San Francisco also experienced a number of events that could have significantly impacted drug deaths, i.e. pandemic, recession, housing crisis, fentanyl, etc. e

San Francisco also experienced a number of events that could have significantly impacted drug deaths, i.e. pandemic, recession, housing crisis, fentanyl, etc. etc. You'd have to carefully control for the impact of these events to make an empirical claim that harm reduction efforts lead to more drug deaths, especially because it makes on the face of it no sense that i.e. needle exchange programs would lead to more drug overdoses.