Fentanyl crisis in San Francisco

Synthetic opioids, most notably fentanyl and drugs laced with it have seen increasing usage in the American city of San Francisco, California since 2019. In 2023, 810 people died from accidental drug overdoses, a majority containing fentanyl, in San Francisco, with overdoses per 100,000 people being more than double the national average. From January to May 2024, 327 people died from unintentional drug overdoses.

Background
In 2014, drug possession in California was reduced to a misdemeanor, rather than a felony, with the passing of Proposition 47. In response, San Francisco law enforcement reduced their efforts against drug possession and use.

San Francisco has not been able to develop a comprehensive and consistent approach to drug use and overdoses; the San Francisco Department of Public Health and local nonprofits tend to argue for harm reduction strategies, while law enforcement agencies have argued for increased penalties for drug possession, use, and dealing.

Sources and pricing
According to the U.S. Drug Enforcement Administration, fentanyl is also substantially cheaper on average in San Francisco - around $100 cheaper per ounce - compared to cities like New York City and Philadelphia, and the California cities of Los Angeles and Sacramento. This cheaper pricing has been blamed for the higher overdose rate in San Francisco. As of January 2023, lower-grade fentanyl was being sold in the streets of San Francisco for $150 to $200 per ounce, while higher-grade fentanyl went for between $500 and $550 per ounce. Some fentanyl users reported that they obtained the drug for free by doing favors with fentanyl dealers.

Members of the DEA have said they believe fentanyl's price is cheaper in the city due to "soft drug policies". Local users have reported they believe the price is cheaper because San Francisco fentanyl has been diluted with other substances, pointing to the more expensive price of fentanyl in previous years. The DEA has reported that "regular" fentanyl sold in the city ranges on average between 5% and 10% purity. Another theory, held by some of those involved with drug policy, is that the saturation of the market in the city has driven down prices.

Authorities have reported that fentanyl from San Francisco is the source of fentanyl in Sacramento, and that users and dealers from across California have traveled to San Francisco to purchase the drug more cheaply, although this latter assertion has been challenged by local nonprofits.

Reactions
In mid-2022, arrests of drug dealers and users increased again, with the appointment of a new district attorney.

In December 2023, the city of San Francisco began testing wastewater for fentanyl, other drugs such as amphetamine, cocaine, methamphetamine, and xylazine, and naloxone. The testing was part of a larger study by the National Institute on Drug Abuse, which was also testing wastewater in 70 other U.S. cities, and is scheduled to continue until August 2024.

Between May 2023 and January 2024, law enforcement in the city seized 145 pounds of fentanyl. In early 2024, the California Highway Patrol recovered 42 pounds of fentanyl within a ten-mile radius of the Tenderloin neighborhood in San Francisco. In the same period, the CHP issued more than 6,000 drug-related citations, leading to nearly 500 arrests.