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The opioid-driven drug overdose crisis in San Francisco, which accelerated in 2020, continues to kill an average of more than 50 people nearly every month in the city. From January to June, 344 people have died of accidental overdoses in San Francisco, 256 of which involved fentanyl, a synthetic opioid 50 to 100 times more powerful than morphine, according to the latest report from the Office of the Chief Medical Examiner. Without the widespread distribution of the opioid reversal drug naloxone, more commonly known by its commercial name, Narcan, the crisis could be worse. (Jung, 7/26)

Several forms of extremely potent synthetic opioids are being found in random samples of Toronto's street drug supply, which experts say is indicative of increased risk for people in a city grappling with an overdose crisis. "What's very dangerous for people who use drugs is just that the supply is getting stronger, and it's also just completely unpredictable — and what people are buying isn't necessarily what they're getting," said Karen McDonald, the lead for Toronto's drug checking service, which operates out of St. Michael's hospital. (Carter, 7/26)

The Canadian province of British Columbia is responding to a surge in overdose deaths with a novel strategy: It is giving out opioids. The province’s controversial policy goes further than the methadone treatment programs that are common in the U.S. and Canada. Doctors in the province will now be able to prescribe stronger drugs like hydromorphone, an opioid that is five times more powerful than morphine; Dexedrine, a stimulant for cocaine and methamphetamine users; and tablets of fentanyl, a potent synthetic opioid. (Monga, 7/25)

OxyContin maker Purdue Pharma LP said on Tuesday that creditors voted in favor of its reorganization plan that would provide billions of dollars to the governments that sued the company for its role in the U.S. opioid crisis. More than 95% of the 120,000-plus votes submitted were in favor of the plan, Purdue said, citing preliminary voting results. (7/27)

Since 2016, the four companies involved in the latest opioid settlement — Johnson & Johnson, McKesson, AmerisourceBergen and Cardinal Health — have funneled a combined $100 billion to shareholders through stock buybacks and dividends. Why it matters: If that's any indication, those companies won't have much trouble paying off a combined $26 billion settlement agreement. (Herman, 7/27)