OFFICE OF THE

CHIEF MEDICAL EXAMINER

London N. Breed, Mayor

VIA EMAIL ONLY

October 9, 2020

Report on Accidental Overdose Deaths - January to August, 2020

Dear Mayor Breed, President Yee and Dr. Colfax,

The enclosed report provides preliminary data of accidental overdose deaths in San Francisco within the
first eight months of 2020. We trust this report adheres to the mandate and spirit of providing timely
information for drug harm strategies. These results are strictly preliminary as of testing to September 25,
2020, and are subject to change as the OCME finalizes the manner and cause of each death.

Pertinent for accurate use of this report is to understand the source of the data and its subsequent process of
summarization. Decedent demographic and case information was obtained from the OCME case
management system. Additionally, specific details from investigator narratives, forensic toxicology results
and, where available, preliminary autopsy findings, were utilized. Collected demographic information
included race, gender, age, fixed address status, zip code of residence, and zip code of death location.

Due to their significance in accidental overdose deaths, the reported drugs of interest were specific to
fentanyl, heroin, medicinal opioids, methamphetamine and cocaine. Their detection in blood was captured
to best determine their relevance in each respective case. Medicinal opioid positive cases required the
presence of morphine, hydromorphone, oxymorphone, codeine, hydrocodone, oxycodone, buprenorphine,
tramadol, and/or methadone. Heroin determination was more closely evaluated, requiring the presence of
specific heroin markers in blood or urine, expected morphine to codeine ratios, and/or case details consistent
with heroin use.

Subject to the nature of the preliminary reporting described above, this report is not intended to replace
other death statistics within the City that consider finalized death certificates only.

Sincerely,

Luke N. Rodda, Ph.D.

Chief Forensic Toxicologist and Director, Forensic Laboratory Division

cc: Office of the City Administrator

enclosures: January-August 2020 Overdose Reports

1 Newhall Street • San Francisco, CA 94124 • Phone (415) 641-3600

ACCREDITED BY THE AMERICAN BOARD OF FORENSIC TOXICOLOGY
 OFFICE OF THE CHIEF MEDICAL EXAMINER CITY AND COUNTY OF SAN FRANCISCO

Preliminary Accidental Drug Overdose Data Report Gender Race Age

as of September 25, 2020

JAN-AUG
2020 20%
80%
Female
Male
4%
26%
Asian
Black
0%
15%
<15
25-34
15-24 4%
35-44 24%
17% Latinx 22% 45-54 55-64 25%
0% Native American >=65
Total Cases Received by OCME (1070) 48%
5%
White
Other/Unknown
10%

Fixed Address Residence Location of Death

70% Yes (see residence) 24% Tenderloin (94102) 23% Tenderloin (94102)
28% No 17% SOMA (94103) 17% SOMA (94103)
1% Unknown 9% Nob Hill (94109) 16% Nob Hill (94109)
8% Inner Mission (94110) 14% Inner Mission (94110)
42% Others 30% Others
56% Other Causes
26% Acc. Overdoses Open
18% Acc. Overdoses Closed

500 Accidental Overdoses by Day of Death

450

400

350

300

250

200

150

100

50

0
1-Jan 1-Feb 1-Mar 1-Apr 1-May 1-Jun 1-Jul 1-Aug 1-Sep

Total Deaths Fentanyl Heroin Medicinal Opioids Methamphetamine Cocaine

"Acc. Overdoses Open" cases do not have a final cause and manner of death classification; "Acc. Overdoses Closed" cases have a final cause and manner of death classification.
"No fixed address" denotes community members who may be experiencing homelessness.
"Residence" denotes address where decedent lived; "Location of Death" denotes the location where death was declared. For "Residence" and "Location of Death", the 4 most affected
neighborhoods are represented, the "Others" category refers to all other zip codes within the City and County of San Francisco and any of out county residences.
"Gender" refers to gender at time of death.
"Total Deaths" denotes Accidental Overdoses where one or more drugs contribute to the cause of death; however, every point for each drug series is inclusive, but not necessarily
exclusive, of that drug. "Total deaths" represents all accidental overdoses including ones for drugs not specified above.

