Last year the number of fatal drug overdoses in San Francisco soared past 300 for the first time, according to new data released last week by the Department of Public Health.
The 2019 data shows fatal drug overdoses are on a three-year rise, driven largely by fentanyl use. Cases of methamphetamine-related drug deaths are also on the rise.
After dropping to 186 fatal drug overdoses in 2016, The City has reported a steady incline in drug overdose deaths since then.
“With the second half of 2018 and progressing into at least the first half of 2019 we are seeing escalating deaths,” Dr. Phillip Coffin, the department’s director of substance research, told the Health Commission last week. “They are generally driven by fentanyl.”
Since 2006, fatal drug overdoses from cocaine, methamphetamine or opioids have hovered around 200 cases annually, with a low of 163 in 2008. The department does not have comparable and reliable data before 2006, according to officials. In the late 1990s, San Francisco was experiencing about 180 overdose deaths annually from heroin alone.
There were 222 fatal drug overdoses in 2017, 259 in 2018 and in 2019 there were at least 330, according to the latest data released by the department and presented to the Health Commission last week.
The data for the first six months of 2019 shows 182 drug overdose deaths, which is not expected to change. The last six months of the year show 148 overdose deaths, which is partial data and could represent anywhere between 30 percent to 70 percent of the actual cases once all the data is in, Coffin told the commission.
Fentanyl-related drug overdoses in 2019 have reached at least 162. In 2018, there were 89 fentanyl related drug overdoses, a 147 percent increase from the 36 in 2017.
Based on reports from people who died and nonprofits who work with drug users, “most people who are using fentanyl are choosing to use fentanyl,” Coffin told the commission.
“It happens to be a drug that can produce a more reliable effect than, for example, black tar heroin,” Coffin said. “It is less expensive. It is easier to transport. It has largely replaced the other opioids on the street because it has those favorable elements to it. Unfortunately, it is also much more likely to result in death.”
Eileen Loughran, the department’s coordinator of drug user health programs, said that one harm-reduction strategy being employed among drug users is to smoke fentanyl and not inject it.
She said that syringe access programs “are now offering tinfoil because many people are smoking rather than injecting.”
The programs also offer testing strips if someone wants to test if the drug they are about to use is tainted with fentanyl.
The department-funded Drug Overdose Prevention and Education Project provides drug users with warnings about fentanyl.
“Fentanyl is about 50 times stronger than heroin. That means the margin of error when using fentanyl is much smaller than when using heroin, so adjust your dose accordingly,” the group warns in one flier available online.
The flier suggests: “Try snorting or smoking instead of injecting. Injecting carries the highest risk for overdose, so shifting to snorting or smoking may help reduce risk. You can still OD by smoking/snorting, especially with fentanyl, so start slow.”
Meth-related drug overdose deaths are also on the rise and can include a combination with other drugs like fentanyl. In 2019, meth-related drug overdose deaths totaled at least 199, up from 126 in 2018.
Given the rise in overdose deaths, there have been calls to improve The City’s response from people including Supervisor Matt Haney, who represents the Tenderloin and SoMa neighborhoods where drug use is concentrated.
Haney has also urged the department to more frequently report overdose data.
Coffin said that there is a lag time of reporting overdose data of about six months due to the time it takes for the medical examiner to make a ruling on the cause and report the data.
“All the cities that I know of that report mortality data, they generally have about a six-month lag before they can report data because of the time it takes to close cases,” Coffin said.
He added that the health department plans to report the data every six months and not annually as in the past.
On Thursday, however, the Board of Supervisors Public Safety and Neighborhood Services Committee is scheduled to vote on legislation introduced by Haney to “require the medical examiner to report information to the mayor, board of supervisors and director of health each month regarding deaths arising from drug overdoses.”
The City has striven to do more to address the rise in deaths, such as by making the overdose reversal drug naloxone more available and increasing prescriptions of buprenorphine.
As an example, Loughran pointed to the planned launch of Mental Health SF, which Haney and Supervisor Hillary Ronen pushed to pass at the Board of Supervisors last year. The program is expected to expand treatment resources and establish an around-the-clock outreach team to help connect people on the street with services.
Loughran also pointed to the planned opening of The City’s first meth sobering center at 180 Jones St. in the Tenderloin that Mayor London Breed announced earlier this month, and a new website showing what substance use treatment beds are available.