S.F. Pins Down Its Needle Problem

The city has distributed clean needles as a public-health service for years — but until now, we’ve fallen short on picking them up.

 Look up any San Francisco neighborhood on Nextdoor, and chances are you’ll come across a post complaining about syringe litter. With more than 22,500 drug users estimated in San Francisco, and no designated space for them to shoot up, it’s no surprise our streets and parks are full of used needles.

While the health hazards needles pose to someone who may accidentally get stuck are slim, the visuals certainly aren’t pleasant — and for years, S.F. residents have filled up politicians’ voicemail inboxes with requests for improvements. With acting Mayor Mark Farrell having only a couple months left in office, tackling this issue is an easy win. On Monday, Farrell held a press conference at a particularly needle-heavy intersection in SoMa — Russ and Natoma streets — pledging that he was on the task, having allocated $750,000 toward the cleanup effort. The San Francisco AIDS Foundation, in partnership with the city, will create 10 new jobs for people whose sole task will be picking up discarded needles across town.

“People quite frankly are fed up with the conditions of our streets, and so am I,” Farrell told a crowd of reporters Monday. “The status quo on our streets today is simply unacceptable, and we’re not going to stand for it. We’re going to do everything we can to combat that.”

It’s not a bad idea. The AIDS Foundation already has a robust program in place with its Harm Reduction Center on Sixth Street — barely a block from where the mayor stood — plus a slew of needle-exchange programs and an existing team of needle-cleanup professionals. They’re helped by some city infrastructure: A little over a year ago, several large syringe-disposal kiosks were installed in the Tenderloin and SoMa.

The numbers speak to the success of all these efforts. Every month, these different channels collect 275,000 needles. But with this addition of 10 new staff, cleanups can become more proactive, not reactive. Although they will respond to 311 requests, the team will also develop a map of known hot spots to sweep regularly.

“We have to go find them,” said Director of Public Health Barbara Garcia. While noting that the kiosks do work, “Many times they’re under gates, they’re in the streets.”

The improved cleanup efforts will help the aesthetics of our streets and prevent the possibility of someone reusing a needle, which could spread disease. But the threat needles pose to everyday people is miniscule, and the possibility of someone accidentally contracting HIV from a used syringe on the sidewalk is nearly urban-legend-level impossible.

“The biggest concern would be someone stepping on them, but we haven’t seen any cases of an outcome of a needle prick,” Garcia said, noting that her health officers say the chances of contracting a disease in such a manner are “one in a million.”

Part of that is because while the city has been somewhat good at reducing used needle waste, it’s been very successful at providing clean needles to those who need them. Between July 1 and Dec. 31, 2017, roughly 3,030,000 clean needles were distributed. The number returned through sites, and collected from sweeps and disposal boxes was around half — 1,672,000.

“One of the things we find about having clean needles is that they don’t transmit disease,” Garcia said. “The more clean needles we have, the less likely it is that a needle’s going to have any kind of risk for a person. That’s the goal. We’re into providing clean needles and making sure people don’t transmit HIV, Hepatitis B, Hepatitis A. And then we have an obligation to clean up some of those needles. We have needle sites, kiosks, but we really need people power.”

While Farrell basks in the glory of this new, hard-to-criticize commitment, he’s far from the only politician to try to get something like it passed. It was only a couple weeks ago that Sup. Jane Kim, who’s also running for mayor, managed to get the Board to pass a $1.1 million street-cleaning budget supplemental. Farrell, using his position as mayor, shut it down, telling the press Monday that it was “completely inappropriate” to ask for funding for street cleaning part way through a budget season. Kim challenged this argument in the Board of Supervisors meeting, stating that most city residents don’t know when our budget starts and ends — and that cleaning efforts couldn’t wait.

Arguments aside, it’s impossible to ignore the unspoken issue looming above this cleanup effort, which really addresses the symptom of a larger problem. Drug users in San Francisco don’t have anywhere safe to go, which means they use on our streets. Last February, the city’s Department of Public Health voted unanimously to support the opening of safe-injection sites in San Francisco. These proposed spaces would offer intravenous drug users a sanitary spot to use, with hygiene supplies, a trained staff, and needle-disposal boxes — a system that has proven successful for reducing needle litter (as well as overdoses and HIV-transmission rates) in cities like Vancouver and Sydney. Those who entered would also have access to drug-addiction prevention and counseling.

But while the city’s leaders have given safe-injection sites the go-ahead, there is a ton of legal chaos to unpack before the first center of its kind can open in the United States. Looking at the list of federal and state challenges it faces, S.F.’s original goal of a facility opening in July is laughably optimistic.

“We’re still working on the legal issues,” Garcia said, when SF Weekly asked about the city’s progress on the sites. “We’re also working with the state on legislation that would provide a little bit more protection. We don’t have a timeline as yet, but we have all the partners ready to go. We just have to work out some of the legal issues that are inhibiting us.”

The protection Garcia references is no small thing. A 2008 article in the American Journal of Public Health states that “Without at least a reasonable claim to legality, a safe-injection facility would be vulnerable to police interference. … Clients could be arrested for drug possession, and staff members might fear arrest or discipline by professional licensing authorities.”

In other words, cops following federal law could arrest people for possession inside a safe injection site, even if it were city-approved.

The City Attorney’s office confirmed with SF Weekly that it’s investigating legal options to better protect the sites, which may include pursuing statewide legislation, such as making it OK for drug users to possess substances in sanctioned areas. But with the primary goal — keeping staff and clients safe — under threat, it’s clear there are some big hurdles to clear before the arguments around where safe injections even can and can’t be located in S.F. begin.

In the meantime, drug users will continue using on our streets. But now, with the help of “people power,” we’ll at least see fewer needles underfoot.

Nuala Sawyer is SF Weekly’s news editor.
nsawyer@sfweekly.com |  @TheBestNuala

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