San Francisco overdose deaths increase in May, but on the decline from 2023

Accidental overdose deaths rose last month in San Francisco after falling in April, according to the latest preliminary data from the Office of the Chief Medical Examiner.

There were 66 overdose deaths in May , and the majority were caused by fentanyl. While this represents an increase from 59 overdose deaths in April, the total number of deaths so far in 2024 (327) is 6% less than this time last year (348).

“We are seeing a downward trend in the second quarter of this year,” said Dr. Hillary Kunins, the director of behavioral health services with the San Francisco Department of Public Health on Friday. “Opioid-involved deaths are preventable through highly effective treatments and other life-saving tasks.”

70% of the overdose deaths were attributed to fentanyl so far this year. A different form of fentanyl, fluoro fentanyl, was attributed to 23 deaths. Fluoro fentanyl has a slightly different chemical compound than other versions but is still treatable with the same methods used to treat opioid substance use disorders, said Kunins.

The slight downward trend in overdoses comes after San Francisco saw its deadliest year for overdose deaths in 2023 since the city began collecting data in 2020. There were 810 overdose deaths recorded in 2023, and more than 80% of those deaths were attributed to fentanyl.

In March, the San Francisco Department of Public Health expanded treatment options for those seeking substance use treatment, launching a telehealth program that would provide access to physicians at late night hours.

The new pilot telehealth program is part of the Night Navigation street-care team, which operates out of the Tenderloin between 7 p.m. and 3 a.m. The program connects people to hotel rooms if they need shelter and connects patients to doctors through telehealth visits from 8 p.m. to midnight.

One of the main benefits of the telehealth program is that doctors can virtually prescribe buprenorphine, an opioid use disorder treatment medication. The prescription can be sent to a 24-hour pharmacy or for next-day pickup.

Between March and last month, the program initiated around 440 nighttime telehealth visits, said Kunins. “We are connecting them with an addiction medicine provider and a safe and supportive place to start treatment,” she said.

SFDPH is also focusing on starting people off with micro-dosing buprenorphine to better ease the transition from fentanyl and other opioids.

“The challenge of buprenorphine is first getting started on the medication — if you start too early, while you still have another strong opioid in your system, like fentanyl, you can actually experience withdrawal symptoms,” said Dr. Joanna Eveland, the chief medical officer for DPH. “Think of this like gradually turning the sound up on your stereo rather than cranking up the volume all at once.”

Buprenorphine isn’t the only option available through the Night Navigation program. Those who would rather take methadone, which is a more regulated substance and has to be dispensed through certified clinics, such as the Opiate Treatment Outpatient Program at Zuckerberg San Francisco General Hospital and Trauma Center.

“Microdosing is a great option,” said Eveland. “It's not the only option, and at the Department of Public Health we believe there's no one correct path.”