San Francisco overdose deaths rise in January as health officials expand treatment in jails and diversion options

A sharper start to the year in the city’s ongoing overdose crisis

San Francisco recorded 53 preliminary deaths from unintentional drug overdoses in January 2026, a marked increase from 36 in December 2025, based on figures released by the city’s Medical Examiner. The January total was the highest monthly preliminary count since May 2025, while remaining below the January totals posted in the prior two years: 62 in January 2025 and 71 in January 2024.

Health officials have consistently identified fentanyl as a central driver of fatal overdoses in San Francisco. The city’s annual totals show little separation between the last two full years: 621 fatal overdoses in 2025 and 635 in 2024.

New treatment push inside the jail system: faster initiation of medication

In response to the latest increase, city health leadership outlined a new clinical approach inside San Francisco’s jail health system focused on speeding access to medication for opioid use disorder. Clinicians have begun using a weekly formulation of injectable buprenorphine for patients who enter custody with opioid use disorder.

The medication is designed to reduce cravings and withdrawal symptoms by acting on opioid receptors. Jail health officials said the injectable formulation allows some patients to begin medication as soon as eight hours after arrest and remain covered for several days. Previously, clinicians relied on an oral form that typically required a longer waiting period before initiation.

• Program launch: January 2026.
• Initial uptake: 115 people in custody received injectable buprenorphine during the first month.
• Continuity after release: about half returned for another injection within 30 days, according to jail health leadership.

Officials described early initiation as a way to reach people who cycle quickly through custody, where short stays can limit opportunities to begin and stabilize on medication.

Linking people to ongoing care after release

City health officials said the jail health system is working with health providers and recovery programs across San Francisco to encourage continuation of buprenorphine or methadone after release. Continuity of care has become a central operational focus as the city seeks to reduce the risk of relapse and overdose in the weeks immediately following a return to the community.

Planned diversion: a new RESET Center as an alternative pathway

Some people arrested while under the influence of drugs or for public intoxication may be diverted from jail to a planned facility described as a Rapid Enforcement, Support, Evaluation, and Triage (RESET) Center. The center is expected to be located next to the Hall of Justice and is described by city leadership as a site intended to provide mental health and substance-use services beyond what is typically available in a jail setting.

The Board of Supervisors approved a contract for an organization to operate the center with the San Francisco Sheriff’s Office. City leadership has said it is expected to open in spring 2026.