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Opioid Overdose Deaths in the City and County of San Francisco: Prevalence, Distribution, and Disparities

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Abstract

Drug overdose is now the leading cause of unintentional death nationwide, driven by increased prescription opioid overdoses. To better understand urban opioid overdose deaths, this paper examines geographic, demographic, and clinical differences between heroin-related decedents and prescription opioid decedents in San Francisco from 2010 to 2012. During this time period, 331 individuals died from accidental overdose caused by opioids (310 involving prescription opioids and 31 involving heroin). Deaths most commonly involved methadone (45.9 %), morphine (26.9 %), and oxycodone (21.8 %). Most deaths also involved other substances (74.9 %), most commonly cocaine (35.3 %), benzodiazepines (27.5 %), antidepressants (22.7 %), and alcohol (19.6 %). Deaths were concentrated in a small, high-poverty, central area of San Francisco and disproportionately affected African-American individuals. Decedents in high-poverty areas were significantly more likely to die from methadone and cocaine, whereas individuals from more affluent areas were more likely die from oxycodone and benzodiazepines. Heroin decedents were more likely to be within a younger age demographic, die in public spaces, and have illicit substances rather than other prescription opioids. Overall, heroin overdose death, previously common in San Francisco, is now rare. Prescription opioid overdose has emerged as a significant concern, particularly among individuals in high-poverty areas. Deaths in poor and affluent regions involve different causative opioids and co-occurring substances.

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Acknowledgments

The authors would like to thank the members of the University of California, San Francisco Drug Users Research Group for their insight on an earlier presentation of this research.

Disclaimer

The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the San Francisco Department of Public Health.

Funding

National Institute on Drug Abuse (R03DA038084).

Author information

Authors and Affiliations

  1. San Francisco Department of Public Health, 25 Van Ness Ave., San Francisco, CA, 94102, USA

    Adam J Visconti, Glenn-Milo Santos, Catherine Burke & Phillip O Coffin

  2. Office of the Chief Medical Examiner of the City and County of San Francisco, 850 Bryant Street, San Francisco, CA, 94103, USA

    Nikolas P. Lemos

  3. University of California, San Francisco School of Medicine, 513 Parnassus Ave. Room S-245, San Francisco, CA, 94143, USA

    Adam J Visconti & Catherine Burke

  4. Georgetown University – Providence Hospital, Family Medicine Residency Program, 4151 Bladensburg Rd, Colmar Manor, MD, 20722, USA

    Adam J Visconti

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  1. Adam J Visconti
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  2. Glenn-Milo Santos
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Correspondence to Adam J Visconti.

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Visconti, A.J., Santos, GM., Lemos, N.P. et al. Opioid Overdose Deaths in the City and County of San Francisco: Prevalence, Distribution, and Disparities. J Urban Health 92, 758–772 (2015). https://doi.org/10.1007/s11524-015-9967-y

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  • DOI: https://doi.org/10.1007/s11524-015-9967-y

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