Heroin

Will California Beat Seattle in Building a Safe Drug Injection Facility?

Lawmakers consider bill that lets eight counties experiment with safe spaces to use illegal drugs.

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Drugs
Diana Eller / Dreamstime

California lawmakers are close to passing a bill allowing a handful of counties to experiment with safe injection sites, facilities where people addicted to drugs can safely get high with professional oversight.

Seattle is trying to become the first community in the United States to do this, but opponents have launched a battle at the ballot box.

If AB 186 is passed and signed by the governor, eight California counties or the cities within them may approve or establish safe drug consumption areas. Los Angeles and San Francisco are among the approved areas. The authorization to operate the facilities sunsets on Jan. 1, 2022.

The bill neither mandates these communities allow these facilities, nor does it provide any funding for them. Citizens in Bakersfield, for example, will not be paying taxes to operate a facility in the Bay Area. If citizens and local officials in Humboldt County (one of the counties authorized in the bill) decide they don't want a safe injection facility, they're under no obligation to provide one.

The bill authorizes communities that so choose to create drug consumption spaces where people can consume drugs under the watch of health care professionals. Facilities will not provide drugs, but professionals can provide sterile needles (and dispose of them), prevent fatal overdoses, provide references to addiction treatment services, and educate participants about HIV and hepatitis.

Neither clients nor employees at these drug consumption sites will be subject to arrest under state law for the drug use. The bill, however, comes into conflict with federal law, as the state Senate's Public Safety Committee analysis notes. The people who own and operate the facility could face federal arrest and charges, not just the users.

If AB 186 passes, it seems likely that the Department of Justice might have something to say about it, given Attorney General Jeff Sessions desire to fight the drug war by maximizing federal criminal sentences for drug crimes and cracking down on doctors who prescribe opioids.

The bill passed the state's Assembly in June by a vote of 41-33. It has made it through both the Senate's Health Committee and Public Safety Committee and awaits a full Senate vote by next week.

If it passes, San Francisco is likely poised to be the first community to consider it. San Francisco put together a task force in April to develop recommendations for creating safe injection facilities.

Assembly member Susan Eggman, a Democrat who represents Stockton and other parts of San Joaquin County, introduced AB 186. Logan Hess, a legislative aide for Eggman, tells Reason these pilot communities were picked because they already have a history of using naloxone as a way of reversing opioid overdoses, and data shows, like many other communities, they're nevertheless struggling with the problem.

That AB 186 was written pretty loosely was a deliberate choice, Hess explains. It does not tie these communities to a particular model of operation. It doesn't tell cities or counties that it must be a non-profit organization, or a hospital, or operated by a public health agency. Participants will make that call.

"One of the reasons we didn't want to be too prescriptive is that certain models might not make as much sense," Hess says. While the injection site in Vancouver, British Columbia, tends to be touted as a role model—it's currently the only site in North American and is Seattle's inspiration—Hess notes that there are other types of operations out there that might be better suited for particular communities.

But that matters only if the law gets past the Senate. The bill is opposed by the California Police Chiefs Association, the California State Sheriffs' Association, and the California District Attorneys Association (along with several other smaller law enforcement organizations and unions).

David Stammerjohan, Eggman's chief of staff, notes that they face a close fight in the Senate. Given the Democratic Party domination of California's government, the Assembly vote should be seen as close, and they're not certain whether Gov. Jerry Brown will even sign the bill into law should it pass.

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  1. Neither clients nor employees at these drug consumption sites will not be subject to arrest under state law.

    Ha HA! Double negative! Tricked you. YOU’RE UNDER ARREST, JUNKIES.

  2. San Francisco put together a task force in April to develop recommendations for creating safe injection facilities.

    San Francisco is the Snobbiest city in America. Fact.

    1. T + L readers deemed San Francisco as the snobbiest city in America?but, they said, at least it’s gay-friendly.

      How much longer can they use that as a rare value added?

      1. I’m trying to imagine what a snobby city that wasn’t gay-friendly would even look like.

        1. I’m trying to imagine what a snobby city that wasn’t gay-friendly would even look like.

          Rome? Tehran? Mecca? Moscow? Define ‘snobby’ and ‘gay-friendly’.

        2. Hell, until recently all of Germany was less gay-friendly than the US, on paper anyway.

        3. Probably Country Club communities in older enclaves in the Northeast. People who say they like the gays and are progressive, but are actually that type of paternalistic conservative that roams freely in New England.