PLEASE NOTE THIS DATA IS PRELIMINARY INFORMATION AND SUSCEPTIBLE TO CHANGE

 OFFICE OF THE CHIEF MEDICAL EXAMINER CITY AND COUNTY OF SAN FRANCISCO

Preliminary Accidental Drug Overdose Data Report Gender Race Age

as of September 25, 2020

JANUARY
2020 24%
76%
Female
Male
3%
26%
Asian
Black
0%
21%
<15
25-34
15-24 0%
35-44 18%
11% Latinx 21% 45-54 55-64 24%
0% Native American >=65
Total Cases Received by OCME (126) 50%
11%
White
16%
Other/Unknown

Fixed Address Residence Location of Death

79% Yes (see residence) 27% Tenderloin (94102) 26% Tenderloin (94102)
21% No 13% SOMA (94103) 8% North Beach (94133)
0% Unknown 7% Ingelside (94112) 8% Nob Hill (94109)
7% North Beach (94133) 16% Inner Mission (94110)
47% Others 42% Others
70% Other Causes
0% Acc. Overdoses Open
30% Acc. Overdoses Closed

40 Accidental Overdoses by Day of Death

35

30

25

20

15

10

0
1-Jan 31-Jan

Total Deaths Fentanyl Heroin Medicinal Opioids Methamphetamine Cocaine

"Acc. Overdoses Open" cases do not have a final cause and manner of death classification; "Acc. Overdoses Closed" cases have a final cause and manner of death classification.
"No fixed address" denotes community members who may be experiencing homelessness.
"Residence" denotes address where decedent lived; "Location of Death" denotes the location where death was declared. For "Residence" and "Location of Death", the 4 most affected
neighborhoods are represented, the "Others" category refers to all other zip codes within the City and County of San Francisco and any of out county residences.
"Gender" refers to gender at time of death.
"Total Deaths" denotes Accidental Overdoses where one or more drugs contribute to the cause of death; however, every point for each drug series is inclusive, but not necessarily
exclusive, of that drug. "Total deaths" represents all accidental overdoses including ones for drugs not specified above.

PLEASE NOTE THIS DATA IS PRELIMINARY INFORMATION AND SUSCEPTIBLE TO CHANGE

 OFFICE OF THE CHIEF MEDICAL EXAMINER CITY AND COUNTY OF SAN FRANCISCO

Preliminary Accidental Drug Overdose Data Report Gender Race Age

as of September 25, 2020

FEBRUARY
2020 23%
77%
Female
Male
5%
28%
Asian
Black
0%
16%
<15
25-34
15-24 2%
35-44 33%
7% Latinx 21% 45-54 55-64 19%
0% Native American 9% >=65
Total Cases Received by OCME (113) 58%
2%
White
Other/Unknown

Fixed Address Residence Location of Death

65% Yes (see residence) 32% Tenderloin (94102) 35% Tenderloin (94102)
35% No 14% SOMA (94103) 12% SOMA (94103)
0% Unknown 11% Inner Mission (94110) 12% Nob Hill (94109)
11% Bayview (94124) 19% Inner Mission (94110)
32% Others 23% Others
62% Other Causes
0% Acc. Overdoses Open
38% Acc. Overdoses Closed

50 Accidental Overdoses by Day of Death

45

40

35

30

25

20

15

10

0
1-Feb 29-Feb

Total Deaths Fentanyl Heroin Medicinal Opioids Methamphetamine Cocaine

"Acc. Overdoses Open" cases do not have a final cause and manner of death classification; "Acc. Overdoses Closed" cases have a final cause and manner of death classification.
"No fixed address" denotes community members who may be experiencing homelessness.
"Residence" denotes address where decedent lived; "Location of Death" denotes the location where death was declared. For "Residence" and "Location of Death", the 4 most affected
neighborhoods are represented, the "Others" category refers to all other zip codes within the City and County of San Francisco and any of out county residences.
"Gender" refers to gender at time of death.
"Total Deaths" denotes Accidental Overdoses where one or more drugs contribute to the cause of death; however, every point for each drug series is inclusive, but not necessarily
exclusive, of that drug. "Total deaths" represents all accidental overdoses including ones for drugs not specified above.

