San Francisco sees record 699 fatal drug overdoses in 2020

A drug user smokes fentanyl on Turk Street in San Francisco's Tenderloin.

San Francisco saw a record 699 fatal overdose last year — a grim tally as the city continues to grapple with a spiraling opioid crisis during a global pandemic, officials announced Thursday. 

The 2020 overdose numbers show a more than 50% increase from 2019, when the city saw a then-record 441 fatal drug overdoses, according to a report by the city’ Office of the Chief Medical Examiner.

"The volume of these types of deaths has increased -- particularly in 2020 -- over the last couple of years," Dr. Luke Rodda, the office's Chief Toxicologist, said in an interview with KTVU. "Every single one is someone's loved one." 

The driving force behind the surging deaths is fentanyl — a powerful opioid estimated to be 50 times stronger than heroin. The drug played a role in just over 500 of last year's deaths.

The report also shows that 82% of the people who died of accidental overdoses were men and 71% of the people had a fixed address. 

Experts believe the COVID-19 epidemic may be exacerbating the death toll. Social isolation has helped reduce the spread of the virus, but for drug users, distancing from others decreases their chances of being revived during an overdose.

A KTVU investigation last year found that nearly three-quarters of people who succumbed to an overdose were inside a home or hotel.

More than 20% of people died in San Francisco’s Tenderloin neighborhood, where in recent years, foil and glass straws used to smoke drugs are now becoming more common than heroin needles. 

Police continue to arrest dealers who treat the neighborhood as an open-air drug bazaar, many selling four or five different drugs to an endless supply of demand.

But as the city works to reduce its jail population and courts are backlogged with cases, most dealers are free within days or even hours after being arrested.

Harm reduction advocates have flooded the streets with the opiate-reversal drug Narcan. The city non-profit Dope Project estimates more than 2,000 people have been revived with the drug last year alone.

Evan Sernoffsky is an investigative reporter for KTVU. Email Evan at and follow him on Twitter @EvanSernoffsky