San Francisco Grapples With ‘Massive Die-Off’: 2023 Is Most Deadly Overdose Year on Record as Fentanyl Plagues the Streets 

‘It’s very clearly an issue where we’ve become this magnet regionally for people,’ one California recovery advocate tells the Sun, ‘not only for drug accessibility but for the robust services that are offered.’

Justin Sullivan/Getty Images
Governor Newsom at Sacramento, February 1, 2023. Justin Sullivan/Getty Images

This year has been San Francisco’s deadliest when it comes to fatal drug overdoses, as the troubled city grapples with an enormous amount of cheap fentanyl on its streets despite efforts by law enforcement to crack down. 

The latest preliminary numbers from the city’s chief medical examiner indicate that there were 752 accidental overdose deaths between January 1 and November 30 of this year, up from the city’s previous high of 726 overdose deaths in 2020. 

San Francisco’s surging numbers come as Governor Newsom has built on his $1 billion “Master Plan for Tackling the Fentanyl and Opioid Crisis,” which his office said has led to a “594 percent increase in seized fentanyl.” 

“We didn’t get here overnight,” a recovery advocate and former intravenous drug user who lived on the streets at San Francisco, Tom Wolf, told the Sun. He adds that it’s going to take “a bunch of different pieces working together,” including public health and criminal justice agencies, to address the crisis. 

“The main thing is the actual amount of fentanyl that’s out there on the street. Despite federal intervention — because the feds have been out here in force, arresting not just drug users but drug dealers,” he said, adding that federal law enforcement has arrested “over 100 drug dealers” while the city’s police department has arrested about 500.  

Despite those arrests, he said, dealers cycle in and out of the criminal justice system and end up dealing on the streets again. The vast amount of available fentanyl is the “main driver” of the crisis, Mr. Wolf said, because the accessibility and amount of it has driven down the price. 

“You can purchase fentanyl on the street for $5,” he said. “And if you want to buy a fentanyl pill they’re selling for as little as $1.50 in some places. So if you’re homeless and you have no money, you just have a couple of bucks on you, you have enough money to get high.”

Vast amounts of fentanyl combined with a “lack of political will” by city leaders has created a “perfect storm,” he said. 

“The old saying here in San Francisco is you have to make it harder to get high and easier for people to access treatment,” Mr. Wolf said. “It’s very clearly an issue where we’ve become this magnet regionally for people to come down from northern California and other parts of the Bay Area, not only for drug accessibility but for the robust services that are offered,” he said, adding that overdose deaths commonly take place in the city’s permanent supportive housing for the homeless.  

San Francisco’s low fentanyl prices and generally less severe law enforcement attract drug users from other areas, he said. 

“We’ve kind of taken this laissez-faire approach to drug possession and using drugs,” he notes, and that combined with enormous amounts of fentanyl has led to “this massive die-off that’s happening amongst that very vulnerable population.”

California voters will have a chance to vote on a measure to allocate billions of dollars to mental and behavioral health resources on the March 2024 ballot. 

“Regardless of where you land politically on the spectrum, we need every reasonable resource available to use, and that’s a baby step in the right direction,” Mr. Wolf said of the measure. 

The San Francisco medical examiner’s report notes that 30 of the overdose deaths this year involved xylazine, an animal tranquilizer not meant for human consumption that is used as a cutting agent for illicit drugs. While xylazine is more prevalent in East Coast cities like Philadelphia, Mr. Newsom has recently proposed harsher penalties for trafficking it in an effort to preemptively stem a larger epidemic, as the Sun has reported.


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