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 as of September 25, 2020 JAN-AUG 2020 Race Gender Preliminary Accidental Drug Overdose Data Report 20% 80% Female Male 4% 26% 17% 0% 48% 5% Total Cases Received by OCME (1070) Fixed Address 70% 28% 1% 56% 26% 18% Age Asian Black Latinx Native American White Other/Unknown 0% 15% 22% 10% Other Causes Acc. Overdoses Open Acc. Overdoses Closed 24% 17% 9% 8% 42% Tenderloin (94102) SOMA (94103) Nob Hill (94109) Inner Mission (94110) Others 23% 17% 16% 14% 30% Tenderloin (94102) SOMA (94103) Nob Hill (94109) Inner Mission (94110) Others Accidental Overdoses by Day of Death 500 450 400 350 300 250 200 150 100 50 0 1-Jan 1-Feb 1-Mar Total Deaths Fentanyl 1-Apr Heroin 1-May 1-Jun Medicinal Opioids 1-Jul Methamphetamine 1-Aug 1-Sep 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 15-24 4% 35-44 24% 55-64 25% Location of Death Residence Yes (see residence) No Unknown <15 25-34 45-54 >=65 OFFICE OF THE CHIEF MEDICAL EXAMINER Gender Preliminary Accidental Drug Overdose Data Report as of September 25, 2020 JANUARY 2020 CITY AND COUNTY OF SAN FRANCISCO 24% 76% Female Male Total Cases Received by OCME (126) Race 3% 26% 11% 0% 50% 11% Fixed Address 79% 21% 0% 70% 0% 30% Yes (see residence) No Unknown Other Causes Acc. Overdoses Open Acc. Overdoses Closed Asian Black Latinx Native American White Other/Unknown Residence 27% 13% 7% 7% 47% Tenderloin (94102) SOMA (94103) Ingelside (94112) North Beach (94133) Others Age 0% 21% 21% 16% <15 25-34 45-54 >=65 Location of Death 26% 8% 8% 16% 42% Tenderloin (94102) North Beach (94133) Nob Hill (94109) Inner Mission (94110) Others Accidental Overdoses by Day of Death 40 35 30 25 20 15 10 5 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 15-24 0% 35-44 18% 55-64 24% OFFICE OF THE CHIEF MEDICAL EXAMINER Race Gender Preliminary Accidental Drug Overdose Data Report as of September 25, 2020 FEBRUARY 2020 CITY AND COUNTY OF SAN FRANCISCO 23% 77% Female Male Total Cases Received by OCME (113) 5% 28% 7% 0% 58% 2% Fixed Address 65% 35% 0% 62% 0% 38% Yes (see residence) No Unknown Other Causes Acc. Overdoses Open Acc. Overdoses Closed Asian Black Latinx Native American White Other/Unknown Residence 32% 14% 11% 11% 32% Tenderloin (94102) SOMA (94103) Inner Mission (94110) Bayview (94124) Others Age 0% 16% 21% 9% <15 25-34 45-54 >=65 Location of Death 35% 12% 12% 19% 23% Tenderloin (94102) SOMA (94103) Nob Hill (94109) Inner Mission (94110) Others Accidental Overdoses by Day of Death 50 45 40 35 30 25 20 15 10 5 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 15-24 2% 35-44 33% 55-64 19% OFFICE OF THE CHIEF MEDICAL EXAMINER Gender Preliminary Accidental Drug Overdose Data Report as of September 25, 2020 MARCH 2020 CITY AND COUNTY OF SAN FRANCISCO 18% 82% Female Male Total Cases Received by OCME (138) Race 2% 25% 18% 0% 47% 8% Fixed Address 71% 27% 2% 63% 0% 37% Yes (see residence) No Unknown Other Causes Acc. Overdoses Open Acc. Overdoses Closed Asian Black Latinx Native American White Other/Unknown Residence 17% 28% 8% 8% 39% Tenderloin (94102) SOMA (94103) Inner Mission (94110) Twin Peaks (94131) Others Age 0% 31% 16% 8% <15 25-34 45-54 >=65 Location of Death 25% 24% 12% 10% 29% Tenderloin (94102) SOMA (94103) Nob Hill (94109) Inner Mission (94110) Others Accidental Overdoses by Day of Death 60 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 15-24 2% 35-44 16% 55-64 27% OFFICE OF THE CHIEF MEDICAL EXAMINER Gender Preliminary Accidental Drug Overdose Data Report as of September 25, 2020 APRIL 2020 CITY AND COUNTY OF SAN FRANCISCO 21% 79% Female Male Total Cases Received by OCME (123) Race 10% 19% 17% 0% 54% 0% Residence Fixed Address 56% 44% 0% 58% 12% 