San Francisco is in the midst of a drug overdose crisis. Indeed, the situation led Mayor London Breed late last year to declare a state of emergency in the Tenderloin, which the Board of Supervisors approved after a marathon meeting. That enabled the city to open the Tenderloin Center, which offers services to people with substance use issues and will be open until this December. We have reported that Tenderloin residents have said they've walked past dead bodies on the street. Overdose deaths have risen sharply since the onset of the COVID pandemic. There were 711 overdose deaths in 2020, and 640 in 2021. The city is on track to meet or exceed those numbers this year, officials have stated. In short, this is unacceptable in the city.
For further context, there were 1,287 cumulative overdose reversals — using naloxone, a medication that can rapidly reverse an opioid overdose — performed by San Francisco emergency medical services citywide between December 13, 2021 and June 19, 2022. Of those, 721 were performed in the Tenderloin. In roughly the same time period, in the same neighborhood, there were 73 overdose deaths, according to figures compiled by the Tenderloin Emergency Initiative.
Now, Governor Gavin Newsom has an opportunity to do something about it. He must sign Senate Bill 57, which would legalize safe consumption sites as pilot programs in San Francisco, Oakland, and Los Angeles — both the city and county. (These are different from the Tenderloin Center program.) The bill, authored by gay state Senator Scott Wiener (D-San Francisco) passed the Senate August 1 on a concurrence vote of 21-11, the bare number of affirmative votes needed. That was the bill's last legislative hurdle and it's now on its way to Newsom's desk. Wiener has been pushing for this pilot program for years. Safe consumption sites, also known as 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, which is a problem in San Francisco.
Wiener was on the cusp of seeing a similar bill signed into law in 2018, only to be thwarted by then-governor Jerry Brown's veto at the last minute. In his veto message, Brown stated that he simply didn't believe in the program, which was unusual as he had long championed out-of-the-box thinking on various issues. Brown wanted a requirement that people undergo drug treatment. The problem with that approach, as many public health and addiction treatment leaders will argue, is that it doesn't meet people where they are. One can't force someone into treatment and have it be successful; the person has to be ready to make that decision on their own. Indeed, that's one of the benefits of supervised consumption sites — they do allow for a harm reduction approach so that if someone is ready to take that step to begin recovery, it's available.
The other problem back in 2018 was the federal government. The Trump administration was hell-bent on opposing such programs and threatened cities or other jurisdictions with aggressive action as federal law doesn't allow for these sites. But a change in administrations with President Joe Biden has led local and state officials to believe there wouldn't be repercussions if pilot programs operated. San Francisco has in fact ramped up in anticipation of Newsom signing SB 57. Last December, the supervisors authorized spending $6.3 million to purchase a site in the Tenderloin that may be used as a supervised consumption facility, as we reported at the time.
Wiener is committed to the pilot programs. "California — like our nation as a whole — is experiencing a dramatic and preventable increase in overdose deaths, and we need every available tool to help people stay alive and get healthy," he stated in a news release.
He also noted that safe consumption sites are models in helping people avoid overdose deaths. Over the decades more than 170 facilities have operated in other parts of the world, not a single overdose death has occurred in one of them, he noted.
Rhode Island legalized safe consumption sites several years ago, as did Philadelphia. Most recently, New York City opened two safe consumption sites, and in the first three months of operation, staff at these sites were able to halt over 150 overdoses, according to an Associated Press report.
Over an 18-month study period of Insite, a safe consumption site in Vancouver, Canada, 336 overdoses were reported — but in every instance, the person overdosing lived. This is because there were trained professionals onsite to administer live saving treatments like Narcan, and get people emergency help. Studies also suggest that overdose prevention programs reduce the burden on emergency services — like ambulances and emergency rooms — that traditionally respond to overdose events. This would save money in pilot program cities like San Francisco.
Newsom is a former mayor of San Francisco and as such, he knows first-hand of the drug overdose crisis on the city's streets. Wiener noted that the legalization of overdose prevention programs has broad support from the leadership of San Francisco, Oakland, and Los Angeles County, as well as public health and addiction treatment leaders. What's more, Newsom has not outright opposed such legislation. On the campaign trail in 2018, Newsom said he was "very, very open" to such a policy. Fast forward to 2022, however, and Newsom, who's expected to be easily reelected to a second term in November, has future political moves to consider, as Politico's California Playbook stated. Though he has said he has "sub-zero" interest in running for president in 2024, he certainly has been making news trolling his Republican counterparts in Florida and Texas.
Governing is about making those tough decisions, however. These supervised consumption site pilot programs do not mean that the cities will become drug-use havens, as opponents want people to believe. Newsom knows that, and he also knows that in order to decrease HIV and hepatitis B and C transmissions, these programs deserve a chance — and so do the people who will use them.
Governor Newsom, sign SB 57.
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