The sharp decline in San Francisco overdose deaths in 2024 appears to be reversing itself in 2025, and the infusion of new synthetic opioids into the market has this year on pace to be SF’s deadliest year for overdoses since, well, 2023.

After the city of San Francisco saw its deadliest year for accidental drug overdoses ever in 2023 (eventually tallied at 810 deaths), it seemed in 2024 that we were turning a corner. The month of July 2024 saw the fewest SF overdose deaths of any month in four years, and 2024’s overall overdose death rate was the lowest in five years. The table appeared to be set for Mayor Daniel Lurie to declare that his “fentanyl emergency ordinance” was some sweeping success that was finally busting up SF’s notorious street drug trade.

Now it looks like Lurie is unlikely to get that opportunity. This weekend’s Chronicle reported that accidental drug overdose deaths rates are creeping back up in SF. And the 2024 decline may have been a mirage, as public health experts say that supply-chain disruptions may have simply made less of the more potent fentanyl available last year — and suppliers have simply restructured their business around synthetic forms of fentanyl.  

“We got to benefit from a supply shock, which is great, because thousands of people who would have been dead are alive,” Stanford University professor of psychiatry and addiction researcher Keith Humphreys told the Chronicle. “But it also means that it wasn’t the end. The markets reconfigured, and we can’t count on [overdose deaths] continuing to go down.”

The SF Department of Public Health just submitted their overdose death numbers for May 2025, a month which saw 57 overdose deaths (that number is likely to be revised upward). On that current pace, San Francisco would see 746 overdose deaths for the year. That is well above the 635 overdose deaths recorded in 2024, and closer to the 810 we saw in the record year of 2023.

And the 2024 decline may have been just because dealers were selling bunk fentanyl, because they couldn't get their hands on the real stuff. The Chronicle spoke with an SF DEA agent, who they say noted that some 2024 drug busts were yielding product that “contained minimal to no traces of the drug," and "In one case, it was merely aspirin." Suppliers now appear to be switching tack to use new synthetic opioids that emulate the effect of fentanyl, but can be much deadlier.

SF’s decline in overdose deaths — and current resurgence of them — mirrors national trends. The Centers for Disease Control's national data on overdose deaths shows an uptick in 2025, though that data is months behind SF’s data. In Seattle, Washington, the King County overdose statistics show deaths coming back to all-time high levels.

So what’s happening in SF is probably reflective of what’s happening pretty much across the country. But as London Breed learned, it is still a political liability when overdoses go up on a San Francisco mayor’s watch, particularly after that mayor declares some sort of "state of emergency" order that ends up failing to substantially resolve the “emergency” in question.

Related: New Synthetic Drug Shows Up On SF Streets, Is Linked to Overdose Death [SFist]

Image: An American Medical Response ambulance during an outbreak of COVID-19 coronavirus in San Francisco, California, March 23, 2020. (Photo by Smith Collection/Gado/Getty Images)