San Francisco’s safe injection sites: down but not out

Assembly Bill 186 would have provided safe injection sites for the intravenous drug-using population of San Francisco. 

It began its uphill battle three years ago. After years of trial and error, the bill finally passed the State Assembly and Senate in August, this time allowing just San Francisco to run three pilot safe injection sites for a trial period of three years. Having the full support of City agencies, such as the Board of Supervisors, District Attorney’s Office, Sheriff Department and the Department of Public Health, the push for the bill’s passage was spearheaded by Mayor Breed, who lost a sister to a fatal intravenous drug overdose.

As soon as the bill passed the Assembly and Senate, it was on its way to be finally decided by Gov. Jerry Brown and signed into California State law by his signature.

Prior to Brown’s consideration, the ultra-conservative Trump Administration’s Deputy U.S. Attorney General, Rod Rosenstein, wrote a threatening op-ed piece in the New York Times. In it, he made direct threats of property confiscation and incarceration of any individuals or organizations who may participate in the life-saving program that this legislation would legally condone on a state level.

He stated in the op-ed piece, emphatically, “It is a federal felony to maintain any location for the purpose of facilitating illicit drug use. Violations are punishable by up to 20 years in prison, hefty fines and forfeiture of that property used in the criminal activity.”

Governor Brown, who has served California through the past several decades, is known to be traditionally progressive. But when it came to legislation to provide for overdose prevention sites, he gave in to the Trump administration’s intimidation and morality-based anti-drug user rhetoric, as he vetoed the bill and cited falsehoods regarding its content to justify the outright veto. Giving no indication that he even read the bill, Brown said in his veto statement that the bill didn’t provide for any rehabilitation services, which is utterly false.

As a community, we absolutely cannot, in good conscience, continue to allow these brothers and sisters of our human family to perish.

One of the primary goals of the proposed legislation was to provide a safe harbor for those that suffer from the disease of addiction, so they would have secure, safe and ready access to detoxification and rehabilitation services, as well as many other necessary quality of life services through informational referral.

As Mayor Breed has unwaveringly stated, “we need to connect with these people on a human level so that we may offer them hope.”

One such center was modeled precisely after the overwhelmingly successful safe injection site known as InSite, which has been operating since 2003 in Vancouver, Canada. Glide Memorial Church partnered with HealthRight 360 constructing and hosting a fully stocked, staffed and functional prototype. All of this was painstakingly done to show that these program sites would be completely safe and sterile, not the illicit crack houses described by the Trump administration and the alt-right conservative opponents of drug users.

The operation of the safe consumption centers is simple, yet extremely effective at putting a huge dent in the number of deaths San Francisco suffers daily due to overdose and complications related to unsafe practices of drug injection.

Throughout the lifetime of the InSite program, approximately 3.5 million medically supervised injections have taken place. Of these, there have been approximately 6,000 cases resulted in overdose, or just less than 0.2 percent. Yet without the medical oversight provided by a dedicated staff of health care professionals, there would have been 6,000 deaths. Fortunately, not one death has occurred in these cases. 

With counselors and trained health care professionals constantly on staff, there are 12 booths provided for people to inject drugs that users themselves provide. Everything else is provided to ensure that their injection is performed safely within a clean and sterile environment — that includes cotton swabs, clean water, fresh tourniquets, as well as other supplies to clean wounds and greatly reduce the risk of infection.As the user injects, staff monitor watches for any signs of danger. 

Through repeated use of the facility, person-to-person connections are developed, with users and staff being on a first-name basis. If at any point the user feels that they wish to change their lives and attempt to cure themselves of their addiction, the staff members are equipped to provide instant detoxification services and support.

For those that need help with basic survival matters, such as food, housing, clothing and an entire host of other social services, likewise, these are also immediately available through effective referrals.

Never do the program’s critics mention the five goals of the proposed legislation:

1. Preventing and/or reversing incidents of overdose, thereby saving lives that would otherwise be lost.
2. Preventing diseases, particularly of the blood borne variety such as HIV/AIDS and Hepatitis C, as well as many others resulting from otherwise non-sterile practices of injecting on the streets under desperate and hurried conditions.
3. Detoxification and treatment availability. An opt-in opportunity open to anyone choosing to make an attempt to cure his or her disease or addiction.
4. Connecting people to other services, both socio-economic and health wise.
5. Reduction of discarded needles on the street and further reduction of needle sharing. 

San Francisco’s needle exchange program faced a similar battle. Critics said that act of sterilized needle distribution was considered to be enabling addiction, thereby propagating the very problems the sterile needle distribution addresses successfully. The idea that needle distribution enables addiction is outright deception, which further marginalizes vulnerable people, resulting in needless suffering and death which the anti-drug user considers to be their just desserts.

The authors and proponents of this AB 186 have vowed to keep fighting to make safe consumption center pilot program a reality in San Francisco. In a city where approximately 22,000 IV drug users reside (according to DPH estimates) this is nothing less than a health crisis of epidemic proportions.

As a community, we absolutely cannot, in good conscience, continue to allow these brothers and sisters of our human family to perish, all simply because we lack a basic understanding that drug addiction is far beyond a choice. It is, in fact, a disease — one that we will only be able to eradicate from a starting point of compassion and love.

This article originally appeared in Street Sheet, San Francisco’s homelessness advocacy newspaper.