There’s no two ways to slice it: America is facing an epidemic of drug overdose deaths, and the crisis is at its worst closer to home.
According to Centers for Disease Control data released last week, the United States saw 93,000 overdose deaths in 2020, a 30 percent increase from the previous year. California saw a similar year-over-year increase, with 9,300 overdose deaths in 2020. San Francisco, which recently has emerged as a major hotspot in America’s opioid crisis with more than 700 overdose deaths in 2020, makes up a disproportionate chunk of those fatalities.
One proven way to curb the carnage is through safe consumption sites — places where people can use drugs under the supervision of medical professionals, without fear of prosecution, and with access to treatment options.
San Francisco’s political leaders have long sought to open up such a facility in the city. But this month, the latest and most promising effort to do so hit a roadblock, ensuring no safe consumption site will be established in California until 2023 at the earliest.
On July 6, a bill that would have legalized a small safe consumption site pilot program from state Senator Scott Wiener of San Francisco was held up in the Assembly’s Health Committee. Assemblymember Jim Wood, D-Santa Rosa, the committee’s chair and the decision maker behind the delay, says he postponed the bill to wait for clarity from the federal government on the legality of the sites.
But safe consumption site proponents and public health professionals don’t quite follow Wood’s logic. Just two days after California’s bill was postponed, Rhode Island’s governor signed a bill authorizing safe consumption sites — making it the first state in the nation to do so. Despite the legal uncertainty at the federal level, Rhode Island will forge ahead with safe consumption sites early next year, while California continues to wait.
“This is a delay that is measured in lives,” says Laura Thomas, director of harm reduction at the San Francisco AIDS Foundation. “It’s beyond frustrating. It’s outrageous.”
The postponed bill represents the third attempt to get these sites legalized in California over the past few years. One recent effort, from then-Assemblymember Susan Eggman, D-Stockton, and co-sponsored by Wiener, passed the legislature only to be vetoed by Governor Jerry Brown in 2018. Brown cited fear of prosecution by the Trump Administration in his veto message, but also registered his ideological opposition to safe consumption sites, writing, “enabling illegal and destructive drug use will never work.”
This time around, Wiener and his allies, including San Francisco Mayor London Breed, were more optimistic about the federal government’s openness to the concept. Wiener’s bill, SB 57, would have legalized a safe consumption site pilot program through 2027 in just three cities: San Francisco, Oakland, and Los Angeles.
Breed and several other big city mayors sent a letter to Attorney General Merrick Garland in April to underscore the value of these sites, and get clarity on their legality. But so far, the feds have remained mum on the matter.
The lack of response was Wood’s justification for holding the bill. Breed “has made a valid request and a response from DOJ would provide the clarity she is seeking,” Wood said in a statement. “Allowing time for that response is the prudent thing to do.”
Except Breed doesn’t see things that way. Her spokesperson Andy Lynch told the Chronicle, “we don’t need to wait for a response from the federal government before passing SB 57.”
Wiener says he’s “very disappointed” about the postponement, and acknowledges he has a “different perspective” on the potential legal issues Wood identified. However, Wiener notes he has a commitment from Wood to move the bill forward in January. Wood’s office confirmed to SF Weekly that the Health Committee will take up the bill again in January whether or not the federal government has provided clarity on the legal questions. Wiener also praised Wood for supporting his bill that would decriminalize psychedelics.
“I do believe this will happen. But sometimes in the legislature, it’s a windy road to get there,” Wiener says. “We’re deeply committed to the bill. We’re not in any way backing off.”
Still, the delay has consequences. Instead of potentially beginning in January 2022, California’s safe consumption site pilot will begin in January 2023 at the earliest.
Meanwhile, San Francisco is still averaging about two overdose deaths per day, most of them attributable to the powerful opioid fentanyl, putting the city on track to equal its overdose death toll from last year.
