OPIOID CRISIS SAN FRANCISCO: OVERDOSE DEATHS PREDICTABLY SURGE BACK UP, EXPERTS SCRAMBLE TO FABRICATE COVER STORIES
Attempts to hide gold standard treatment failure require rationalizations confabulated by experts and negated by longstanding evidence
by Clark Miller
Published July 25 , 2025
We already knew why the sudden drop in opioid overdose deaths in San Francisco was predictably short-lived based on what the evidence has been telling us, what the evidence has established, covered here and here.
That evidence, as we’ve seen, is widespread, naturally replicated, and requires no conjecture of what has “probably” happened, as depended upon by the expert deferred to in a recent S.F. Chronicle piece.
Reliance on scientific confidence and interpretive competence rather than evidence-free conjecture is especially important when lives and additional costs are at stake daily and we want to ground conclusions in what consistent, replicated evidence tells us, rather than what someone, even one of America’s top experts, supposes is “probably” so.
We’ll get to that.
After falling almost to a five-year low in 2024, the average number of monthly overdose deaths in San Francisco during the past five months has risen nearly to the levels seen at the beginning of last year. About 60 people died each month, on average, from December to May, up from 43 from June to November 2024, according to reports from the San Francisco Office of the Chief Medical Examiner.
The regression in San Francisco appears to fall in line with national data released in June by the U.S. Centers for Disease Control and Prevention, indicating fatal drug overdoses are rising for the first time in a year. The same is true for the Seattle area, where data from the county’s medical examiner indicates last year’s unprecedented plummet in overdose deaths hasn’t lasted, with overdoses jumping back to near their peak.
And yes that’s right, CDC data for nationwide trends appears to indicate an upturn in fatal drug (reflecting opioid) overdoses for the end of last year.
As appears to be true for the Seattle area, King County, by a measure that, unlike fatal overdoses, is valid as an indicator of the severity and direction of of the opioid crisis – nonfatal overdoses (not conflated by the dynamics of naloxone reversals).
In the same report, CDC also provided a graphic that is, as we will see, highly relevant to our understanding of the avoidable and predictable mortality trends in San Francisco and the distortions comprising medical misinformation that perpetuates them –
The outlier states, with the worst outcomes for fatal opioid overdose trends, are specifically those in which the types of intense, targeted, well-funded, successful naloxone campaigns entirely accounting for sharp OD death drops in other states were failing by delay or by absence, described in detail in posts here for Nevada, Utah, Washington, South Dakota, Iowa, and Vermont.
We’ll get to that too.
It’s the “Why” that matters,
the vacuum of credible, tenable evidence-supported accounts of how to understand the crisis ensuring persistence of decades of mounting deaths and additional social costs accruing from expert assurances and guidance.
True to form, experts relied upon by the SF Chronicle to help a reeling, vulnerable public understand why deaths keep mounting, provide contorted, spun-together, overtly false representations of the driving forces and evidence that are directly and incontroveribly invalidated by what is known.
Here’s addiction expert Dr. Keith Humphreys explaining the cause of the return to more frequent drug overdose deaths –
Addiction researchers and drug enforcement officials who spoke to the Chronicle believe last year’s decline was primarily the result of a nationwide supply shortage of the powerfully addictive opioid fentanyl. But since then, the drug supply chain has stabilized and the fentanyl sold on the streets of San Francisco is more readily available and in a more pure form, they say.
“We got to benefit from a supply shock, which is great, because thousands of people who would have been dead are alive,” said Keith Humphreys, an addiction researcher and professor of psychiatry at Stanford University. “But it also means that it wasn’t the end. The markets reconfigured, and we can’t count on (overdose deaths) continuing to go down.” …
Although it’s unclear exactly how the markets changed, Humphreys said new suppliers probably entered the market and began manufacturing synthetic opioids such as fentanyl, which are both cheaper and easier to make than other drugs such as heroin.
[emphasis added]
Okay . . . . let’s take a look.
The most recent San Francisco trends upward in overdoses and fatal overdoses for drugs (almost certainly also reflecting opioids only) are almost certainly real, apparent from the graphical representation of the data.
The national data from the CDC? No – same reason, and as described to NPR by the CDC as an inflection, a “slight increase [that] reflects historic data” indicating more overdose deaths in January 2025 than in January 2024. That is not a national trend and at this time not pointing to explanations pending more data, more time, and most importantly finer grained analysis of how changes varied among states and locales, critical to understanding the “Why” of recent trends.
