Remarkable shift in S.F. on opening safe injection sites
San Francisco political leaders have been steadily coming around to the idea of opening safe injection centers where addicts could shoot drugs in a controlled situation instead of outside on the sidewalk. And now, it seems, they won’t let state or federal law get in their way.
“We’ve got to take chances,” said Board of Supervisors President London Breed, who in April became an unexpected champion of safe injection drug sites and was behind the creation of a task force that’s expected to recommend opening them.
That attitude isn’t new. San Fran-
cisco has ignored state and federal law before, when it started a needle exchange program, opened medical cannabis clubs and married same-sex couples. Some politicians say it’s now time to open the first-ever safe injection drug site in the United States, even if that means exposing the city to risks on multiple fronts.
The Safe Injection Task Force the Board of Supervisors created in April will present its first report next month, with evidence on how these clinics have lowered overdose rates and prevented deaths in other cities.
The report will come just weeks after a bill to legalize the sites stalled in the state Senate, two votes short of the 21 it needed to pass. It had previously passed the Assembly. Even if the state bill had passed, the federal Controlled Substances Act makes it illegal to own or rent a building where people can use drugs. Breed, however, is resolute. “If (this) means disobeying state and federal laws, so be it,” she said.
The city’s newly accepting stance toward injection clinics, where addicts can use drugs in a clean environment staffed by nurses on hand to prevent overdoses, signals a remarkable shift. Up until last year there was almost no appetite for such places. Though the drug use clinics have been open in Canada for more than a decade, there is not a single one in the United States.
When former Supervisor Scott Wiener said in 2011 that he’d welcome the idea in San Francisco, he was seen as an outlier.
“Elected officials just weren’t saying that in public,” said Wiener, who is now a state senator and co-sponsored the bill to legalize injection facilities. He and the author, Assemblywoman Susan Talamantes Eggman, D-Stockton, will reintroduce the bill in January.
But all that has changed in the last year, as the heroin and meth epidemic has grown more pronounced on city streets. Residents say they are tired of stepping around needles and watching people shoot up on the streets.
A report published last year in the Journal of Drug Issues estimated that San Francisco had 22,500 injection drug users — meaning they comprise about 2.6 percent of the city’s population.
“The problems we’re seeing with people injecting on our streets have really festered,” Wiener said.
Former Supervisor David Campos, who was an early supporter of the clinics, said he is “pleasantly surprised” by the turn in public opinion.
Campos visited two safe injection sites in Vancouver, British Columbia last year. He described one as a “hospitallike” setting, and the other as a nondescript three-story building with two upper floors that contained treatment facilities, and a bottom floor that resembled a beauty salon. It had rows of private booths, each with a chair and a large mirror.
“I thought the mirror was a big deal, because many of these (addicts) haven’t looked at themselves in a long time,” Campos said. To him, the clean, antiseptic settings of these clinics — with their cubicles, couches and small cafeterias — were in stark contrast to the trashstrewn sidewalks where addicts shoot up in San Francisco.
Data from InSite, the threestory injection clinic that opened in Vancouver in 2003, showed its staff has intervened in 6,440 overdoses and that no one has died in the center.
Last year, Campos wrote a law requiring San Francisco to open six Navigation Centers — the city’s modernized homeless shelters that also provide services — including one for injection drug users. He scrapped the injection site from the final version, because Mayor Ed Lee and the other supervisors did not back it.
Wiener said he would support an aggressive effort to open drug use centers in San Francisco, even if his bill doesn’t become law. And it appears that other officials feel the same way.
“We’ve reviewed the evidence, and looked at the challenges, and decided this is something that’s worth doing,” said task force member Laura Thomas, who is also the deputy state director of the Drug Policy Alliance.
Lee has not publicly taken a position on injection clinics, but said he supports the task force.
The big question is whether federal and state law enforcement will look the other way if a clinic were to open and addicts were shooting heroin and speed under city supervision.
It presents an unsettling legal
quandary for City Attorney Dennis Herrera, who has already faced off with the Trump administration on immigration issues.
“We are analyzing the various legal issues involved, and we will advise our clients, including the Department of Public Health and members of the Board of Supervisors, accordingly,” said Herrera’s spokesman, John Coté.
The Controlled Substances Act dates to 1971 and was originally designed to eliminate crack houses and music venues that condoned illegal drug activity — “not health care facilities,” said Corey Davis, deputy director of the Network for Public Health Law, a nonprofit that provides legal assistance on public health issues, including drug policy.
“There’s this question of whether the Trump administration wants the optics of sending armed federal agents into a nonprofit center to pull out a public health nurse in handcuffs,” Davis said. “No previous (president) would have wanted to do that. With this administration, it’s not clear.”
But if city officials are intent on defying the law, they could try a tactic that former Mayor Frank Jordan used when he began funding an illegal needle exchange program in 1992. The program, called Prevention Point, started as an act of civil disobedience in the late 1980s, when volunteers began handing out clean syringes to drug users from a baby carriage.
Jordan made the program temporarily allowable under state law by deeming AIDS a public health emergency. The Board of Supervisors had to re-declare the state of emergency each month, to stave off raids or prosecution by federal law enforcement. Needle exchanges became legal in California in 2000.
Mike Discepola, a behavioral health services director at the San Francisco AIDS Foundation who also serves on the city’s Safe Injection Task Force, sees parallels between the AIDS epidemic of the 1980s and ’90s and the opioid scourge of today.
“Given the rates of overdoses we’re seeing, and people being unwittingly poisoned, I do think this is an emergency,” Discepola said.
And the sheer magnitude of injection drug use is becoming more apparent to officials who work in City Hall, which is surrounded by the Civic Center, where drug addicts hang out. Legislative aide Carolyn Goossen said she narrowly saved the life of a man overdosing in front of the Civic Center Burger King in February, by whipping a can of opioid-reversing naloxone out of her purse.
Goossen had attended a training and gotten the naloxone nasal spray just three days earlier.
Wiener said the United States has fallen behind Canada and Europe in trying innovative approaches to hard drug use, and he wants San Francisco to be the exception.
“I have no problem with the city taking an aggressive, innovative, envelope-pushing approach, the same way we did for medical cannabis before it was legal, and the same way we did for needle exchanges before they were legal,” he said. “I’d be proud if the city takes the lead instead of waiting for the state to catch up.”