Grim New Record

2023 was San Francisco’s deadliest year for drug overdoses. 752 people fatally overdosed in the city, mostly from fentanyl, sometimes from meth, and increasingly from xylazine (aka ‘tranq’), a non-opiate sedative that rots flesh and resists opioid antagonists like Narcan. The most recent available data from the CDC shows the rate of overdose deaths in SF far outpaces both California and the nation. In fact, among areas with over 500,000 residents, San Francisco lags only behind Baltimore, Philadelphia, Memphis and Louisville — East Coast cities with several more years of fentanyl exposure under their belts — in rate of fatal overdoses per 100,000 residents.

The scale of the human tragedy both locally and across the country — where overdose deaths have increased so sharply they are driving down overall life expectancies — is difficult to fathom. Fentanyl, which cartels manufacture by the ton in clandestine labs across northern Mexico, is the clear game-changer. But faced with a drug that is highly addictive, cheap to produce, and easy to smuggle through sophisticated networks of organized criminals, what are policymakers to do?