When San Francisco and L.A. show lower overdose death rates than the rest of the country, it’s time to take notice

By Mike Males, Special to CalMatters

San Francisco, whose death rate from overdoses of illicit drugs once soared to nine times the national average, now has a lower drug mortality rate than the country as a whole.

Today, residents of New Hampshire, Florida, Utah, and 24 other states are more in danger of overdosing on illicit drugs than San Franciscans. That defies decades of statistics and the legend of a city that embraced excess.

But does San Francisco deserve congratulations? In terms of drug abuse, San Francisco basically stayed San Francisco over the years while America caught up. San Francisco’s fatal drug O.D.. rate remains 50% above the state average and more than double the rate in Los Angeles, a city also known for sensational drug tragedies.

Celebration isn’t exactly in order. While the rest of the United States has suffered exploding levels of drug fatality during the opiate epidemic, California displays a “small” increase.

California’s slower increases in drug death rates are certainly better than the 600% surge the rest of the United States endured over the last quarter century, with preliminary 2018 national numbers showing continuing troubles. California’ cities and coastal areas deserve credit for not joining the national drug abuse trend.

Do California’s trends hold lessons applicable to other states? California innovated a series of drug policy reforms that reduced lower-level drug and property offenses, many of which involve addiction, to misdemeanors, restricted prison and jail sentences for certain drug offenses in favor of community-based treatment, legalized marijuana, and experiments with anti-overdose therapies.

These reforms had major effects. Since 2010, California’s arrests for drug felonies have decreased by 75%, marijuana arrests have plummeted by 93%, and imprisonment for drug and property offenses have fallen by two-thirds. Reducing criminal penalties may have public health benefits in terms of promoting treatment and reducing drug abuse mortality.

Another factor may be the effects of immigration. 

Since 1990, California has gained 11 million Hispanics and Asians, populations that have much lower levels of drug fatality than whites, Native Americans, and African Americans. Hispanics have drug overdose death rates just one-third, and Asians one-sixth, the levels of non-Hispanic White Californians.

In a nation in which half a million people died from drug abuse in the last 10 years–including 46,000 in California–why can’t we find solutions to a crisis that has been clearly evident for more than two decades?

If anyone wants ideas, California offers two populations to study: young people, and Los Angeles County residents. The most encouraging trends are among the 1.5 million urban teenagers in California’s coastal counties, whose drug overdose numbers remain low, stable, and largely untouched by the opiate epidemic. In the last decade, fewer San Francisco teenagers died from overdoses than would die in a single year in the 1970s.

Los Angeles presents a larger mystery. A deadly 1960s-70s barbiturate, speed, and heroin scourge once made L.A. a major overdose capital. Today, Los Angeles—along with several Bay Area counties—are among the nation’s safest from drug fatality. No one has really explained why.

Why is California weathering the opiate epidemic better than the rest of the country? Is it demographics? Immigrants have low drug abuse rates. Is it good luck? Did court-mandated reforms to reduce prison overcrowding have serendipitous public health benefits? Is it the legacy of tragedy? Had past drug epidemics had already killed off many drug abusers?

The dismal reality is that America stumbles from crisis to crisis, allowing epidemics to soar out of control. If serious researchers can get the politicians, ideologues, and authorities who haven’t had a new idea in 50 years out of the way, perhaps the nation can learn from California’s unexpected trends.


Mike Males is senior researcher for the Center on Juvenile and Criminal Justice. He wrote this commentary for CALmatters. To read his past commentaries, please click  herehere, here, here, here, here, and here.

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