In San Francisco, no game of NIMBY bingo is complete without a complaint of “used needles.”
In Chronicle columns, letters to the editor, and harrowing tales of urban living, evidence of heroin use ends up everywhere: in children's sandboxes, at Muni stops, and anywhere else people walk. For once, this problem could possibly be understated. As this column has pointed out before, it's a small wonder we aren't all swimming in discarded syringes: San Francisco is experiencing a needle boom.
In 2013, just one of the city's many needle-exchange programs handed out three million clean hypodermic syringes; in 2015, according to Department of Public Health spokeswoman Nancy Sarieh, health workers passed out 3.8 million. (While the city keeps a tab, most of the needles are paid for by nonprofits like the San Francisco AIDS Foundation. The city must keep its hands clean, after all.) This figure excludes any needles purchased at a Walgreen's when the needle-exchange programs, generally open just a few hours a day, aren't available.
This is a remarkable number, considering health officials estimate there are “only” between 13,000 and 16,000 heroin users in the city. That number, the official tally as of last summer, is likely outdated, if San Francisco's opiate users are following the trend seen around the country.
Heroin never left America. But as a topic of debate, heroin use is back with a vengeance. The epidemic and what to do with it has been a political football tossed around at the Republican presidential debates. The main reason why might be called the “pharmaceutical-police complex.” For years, physicians over-prescribed prescription pain medication, with some docs willing to write a prescription for nearly unlimited Vicodin for anyone with a few extra dollars. Wherever police shut down one of these pill mills, their “success” yielded a population of opiate addicts with nowhere to turn for a fix other than the street. Instead of Oxy, they turned to heroin.
It remains to be seen whether the city's pill users are making this same shift. If they are, there are likely to be many more heroin users in town than previously thought: Fatal heroin overdoses dropped to about 10 a year between 2010 and 2012, the most recent data available. During that same time frame, there were 100 annual fatal overdoses from prescription pills.
To deal with this public health crisis, elected officials and law enforcement authorities in Seattle are taking a long, hard look at supervised injection sites — places where heroin users can access needles and even slam a dose home under the eyes of health workers.
If someone overdoses, there are shots of anti-overdose drug naloxone nearby. If someone decides they're tired of the life and wants services — the catch-all term for the government's solution to the decades-long economic and mental health conundrum we call “homelessness” — they can get that, too.
Vancouver has had supervised injection sites for some time as well. So far, it's the only city in North America to try them out.
In San Francisco, this notion is enormously popular — even more popular than legalizing marijuana, according to a recent poll.
As the Chronicle first reported last Sunday, a poll paid for by the Drug Policy Alliance revealed 72 percent support for supervised injection sites. And this from a population consisting mostly of white people over 65, traditionally the city's bastion of conservatism. By contrast, these same respondents offered “only” 68 percent support for legalizing cannabis.
But with the man calling the shots, safe injection is a total nonstarter. Mayor Ed Lee has a “vigorous disagreement” with the idea of safe injection sites and with “wet houses,” where street people addicted to alcohol are housed and allowed to drink. (Seattle, Lee's hometown, has had a wet house for several years. Health officials claim it's working.)
It's not entirely clear why Lee is so opposed to these 21st-century innovations in winning the real drug war. The city began its needle exchange programs to cut down on the transmission of HIV among intravenous drug users. By all metrics, it has succeeded. Two years ago, without discussion or much explanation, Lee nixed a proposal to do the same with crack pipes — whose users skew black, as opposed to heroin users, who skew white.
Christine Falvey, the mayor's spokeswoman, says Lee wants to put more people into treatment “and not focus on a city-funded injection center.”
That appears to be happening, as the number of people in methadone treatment in San Francisco increased from about 2,000 in 2013 to almost 3,000 last summer, the most recent data available.
But incredibly, Lee is also answering the drug problem with a decidedly exploded 20th-century solution: more police.
In December, following a speech on homelessness, Lee directed the Police Department to step up enforcement and arrestpeople selling drugs near homeless “shelters and treatment centers,” Falvey told SF Weekly on Tuesday.
It was not immediately clear if the program has launched, but the mere suggestion is staggering. The innovation mayor of San Francisco has responded to a drug problem with the Nixonian strategy of calling in the cops. What could possibly go right?
In a fine twist, police are some of safe injection's biggest supporters. “As long as there was strong, very strong, emphasis on education, services and recovery, I would say that yes, the benefits [of safe injection] outweigh the drawbacks,” King County Sheriff John Urquhart told the Los Angeles Times.
Laura Thomas, the Drug Policy Alliance's deputy state director, believes Lee will “come around” on safe injection. But it seems clear drug reform will never be a San Francisco priority as long as Lee is mayor.
Lee has famously never visited a marijuana dispensary — and cannabis is at least a $150 million annual industry in the city. What are a couple of junkies — or a couple million needles — compared to that?