New data from the Centers for Disease Control finds that Baltimore and San Francisco are, among major cities, home to the highest concentrations of overdose deaths in the last year.Overdose death numbers may still be declining since the pandemic in San Francisco, but they remain high among major Ame rican cities when counted against the size of the population.For the period of September 2024 to August 2025, San Francisco saw over 580 overdose deaths, which amounts to 70.5 deaths for every 100,000 people in the city. As the Chronicle reports, only Baltimore, with a rate of 108.6 deaths per 100,000 people, saw a higher rate during this period, as fatal overdoses have become less frequent in cities like Philadelphia, which have also been hit hard by the fentanyl epidemic.As overdose deaths have declined in recent years in San Francisco, experts have cited multiple factors that may explain it, including the increased availability and prevalence of naloxone, and greater awareness of the dangers of fentanyl among the population. A more morbid factor at play may be that most of the user population who were most at risk of dying by overdosing have already died. This is combined with the fentanyl supply reportedly shrinking due to law enforcement efforts — forcing dealers to cut the drug with less fatal components — and the higher tolerance of fentanyl users over time.San Francisco's real number of overdose deaths for all of 2025, according to more comprehensive records kept by the city's Department of Public Health and the medical examiner's office, was 624, which was down slightly from 635 in 2024. (The numbers by mid-year in 2025 looked worse than they turned out to be by year-end.) But experts say that steeper declines may be on the way, per the Chronicle, as the trend of fewer fatal overdoses moves west.Philadelphia and Nashville, which had seen much higher rates of fatal overdoses several years ago, have seen sharp declines in the last two years due to the factors discussed above. And experts suggest that the fentanyl crisis took hold in East Coast cities slightly earlier than it did on the West Coast, and the trends are therefore starting in the east.Brendan Saloner, an addiction researcher at Brown University, tells the Chronicle he's worried that Trump administration cuts to health care will cause larger issues in San Francisco and elsewhere when it comes to offering drug treatment, adding, "I have a pit in my stomach" over it.Previously: SF Overdose Deaths Back on the Rise, After an Encouraging Decline in 2024 ...read more read less