On a sunny morning in July, San Francisco Board of Supervisors President London Breed addressed a group of doctors, service providers, researchers, and community members about drug addiction and overdose. The small crowd was gathered for the second meeting of the San Francisco Safe Injection Services Task Force.
Like most people in the room, Breed was earnest about finding a solution to the escalating opioid crisis—and for someone like her, whose younger sister died from an opioid overdose, the subject was especially personal.
With that in mind, Breed said, a safe injection site (SIS) might “make it possible for somebody’s life to change.” She urged participants “to understand why a site … is important whether they agree with it or not.”
Safe injection sites are professionally supervised facilities where drug users can inject pre-obtained drugs. Many experts consider them to be the next frontier in harm reduction, a public health framework that seeks to reduce the negative consequences associated with drug use. It also emphasizes civil and social respect for people who use drugs.
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The task force held its first meeting in June and will come together for the last time later this month, when it will finalize recommendations to San Francisco’s mayor about potentially establishing the first SIS in California—an objective that may be aided by a bill making its way through the state legislature.
In 2015, according to the Centers for Disease Control and Prevention, 52,404 people died of drug overdose in the United States; more than 60 percent of the mortalities involved an opioid. In the city of San Francisco alone, nearly 23,000 people inject drugs. Of that group, half use heroin and nearly 70 percent are homeless.
In a study released in December, researchers found that a supervised injection facility would lower San Francisco’s total annual injection-related HIV and hepatitis C infections by 6 percent and 3-to-5 percent, respectively. It would also save the city $3.5 million in a country that loses $75 billion a year as a result of the opioid crisis. An SIS facility would also decrease hospital stays and disease infection rates, the study said, and increase the number of people seeking treatment. A study measuring the impact of a supervised injection site in Vancouver found that they also drastically decrease public injection and discarded needles.
Yet, around the country, legal and political hurdles to SIS facilities abound.
In January, Seattle approved two safe injection sites, the first in the country. In March, conservative political opposition led by state Sen. Mark Miloscia (R-Federal Way) passed SB 5223, which would remove local authority to establish heroin injection spaces in Washington. The bill is currently under review by the state’s House Health Care and Wellness Committee. To date, the facilities have yet to break ground.
A common argument against SIS is that they encourage of criminal behavior and drug use. On his website, Miloscia says, “Toleration is not compassionate, it is a signal of defeat. We cannot give up on drug users. In the end, these sites will only distract us from getting resources into real, medically proven treatment options.”
Despite challenges northward, representatives for Assemblymember Susan Eggman (D-Stockton) don’t think political opposition will be a problem for the Bay Area. Last year, Eggman, a former social worker who has experience with substance abuse populations, attempted to pass a bill that would permit testing of supervised injection sites across the state.
It failed, largely due to backlash from law enforcement. This year, she introduced a new bill, AB 186, that would do the same thing in specific counties, including San Francisco. It is the first state bill on supervised consumption services in the country to win legislative votes.
Under existing law, it is a crime to possess, use, or even be in a room where drugs are being unlawfully used. AB 186 would create a highly regulated exception to this policy, making it easier for a safe injection site to survive. Earlier this summer, it passed out of committee with bipartisan support. It now awaits the California Senate.
Eggman’s communications director, Christian Burkin, says he is confident AB 186 will garner the necessary support.
“The California legislature isn’t the U.S. Congress … There are broadly changing attitudes about the ‘drug war’ from both parties,” he said in an interview with Rewire.
Some advocates fear that federal pushback may dampen any SIS growth in the state. Recently, for example, Attorney General Jeff Sessions recommitted to cracking down on drug-related crime and returning to the sentencing minimums of the 1980s. Lydia Bransten, a manager at St. Anthony’s Dining Room, a nonprofit that serves meals and offers a medical clinic in San Francisco, cited the federal government as a major challenge to creating safe injection sites. “The Department of Justice is a significant threat right now. I doubt they’ll look friendly at SIS,” she told Rewire.
Still, Burkin said, “What’s going on with Jeff Sessions and the really reactionary direction the federal government is taking is out of step.”
Laura Thomas works for the Drug Policy Alliance, overseeing the organization’s municipal drug strategy work in San Francisco. She says she has been “amazed” by the legislative success of AB 186. Thomas attributes its relative ease at the state level to the presidential administration itself. In fact, she says, “in part because of the direction of the federal government, California legislators feel even more compelled to listen to community and evidence.”
Experts in public health agree, positioning state laws as a primary battleground for combating the opioid crisis. At the task force meeting, Mike Discepola of the San Francisco AIDS Foundation argued that “legal barriers … will dictate what our options are.”
A leader from the San Francisco Drug Users Union who asked that her name be withheld told Rewire that she “gets more confident every time [AB 186] passes another committee, another vote.”
Regardless, and perhaps because of, the controversy and potential pushback from the current presidential administration, the political will in favor of supervised injection sites in San Francisco and other countries is high.
As Burkin said, “California has experience here with doings things that we think are right far before the rest of the country is ready to do themselves and we’ve been proved right many times over.”