  3. A ‘safe, drug injection facility’, ‘safe drug-injection facility’, ‘safe-drug injection facility’, or a ‘safe drug injection facility’?

    Asking for my grammar Nazi/autistic friend.

  4. California is looking for places to install their new license plate readers.

    1. Fail. Homeless meth addicts ride stolen mountain bikes.

      1. If I ignore the “Fail.” introductory portion of your post, Paul, I can read the remainder in the idiom of an Agile Cyborg post.

        (This is not a criticism of either of you.)

        1. Too few participles.

  5. An alternate view on the success of Vancouver’s safe-injection site.

    I don’t have a strong opinion on this, and of course ‘study’ doesn’t mean magical science-of-truth correctness, but I think it’s important to look at various factors.

    It provides some interesting data though.

    The number of overdose deaths in Vancouver and the Downtown Eastside has increased since Insite started up. This site at least suggests that in its three years of operation Insite has produced no impact on overdose deaths.”
    Mangham also says a study published in the American Journal of Infectious Diseases in 2005 about the reduction in shared needles among addicts using Insite is misleading.

    “Only exclusive use of Insite correlates with reduced sharing,” he says. “If someone uses Insite for all their injections, it goes without saying they would not share needles. Only one in 10 HIV negative participants reported using Insite for all their injections.”

    1. “Safe injection sites” are certainly no magic bullet. As you point out, it pretty much just reduces needle sharing. If they’re not going to offer testing services to establish purity, they’re not really addressing one of the main causes of overdoses.

      Plus, as Switzerland and the Netherlands found out decades ago, if you’re the only place offering safe injection sites or areas of tolerance/decriminalization, you become something of a magnet for likely overdose cases.

      1. I believe the Vancouver site (Insite) claims it sees something like 3 overdoses a day. I was a little shocked when I read that.

        It makes one wonder if they’re enabling an increase in overdoses, but are able to save the lives of those overdosing because of onsite personnel. Since they only seem to count overdose ‘deaths’, this could very well be the case. Increase the number of overdoses, but reduce the number of resulting deaths.

        It’s my opinion that Seattle’s safe-injection site is being resisted by locals because it feels like they’re treating the symptom of a larger problem, a larger problem that was created and encouraged by the very people who’re offering the safe-injection site.

        1. it feels like they’re treating the symptom of a larger problem

          And I think they’re right to feel that way. The safest injection scenario is with a legal drug whose contents you know in the safety of your own home.

          “Safe injection sites,” even if they do test the drugs, provide medical monitoring, etc., can only ever be harm reduction measures to try to mitigate the negative effects of a fundamentally fucked up policy. And they mean concentrating those problems at a particular location.

          So it’s not surprising that people in the vicinity of the proposed location might object.

          1. It was interesting to watch just how quickly every surrounding burgh around Seattle moved to ban the sites. It’s like all of Seattle’s neighbors have had enough of the second-order problems created by the Seattle City Council and just decided to slam the door on the idea.

            1. Which is exactly how the concentration/ghettoization happens.

              We have this issue with prostitution in the East Bay. Most of the suburbs around Oakland are tough on prostitution, and are serious about not allowing it in their towns.

              Oakland, however, is patchy on prostitution – it’s not exactly tolerated, but there’s a lot of looking-the-other-way that goes on, for a variety of reasons.

              Most of the clients, however, are from the suburbs where prostitution is not tolerated.

              Thus, while there’s a widespread and diffuse market for prostitutes, that market is concentrated in Oakland due to NIMBYism.

              It is my belief that were it not for drug prohibition, the market for things like injection sites would also be considerably more diffuse and, as a consequence, less visible and impactful.

              1. I’ve been thinking about this post, and it’s funny, homelessness becomes much more diffuse if you don’t tolerate it as well. Seattle has not only actively tolerated homelessness, but encouraged it which literally attracted thousands of people from across the nation to come here just to be homeless.

                There are young, healthy fit people living in tents under every overpass. And I’m not talking about troubled teens who are runaways– I’m talking about 26 year old couples who look like any typical hipster, people who have chosen homelessness as a lifestyle.

                Those are the people who are refusing services from the City. The whole point is to live under an overpass in a tent and cook on your donated barbecue grill.

