San Diego's overdose decline is real — and uneven

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San Diego County's overdose deaths have fallen two years in a row — from 1,203 in 2023 to 945 in 2024, a 21% drop (Task Force all-drug count). Preliminary state data suggests the decline continued into 2025. That is a genuine public health win, and it deserves to be reported as one. It also deserves to be reported precisely, because the average conceals who the decline has and hasn't reached.

First, get the peak right

Local coverage has variously called 2021 or 2022 the peak. Both are defensible — for different metrics, per the SUOPT indicator table:

• By count, 2021 peaks: 1,309 deaths (vs. 1,300 in 2022).
• By rate, 2022 peaks: 37.7 per 100,000 (vs. 37.3 in 2021).

From either peak, 2024's 945 deaths (27.2/100k) is a decline of roughly 28%. But 2024 is still nearly double 2015's toll — the county has retraced the last surge, not the epidemic.

The opioid-specific slice tells the same story in a different universe: CDPH's surveillance dashboard shows 441 opioid overdose deaths in 2024 (13.6/100k), with the 12-month rolling count easing further through 2025 — 428, 391, then a small uptick to 412 by Q3 (preliminary).

Who the decline reached last

The same 2024 data that produced the countywide average also shows where the burden concentrates (SUOPT 2025, Task Force universe):

• Geography: Central San Diego's overdose death rate was 103.0 per 100,000 and Mountain Empire's 96.9 — nearly four times the countywide 27.2. East County communities also ran well above average.
• Race: Black/African American residents had the highest mortality rate of any group, 68.6 per 100,000 — two and a half times the county figure.
• Homelessness: people experiencing homelessness accounted for roughly 30% of 2024 overdose deaths, while representing well under 1% of the population (9,905 in the 2025 Point-in-Time count).
• Sex: men died at more than three times the rate of women (13.3/100k for women).
• Setting: homes were the leading place of death (36%) — most overdose deaths happen where naloxone-carrying bystanders aren't.

One unambiguous bright spot: for the first time in years, no San Diegan under 18 died of an overdose in 2024. (How treatment and stable housing during treatment connect is its own page.)

Why "uneven" is the operative word

The interventions credited with the decline — mass naloxone distribution, ED-based peer response, field buprenorphine (part 7) — are opioid-specific and reach people who touch the health system. The populations still dying at multiples of the county rate are precisely those least reached by that toolkit: stimulant users (part 8: meth has no naloxone equivalent), unsheltered residents, and neighborhoods where the leading cause of death arrives at home. A decline produced by opioid-specific tools will, by construction, be slowest where the problem is least opioid-shaped.

The county's own equity analysis said as much on the way up: from 2017 to 2021, opioid death rates rose 209% countywide, but 2-3 times faster among Native American and Black residents. The way down is tracking the same gradient, in reverse order.

What to watch

• Whether the 2025 preliminary numbers hold through finalization (the Q3 uptick in the CDPH rolling count bears watching).
• Whether the 2026 SUOPT report card shows the Central SD / Mountain Empire / PEH gaps narrowing — the truest test of the county's harm reduction expansion.