Drug Overdose Deaths Before and After Shelter-in-Place Orders During the COVID-19 Pandemic in San Francisco
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Discussion
In this cross-sectional study, we found a continued increase in drug overdose deaths in San Francisco since the onset of COVID-19, with a 50% increase in weekly median overdose deaths. Of note, between March 17 and November 30, 2020, San Francisco recorded 537 drug overdose deaths, while recording 169 deaths due to COVID-19 in the same time period.6 The number of fatal overdoses among people experiencing homelessness during COVID-19 doubled.
This follows the increasing trend in 2019 overdose deaths because of fentanyl, which is also associated with the increase in 2020. However, societal disruption related to COVID-19 is likely contributing, as it disproportionately affects people experiencing poverty and marginal housing. Likewise, overdose deaths among Black individuals in San Francisco have been persistently and disproportionally high. Preventing fentanyl-related deaths is of paramount importance, as deaths continue to increase amid the COVID-19 pandemic2; however, an ongoing focus on methamphetamine in our region is also needed.
This study was constrained to 1 geographic region, used OCME data (limiting covariate adjustment), and was cross-sectional, precluding causative statements. San Francisco has had a low COVID-19 mortality rate compared with other municipalities and adopted a comprehensive response to the pandemic. Our findings suggest that to complement a strong public health response to COVID-19, there must be more robust overdose prevention for people who use drugs, particularly for people experiencing homelessness, people who identify as Black, and people who use fentanyl and/or stimulants.