Fentanyl Crisis
King County’s opioid epidemic centered in downtown Seattle
Overdose death counts continue to rise at a startling rate in Washington state. Between September 2022 and September 2023, Washington reported a 41% rise in drug overdose fatalities — the highest increase in the United States. As the most populous county within the state, King County saw the highest number of overdose deaths, a majority of them concentrated in Seattle and downtown, in particular. In 2023, overdose deaths downtown represented more than 11% of overdose deaths within King County.
In downtown, synthetic opioid-involved overdoses rose more than 63% in 2023 from the previous year. What’s more, the fentanyl epidemic has exacerbated challenges facing King County’s most vulnerable populations. Individuals experiencing homelessness, already grappling with myriad issues, find themselves particularly susceptible to the lethal grip of fentanyl. They now account for nearly 25% of all overdose deaths in King County.
Moreover, the influx of fentanyl into downtown Seattle has strained the resources of local healthcare providers and social service organizations. Emergency calls coming from downtown regarding an overdose nearly doubled in 2023. MID ambassadors and MID-funded Iron & Oak security officers administered naloxone to more than 300 individuals suffering from a fentanyl overdose in 2023. The dramatic increase in overdose deaths these past few years underscores the severity of the escalating public health crisis gripping the heart of the city, taxing public services and increasingly harming the most vulnerable members of our community.
Key Takeaways
- In 2023, Washington state and Oregon experienced the largest percent increases in overdose fatalities in the U.S.
- Among eight peer counties examined, King County saw the largest percent increase in overdose deaths, and 82% of overdose deaths last year in the county involved fentanyl.
- Downtown saw the highest rate of overdoses in King County in 2023.
- In 2023, nearly 25% of overdose victims in King County were designated as living in a “location not meant for human habitation or emergency shelter.”
- Since the start of the pandemic, COVID-19 has accounted for nearly 900 deaths in Seattle. Over that same period, an estimated 1,200 Seattle residents have overdosed from fentanyl.
2022–2023
Health-Seattle & King County data, Ahmad FB, Cisewski JA, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics, 2023.
*Provisional 12-month ending count September 2022-September 2023
King County saw a 79% increase in overdose deaths in the 12 months between June 2022-June 2023. This was the highest percent increase among eight peer counties examined.
By county, 2022—2023
*Provisional 12-month ending count June 2022-June 2023
*Area as defined by Seattle & King County Public Health.
In 2023, overdose deaths in the downtown core climbed to 143 — a 46% increase compared to 2022, and nearly double the total from two years ago.
The Downtown, Belltown and First Hill subregion of King County saw the highest rate of overdoses in 2023 (after controlling for population) with a rate of 331.5 deaths per 100,000 residents — nearly double the next closest subregion.
In King County
In 2019, fentanyl-involved overdoses accounted for around a quarter of overdose deaths in King County.
By 2023, fentanyl-involved overdoses accounted for 82% of total overdoses in King County — a nearly 60 point increase since 2019.
In 2023
By neighborhood
- Among DSA/MID neighborhoods, nearly 75% of MID ambassador-observed drug activity in 2023 was in the retail core, followed by Belltown with more than 9%.
- The retail core also saw the highest concentration of street-level (i.e., ground-floor) business vacancies (30.8% of total).
- In 2023, three blocks in downtown had distinguishably high drug activity. All three blocks were along Third Avenue: between Pine and Union, between James and Cherry and on Bell Street.
- Already vulnerable populations are dealing with the increasing impact of fentanyl. In 2023, King County saw a 50% increase in overdose deaths among those individuals whose housing status was considered “unsheltered” or “emergency shelter” compared to 2022.
- Additionally, there was a 44% increase in overdose deaths among those whose housing type was designated as “being a location operated or subsidized by governmental or social service agency.”
- In 2023, King County saw 314 overdose deaths of individuals designated as being unsheltered or in emergency shelter — a 50% increase from the prior year, and nearly four times the number from 2021.
By housing status
In 2023, there were 2,143 initial emergency calls designated as “overdose/drug-related casualty” within the center city — an 86% increase from the previous year.
Also in 2023, 54% of 911 initial overdose calls occurred in downtown’s retail core.