That doesn’t disallow us from evaluating this top expert explanation: of a nationwide supply shortage of fentanyl that resulted in the sharp, dramatic drop in fatal opioid overdoses in San Francisco, at the same time setting fentanyl users up for rising risk and a fatal overdose surge only after that scarcity was followed by return of a stable fentanyl supply, “probably”, added as expert qualification. We’ll get to that.
“Nationwide” is key, telling us that we should expect, at least broadly, to see similar effects and trends over much or all of the country, “nationwide” in 2024, as in San Francisco, dramatic drops in fatal ODs. We’ll take a look.
But first: down later in the SF Chronicle piece, the reporter questions city officials about their strengthened focus on interdiction disruption of drug supplies including arrests of users, citing recent research published in “the Journal of the American Medical Association [that] analyzed drug seizures by law enforcement in San Francisco and concluded that such interdictions were associated with an increase in fatal overdoses in the surrounding area the next day”.
We don’t have to wonder why that would be, we know from decades of observational and research findings that users adaptively switch drugs to cope with vagaries in supply, often with increased risk. On our experts’ account, instead, the opposite effect of decreased high-risk use occurred because users highly dependent on fentanyl, faced with a dwindling supply …. ?
Did what?
Stopped using and toughed it out, lowering their risk of fatal overdose? Got into treatment, as evidenced by … ? Avoided heroin, other opioids, other unknown drug combinations on the street as they scrambled to replace the desperately, compulsively needed effects they had been getting from fentanyl? Avoided benzos, psychostimulants, illicitly manufactured opioids appearing to be prescription opioids with risk of exposure to carfentanil, other synthetics? Left town for a while, then returned when the fentanyl came back? Probably?
Right.
Very generously expressed by the reporter, at the cost of the lethal civility that defines journalism these days, “it’s unclear exactly how the markets changed” to explain the expert conjecture. That was answered with the non-answer, “Humphreys said new suppliers probably entered the market and began manufacturing synthetic opioids such as fentanyl”. And it took a year? For a new supplier to enter a waiting, desperate market? While street illicit opioid users avoided high-risk drug use, waiting for their preferred product to return? “Probably”?
The expert, evidence-free conjecture requires the supposition of something we know not to be true: that desperately-driven high-risk opioid users are highly discriminate in their use of available illicit substances, foregoing high-risk use when a familiar supply is not available.
Let’s consider what happened in Baltimore over past weeks.
Two mass overdose events in a week – with only a concerted, successful community Narcan response preventing what otherwise most likely would have been headlines about mass overdose deaths – are an illustration of how indiscriminate in day-to-day use those street opioid users are, accepting in roles as testers free quantities of substances entirely unknown to them, and yet known at some level of understanding to include elevated risk.
From the recent post –
What is most remarkable and ultimately disturbing about the MASS OVERDOSE in Baltimore is the shock effect of an entirely predictable and inevitable – albeit more acute and headline-grabbing – instance of what is g0ing on every day in every city in America. While deaths drop due entirely to intense, targeted, successful naloxone campaigns serving as desperate, emergency harm reduction, high-risk, indiscriminate opioid use is worsening. That, as we’ll see, is happening in Baltimore, where provision of America’s expert gold standard treatments has surged over past years, is happening in Columbus, Ohio, happening in Philadelphia, happening everywhere in America.
High risk, potentially fatal street opioid use does not stop with supply disruptions of a favored opioid or supplier, it shifts.
Shifts driven by the desperate, untreated need of users to gain relief from intolerable inner distress. With never-safe, persistently unpredictable street drug supplies, no user is safe.
Not safe on the streets of Baltimore, users impervious to a mass overdose event.
Not safe for the Alaskan getting long-lasting (30-day) injections of gold standard buprenorphine “Sublocade” and using street opioids to “still get high” but “way less often”.
Not safe for opioid users getting “bupe” that commonly is their sweet currency for fentanyl, or whatever synthetic street drug combination it is exchanged for.
Not for anyone.
Back to our current post –
That known, established, desperate behavior of indiscriminate use elevating risk was described by a Baltimore street drug user in this recent news piece.
Many of the same conversations are happening in D.C., where users and outreach organizations are also attempting to keep pace with an unpredictable drug supply.
“To me, a bad batch means it contains something that isn’t what I’m expecting,” said Lyndon Ferrell, a 30-year-old drug user in Washington. “When I’m withdrawing, it can feel like I can’t move, I can’t breathe, and if I take something that doesn’t help me feel better, that’s a bad batch. A bad batch could also be one that I take and it instantly puts me out. That means there’s something like tranquilizers in it, and those put you down instantly.”
