San Francisco, CA — The Office of the Chief Medical Examiner has released their Report on Accidental Overdose Deaths for the first four months of this year. The preliminary number of accidental overdose deaths in April 2023 is 66, which brings the total accidental overdose deaths for this year up to 268 – there were 196 accidental overdose deaths across the same months in 2022.[1]

Accidental Overdose Death Graph

San Francisco is far outpacing its overdose mortality rates seen in previous years. Noticeable in the data, however, is the dip in accidental overdose deaths in 2022, when the Tenderloin Center was operational. The Center, which was located at United Nations Plaza and served over 400 people per day from January 2022 to December 4, 2022, was closed without any replacement services.[2][3]

The positive impacts of the Tenderloin Center were far more than the over 330 reversals that were performed on site, though these reversals marked a significant accomplishment in saving lives.[4] The Center, which provided low-threshold, compassionate care to people who use drugs, helped to foster a culture of safety and wellbeing. When people are not criminalized, when people do not use drugs in isolation or shame, rush their use, or use larger doses to limit their frequency for fear of being caught, this all helps to mitigate the risk of overdose.

Since the closure of the Tenderloin Center – coupled with a lack of continuity of a similar model of care – San Francisco officials have increased enforcement and arrests of people who use drugs and have increased charging rates while reducing opportunities for diversion.[5][6] Several factors are different this year compared to last year, the combination of which may account for the decrease in accidental overdose deaths in 2022 versus the increase in 2023 – the closure of the Tenderloin Center and an escalation in punitive approaches  and criminalizing drug use.

Despite increases in client intakes for withdrawal management and residential substance use disorder treatment programs, San Francisco lacks a full suite of evidence-based solutions to address the overdose crisis to scale. Further complicating effective service delivery are worker recruitment and retention challenges, which could be addressed with improved contracts that allow for competitive wages and account for historic underfunding and inflation. To implement a comprehensive continuum of care grounded in public health, we recommend expanded access to medication for addiction treatment, scaling up drug sobering centers and drug adulterant testing, support and resourcing for syringe services programs, and implementing harm reduction interventions such as overdose prevention centers and safer supply.

About HealthRIGHT 360:

HealthRIGHT 360 is a non-profit provider of substance use disorder treatment, mental health services, and primary care to over 47,000 Californians annually, including more than 15,000 San Franciscans. HealthRIGHT 360 provides care that is compassionate, non-judgmental, and evidence-based. We provide services, regardless of one's ability to pay; inspired by our belief that healthcare is a right, not a privilege. Learn more about HealthRIGHT 360 and our programs at http://healthright360.org


[1] "Accidental Overdose Report, Jan 2023 - Apr 2023." Office of the Chief Medical Examiner, OCME Toxicology Reports, May 12, 2023. https://sf.gov/resource/2020/ocme-toxicology-reports

[2] Moench, M. "Here’s what new research on Mayor Breed’s Tenderloin Center found about its impact" San Francisco Chronicle, November 16, 2022. https://www.sfchronicle.com/bayarea/article/breed-tenderloin-center-sf-17588199.php

[3] Moench, M. "Mayor Breed’s Tenderloin Center just closed. What does that mean for S.F.’s ongoing drug epidemic?," San Francisco Chronicle, December 5, 2022. https://www.sfchronicle.com/sf/article/Mayor-Breed-Tenderloin-Center-17631151.php

[4] Chabria, A. "Column: Overdose prevention reaches a critical crossroad in San Francisco. What will Mayor Breed do?" Los Angeles Times, December 28, 2022. https://www.latimes.com/california/story/2022-12-28/column-san-francisco-closed-its-safe-drug-consumption-site-pushing-california-toward-more-death

[5] Leonard, C. "'Enormous rise' in San Francisco overdose deaths in 2023," San Francisco Chronicle, April 19, 2023. https://www.sfchronicle.com/sf/article/drug-overdose-deaths-2023-17904060.php

[6] Neilson, S. "Brooke Jenkins has transformed San Francisco's crime policies. Here's what the data shows," San Francisco Chronicle, March 29, 2023. https://www.sfchronicle.com/bayarea/article/san-francisco-arrests-jail-17837526.php