San Francisco could soon become the first U.S. city to open official safe injection sites for drug users.
For legally operating safe injection sites to become a reality, the California State Senate would need to approve the passage of Assembly Bill 186 (AB-186). The senate is expected to take up the issue this month. California law currently prohibits the possession of controlled substances and makes it a crime for a person to use any building for the distribution of these substances. But AB-186 would authorize six California counties including San Francisco, Los Angeles, and Alameda to operate supervised injection sites without criminal sanctions.
Safe injection sites and the city’s approach in handling drug use and outbreaks are an important part of efforts by the city to address issues related to the homeless population, said Terry Morris, Manager of the Syringe Access Services at the San Francisco AIDS Foundation. The Department of Homelessness and Supportive Housing in San Francisco is working to cut the city’s homeless population in half over the next five years and the city has a number of critical issues to address in the short-term.
The city’s approach to handling drug use and outbreaks is particularly relevant, said Dr. Paula Lum, a researcher and medical doctor at UCSF where she specializes in addiction medicine.
Drug users who have been pushed out onto the streets due to rapid gentrification have no choice but to inject drugs in a public space, Morris said. As a result, needles are often discarded on the streets, increasing the risk of disease transmission.
“Public and visible injection on San Francisco streets impacts everyone who lives here,” Morris said.
The national opioid epidemic as well as outbreaks of Hepatitis A in San Diego and Santa Cruz have magnified the necessity of providing reliable harm reduction services to communities in need, she said.
“A safer injection facility would offer a safe, sterile environment for people to inject drugs with supervision,” said Holly Bradford, the program coordinator of the San Francisco Drug Users Union and a member of the Safe Injection Services (SIS) task force. “So if there was an overdose, that would be attended to and reversed.”
The sites would also distribute drugs such as methadone and suboxone, which help reduce withdrawal symptoms for people recovering from addiction, Bradford said.
Opening just one safe injection center with medical experts on site would reduce hospital stays by 415 days per year, decrease cases of HIV and Hepatitis C, and yield $3.5 million in annual net savings, according to a cost-benefit analysis by the SIS task force.
The board of supervisors, under board president London Breed, launched the 15-member task force in April 2017. The task force has held three public meetings to solicit public input. It aims to engage the community in dialogue and to ensure the passage of AB-186.
The bill passed through the Health and Safety Committee of the House in June 2017. After reaching the floor of the Senate, however, the bill was pulled, lacking two votes. The Senate unanimously granted reconsideration of the bill, which is set for this month.
For Lum, who is also a member of the task force, this feels a bit like deja vu. The promotion of safe injection sites mirrors the battle for the approval of needle exchange programs in the late 1980s, she said. The city ended up declaring a state of emergency and defying state law by distributing clean needles. Needle exchanges ultimately became legal in the state in 2000.
Lum emphasized the importance of involving members of the community who understand the needs of drug users in the process of designing the sites. With this same interest in mind, the Department of Public Health has surveyed people who inject drugs in order to gauge the interest of the community.
“You can’t have just one facility that all you do is provide supervised injection,” Lum said. “You have to integrate all these other services to maximize its potential.”
Morris echoed this belief, explaining that the sites would also offer additional medical services, mental health services, and guidance on getting connected with other everyday resources.
“You can’t separate out our homeless crisis in San Francisco from the need for safe injection facilities,” Morris said.