One problem is that people started calling getrandom all over the place. The original name in OpenBSD, getentropy, is better - it's intended for uncommon use to seed userland RNGs (libc's arc4random and others) which would be the primary things used by consumers.
Is there some reason OpenBSD's can't be used to generate arbitrarily many random bytes? Because that seems like a real issue. Userland RNGs are too easy to screw up in the face of things like fork(). We should aim for security by default.
OpenBSD provides arc4random in libc. It provides a nicer, higher-level API that's harder to misuse and handles fork properly. The intention is that nearly everyone uses arc4random, not getentropy directly. It encourages using a CSPRNG by not forcing system call overhead for it.
Looking through https://github.com/openbsd/src/tree/master/lib/libcrypto/arc4random…, it appears to be relying on pthread_atfork (which doesn't work in all cases according to comments) and PIDs which can wrap around. I could see a remote attacker being able to control or predict process spawning (and thus PIDs).