                The irony is by not tolerating homelessness, cities actually end up getting people off the street and into services.

                1. “I was like, ‘How in the world do you live in a place that covers this story and it’s OK, not only one infant in a car but infants in a car?'” she said.

                  “In almost every community in the United States it’s completely unheard of and unacceptable that a child is living outside,” Poppe said, noting that many communities have youth and young adults living on the street. But there are plans in place.

                  That’s Barb Poppe, the Obama administration’s expert on homelessness. Anyone going to accuse her of not being compassionate? Anyone going to accuse her of not being liberal?

                  Essentially, what she went on to say is that Seattle’s progressive approach of not wanting to ‘disturb’ the homelessness in their lifestyle has created a much worse situation. I suspect Barb Poppe is a garden-variety old school liberal, and not a west coast blue state crank.

                2. Seattle has not only actively tolerated homelessness, but encouraged it which literally attracted thousands of people from across the nation to come here just to be homeless.

                  Berkeley and Oakland have the same problem, but it’s so bad that there’s a pendulum swing where every 10-15 years the business owners demand that the homeless get chased out.

                  Oakland is at a particular high-water mark now.

            2. It doesn’t help that they seemed to be shopping around the injection site like it was some significant award to the community. I don’t have any issue, but having to build and maintain a new municipal location for drug addicts when we already have libraries just seems a burden.

          2. I used to live in a rental house with three other guys, during college, that turned out to have a methadone clinic right next door.

            Yeah, there are some really good reasons not to want to live next to a place like that. People have a rational interest in maintaining their property value.

            1. It’s not unlike the problem of homeless shelters. Everyone favors them in the abstract, but no one wants to live near one.

              1. People of all political stripes have a very strong NIMBY impulse, I’ve found. IF you don’t want something in your own backyard, don’t try to mandate someone else do so is my view.

                There is truly something to the idea that your average ‘liberal’ really does just operate on feels, and that when the rubber really hits the road and people start talking about putting their current pet feelz project in their neighborhood suddenly they remember a whole lot of reasons why it should be somewhere else.

              2. Seattle fixed that problem by turning every open space into a homeless shelter.

      2. If they’re not going to offer testing services to establish purity

        Even if they do or are, their status, criminal law aside, is far from clear. Obviously, if a volunteer in a soup kitchen poisons someone to death, they’ve committed a crime but if a volunteer in one of these places is negligent? Moreover, if two users come in together, one with prescription opioids and the other with street drugs and one or both end up dead, is it negligence or were the drugs contaminated? Are the taxpayers on the hook for any/all liability?

        1. Yeah – my understanding of the current state of the law is that if some junkie comes into my house and shoots up with my knowledge, my house is subject to asset forfeiture. If he ODs and dies, I can be charged with murder.

          So I can completely understand not wanting to certify someone’s drugs before they take them.

    2. One thing that I don’t like is that all of these injection site laws seem to require that they be municipally involved. I think they would improve much more if a they just let people build them, then you’d see Churches and charities. Hell, you’d probably see for-profit injection sites. I imagine that the proliferation of them would lower the hurdles for regular usage of them.

      The problem is that I don’t believe that injection sites are particularly viewed as a means to increase the legal rights of individuals or anything. They are strictly viewed as government aid. So these moves are probably orthogonal to real improvements in drug-policy.

      1. The only profit in a safe injection site would still be taxpayer funded– at least as far as I can see it. Maybe there’s a model somewhere that could turn a profit on such a thing, but I can’t imagine what it would look like.

        1. taxpayer funded

          Or shielded. I could see a (profitable) situation where private drug companies and/or formularies allow their drugs to be (ab)used under their roof and according to their protocols but, just like with vaccines and new/other drug testing, these companies are going to be shielded from prosecution when somebody dies or has some other adverse reaction.

          1. I could see a (profitable) situation where private drug companies and/or formularies allow their drugs to be (ab)used under their roof and according to their protocols but, just like with vaccines and new/other drug testing,

            I’m imagining the media reaction to something like this. I’m imagining.

            1. I’m imagining the media reaction to something like this. I’m imagining.

              More or less generally psychotic than TDS?