PLEASE NOTE THIS DATA IS PRELIMINARY INFORMATION AND SUSCEPTIBLE TO CHANGE

 OFFICE OF THE CHIEF MEDICAL EXAMINER CITY AND COUNTY OF SAN FRANCISCO

Preliminary Accidental Drug Overdose Data Report Gender Race Age

as of September 25, 2020

MARCH
2020 18%
82%
Female
Male
2%
25%
Asian
Black
0%
31%
<15
25-34
15-24 2%
35-44 16%
18% Latinx 16% 45-54 55-64 27%
0% Native American >=65
Total Cases Received by OCME (138) 47%
8%
White
8%
Other/Unknown

Fixed Address Residence Location of Death

71% Yes (see residence) 17% Tenderloin (94102) 25% Tenderloin (94102)
28% SOMA (94103) 24% SOMA (94103)
27% No
2% Unknown 8% Inner Mission (94110) 12% Nob Hill (94109)
8% Twin Peaks (94131) 10% Inner Mission (94110)
39% Others 29% Others
63% Other Causes
0% Acc. Overdoses Open
37% Acc. Overdoses Closed

60 Accidental Overdoses by Day of Death

50

40

30

20

10

0
1-Mar 31-Mar

Total Deaths Fentanyl Heroin Medicinal Opioids Methamphetamine Cocaine

"Acc. Overdoses Open" cases do not have a final cause and manner of death classification; "Acc. Overdoses Closed" cases have a final cause and manner of death classification.
"No fixed address" denotes community members who may be experiencing homelessness.
"Residence" denotes address where decedent lived; "Location of Death" denotes the location where death was declared. For "Residence" and "Location of Death", the 4 most affected
neighborhoods are represented, the "Others" category refers to all other zip codes within the City and County of San Francisco and any of out county residences.
"Gender" refers to gender at time of death.
"Total Deaths" denotes Accidental Overdoses where one or more drugs contribute to the cause of death; however, every point for each drug series is inclusive, but not necessarily
exclusive, of that drug. "Total deaths" represents all accidental overdoses including ones for drugs not specified above.

PLEASE NOTE THIS DATA IS PRELIMINARY INFORMATION AND SUSCEPTIBLE TO CHANGE

 OFFICE OF THE CHIEF MEDICAL EXAMINER CITY AND COUNTY OF SAN FRANCISCO

Preliminary Accidental Drug Overdose Data Report Gender Race Age

as of September 25, 2020

APRIL
2020 21%
79%
Female
Male
10%
19%
Asian
Black
0%
13%
<15
25-34
15-24 10%
35-44 29%
17% Latinx 13% 45-54 55-64 29%
0% Native American 6% >=65
Total Cases Received by OCME (123) 54%
0%
White
Other/Unknown

Fixed Address Residence Location of Death

56% Yes (see residence) 34% Tenderloin (94102) 29% Tenderloin (94102)
44% No 14% Nob Hill (94109) 15% SOMA (94103)
0% Unknown 10% Haight-Ashbury (94117) 23% Nob Hill (94109)
10% Inner Mission (94110) 13% Inner Mission (94110)
31% Others 19% Others
58% Other Causes
12% Acc. Overdoses Open
30% Acc. Overdoses Closed

60 Accidental Overdoses by Day of Death

50

40

30

20

10

0
1-Apr 30-Apr

Total Deaths Fentanyl Heroin Medicinal Opioids Methamphetamine Cocaine

"Acc. Overdoses Open" cases do not have a final cause and manner of death classification; "Acc. Overdoses Closed" cases have a final cause and manner of death classification.
"No fixed address" denotes community members who may be experiencing homelessness.
"Residence" denotes address where decedent lived; "Location of Death" denotes the location where death was declared. For "Residence" and "Location of Death", the 4 most affected
neighborhoods are represented, the "Others" category refers to all other zip codes within the City and County of San Francisco and any of out county residences.
"Gender" refers to gender at time of death.
"Total Deaths" denotes Accidental Overdoses where one or more drugs contribute to the cause of death; however, every point for each drug series is inclusive, but not necessarily
exclusive, of that drug. "Total deaths" represents all accidental overdoses including ones for drugs not specified above.

