A steady drop in drug deaths that had given public health officials hope in fighting the overdose crisis now appears to be reversing course in parts of the Bay Area.
In Santa Clara County, drug fatalities have begun to rise after falling to a four-year low last fall, according to county coroner data. The trend is mirrored in San Francisco, the only other place in the five-county region that publicly reports overdose deaths.
“We’re at this point of extreme uncertainty of what’s going to happen next,” said Keith Humphreys, a behavioral science professor at Stanford University and expert on overdose trends.
During the coronavirus pandemic, drug deaths exploded as fentanyl — an extremely powerful synthetic opioid — took hold across the country and public health restrictions isolated people in their homes, drove massive job losses and blocked access to treatment.
But in the middle of 2023, overdose deaths started a dramatic decline. The drop came amid a federal push to disrupt the illegal international drug trade and pressure China to crack down on manufacturers of the chemicals needed to synthesize fentanyl. Testing soon revealed that fentanyl had become less potent, and researchers said it became more difficult to find on the street.
In recent months, however, researchers, drug enforcement officials and treatment providers say more dangerous fentanyl and methamphetamines appear to be flowing into the Bay Area — potentially driving the rise in overdose deaths.
“Illicit markets that are disrupted often reorganize,” Humphreys said.
In Santa Clara County, there were an average of 29 drug fatalities a month between October 2024 and March 2025, up from a low of 25 monthly fatalities on average in the previous six-month period between May 2024 and October 2024. At the peak of the overdose crisis in early 2023, the county averaged around 40 drug deaths a month.
Overdose death investigations often take months, and more recent complete data was not available.
In San Francisco, the number of drug fatalities rose to an average of 61 in May, up from an average of 43 in November. The city averaged a record 73 deaths in summer 2023.
According to the latest data from the Centers for Disease Control and Prevention, fatal overdoses in California and across the U.S. have continued to fall through February, though at a slower rate in recent months. The agency had reported a spike in drug fatalities in January, but revised the figures this month after updating how it models provisional overdose death data.
In total, the CDC reported more than 78,300 people died of overdoses in the U.S. during the 12-month period ending in February. More than 9,700 of those deaths were in California.
Kevin Casey vapes in St. James Park in downtown San Jose, Calif., on Wednesday, July 16, 2025. (Nhat V. Meyer/Bay Area News Group)
Kevin Casey, 36, who lives in a halfway house near downtown San Jose and describes himself as an occasional hard drug user, said he’s noticed more people overdosing lately. He’s sworn off fentanyl, he said, because it’s too risky.
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“I did it twice, and I OD’d,” Casey said while smoking an electronic vape in St. James Park. “I like the pure heroin.”
Researchers say it’s still unclear how more deadly drugs could be entering the Bay Area. In response to efforts to cut off drug distribution channels, experts say cartels may have established new smuggling routes or drug labs. Chinese manufacturers of fentanyl precursor chemicals may have developed methods to evade detection, or precursor plants in India may have boosted output to fill supply gaps.
“If you squeeze the balloon on one end, it sometimes pops out the other side in an unexpected way,” said Dr. Daniel Ciccarone, a drug researcher at the University of California, San Francisco.
Bob Beris, special agent in charge of the federal Drug Enforcement Administration’s San Francisco division, which covers Northern California, said his office regularly tests fentanyl potency and was unsurprised that overdose deaths are trending up in the Bay Area.
“What we’re seeing is higher purity,” Beris said, noting the opioid is often mixed into other drugs, including black market pills advertised as prescription painkillers.
He said methamphetamine testing has shown that drug continues to be extremely deadly nationwide.
“Fentanyl gets a lot of the headlines, but meth is still an issue, and purity levels of meth are really high,” Beris said.
In Santa Clara County, meth has long been a major cause of overdose deaths. From October 2024 through March 2025, the drug accounted for 47% of overdose deaths, up from 40% the year prior, according to county coroner data. Deaths caused by a combination of meth and opioids made up 19% of fatalities, while opioids alone accounted for 11%.
“We know that meth has been around for a very long time, and it’s changing,” said Sara Morales, a program director with South Bay treatment provider Momentum for Health. “Clients are experiencing more psychosis. Our clients are sicker in general when they come into treatment than they used to be.”
Dr. Cheryl Ho, behavioral health medical director for Santa Clara County, said many homeless people use meth to stay alert on the street and ward off violence or sexual assault. She said the drug is also a growing concern for the broader population.
“We are seeing it in all walks of life,” Ho said.
So far this year, the DEA said it has already seized twice as much meth as it did in all of last year nationally and pledged to further its crackdown on illegal drug markets. Even so, Humphreys, with Stanford, said meth poses a particular challenge since it’s cheaper and easier to produce than fentanyl. And unlike fentanyl, meth has no life-saving overdose reversal medication such as Narcan.
Humphreys warned that Trump administration proposals to slash funding for treatment and public health programs, as well as recently approved cuts to Medicaid, could hamper the response to an influx of meth or a potential surge in overdoses.
“When you take a trillion dollars out of Medicaid,” he said, “you are effectively kneecapping the addiction care system.”