              1. The same old weathered anti-drug arguments that are pervasive on both sides forever.

              2. The same old weathered anti-drug arguments that are pervasive on both sides forever.


  6. Neither clients nor employees at these drug consumption sites will not be subject to arrest under state law. The bill, however, comes into conflict with federal law, as the state Senate’s Public Safety Committee analysis notes. The people who own and operate the facility could face federal arrest and charges, not just the users.

    So in other words, no one’s going to go ahead and do that until someone else tries it first and doesn’t go to prison.

    Of course, this is more or less how the dispensaries started up so I expect we’ll see the same federal tactics in running through the area and busting some low hanging fruit before declaring ‘mission accomplished’ for a few months. Given that it sounds like these area’s are for more ‘hard core’ drugs than pot, I suspect we’ll see more frequent bust ups.

    And of course, none of these facilities will be able to use a bank so if you’re a junkie you’ll have a pretty good idea of the source of your next cash infusion for more drugs.

  7. facilities where people addicted to drugs can safely get high with professional oversight.

    Oh, FFS!

    “Prior to your entry, we must scan your state-issued addiction certificate. Then you will be supervised by Officer O’Malley, who moonlights as a professional here. And don’t start up with that ‘Just legalize it’ bullshit like last time!”

  8. Whatever happened to “personal responsibility” and “fuck you, cut spending”?

    1. To some extent this is related to the former as the ability to be personally responsible with ones drug consumptions is directly opposed by the government.

  9. Portugal is held up as the gold standard for “decriminalizing” drugs and not “judging” the addict. Their programs has some success due to wrap-around services and is mandatory. Drug dealing is still illegal and dealt with harshly. Other EU countries tried to emulate the program. With the 2008 recession, their budgets were slashed for the addicts in program and caused overdoses, increased crime, and increased disease transmission, increased homelessness. Can you see us having an Injections Site AND wrap-around services? I don’t believe there will be funding for both. Why not use any proposed funding and increase needed detox/rehab facilities and sober living environments along with all the needed physical/mental health and social services. The way I see it, Injections Sites are prolonging the suffering and misery of the addict with the usual end result of death. Which would be more compassionate?

    1. Vancouver’s INSITE service and other Supervised injection sites: What has been learned from research?

      Final report of the Expert Advisory Committee

      http://www.kiro7.com/news/loca…../466411868

      http://www.seattletimes.com/se…..r-seattle/

      “Although Insite is paired with a drug-treatment center, called Onsite, Berner and other critics point out that completion rates are low. Of the 6,500 people who visited Insite last year, 464 were referred to Onsite’s detox center. Of those, 252 finished treatment.”

  10. http://www.globaldrugpolicy.org/Issues/Vol 1 Issue 3/A Critical Evaluation.pdf

    THE JOURNAL OF GLOBAL DRUG Policy AND PRACTICE
    A Critical Evaluation of the Effects of Safe Injection Facilities
    Garth Davies, Simon Fraser University

    Conclusion: Taking Causality Seriously
    On the subject of the effects of SIFs, the available research is overwhelmingly positive. Evidence can be found in support of SIFs achieving each of the goals listed at the beginning of the evaluation. In terms of our level of confidence in these studies,the assessment offered here is far less sanguine. In truth,none of the impacts attributed to SIFs can be unambiguously verified. As a result of the methodological and analytical problems identified above, all claims remain open to question.

  11. http://www.huffingtonpost.ca/m…..49237.html

    “Ten years later, despite any lofty claims, for most addicts, InSite’s just another place to get high.”

    In the media, Kerr frequently mentions the “peer review” status of his studies, implying that studies published in medical journals are unassailable. Rubbish. Journals often publish controversial studies to attract readers — publication does not necessarily equal endorsement. The InSite study published in the New England Journal of Medicine, a favourite reference of InSite champions, appeared as a “letter to the editor” sandwiched between a letter about “crush injuries” in earthquakes and another on celiac disease.”

  12. http://www.hc-sc.gc.ca/ahc-asc…..ex-eng.php

    Reducing the Transmission of Blood-Borne Viral Infections & Other Injection Related Infections

    “Self-reports from users of the INSITE service and from users of SIS services in other countries indicate that needle sharing decreases with increased use of SISs. Mathematical modeling, based on assumptions about baseline rates of needle sharing, the risks of HIV transmission and other variables, generated very wide ranging estimates for the number of HIV cases that might have been prevented. The EAC were not convinced that these assumptions were entirely valid.

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