PLEASE NOTE THIS DATA IS PRELIMINARY INFORMATION AND SUSCEPTIBLE TO CHANGE

 OFFICE OF THE CHIEF MEDICAL EXAMINER CITY AND COUNTY OF SAN FRANCISCO

Preliminary Accidental Drug Overdose Data Report Gender Race Age

as of September 25, 2020

MAY
2020 14%
86%
Female
Male
4%
25%
Asian
Black
0%
13%
<15
25-34
15-24 3%
35-44 28%
18% Latinx 27% 45-54 55-64 23%
0% Native American >=65
Total Cases Received by OCME (143) 51%
1%
White
Other/Unknown
7%

Fixed Address Residence Location of Death

62% Yes (see residence) 25% Tenderloin (94102) 21% Tenderloin (94102)
38% No 30% SOMA (94103) 24% SOMA (94103)
0% Unknown 5% Inner Mission (94110) 14% Nob Hill (94109)
7% Lake Merced (94132) 15% Inner Mission (94110)
34% Others 25% Others
50% Other Causes
39% Acc. Overdoses Open
10% Acc. Overdoses Closed

80 Accidental Overdoses by Day of Death

70

60

50

40

30

20

10

0
1-May 31-May

Total Deaths Fentanyl Heroin Medicinal Opioids Methamphetamine Cocaine

"Acc. Overdoses Open" cases do not have a final cause and manner of death classification; "Acc. Overdoses Closed" cases have a final cause and manner of death classification.
"No fixed address" denotes community members who may be experiencing homelessness.
"Residence" denotes address where decedent lived; "Location of Death" denotes the location where death was declared. For "Residence" and "Location of Death", the 4 most affected
neighborhoods are represented, the "Others" category refers to all other zip codes within the City and County of San Francisco and any of out county residences.
"Gender" refers to gender at time of death.
"Total Deaths" denotes Accidental Overdoses where one or more drugs contribute to the cause of death; however, every point for each drug series is inclusive, but not necessarily
exclusive, of that drug. "Total deaths" represents all accidental overdoses including ones for drugs not specified above.

PLEASE NOTE THIS DATA IS PRELIMINARY INFORMATION AND SUSCEPTIBLE TO CHANGE

 OFFICE OF THE CHIEF MEDICAL EXAMINER CITY AND COUNTY OF SAN FRANCISCO

Preliminary Accidental Drug Overdose Data Report Gender Race Age

as of September 25, 2020

JUNE
2020 7%
93%
Female
Male
4%
19%
Asian
Black
0%
8%
<15
25-34
15-24 7%
35-44 24%
27% Latinx 23% 45-54 55-64 26%
0% Native American >=65
Total Cases Received by OCME (140) 47%
3%
White
Other/Unknown
12%

Fixed Address Residence Location of Death

73% Yes (see residence) 26% Tenderloin (94102) 23% Tenderloin (94102)
26% No 9% SOMA (94103) 15% SOMA (94103)
1% Unknown 7% Inner Mission (94110) 18% Nob Hill (94109)
9% Nob Hill (94109) 11% Inner Mission (94110)
48% Others 34% Others
47% Other Causes
51% Acc. Overdoses Open
2% Acc. Overdoses Closed

80 Accidental Overdoses by Day of Death

70

60

50

40

30

20

10

0
1-Jun 1-Jul

Total Deaths Fentanyl Heroin Medicinal Opioids Methamphetamine Cocaine

"Acc. Overdoses Open" cases do not have a final cause and manner of death classification; "Acc. Overdoses Closed" cases have a final cause and manner of death classification.
"No fixed address" denotes community members who may be experiencing homelessness.
"Residence" denotes address where decedent lived; "Location of Death" denotes the location where death was declared. For "Residence" and "Location of Death", the 4 most affected
neighborhoods are represented, the "Others" category refers to all other zip codes within the City and County of San Francisco and any of out county residences.
"Gender" refers to gender at time of death.
"Total Deaths" denotes Accidental Overdoses where one or more drugs contribute to the cause of death; however, every point for each drug series is inclusive, but not necessarily
exclusive, of that drug. "Total deaths" represents all accidental overdoses including ones for drugs not specified above.

