The Problem
The data exists.
The integration layer does not.
San Francisco has the public data, the agencies, and the infrastructure to respond to its overdose crisis in near real time. What it lacks is a system that brings those streams together into actionable intelligence. This is that system.
Section 1 — Scale of the Crisis
More than one person
lost every day.
San Francisco recorded 810 accidental overdose deaths in 2023 — the deadliest year in the city’s recorded history. By the end of 2025, the toll declined to 625, a 23% reduction from the peak. The trajectory is meaningful. The scale remains acute.
Fentanyl drives the crisis — accounting for 72% of 2022 overdose deaths and 81% of 2023 deaths according to SF OCME annual reports. Black and African American San Franciscans die from overdose at more than five times the citywide rate, a figure documented explicitly in the SF DPH 2024 Overdose Prevention Plan.
The geographic concentration is equally stark. In 2025, nearly four out of five overdose deaths occurred in just four zip codes. Enforcement-driven displacement has spread the crisis from the Tenderloin into the Mission, Nob Hill, and Bayview — and no system tracks this in real time.
SF OCME Annual Death Trajectory
Source: SF OCME Annual Reports 2020–2026 · 2026 Q1 preliminary
Section 1 continued — Emerging Synthetic Threats
The supply is evolving
faster than surveillance.
Three novel synthetic compounds have entered San Francisco’s drug supply since 2022. Each requires a different clinical response. None is detectable by standard fentanyl test strips.
San Francisco identified its first cychlorphine death retrospectively — through toxicology review after death, not through any early warning system. The city has no infrastructure capable of detecting novel substance presence before the first fatality. The Synthetic Threat Index is designed to close this gap.
Section 2 — The Infrastructure Gap
What other cities built.
What San Francisco has not.
The data to build real-time overdose intelligence exists in San Francisco. The gap is in the integration layer.
Other cities have built:
Near real-time overdose mapping. 5,300+ agencies in all 50 states. Spike alerts within a rolling 24-hour window. Nearly 3 million overdose events logged as of April 2025.
ML-based forecasting at census block group level. RCT of community co-designed dashboard. Published in Addiction (Marshall et al. 2022, DOI 10.1111/add.15731).
Comprehensive EMS performance data published annually. Paramedics responded to 48,000+ ALS calls in 2024. Publishes response time, OHCA survival, and overdose intervention data by neighborhood.
San Francisco has:
The SF DPH 2024 Overdose Prevention Plan lists Medical Examiner report review as its primary data mechanism. ME reports are lagged by weeks to months after death.
No equivalent to PROVIDENT exists in San Francisco. Resource deployment is reactive, not predictive.
Cychlorphine’s first SF victim was identified post-mortem. No wastewater surveillance, no real-time toxicology signal layer exists.
Enforcement operations have documented displacement from Tenderloin to Mission and Nob Hill. No system tracks this in real time.
SF distributes 158,000+ naloxone doses annually but has no system mapping coverage deserts relative to overdose call density.
The Response
EMERGENZ Meridian is the integration layer.
Not a response to a hypothetical gap. A response to documented, active conditions — confirmed by peer-reviewed research, federal agency data, and city government reports.