The San Francisco Department of Public Health is trying out new strategies to tackle the city’s drug crisis after seeing a considerable jump in overdose deaths in January compared to the previous month.
Preliminary numbers show that 53 people died in January from unintentional overdose deaths, up from 36 deaths in December, according to the San Francisco Medical Examiner’s Office.
It’s the highest number of monthly preliminary overdose deaths since May 2025, yet lower than January figures from the last two years. In January 2025, 62 people died from unintentional drug overdoses and in the same month in 2024, 71 people died of overdoses.
Fentanyl, the synthetic opioid that is 50 to 100 times stronger than morphine, is the main culprit of the city’s overdose crisis.
“As I say every single month when I’m up here, every single overdose death is tragic,” Daniel Tsai, the city’s Department of Public Health director, said in a Friday briefing. “It’s preventable, it’s unacceptable, and we here in San Francisco at the Department of Public Health, across city governments and this administration, are going to continue to be tackling this as the public health epidemic that it is.”
New approach allows for earlier intervention
Tsai has been the director of DPH for one year after being appointed by Mayor Daniel Lurie. Tsai’s approaches to tackling the drug crisis have centered around getting people connected to treatment.
Things like medication-assisted treatment to help people get off drugs, getting people with substance use disorder connected to treatment beds, and modifying harm-reduction approaches are some of the strategies that DPH has implemented.
But in 2025, the number of unintentional overdose deaths remained largely stagnant compared to the previous year. There were 621 fatal overdoses in 2025 and 635 in 2024.
“… Every single overdose death is tragic. It’s preventable, it’s unacceptable, and we … are going to continue to be tackling this as the public health epidemic that it is.”
Daniel Tsai, Department of Public Health director
At Friday’s briefing, Tsai discussed an updated approach using medication to help people get treatment in the city’s jail system.
“Our clinical teams, doctors, nurses, other clinicians, pharmacists and others, provide the best possible care to anybody that comes through the doors of the jail in San Francisco, because a large number of those folks have a substance use disorder,” Tsai said.
At San Francisco Jail Health Services, a branch of DPH, clinicians are starting to use injectable buprenorphine for patients coming into jail with opioid use disorder. Buprenorphine is a medication that acts on opioid receptors to help reduce cravings and withdrawal systems for those addicted to drugs like fentanyl.
“We recently launched a promising pilot using a weekly formulation of injectable buprenorphine,” said Chief Medical Officer of San Francisco Jail Health Services Dr. Tyler Mains at the briefing. “This has been a game changer for us because it allows patients to start medication eight hours after arrest, and the medication stays in their system for a few days.”
Injectable medication helps prevent withdrawal
Before the buprenorphine injection was introduced, clinicians at the jails were using the oral form of buprenorphine. To take the medication orally, inmates had to wait at least two to three days.
But according to Mains, more than half of the inmates coming into jail with opioid use disorder are released within a few days, thus they miss the opportunity to get started on buprenorphine.
“This weekly buprenorphine injection allows people to start treatment earlier,” Mains said. “It allows them to get better control of their withdrawal symptoms and to get to a more stable dose very quickly.”
In January, when the pilot program launched, 115 inmates received injectable buprenorphine. About half of those who got the vaccine in jail also followed up to get another injection within 30 days of release, according to Mains.
DPH and San Francisco Jail Health Services collaborate with several health providers and recovery centers throughout the city to help encourage people exiting jail to continue using buprenorphine or methadone.
Some of the people who are in jail who are arrested under the influence of drugs or for public intoxication may be diverted to a new center that is planned as an alternative to jail.
Last month, Lurie announced an effort to bring what’s called a “RESET” Center, or “Rapid Enforcement, Support, Evaluation, and Triage Center.” The center will provide more mental health and substance use treatment services than what nurses in the jails are able to provide.
Last week, the Board of Supervisors approved a contract with an organization to operate the RESET Center with the San Francisco Sheriff’s Office. Lurie has said that the site is expected to come in the spring and will be located next to the Hall of Justice.