The number of accidental overdose deaths in San Francisco, most of them caused by fentanyl, has risen sharply in the first quarter of 2023 — with 200 deaths so far this year, up from 142 in the same period last year.

The new death count comes from the city's medical examiner, and as the Chronicle reports, this spike in deaths coincides with the shutdown of the Tenderloin Center in December. When the center closed, the city said that the safe-consumption site — which also provided users with a path to treatment — was responsible for reversing over 300 overdose deaths.

Mayor London Breed has called for a pause in opening new safe-consumption sites (or "Wellness Hubs") with city funds, citing legal liabilities and a recent decision by the governor that could leave SF open to legal trouble.

The Department of Public Health issued the vaguest of statements to the Chronicle, regarding the rise in overdose deaths. "These deaths drive us to find more ways to prevent overdoses and reduce the harms caused by fentanyl, which drive these deaths, and by other substances as well," the statement reads.

2020 was the worst year on record for overdose deaths, with 712 — about triple the number of deaths from COVID in the city that first pandemic year. But with 200 in the first three months of 2023, this year is on track to see around 800 deaths, outpacing 2020 and the last two years in which accidental overdoses seemed to be on the decline.

Public health efforts, including widespread distribution of free Narcan, were credited with bringing overdose deaths down the last two years. However the fentanyl crisis seems to only have gotten worse.

Per the Chronicle, of the 200 deaths this year, 61 of them occurred among the homeless population.

Dr. Daniel Ciccarone, a professor of family and community medicine at UCSF, tells the paper that the rise in fentanyl deaths reflects a failure of public policy. And he defends the efficacy of the Tenderloin Center, which was a widely criticized, 11-month experiment in harm reduction.

"We simply didn’t let the project last long enough to see the benefits," Ciccarone says.

District Attorney Brooke Jenkins has made a priority of prosecuting drug dealers in her first nine months in the job. And drug busts like this one in February that netted 20 pounds of fentanyl, or this one last week that netted 10 pounds, are reported on frequently. But the supply doesn't seem to be impacted enough by law enforcement to reduce the number of overdoses.

In 2020, when 712 people died from overdoses in the city, the SFPD touted the fact that they had seized four times as much fentanyl that year than in the previous year.

Accidental overdoses have also increased among users who aren't even doing fentanyl on purpose — the Department of Public Health issued a warning last year about fentanyl-laced cocaine being linked to a rising number of overdose cases.

As state Senator Scott Wiener writes on Twitter this morning, "We must end the open air drug markets. They’re a public safety hazard. But, that won’t stop the overdoses. Drug users will find drugs. We need more treatment, safe consumption sites, robust access to Narcan & drug testing to save lives." (By drug testing, he's referring to drug-testing kits to detect fentanyl contamination.)

Also, the crisis is not confined to the Tenderloin — as we reported last fall, the city was seeing around 50 overdose deaths per month in 2022, with only 21% of those in the Tenderloin proper. The latest report shows 23% of the deaths occurring in the Tenderloin since January, but another 36% occurred in the adjacent areas of SoMa and Polk Street.

We can expect another round of finger-pointing at this news, and perhaps some renewed effort around these Wellness Hubs.

Previously: SF Has Seen More Than 500 Overdoses This Year, Though That’s Down From 2020 and 2021