San Francisco overdose deaths fell in 2025, reaching the lowest level since 2020 amid fentanyl shifts
A five-year low after a deadly peak
San Francisco recorded 621 fatal accidental overdose deaths in 2025, a decline of 23.3% from the city’s fentanyl-crisis peak of 810 deaths in 2023. The 2025 figure is also slightly below the 635 overdose deaths reported in 2024 and marks the city’s lowest annual total since 2020, based on preliminary findings from the Office of the Chief Medical Examiner.
The decline follows several years of steep volatility. City health data show San Francisco recorded 725 accidental overdose deaths in 2020, 640 in 2021, and 620 in 2022 before surging to 810 in 2023. The two consecutive annual decreases since that peak indicate measurable improvement, while the continuing loss of more than 600 people in a single year underscores the scale of the crisis that remains.
Fentanyl remains the dominant driver, with new substances emerging
Even with the lower total, fentanyl continued to be involved in most overdose deaths in 2025, accounting for 467 fatalities. City officials and medical experts have also tracked the presence of other drugs in the local supply, including sedatives such as xylazine and medetomidine, which have appeared in toxicology findings in some cases. These substances can complicate overdoses and emergency response, particularly when mixed with opioids.
Policy response: treatment expansion, harm reduction, and enforcement
City leaders have pointed to expanded treatment access and intensified public safety efforts as central components of the response. In 2024, San Francisco expanded an on-demand medication program that connects people using fentanyl to clinicians for rapid buprenorphine initiation via telehealth from 8 a.m. to midnight daily. The same city update reported increased utilization of medications for opioid use disorder, including higher methadone admissions and more buprenorphine prescriptions filled through public health services.
At the same time, public officials have emphasized efforts to disrupt open-air drug markets and the fentanyl supply chain, while also developing new service models aimed at stabilizing people in crisis and routing them into care.
Why deaths may be falling—and what remains uncertain
Pinpointing a single cause for the decline is difficult. Local reporting has described a possible “supply shock” period tied to international precursor controls that may have reduced fentanyl availability or potency for a time, followed by signs of a rebound that could help explain why the annual decline from 2024 to 2025 was relatively modest.
Across the United States, provisional federal data released in 2025 also showed a sustained decline in overdose deaths from earlier peaks, suggesting broader forces may be influencing local trends.
2025 total overdose deaths: 621 (preliminary)
Peak year: 2023 with 810 deaths
Fentanyl involvement in 2025: 467 deaths
San Francisco’s trajectory into 2026 will likely depend on whether the drug supply shifts again, how quickly people can access sustained treatment, and whether prevention tools—such as naloxone distribution and low-barrier clinical engagement—continue to reach those at highest risk.