Ferrell is no stranger to bad batches. In the District, as in Baltimore and much of the country, tranquilizers like xylazine are increasingly common additives to street drugs. Those tranquilizers are not opioids, meaning they are not responsive to naloxone.
And described by another Baltimore street drug user in this report.
Five people were hospitalized Friday after another reported overdose incident in Baltimore’s Penn North neighborhood, according to Baltimore police.
It comes almost one week after a mass overdose in the community sent 27 people to hospitals. Currently, officials said there is no evidence to suggest the two incidents are related.
“People have already heard what is out here and yet they still gotta go get it because their body is calling for it,” one man who goes by the nickname ‘Slim Rob’ told WJZ Investigator Mike Hellgren at the scene. “It’s heartbreaking, man. It’s heartbreaking. You got people’s mothers, fathers, aunts and uncles, grandparents out here—and the kids need them and yet they need that when you can be gone like this.”
And back to the expert relied upon by the SF Chronicle for understanding of trends in opioid crisis deaths –
The strongest evidence of the expert distracting fabrications being absurd on their face is the concrete evidence represented by differences among states over the period in question, 2024, when “nationwide” disruption of fentanyl supplies caused, per our experts, drops in fatal opioid overdoses. Here’s that CDC graphic again.
Certain questions seem to be raised, don’t they? About the apparent differences among states in the alleged protective effects of that “nationwide” fentanyl supply disruption that is the expert explanation for drops in opioid fatal ODs?
Did Nevada, Utah, and South Dakota have hidden, backup supplies of fentanyl that kept users supplied, and fatally overdosing while other states benefitted?
Was Oregon’s fentanyl supply mercifully disrupted more severely than Washington’s across the Columbia?
Did new suppliers of fentanyl jump right back into Vermont, decreasing the protective effects of the disruption, while ignoring the fentanyl markets left open in neighboring New York and New Hampshire? And so on.
Did the interdictions drying up the “nationwide” supply of fentanyl affect Midwestern, Mountain and Intermountain states less disruptively and this less protectively? Somehow? “Probably”?
And? And, is it believed to be true, by expert judgement and discernment, considering how variable outcomes were in 2024 among states all affected by a nationwide phenomenon, that by some remarkable, freakish coincidence, those with the largest reductions in fatal opioid overdoses have been found, consistently, supported by detailed analysis to have engaged – in a timeline that establishes causality – in intensive, elevated, resource-rich, targeted, and successful campaigns to supply and provide training on use of the opioid fatality-reversing agent naloxone? And that other states, as distinct outliers to that general trend, again based on detailed analysis of timeline, factors and available evidence, have been found to be the “exceptions that prove the rule” of recent opioid death trends being explained by successful, versus delayed, versus ineffective, versus essentially absent efforts to implement Narcan campaigns?
Or are we faced with different conclusions?
Posts describeing the successful naloxone campaigns in states achieving remarkable drops in opioid OD deaths, attributable entirely to the naloxone campaigns, are linked to here and in multiple additional posts at A Critical Discourse and Illness and Cure.
And again, the outlier states, with the worst outcomes for fatal opioid overdose trends, are specially those in which the types of intense, targeted, well-funded, successful naloxone campaigns entirely accounting for sharp OD death drops in other states were failing by delay or by absence, described in detail in posts here for Nevada, Utah, Washington, South Dakota, Iowa, and Vermont.
That brings us back to what has been conveyed to us via major media reporting from our trusted, esteemed public health and addiction experts.
Although greater access to the overdose antidote naloxone and medications proven to treat opioid use were thought to have played a role in last year’s drop, Humphreys said such interventions — though vital in helping to reduce total overdose deaths — would not explain such a rapid, drastic change across the country.
“across the country”
Some types and instances of misinformation are benign and explained primarily by diminished capacity for critical thought and veracity, others darker in nature, deadly in outcome.
There is no, and was not ever, a “rapid drastic change across the country”.
Any internet search on this subject – trends in opioid fatal and nonfatal overdose in the U.S. – will clearly, consistently, and incontrovertibly establish the near opposite: notable, remarkable variation in timelines, magnitudes, patterns, and geography among states and locales, that variation defying attempts by useful experts to mystify underlying causes of the trends.
In this post, we deconstructed expert lies about opioid crisis trends,
then considered and outlined the primary, established causal driver of those trends, – escalation and implementation, or delay or lack, of successful naloxone campaigns that account for the recent drops in deaths and point to expert, gold standard treatment failure.
That established failure is the other potent factor driving trends in deaths, in this post set aside, for now.