30% Yes (see residence) No Unknown Other Causes Acc. Overdoses Open Acc. Overdoses Closed Asian Black Latinx Native American White Other/Unknown 34% 14% 10% 10% 31% Tenderloin (94102) Nob Hill (94109) Haight-Ashbury (94117) Inner Mission (94110) Others Age 0% 13% 13% 6% <15 25-34 45-54 >=65 Location of Death 29% 15% 23% 13% 19% Tenderloin (94102) SOMA (94103) Nob Hill (94109) Inner Mission (94110) Others Accidental Overdoses by Day of Death 60 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 15-24 10% 35-44 29% 55-64 29% OFFICE OF THE CHIEF MEDICAL EXAMINER Gender Preliminary Accidental Drug Overdose Data Report as of September 25, 2020 MAY 2020 CITY AND COUNTY OF SAN FRANCISCO 14% 86% Female Male Total Cases Received by OCME (143) Race 4% 25% 18% 0% 51% 1% Fixed Address 62% 38% 0% 50% 39% 10% Yes (see residence) No Unknown Other Causes Acc. Overdoses Open Acc. Overdoses Closed Asian Black Latinx Native American White Other/Unknown Residence 25% 30% 5% 7% 34% Tenderloin (94102) SOMA (94103) Inner Mission (94110) Lake Merced (94132) Others Age 0% 13% 27% 7% <15 25-34 45-54 >=65 Location of Death 21% 24% 14% 15% 25% Tenderloin (94102) SOMA (94103) Nob Hill (94109) Inner Mission (94110) Others Accidental Overdoses by Day of Death 80 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 15-24 3% 35-44 28% 55-64 23% OFFICE OF THE CHIEF MEDICAL EXAMINER Gender Preliminary Accidental Drug Overdose Data Report as of September 25, 2020 JUNE 2020 CITY AND COUNTY OF SAN FRANCISCO 7% 93% Female Male Total Cases Received by OCME (140) Race 4% 19% 27% 0% 47% 3% Fixed Address 73% 26% 1% 47% 51% 2% Yes (see residence) No Unknown Other Causes Acc. Overdoses Open Acc. Overdoses Closed Asian Black Latinx Native American White Other/Unknown Residence 26% 9% 7% 9% 48% Tenderloin (94102) SOMA (94103) Inner Mission (94110) Nob Hill (94109) Others Age 0% 8% 23% 12% <15 25-34 45-54 >=65 15-24 7% 35-44 24% 55-64 26% Location of Death 23% 15% 18% 11% 34% Tenderloin (94102) SOMA (94103) Nob Hill (94109) Inner Mission (94110) Others Accidental Overdoses by Day of Death 80 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 Gender Preliminary Accidental Drug Overdose Data Report as of September 25, 2020 JULY 2020 CITY AND COUNTY OF SAN FRANCISCO 24% 76% Female Male Total Cases Received by OCME (148) Race 3% 35% 14% 0% 42% 7% Fixed Address 79% 21% 0% 51% 48% 1% Yes (see residence) No Unknown Other Causes Acc. Overdoses Open Acc. Overdoses Closed Asian Black Latinx Native American White Other/Unknown Residence 18% 18% 11% 12% 42% Tenderloin (94102) SOMA (94103) Inner Mission (94110) Nob Hill (94109) Others Age 0% 4% 24% 17% <15 25-34 45-54 >=65 Location of Death 13% 19% 18% 15% 35% Tenderloin (94102) SOMA (94103) Nob Hill (94109) Inner Mission (94110) Others Accidental Overdoses by Day of Death 80 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 15-24 1% 35-44 25% 55-64 29% OFFICE OF THE CHIEF MEDICAL EXAMINER Gender Preliminary Accidental Drug Overdose Data Report as of September 25, 2020 AUGUST 2020 CITY AND COUNTY OF SAN FRANCISCO 31% 69% Female Male Total Cases Received by OCME (139) Race 5% 29% 18% 0% 38% 9% Fixed Address 77% 17% 6% 53% 47% 0% Yes (see residence) No Unknown Other Causes Acc. Overdoses Open Acc. Overdoses Closed Asian Black Latinx Native American White Other/Unknown Residence 24% 16% 10% 10% 40% Tenderloin (94102) SOMA (94103) Inner Mission (94110) Nob Hill (94109) Others Age 0% 23% 25% 8% <15 25-34 45-54 >=65 Location of Death 20% 12% 20% 14% 34% Tenderloin (94102) SOMA (94103) Nob Hill (94109) Inner Mission (94110) Others Accidental Overdoses by Day of Death 70 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 15-24 5% 35-44 20% 55-64 20%