San Francisco is seeing a promising drop in overdose deaths this year after years of high death rates. Experts say there are many reasons why the city looks likely to see fewer deaths in 2026 and the city’s trendlines reflect a drop nationwide.
Drug overdose deaths in San Francisco declined by 27% in the first six months of 2026 compared to the same period last year.
Preliminary data shows 262 overdose deaths from January to June of this year, though that number is likely to rise slightly as more deaths from recent months are reported. At this pace, the city is on track for 524 deaths this year vs. 625 last year. The death rate remained mostly flat from 2024 to 2025.
That tally marks a drop that echoes national data showing lower overdose deaths since late 2023, which experts attribute to North America’s fentanyl supply substantially losing purity, a shrinking group of people susceptible to fentanyl addiction, and local and state public health responses, among other reasons.
“We’re making forward progress,” said Department of Public Health Director Daniel Tsai in a news conference. “I do expect the numbers to continue to bounce up and down, and even as I’m excited about the improvement, the number is still far too high.”
Keith Humphreys, a professor and addiction researcher at Stanford University’s medical school, said the national trend of lower deaths makes this “the best period since this whole awful thing started.” He said a factor contributing to the trend is that the fentanyl coming into the United States, as well as North America more broadly, has seen a “supply shock” and has dropped in purity.
“San Francisco’s been making good decisions, and that never hurts,” he said, noting that most of the drop is likely not due to local government investments in treatment and policing.
San Francisco has spent hundreds of millions of dollars in federal, state and local funds to fight the drug overdose epidemic, with recent efforts focused on expanding treatment options and availability, as well as ramping up distribution of the overdose reversal spray Narcan. The city is also partnering with Biobot Analytics to test wastewater for various drugs, allowing officials to track emerging drug use trends.
Since taking office, Mayor Daniel Lurie has made reducing public drug use and cleaning up city streets a top priority. Lurie’s administration has opened a new sober shelter, a crisis stabilization center and new sober living facilities, but it has also cracked down on drug users despite criticism from some harm reduction advocates who say it’s a waste of resources and criminalizes addiction. Arrests of users have spiked while arrests of dealers have not.
But local efforts, both in San Francisco and across the country, are a small piece of a larger puzzle, experts said.
“If anyone you talk to says overdoses are going down and I can tell you why, if they don’t give you more than one reason, they’re not telling you the truth,” said Dr. Dan Ciccarone, a professor at UCSF’s medical school. “There is no single right answer.”
Ciccarone attributed the drop in overdose deaths partly to a complex phenomenon: as people who use fentanyl get older, enter treatment, transition to other drugs or die, younger Americans are not “replacing” them at the same rates. Recent evidence suggests youth opioid misuse plateaued after the pandemic, he added.
The trend of lower overdose deaths doesn’t mean that the lives of people who are homeless and addicted to fentanyl or other highly dangerous drugs have gotten substantially easier. Krissi Showers, 42, has lived on the streets in San Francisco for about two years, and said she struggles to navigate the city’s complex system of healthcare and addiction resources.
Showers sat on the sidewalk with her dog Phoebe along Willow Street and Polk Street on Friday with lesions visible on her arms. She said she has overdosed five times, and that the opioids she can get are much more diluted than they used to be. Showers said she has seen more people on the streets using animal tranquilizers, a type of illicit drug that has sparked concern among San Francisco officials.
Showers grew up in North Carolina and worked as an emergency medical technician. She said she became addicted to opioids after she was prescribed pain medication to treat cancer. She then bounced around treatment and harm reduction centers, which she said are important and should be easier to access. Despite the drop in deaths, Showers said the reality on the streets remains brutal.
“I see people dying or almost dying every day,” she said.