Corey Sylvester walks past the names of people who lost their lives to addiction outside San Francisco City Hall in 2023. More than 580 people died of a drug overdose in San Francisco from September 2024 to August 2025.
Gabrielle Lurie/The Chronicle
San Francisco now has the second-highest rate of fatal overdoses among large county-level U.S. jurisdictions, according to the latest reliable federal data.
More than 580 people died of a drug overdose in San Francisco from September 2024 to August 2025, according to data from the U.S. Centers for Disease Control and Prevention. That meant San Francisco saw 70 deaths per 100,000 residents during that 12-month period, more than three times the national rate of 20.
Only the city of Baltimore, one of the epicenters of the country’s overdose crisis, had a higher rate: Out of every 100,000 residents, nearly 110 people died during that yearlong period.
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The CDC’s data is based on preliminary reports from counties and cities not part of any county. The Chronicle’s analysis did not include more recent data, which tends to undercount deaths due to delays in reporting.
It’s not that San Francisco’s overdose crisis is getting worse. In fact, overdose deaths are down from their mid-pandemic peak in San Francisco and most of the U.S. Data from the San Francisco medical examiner’s office, which provides more comprehensive local reports than the CDC, shows that 624 people died from accidental fatal overdoses last year, down slightly from 635 in 2024. Preliminary data from this year indicates that fatalities may be on track to decline again.
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But San Francisco’s overdose death rate remains far higher than it was before the pandemic. By comparison, other hard-hit counties like Philadelphia experienced much starker improvements last year.
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To take another example, Davidson County, which includes Nashville, had an overdose rate of nearly 100 per 100,000 residents in the 12-month period ending August 2022, giving it the second-highest rate of any jurisdiction with at least 500,000 people. By the same period ending in 2025, Davidson County’s rate had dropped to 56.
San Francisco’s rate, which surged to a record high of 90 in 2023, also declined — but only to 70.
The slower rate of improvement in San Francisco is part of a regional difference, experts say. Cities and counties on the East Coast and Appalachia, which were the first to see fentanyl gain dominance in the illicit drug supply, have seen the steepest drops in deaths, while areas in the West have seen more moderate declines.
San Francisco, Portland and other West Coast cities will likely see deaths drop more quickly in the future, said Brendan Saloner, an addiction researcher at Brown University.
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“Unfortunately, the change is happening too slow, slower than we’d hope,” he added.
Researchers have offered a variety of theories as to why overdose deaths have dropped nationwide. Some have pointed to increased awareness about the hyper-potent opioid fentanyl, as well as harm reduction initiatives, such as growing access to the overdose reversal drug naloxone.
Others, including Saloner, believe that the supply of fentanyl has dried up as countries continue to target the illicit drug trade, forcing dealers to sell less of the opioid or mix it with less lethal — but still highly dangerous — alternatives. Some of those adulterants, such as xylazine and medetomidine, are already creating new challenges for addiction specialists in Philadelphia.
Keith Humphreys, a professor of psychiatry who studies addiction at Stanford University, suggested a bleaker theory: Many of the people on the East Coast who were most vulnerable to a fentanyl overdose have already died. Those who have survived may have simply built up a tolerance to the most potent opioids, he added.
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Humphreys acknowledged that there’s little city and county leaders can do about the drug trade. He supports policies that provide sober housing for people seeking addiction treatment, as well as San Francisco Mayor Daniel Lurie’s RESET Center, which will allow police to bring drug and alcohol users to a pilot facility. They’ll only be allowed to leave once staff determine they’re sober enough, an approach which has drawn some concerns about the program’s legality.
“Few people will just spontaneously seek health,” Humphreys said. “Often there needs to be pressure in addiction, unlike depression or cancer, or something that feels objectively awful all the time.”
Saloner said that while San Francisco has a decent safety net, it’s struggled to provide comprehensive treatment services to everyone who wants it. And he worries that if the Trump administration slashes health care funding, it’ll be even harder.
“No matter what happens with county and city policy, if the federal government creates a very hostile environment, that’s going to have a lot of repercussions,” he said. “I have this pit in my stomach.”
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