We knew we were on track to pass this morbid milestone for months, and now it has come to pass: an all-time high 752 people in SF have died from accidental drug overdoses in 2023, and we still have a couple more weeks of December to go.

It was a foregone conclusion we’d resigned ourselves to months ago, but now it is offical reality. The Chronicle reported Thursday that 2023 is now officially the deadliest year ever for drug overdoses in SF, with a total of 752 overdose deaths this year, according to monthly data from the SF Department of Public Health (SFDPH). The previous deadliest year was the shut-in year of 2020, with 726 accidental overdose deaths.

That data only runs through the end of November, so there will surely be dozens more deaths added to 2023’s grim overdose total before the year is done.


This total comes from the monthly SFDPH data release of overdose deaths. In November, 57 people died from overdoses, nearly two people a day. While that’s down from 65 deaths in the previous month of October, and lower than the 84 overdose deaths SF recorded in both the months of August and January of this year, those 57 November fatalities still cement 2023 as SF’s worst year ever for drug overdoses.


The culprit here is certainly fentanyl. As the Chronicle points out, “More than 80% of San Francisco’s accidental overdose deaths this year” have involved fentanyl.

As recently as 2018, before fentanyl became widely popularized, the city did not even see half that many overdose deaths as it is suffering now.

People will blame San Francisco and its policies, but the problem is nationwide. Nashville, Tennessee has had consistently more drug overdose deaths than SF, and Louisville, Kentucky also has a higher overdose death rate than SF. And Baltimore, Maryland and Philadelphia, Pennsylvania have the highest overdose death rates of any U.S. city, according to the most recent data. But San Francisco is still in the top five U.S cities for drug overdose death rates (behind the four aforementioned cities, per 2022 data), so that is not good.


We’re not sure if it will be of help, but the SFDPH also announced Thursday that they would begin testing wastewater for fentanyl, as well as the veterinary tranquilizer xylazine, known as “tranq,” which is emerging as a fentanyl substitute. SFDPH director of behavioral health services Dr. Hillary Kunins said in a release that “While SFDPH continues to aggressively expand access to treatment services, we need all the tools available to identify the presence of substances that may be used to halt and reverse this deadly epidemic. Data from wastewater testing will help provide information about the presence of risky substances in San Francisco and prompt more strategic interventions aimed at saving lives.”

Related: July Was Second-Deadliest Month Yet For SF Overdoses, With 71 Dead, Mostly From Fentanyl [SFist]

Screenshot: Urgences Genève via Youtube