Safe injection plan could face fed challenge
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San Francisco Mayor London Breed and community advocates opened a realistic model safe injection site in the Tenderloin Wednesday, August 29, as Governor Jerry Brown makes a decision about state legislation to authorize a working pilot program and the U.S. attorney general's office warns that such efforts could face "aggressive action."
Dubbed Safer Inside, the full-scale prototype at Glide Memorial Methodist Church will be open for four days to give city officials and the public an opportunity to see what a working facility would look like and hear from experts about how it would operate.
Mayor London Breed, who lost her younger sister to a drug overdose, spoke at a news conference in Boeddeker Park following a site tour.
"We are here today to save lives. That's what this is about. It is a proven, evidence-based approach to solving a public health crisis," Breed said. "We know that there are legal challenges, but here in San Francisco we are not afraid. We have faced worse obstacles in trying to move this city and this country forward. Today you find a community of people who will stand strong and who will do the right thing. The lives of the people we are trying to help are counting on it."
Supervised injection facilities allow people to use drugs under the watch of medical staff, reducing the risk of overdose deaths. They provide sterile needles, which prevents transmission of HIV and hepatitis B and C, and offer clients an entry point for seeking medical care and addiction treatment. Indoor sites also reduce street-based drug use and improper syringe disposal, seen as a growing problem in the city.
"We're trying in create a sanctuary, a safe space, different from the chaos they get on the street," said GLIDE volunteer Linda Mantel during a tour of the project Wednesday.
San Francisco is among several cities - including New York, Philadelphia, and Seattle - vying to open the first supervised injection facility in the United States. The city is home to an estimated 22,500 people who inject drugs, and had 193 overdose deaths last year, Breed said.
There are currently around 100 safe injection sites worldwide. Vancouver's Insite, the first North American facility, has 13 injection booths and served over 7,300 clients in 2017. A recent study found that a single supervised injection facility of the same size in San Francisco could avert at least three new HIV infections and 19 cases of hepatitis C per year, while saving the city $3.5 million annually.
The Safer Inside demonstration site, presented by the Tenderloin Health Improvement Partnership and designed by Capital One Design Pro Bono, has seven injection booths and a common "chill" area. Once operational, it could have between six and 12 stations and would provide linkage to a range of medical, addiction treatment, and harm reduction services. The facility would provide injection supplies, but clients must bring their own drugs from outside; drug consumption is not permitted during the demonstration period.
"We know that what we are doing now is not working," Glide harm reduction program manager Paul Harkin told the Bay Area Reporter. "People who use drugs need to be supported with compassionate, evidence-based programs. The evidence is crystal clear that [safe consumption spaces] are remarkably effective. They prevent overdose deaths, they prevent HIV and hepatitis C transmission, and they create a bridge to other services that improve the overall wellbeing of individual drug users and the community."
Legal battle brewing
A major state-level barrier standing in the way of supervised injection sites may soon be gone, but legal troubles could still come from the federal government. Already at odds with the city over its sanctuary city policy, the Trump administration could make an example of San Francisco if it opens a first-in-the-nation supervised injection facility.
On August 21 the California Senate passed Assembly Bill 186, a bill that amends state controlled substances laws to allow San Francisco to implement a three-year supervised injection pilot program. The bill, sponsored by lesbian Assemblywoman Susan Talamantes Eggman (D-Stockton) and co-authored by gay state Senator Scott Wiener (D-San Francisco), originally applied to several counties, but Eggman limited its scope after it narrowly failed to pass the Senate last year.
"AB 186 is a bill that asks one specific policy question - should we keep trying what has failed for decades or give San Francisco the choice to try something that we know saves lives, reduces disease, and saves money?" Eggman said. "The opioid epidemic has ravaged communities up and down the state and all across the country. This bill provides a path for taking it on as the health crisis that it is."
On Monday the Assembly, which passed the bill in June 2017, approved the Senate amendments and sent the legislation to the governor. Brown, who has previously indicated that he would sign the bill, has until September 30 to either sign or veto it.
The same day, the San Francisco Chamber of Commerce announced its unanimous support for supervised injections sites, after members of the group visited Insite in Vancouver.
"Our street environment is becoming more and more of an impediment to growing our businesses, attracting customers, and retaining our workforce," Chamber of Commerce President and CEO Tallia Hart said in a statement. "We need to protect the health of San Francisco residents, employees, and visitors. While not a panacea, safe injection sites could be one of many tools to address the state of our streets."
But the federal government is not on board.
"Unfortunately, some cities and counties are considering sponsoring centers where drug users can abuse dangerous illegal drugs with government help," U.S. Deputy Attorney General Rod Rosenstein wrote in an August 27 opinion piece in the New York Times. "Injection sites normalize drug use and facilitate addiction by sending a powerful message to teenagers that the government thinks illegal drugs can be used safely."
"It is a federal felony to maintain any location for the purpose of facilitating illicit drug use," Rosenstein warned. "Because federal law clearly prohibits injection sites, cities and counties should expect the Department of Justice to meet the opening of any injection site with swift and aggressive action."
Advocates counter that federal officials are putting ideology above evidence.
"The federal government has long been on the wrong side of science and history when it comes to reducing the harms of drug use - whether it be attempts to thwart sterile syringe access, medical and adult-use cannabis, or, now, safe consumption sites," said Lindsay LaSalle, senior staff attorney at the Drug Policy Alliance. "When we let ideology trump evidence, and prioritize punishment over preserving life, the result is 72,000 preventable [overdose] deaths just last year. Supervised consumption sites provide an opportunity to reverse the course of this crisis."
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