Meth quietly passed fentanyl in San Diego's overdose deaths

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:

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 SUD live-in expansions 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.