After pandemic explosion, California drug overdose deaths are falling fast

For nine straight months, overdose deaths in California have been on a rapid decline, a remarkable reversal following an explosion of drug fatalities during the pandemic.

Experts speculate the drop, which mirrors the nationwide trend, could be due to a combination of factors: expanded treatment and intervention efforts, recent crackdowns on the illicit opioid trade and less lethal pills on the street — or simply because the overdose epidemic has passed its inevitable peak.

“The big caveat is that nobody knows, because it is a startling finding,” said Dr. Daniel Ciccarone, a drug researcher at UC San Francisco.

Over the 12 months ending in July, the state saw a 17% decrease in deaths from the peak in August 2023, and a 14% reduction from the same period last year, according to the most recent provisional data from the Centers for Disease Control and Prevention. It was the first extended monthly decline dating back to at least 2014.

Recent data for the core Bay Area was only publicly available for Santa Clara and San Francisco counties, but both reported significant declines in overdoses in recent months.

Still, the recent 12-month California overdose total — more than 10,400 deaths — was nearly double that of just four years ago. The staggering figure underscores the ongoing challenge of stemming a drug crisis that’s devasted the lives of countless Californians, from those living on the street to suburban high schoolers and their families.

For the entire U.S., the CDC reported more than 90,000 drug deaths over the year-long period ending in July, a 17% decline. On the West Coast, Oregon and Washington reported slight year-over-year increases, though overdose deaths in both states have been trending downward on a monthly basis since the spring. All but six states saw drug fatalities decline.

California’s recent spike in overdose deaths started in 2019 — just as fentanyl, an extremely potent synthetic opioid, arrived across the West Coast. The following year, as the pandemic isolated more people in their homes, forced massive job losses, and blocked access to treatment, more and more became addicted, and fatalities surged even higher.

Researchers said it will likely take a few years to understand what’s behind the recent turnaround, assuming it continues. One explanation, however, is that after so many thousands have died of fentanyl overdoses, there may now be fewer people alive who are predisposed to use the drug.

“We may finally have a tipping out where the susceptible population is getting smaller,” Ciccarone said.

Dr. Anna Lembke, a behavioral sciences professor at Stanford University, was skeptical of the idea that the crisis has begun to burn itself out because of the number of users who’ve died.

“We can’t assume a vulnerable group is no longer with us,” she said.

Instead, one possible explanation she cited is the ongoing push for public awareness campaigns about the risks of fentanyl, which is sometimes added to party drugs such as ecstasy or cocaine. She also pointed to the billions of dollars spent to expand access to addiction medicines such as methadone and naloxone, an over-the-counter nasal spray that can reverse opioid overdoses.

Across the state, advocates and public health officials have worked to distribute naloxone everywhere from college campuses and music festivals to prisons and homeless camps. The effort is part of a broader “harm reduction” strategy, which can sometimes include needle exchanges or safe consumption sites, though such programs are rare in the U.S.

Developed in the 1990s in response to the AIDS epidemic, harm reduction has become increasingly controversial in recent years as opponents have claimed it’s enabled drug use and exacerbated the crisis.

April Rovero, founder of the National Coalition Against Prescription Drug Abuse, a nonprofit based in San Ramon that helps distribute naloxone and fentanyl test kits across the East Bay, defended the practice of ensuring people who use opioids do so safely.

“As long as they are alive, there is hope,” said Rovero, who lost her son to a prescription overdose in 2009. “I see it this way: They’re somebody’s loved one.”

Another potential explanation is that illicit fentanyl pills have started to become less potent. According to the U.S. Drug Enforcement Administration, five in 10 pills the agency tested in 2024 had a potentially deadly dose of fentanyl, down from seven in 10 last year.

“The cartels have reduced the amount of fentanyl they put into pills because of the pressure we are putting on them,” the DEA said in a statement last month announcing the testing results.

In California, Gov. Gavin Newsom and local officials, including San Francisco Mayor London Breed, have also launched crackdowns on the illegal drug trade. But experts cautioned that, as with expanded treatment and intervention, it was too early to know for certain whether those efforts are responsible for bringing down overdoses.

In Santa Clara County, the decline in drug-related deaths appears to be outpacing the statewide drop. For the 12 months ending in October, the county saw 329 drug-related deaths, a 26% plunge from the same period in 2023, according to the most recent county data.

Even so, Dr. Cheryl Ho, the county’s top behavioral health medical director, said local officials are growing increasingly concerned about overdoses from a mix of fentanyl and methamphetamines. She worries meth and other non-opioid drugs could soon drive a coming wave of fatalities.

Ho singled out Xylazine, a veterinary sedative also known on the street as “tranq,” which in recent years has become common in some East Coast cities. It was first detected in Santa Clara County in 2023.

“I don’t think it’s ‘if,’ I think it’s ‘when’ the next wave will come,” she said.