open-air drug markets in the Tenderloin resulted in the seizure of over 100 pounds of fentanyl and more than 1,000 narcotics-related arrests between June and September of that year.