Small but Mighty
Across the country in Rhode Island, the leader of the successful effort to legalize safe consumption sites says there are too many lives on the line to worry about the federal government’s response.
“If the federal government wants to tell us we can’t do everything in our power to save lives, they can go screw themselves,” says Steve DeToy, the director of government and public affairs for the Rhode Island Medical Society. “You’ve got to do something.”
Asked whether California’s delay makes sense, DeToy replied, “No. Because if you had waited for the federal government to approve medical marijuana out there, you might still not have it.”
DeToy believes there can be three safe consumption sites up and running in the small state by March 1 when the new law goes into effect. The sites, officially dubbed harm reduction centers, will have access to treatment opportunities and healthcare in addition to resources like clean needles and drug testing strips.
The only thing Rhode Island needs from the feds in order to start its program is to “stay out of our way,” DeToy says. “Or as somebody else would say, a wink and a nod.”
Wiener also believes the most likely response from the federal government is that they take “no position” on safe consumption sites. “They’re not neanderthals like the Trump administration. I would be really surprised if they threatened to arrest people the way that the Trump administration did.”
Especially in light of the pandemic, and the government’s emphasis on “evidence-based medicine and protocols,” shutting down these sites would be a really bad look, DeToy says. “This is an evidence-based approach to saving lives. And the evidence is overwhelming.”
Since they were first developed in Europe in the 1980s, safe consumption sites, sometimes called safe or supervised injection sites, have a perfect track record of preventing overdose deaths. There are over 100 such sites in operation today in several European countries as well as in Canada and Australia.
“No one who has used one of these programs has ever died in them,” says Ricky Bluthenthal, a professor of public health at University of Southern California. “Then because of the way they’re designed, the access to sterile equipment, that clean space, the good lighting, you have a lot of ancillary benefits.”
Research from the European Monitoring Centre for Drugs and Drug Addiction found that safe consumption sites reduce drug use in public space (and discarded needles) and increasing participation in drug addiction treatment programs. They also help limit the spread of HIV, Hepatitis C, and bacterial infections that are associated with intravenous drug use. According to the text of SB 57, it’s estimated that a safe consumption site in San Francisco could save the city $3.5 million per year in other costs.
While elected officials in San Francisco are pretty much all onboard with safe consumption sites, the idea remains controversial. A safe injection site proposal in Seattle caused a significant public uproar, including an unsuccessful attempt to launch a ballot measure banning the sites. A proposed safe injection site in Philadelphia has been in a protracted legal and political battle for years. While many city and state leaders support the concept, finding a place to put the site has been one of the biggest challenges.
Critics fear these sites enable drug use, and lead to increases in crime nearby. Law enforcement groups tend to oppose these programs because they condone illegal activity.
A 2018 study in the International Journal of Drug Policy found that previous studies of safe injection sites may have been biased, and overstated their benefits. It did not, however, find evidence that safe injection sites enable drug use or increase crime. The study made waves in the media when it was released, but was subsequently retracted by the journal for shoddy research methods.
Thomas Wolf, a drug policy advocate in San Francisco who has been critical of the harm reduction approach to drug policy, supports safe injection sites, albeit cautiously. “The implementation of safe consumption sites is something that we need to look really closely at, like having resources available on the spot to move someone towards a detox environment or towards treatment,” Wolf says. “Otherwise, basically what you’re doing is you’re creating an opium den.”
Political factors unique to California also may have played a role in the delay of SB 57. An April article in Politico speculated Governor Gavin Newsom may not want to sign the bill for fear of riling up conservatives right before his recall election.
Thomas says she was surprised to see that Wood, a dentist by profession and a major public health advocate in the legislature, was behind the delay. Wood voted in favor of the two most recent safe consumption site bills in the Health Committee and on the Assembly floor. “I don’t quite understand what is different this year,” Thomas says. “We’re leaving extremely effective evidence-based options aside just because of stigma and fear of taking controversial votes.”