A newly-formed task force is studying the possibility of implementing safe injection services for injection drug users in San Francisco in an effort to combat the city’s opioid epidemic through harm reduction methods.
The creation of the Safe Injection Services Task Force was announced by city officials and supporting organizations earlier this week to study the effectiveness, community need and practicality of implementing safe injection sites in the city.
“This is too big of an issue for us to rule out the possibility without at least understanding it and studying it first,” Board of Supervisors President London Breed said during a press conference.
A resolution urging the department of Department of Public Health to convene the task force was enacted on April 11th stating that nearly 22,500 people inject drugs in San Francisco. The resolution estimated that 100 people die from overdose every year in the city, with most deaths concentrated in high-poverty areas disproportionately affecting African-Americans.
“I’ve known two people who’ve died from heroin,” Tenderloin resident Kevin Lily said. “I’ve lived in this neighborhood for a long time and I think it’s good for them so they can do their thing and needles would be thrown away.”
The 15-member task force will consist of representatives from the Department of Public Health, the San Francisco Police Department, healthcare professionals and researchers specializing in substance use and treatment, homeless and drug user advocacy groups and small business owners affected by public drug use.
“We came to the conclusion that safe injection facilities are not only a humanitarian response to what is a crisis of huge proportions,” said Lydia Bransten, a dining room manager at St. Anthony Foundation. “But also a way for neighborhoods to be able to have a path out of injecting on the street.”
There are nearly 100 safe injection sites operating around the world today, with most of them located in Europe. Safe consumption facilities have also been implemented in Canada serving as a leading model of harm reduction policy since they opened Insite in 2003—the first safe injection facility in North America.
Since its opening, Insite has served over 18,000 injection drug users and has intervened in nearly 5,000 overdoses, resulting in zero deaths within the supervised injection site. In 2015, the site referred over 450 of its clients to detox treatment facilities. About 54 percent of the clients referred completed the detox program.
“The evidence is overwhelmingly positive,” Laura Thomas of the Drug Policy Alliance said. “We know from that when you open a program like this, there is an immediate decrease in public injection drug use and improperly disposed of syringes, that you can reduce overdose deaths not only in the particular neighborhood around it.”
Currently no safe injection facilities exist in the United States. However, cities including Boston, New York City, Baltimore and Seattle are looking into the possibility of implementing supervised injection sites. Seattle recently passed legislation to open two facilities expected within a year.
“We have to start with something,” Bransten said. “So if we can start with one, that’s great. If the city wants to say, ‘lets put them throughout the city,’ even better.”
The implementation of a supervised injection facility in San Francisco would provide drug users a safe space to inject illicit drugs such as heroin, have access to clean needles and means to safely dispose of them, all while being under the supervision of trained staff in order to prevent overdoses. The sites will also provide opportunities to connect drug users with health and social services.
A survey showed that about 85 percent of individuals who inject drugs in San Francisco said they would use safe injection services according to Drug Alcohol Dependence in 2010.
“A safe consumption space, or supervised injection facility, is not just a place where people can go to use their drugs,” Executive Director Monique Tula of the Harm Reduction Coalition said. “But also to build relationships with healthcare providers or mental health treatment providers who have access to resources that they wouldn’t necessarily have access to.”
According to Breed, the implementation of supervised injection sites would not only combat opioid overdoses and deaths, but will also save taxpayer money. About $3.5 million per year would potentially be generated in savings for the implementation of one safe injection program—nearly $2.33 would be saved for every dollar spent on such services.
Legislation in Sacramento is underway to remove existing barriers preventing the implementation of these sites. Assembly Bill 186, introduced by Assemblymember Susan Talamantes Eggman, D-Stockton, and co-authored by California State Senator Scott Wiener, would legalize illicit drug use in supervised facilities within designated municipalities and counties. Drug users would be allowed to inject pre-obtained illicit drugs onsite under the supervision of healthcare professionals trained to deal with substance use and overdoses. The bill passed in the Assembly Public Safety Committee and the Assembly Health Committee, and has yet to be voted on in the Assembly Floor.
However, not everyone is in support of the implementation of such sites. Concerns over community safety, initiatives to support drug users and law enforcement drug policies have stirred opposition from some residents and law enforcement agencies.
“We’ve had so many things implemented for these people and they abuse it,” Dan Jordan, a San Francisco resident for 21 years, said. “Most people are going to get out and go back to square one.”
Supporters of supervised injection facilities have argued that such philosophies against harm reduction methods are unsupported. Initiatives such as needle exchanges, distribution and training on the use of naloxone in public libraries and the push to decriminalize drug use on the state-level has been a goal of individuals seeking to support marginalized populations with substance use disorders.
“People cannot get any recovery when they’re dead,” GLIDE HIV/Hep-C Program Manager Paul Harkin said. “So let’s stop people dying. Let’s work with them and their psychosocial issues and help them get on and improve their lives.”
Harkin, who has 17 years of experience working with populations in the Tenderloin, says he is open to the idea of converting his space at GLIDE into a safe injection site equipped with 14 booths and medical supervision. The organization has a reputation of working with marginalized communities to break the cycle of poverty by providing housing, food and healthcare programs and services for over 40 years.
“The reason we’re here is because our friends are dead,” Holly Bradford of the San Francisco Drug Users Union said in a press conference. “Our family members have passed on the street, in bathrooms, in alleys.”
The task force is expected to submit its findings after a 90-day period where they will then decide whether or not to implement the nation’s first supervised injection facilities according to Breed.