PLEASE NOTE THIS DATA IS PRELIMINARY INFORMATION AND SUSCEPTIBLE TO CHANGE

 OFFICE OF THE CHIEF MEDICAL EXAMINER CITY AND COUNTY OF SAN FRANCISCO

Preliminary Accidental Drug Overdose Data Report Gender Race Age

as of September 25, 2020

JULY
2020 24%
76%
Female
Male
3%
35%
Asian
Black
0%
4%
<15
25-34
15-24 1%
35-44 25%
14% Latinx 24% 45-54 55-64 29%
0% Native American >=65
Total Cases Received by OCME (148) 42%
7%
White
Other/Unknown
17%

Fixed Address Residence Location of Death

79% Yes (see residence) 18% Tenderloin (94102) 13% Tenderloin (94102)
21% No 18% SOMA (94103) 19% SOMA (94103)
0% Unknown 11% Inner Mission (94110) 18% Nob Hill (94109)
12% Nob Hill (94109) 15% Inner Mission (94110)
42% Others 35% Others
51% Other Causes
48% Acc. Overdoses Open
1% Acc. Overdoses Closed

80 Accidental Overdoses by Day of Death

70

60

50

40

30

20

10

0
1-Jul 31-Jul

Total Deaths Fentanyl Heroin Medicinal Opioids Methamphetamine Cocaine

"Acc. Overdoses Open" cases do not have a final cause and manner of death classification; "Acc. Overdoses Closed" cases have a final cause and manner of death classification.
"No fixed address" denotes community members who may be experiencing homelessness.
"Residence" denotes address where decedent lived; "Location of Death" denotes the location where death was declared. For "Residence" and "Location of Death", the 4 most affected
neighborhoods are represented, the "Others" category refers to all other zip codes within the City and County of San Francisco and any of out county residences.
"Gender" refers to gender at time of death.
"Total Deaths" denotes Accidental Overdoses where one or more drugs contribute to the cause of death; however, every point for each drug series is inclusive, but not necessarily
exclusive, of that drug. "Total deaths" represents all accidental overdoses including ones for drugs not specified above.

PLEASE NOTE THIS DATA IS PRELIMINARY INFORMATION AND SUSCEPTIBLE TO CHANGE

 OFFICE OF THE CHIEF MEDICAL EXAMINER CITY AND COUNTY OF SAN FRANCISCO

Preliminary Accidental Drug Overdose Data Report Gender Race Age

as of September 25, 2020

AUGUST
2020 31%
69%
Female
Male
5%
29%
Asian
Black
0%
23%
<15
25-34
15-24 5%
35-44 20%
18% Latinx 25% 45-54 55-64 20%
0% Native American >=65
Total Cases Received by OCME (139) 38%
9%
White
Other/Unknown
8%

Fixed Address Residence Location of Death

77% Yes (see residence) 24% Tenderloin (94102) 20% Tenderloin (94102)
17% No 16% SOMA (94103) 12% SOMA (94103)
6% Unknown 10% Inner Mission (94110) 20% Nob Hill (94109)
10% Nob Hill (94109) 14% Inner Mission (94110)
40% Others 34% Others
53% Other Causes
47% Acc. Overdoses Open
0% Acc. Overdoses Closed

70 Accidental Overdoses by Day of Death

60

50

40

30

20

10

0
1-Aug 31-Aug

Total Deaths Fentanyl Heroin Medicinal Opioids Methamphetamine Cocaine

"Acc. Overdoses Open" cases do not have a final cause and manner of death classification; "Acc. Overdoses Closed" cases have a final cause and manner of death classification.
"No fixed address" denotes community members who may be experiencing homelessness.
"Residence" denotes address where decedent lived; "Location of Death" denotes the location where death was declared. For "Residence" and "Location of Death", the 4 most affected
neighborhoods are represented, the "Others" category refers to all other zip codes within the City and County of San Francisco and any of out county residences.
"Gender" refers to gender at time of death.
"Total Deaths" denotes Accidental Overdoses where one or more drugs contribute to the cause of death; however, every point for each drug series is inclusive, but not necessarily
exclusive, of that drug. "Total deaths" represents all accidental overdoses including ones for drugs not specified above.

PLEASE NOTE THIS DATA IS PRELIMINARY INFORMATION AND SUSCEPTIBLE TO CHANGE