San Francisco Health Director Barbara Garcia has never opposed the idea of safe injection sites for drug users. Her comment at a Board of Supervisors hearing last week raised the possibility that the city could operate such a site, which has long been a goal of harm reduction and homeless advocates. They reason that if people who live on the streets inject drugs in a safer environment, they might reduce their use or get clean. At a minimum, they wouldn't be using dirty needles that put them at risk for HIV and other diseases, such as hepatitis C. During the Bay Area Reporter 's participation this week in a second Day of Coverage as part of the SF Homeless Project organized by the San Francisco Chronicle, we say it's time for city leaders to prioritize a pilot program to study the issue.
At last week's hearing, Garcia was quoted by the Chronicle as saying, "I think even if we were to open one it would be very successful." That prompted an outpouring of support from policy leaders, harm reduction advocates, and others, who want to see the city try innovative programs to reduce homelessness.
As Garcia told us earlier this year during an editorial board meeting, determining the exact location of a safe injection site (also called supervised injection facilities) is one of the thorniest issues. Most neighborhoods would be opposed to hosting one and would surely scrutinize the location's proximity to schools, parks, and other areas frequented by children. But a progressive city like San Francisco must find a location for a pilot program to address a growing problem. This week, Garcia estimated that the city has up to 22,000 injection drug users, and that a single location would not be enough. She's right. But this first step is a pilot program, which, if it's successful, would likely ease residents' concerns and provide insight about identifying other locations. Most people encounter drug users shooting up in doorways or in plain view on the streets. A managed facility would be cleaner and safer than the streets, bringing injection drug users in contact with trained harm reduction specialists and health workers.
Garcia noted in a statement to us that state and federal law currently do not allow safe injection sites. But San Francisco has been a leader of innovative public policy before. We see it with the city's sanctuary city policy, and it was true three decades ago in response to the AIDS crisis. State Senator Scott Wiener (D-San Francisco) has told us that he's open to such facilities �" with the caveat that they be well managed so as not to create negative impacts on the neighborhood. In support of local decision-making, he said that state law should not be a barrier to local jurisdictions implementing safe injection sites.
One of the hurdles for advocates is Mayor Ed Lee, who remains opposed to safe injection sites. "I am not immediately buying arguments" of advocates, the mayor told us.
For years syringe exchange programs have helped reduce the spread of HIV and hep C. It was a controversial idea too; back in the 1990s, the Board of Supervisors regularly had to declare a public health emergency to enable the programs to operate. But the city kept at it because needle exchange worked. And the programs continue today for that same reason.
Gay Men's Health Crisis in New York City recently praised that city's decision to allocate $100,000 to study supervised injection facilities. The agency noted that there are now approximately 100 such programs operating in at least 66 cities around the world in nine countries. The first North American supervised injection site opened in Vancouver, Canada in 2003, and the evidence has shown that the sites reduce HIV and hepatitis transmission risks, prevent overdose deaths, reduce public injections, reduce discarded syringes, and increase the number of people who enter drug treatment, GMHC noted in a news release.
"For too long, local governments have rejected supervised injection facilities because of our collective discomfort with the painful challenges of drug addiction," GMHC CEO Kelsey Louie said in a statement.
We know the city's budget will suffer if President-elect Donald Trump follows through on his campaign statements to cut federal funds to sanctuary cities. But allocating $100,000 like New York is a realistic option to study safe injection sites. During a meeting about how to develop stories about people who are homeless for the Day of Coverage, reporters and editors from more than 80 media outlets reached consensus that we should focus on solutions. To us, safe injection sites offer one possible way of reducing harm caused by drug users who are living on the streets. And, in the long run, such facilities might significantly reduce costs down the line, like emergency responders and unnecessary hospital visits. We encourage the mayor to talk to health officials and include some money in the budget for a study.