Safe Consumption Sites, By Any Means

Gary McCoy is staging a hunger strike and calling on the city to act unilaterally to legalize a proven method of reducing overdose deaths.

Gary McCoy is sitting in a folding lawn chair on the shady side of City Hall. He has a bit of a headache, but otherwise feels surprisingly good. “I thought I would be feeling worse at this point,” McCoy says. “Yesterday was rough only in adjusting to being incredibly bored.” 

McCoy, who currently works as policy director at the healthcare non-profit Health Right 360, is in hour 26 of a hunger strike aimed at pushing the city to establish a safe consumption site program. For as long as his body can take it, he will remain outside City Hall, abstaining from food, and telling anyone who will listen how important these sites are for preventing overdose deaths.

McCoy’s strike comes in response to the state government’s decision last month to delay legislation that would have legalized a safe consumption pilot program in San Francisco as early as January. Assemblymember Jim Wood of Santa Rosa, the lawmaker behind the decision, said it was important to wait for clarity on the legality of these sites from the federal government. As a result, California won’t legalize safe consumption sites until January, 2023, at the earliest. Meanwhile, San Francisco continues to see nearly two overdose deaths per day, most of them attributable to the potent opioid fentanyl.  Across the world, dozens of safe consumption sites have been in operation for decades, and not a single person has died in one of them, as USC public health professor Ricky Bluthenthal told SF Weekly last month. 

Like other public health advocates, McCoy was “crushed” by the delay. He’s hoping his protest will inspire the city to act unilaterally, without waiting for the OK from the state or federal government. 

“There’s a lot of precedent in San Francisco,” McCoy says. In 1993 Mayor Frank Jordan, with the backing of the full Board of Supervisors and the Health Commission, declared a state of emergency to legalize a syringe access program to slow the spread of HIV. “The California Attorney General said it would be illegal, and if any public officials have anything to do with it they could be fired, but he did it anyway,” McCoy says.  

In subsequent years, syringe access programs, also known as clean needle exchanges, became commonplace across the country. San Francisco’s early legalization of medical marijuana and its embrace of same-sex marriage represent two more instances where city leaders risked legal consequences to pursue policies they believed in, only to see those policies swiftly enter the mainstream.  

Preventing fatal overdoses is personal for McCoy, who has had his own struggles with substance use disorder. Reflecting on the more than 700 people who died of a drug overdose in San Francisco last year, McCoy says, “All of those deaths are lives. Those are people. And a good number of those people are friends or people that I’ve worked with. And it could have easily been me. I don’t know why it wasn’t.” 

Since his recovery 10 years ago, McCoy has become a player in local politics, with a knack for picking winners. He worked for London Breed and Scott Wiener when they were district supervisors, and then joined the office of House Speaker Nancy Pelosi before starting his current gig at Health Right 360. “I have friends on every side of the Democratic spectrum in San Francisco, and they’re all very supportive” of safe consumption sites, McCoy says. “The only time I see people oppose it, they’re just not as educated and making sort of a knee jerk reaction.”

Given his experience in local politics, McCoy figured a theatrical gesture like his hunger strike at the beginning of Overdose Awareness Month would be the kick-in-the-pants the city needs. “I thought this would be the best way to get their attention in the building,” he says, gesturing toward City Hall. 

The Board of Supervisors is on recess for the month of August, but electeds are still getting the message. So far, Supervisors Matt Haney and Rafael Mandelman have told McCoy they would support a declaration of emergency to authorize safe consumption sites. Ultimately, it would be up to Mayor Breed to execute such an action, but having the support of the full Board of Supervisors and the Health Commission will also be essential, McCoy believes. 

With President Biden in office, the worst that could happen is that state or federal law enforcement agencies would send the city a cease and desist letter, McCoy predicts. And even that would be extreme. “I would suspect the DOJ would probably look the other way, especially if it was done by a declaration of emergency.” 

For now, McCoy is hoping local law enforcement continue to look the other way as he settles in for the long haul on the grass beside City Hall. On night one, so far so good. 

McCoy knows firsthand that in San Francisco, certain laws are selectively enforced. And in the battle to legalize safe consumption sites, that can only be a good thing. 

“I’ve worked for supervisors, and I’ve seen the confidential memos from the City Attorney’s office that say, ‘Hey, this isn’t gonna fly.’ But it never stops anyone. If it’s something we want to do and move forward, we’ll make it work.”

CORRECTION: A previous version of this article said Mayor Frank Jordan created a syringe access program by emergency declaration in 1995. In fact, the program was created in 1993.

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