For five years, San Diego's overdose story has been told as a fentanyl story: and for the worst of those years, it was one. But the 2025 report card...
Jump to a section
If you or someone you know uses drugs: free naloxone is available countywide, including via vending machines. In a crisis, call or text 988, or the Access & Crisis Line at (888) 724-7240.
For five years, San Diego's overdose story has been told as a fentanyl story. And for the worst of those years, it was one. But the 2025 report card from the county's Substance Use and Overdose Prevention Taskforce contains a crossover that has gotten far less attention than it deserves: in 2024, methamphetamine was present in a larger share of the county's overdose deaths than fentanyl.
The two curves
Unintentional overdose deaths caused by each drug, as a share of all unintentional drug/alcohol deaths:
| Year | Fentanyl deaths | Fentanyl share | Meth deaths | Meth share |
|---|---|---|---|---|
| 2020 | 462 | 47% | 551 | 56% |
| 2021 | 814 | 62% | 757 | 58% |
| 2022 | 814 | 63% | 803 | 62% |
| 2023 | 749 | 62% | 756 | 63% |
| 2024 | 494 | 52% | 600 | 63% |
Fentanyl's collapse is the good news: 749 → 494 deaths in one year, a 34% drop, part of the overall 21% decline in county overdose deaths (1,203 → 945). Methamphetamine fell too, but far more slowly, and its share has now led fentanyl's for two consecutive years. Nor are the two separable: deaths involving both drugs together peaked at 495 (2022) and still numbered 303 in 2024: roughly a third of all overdose deaths.
Where the gap between attention and data is widest
People experiencing homelessness. Among PEH (roughly 30% of the county's 2024 overdose deaths), methamphetamine deaths outnumbered fentanyl deaths in every year from 2020 to 2024 (both peaked in 2023). The population at the center of the county's overdose burden has been dying of meth more than fentanyl the entire time. Stable housing changes those odds. See housing options for people experiencing homelessness in San Diego.
The response toolkit. The asymmetry matters clinically. Fentanyl has naloxone, distributed at scale (part 7): and buprenorphine, now initiated in the field by paramedics. Methamphetamine has no reversal agent and no FDA-approved medication treatment; the evidence-based response is treatment (contingency management, live-in and outpatient SUD care) and sustained engagement. Exactly the treatment-capacity questions the rest of this series documents. The county's 44 new withdrawal-management beds (2026) and its expanding live-in SUD capacity are the relevant investments here.
The justice system sees it. Felony prosecutions involving methamphetamine consistently exceeded fentanyl prosecutions from 2020 to 2024, and among adult arrestees, positive meth tests declined only modestly, with more than 84% describing the drug as easy or very easy to obtain.
Kept honest
Two things this page is not claiming: that fentanyl is over (2024's 494 deaths remain roughly twenty times the 2015 toll (about 22 deaths that year, per county health officials), and fentanyl is still the single deadliest drug for most demographic groups), or that the meth numbers are rising (they fell in 2024, like everything else). The claim is narrower and better supported: San Diego's overdose problem is now at least as much a stimulant problem as an opioid problem, and the county's own data has been saying so since 2023.
Sources
- SUOPT 2025 Annual Report Card (Substance Use and Overdose Prevention Taskforce / Center for Community Research).https://suopt.org/report-cards/
- County News Center / KPBS (Aug 2025), 945/-21% headline framing.
Reviewed by
Matthew Beck, LMFTProgram Director & Clinical Director
Matthew Beck, LMFT, is Program Director and Clinical Director at Golden Coast Rehab. A licensed Marriage and Family Therapist with more than a decade in substance use and mental health treatment, he oversees clinical delivery, supports staff, and holds the standard of care across programs. He has spent over ten years working directly with individuals and families affected by addiction and co-occurring mental health conditions. His therapeutic approach draws on person-centered, cognitive behavioral, and solution-focused work, meeting clients where they are while building practical tools for the long term. Matthew is open about his own recovery, and that experience informs how he runs a program: accountable, unsentimental about what the work requires, and unwilling to treat people as cases.
Written by the Golden Coast Rehab Editorial Team and reviewed for clinical accuracy before publication.
