San Francisco’s Homelessness Deaths Rise Sharply, Driven by Overdoses and Fentanyl

San Francisco recorded a significant increase in deaths among people experiencing homelessness over the past five years, with drug overdoses and fentanyl playing a central role, according to newly released city and medical examiner data. The figures highlight how deeply the overdose crisis has intersected with the city’s long running homelessness emergency, even as local and state officials pour money into housing, treatment, and street outreach.

The data show that the number of deaths among unhoused residents in San Francisco has climbed compared with the years before the COVID 19 pandemic. Overdoses now account for the majority of those fatalities, and fentanyl appears in most toxicology reports where a specific substance is identified. According to the information compiled by city health and public safety agencies, many of the deaths occurred on sidewalks, in encampments, and in temporary shelters spread across neighborhoods including the Tenderloin, SoMa, and parts of the Mission.

City analysts link the rise in deaths to a combination of factors, including the increased presence of fentanyl in the local drug supply, ongoing housing instability, and limited access to consistent treatment for substance use disorder. The report indicates that even as San Francisco has invested in supportive housing units and behavioral health programs, these efforts have not yet offset the lethal impact of fentanyl and other synthetic opioids circulating on the street.

Researchers and public health officials note that the profile of people dying while homeless in San Francisco has shifted. The average age of the deceased has risen in recent years, suggesting that many are long term unhoused residents or individuals cycling in and out of housing and shelter. The majority are men, and a large share have a documented history of substance use. The data also point to racial disparities, with Black residents disproportionately represented among the dead compared with their share of the city’s overall population. The source does not specify exact percentages by race.

According to the findings, fentanyl has become the dominant driver of overdose deaths in the homeless population, often in combination with other substances such as methamphetamine or alcohol. In many cases, the medical examiner identified multiple drugs in the system of the deceased, but fentanyl was frequently listed as a primary or contributing cause. The report states that accidental overdoses far outnumber deaths from other causes, including untreated chronic illness, accidents, or exposure.

The timing of the increase aligns with broader shifts in San Francisco’s drug market. City officials and health workers have previously described how fentanyl, which is cheaper and more potent than heroin, began to appear in the local supply in greater volume just before the pandemic and then rapidly became entrenched. The new data suggest this transition had a direct and deadly impact on unhoused residents, who often use drugs in public spaces or semi public settings such as shelters, single room occupancy hotels, and sanctioned or unsanctioned encampments.

The report also tracks where deaths are occurring. According to the data, a large number of fatalities happened on the street or in outdoor settings, including sidewalks, tents, and makeshift encampments. Others occurred in temporary housing, navigation centers, and shelter programs, as well as in permanent supportive housing sites serving formerly homeless individuals. The source does not provide a detailed breakdown by facility type, but officials say the pattern underscores the need for consistent overdose prevention and response capacity wherever people who use drugs are living or sleeping.

San Francisco has deployed several tools meant to reduce overdose deaths among both housed and unhoused residents. These include widespread distribution of naloxone, the medication that can reverse opioid overdoses, and training for outreach workers, shelter staff, and some residents on how to use it. The city has also expanded access to medications for opioid use disorder such as buprenorphine and methadone, and has opened dedicated programs for people who are homeless and actively using drugs. According to the available information, officials say these interventions have prevented many deaths, but they have not fully contained the surge among the homeless population.

The data on deaths among unhoused people arrive as San Francisco leaders continue to debate how to handle visible homelessness and open air drug use in key corridors. Business groups and some neighborhood organizations have pushed for more enforcement oriented responses, including police crackdowns and encampment clearings, particularly in downtown and Tenderloin areas. Advocates for homeless residents and harm reduction groups argue that stable housing, low barrier shelter, and expanded treatment and overdose prevention are more effective and humane strategies. The new figures are likely to feed into those ongoing policy fights at City Hall and in state politics.

State and local spending on homelessness and behavioral health has grown significantly in recent years, though the report does not list specific budget totals. San Francisco has added shelter beds, supportive housing units, and street outreach teams, often with funding support from Sacramento. Yet the rising number of deaths among homeless residents underscores how difficult it has been to translate those investments into improved health outcomes for people who remain outside or in unstable housing.

The findings also raise questions about how effectively data is being used to target services. According to officials involved in compiling the report, better real time information on overdoses, nonfatal incidents, and near misses in shelters, encampments, and housing sites could help the city deploy mobile treatment teams and peer workers more strategically. At the same time, privacy and logistical constraints make it challenging to track individuals across different systems, such as hospitals, jails, and homeless services.

For Bay Area residents, the trend lines in San Francisco are an indicator of broader regional pressures. Other cities around the region are also facing increases in homelessness and in fentanyl related overdoses, although the report at issue focuses specifically on San Francisco. Because the city has long served as a hub for services and a destination for people experiencing homelessness, shifts in its policies and outcomes often influence neighboring counties and regional planning efforts.

Officials say the data will be used to inform ongoing work on the city’s homelessness and overdose response strategies, including potential changes in how and where services are delivered. That could involve expanding overdose prevention resources in shelters and supportive housing, increasing access to treatment tailored to people who are homeless, and refining outreach in neighborhoods where deaths have been most concentrated. The source does not specify which concrete policy changes will result from this report or on what timeline.

The report concludes that preventing further deaths among San Francisco’s homeless residents will require sustained cooperation between public health agencies, homeless services providers, law enforcement, and community organizations, along with continued funding. The scale of fentanyl’s impact described in the data suggests that even with existing tools in place, the city faces a prolonged effort to reduce mortality among its most vulnerable residents.