San Francisco to Open Safe Drug Injection Sites by Summer

They will be privately funded and operated by nonprofits.

Viktoriya Kuzmenkova / Dreamstime.com

San Francisco may end up being the first city in the United States to open injection sites where drug addicts can shoot up safely.

Several other major cities are considering proposals. Seattle has been planning injection sites but has had to fight off a ballot initiative to try to stop them. San Francisco is now moving forward with plans to open two sites by July.

Barbara Garcia, director of the city's Department of Public Health, told the San Francisco Chronicle that facilities' operators would be selected from the small group of nonprofits that already operate needle exchange programs in San Francisco. The facilities will be funded from private sources, though Garcia declined to say where specifically the money will come from.

The private operations should ease some heartburn among people who don't like the drug war but aren't fond of the notion of using public dollars to subsidize drug use.

The reason the sites will be privately funded, Garcia explained, is to avoid any potential liability for the City of San Francisco, since the sites will be operating in defiance of state and federal law. San Francisco is already in the Department of Justice's crosshairs because of its status as a sanctuary city for illegal immigrants.

San Francisco has an estimated 22,000 intravenous drug users, and they often shoot up in public. City officials think 85 percent of those drug users would use an injection facility if they could. They also think this could potentially save the city $3.5 million in medical costs, given that it will be overseen by professionals and will hopefully reduce the need to call emergency responders.

Some lawmakers and prosecutors complain that allowing for drug injection facilities "normalizes" heroin use. But that ship has long sailed. Studies have shown that in practice, safe injection sites reduce overdoses and help marginalized users find access to health care, and that they do not lead to more drug use, drug trafficking, or crime. Other Western countries have opened such facilities; as overdose deaths climb, it's time America tried this option too.

Comments

[Fist of Etiquette]

Remember when Geraldo opened a safe and drug us all along for the ride? Didn't turn out well, did it?

[Chipper Morning Baculum]

That was excellent, Fist. Respect.

[Don't look at me.]

Yeah, no shit.

[Fist of Etiquette]

KMW is going to put up with these shenanigans for only so long.

[SIV]

Private sources that receive public funding no doubt.

[Hugh Akston]

It's amazing that you're able to divine that conclusion without access to any facts at all.

[Chipper Morning Baculum]

Chicken entrails don't lie, Hugh.

[Hugh Akston]

Especially when they're warm and wet and inviting.

[SIV]

. The facilities will be funded from private sources, though Garcia declined to say where specifically the money will come from.

[Hugh Akston]

Right, so you don't actually know where the private sources get their money, do you?

[SIV]

They're nonprofits that have received public funding in the past.

[Hugh Akston]

Have they also received private funding in the past? Is there any way to tell what sources they're going to use to fund the injection sites?

[Diane Reynolds (Paul.)]

Is there any way to tell what sources they're going to use to fund the injection sites?

Put me in a room with Garcia and a couple of car batteries, and we'll figure out where the funding is coming from.

[silver.]

Shoot, that's way too much work, just grease his palms with a Benjamin and he'll tell all.

[completely impervious]

What a strange thing to be petulant about.

[Flinch]

Indeed. There is a law firm making money off this no doubt.

[Hugh Akston]

The private operations should ease some heartburn among people who don't like the drug war but aren't fond of the notion of using public dollars to subsidize drug use.

Cause that's totally what it is.

[NotAnotherSkippy]

Hear the warble of the bleeding heart libertarian who totally believes in the individual except when it comes to personal responsibility.

[Hugh Akston]

It's weird how the system threaded your comment like that even though it has absolutely nothing to do with what I said.

[completely impervious]

More than you seem to realize.

[Flinch]

It's just another head of the Hydra: SF is on balance, a public health hazard. Any policy to make the city a bigger aids parlor than it already is will receive support of the gang of lawyers looting the city treasury.

[EscherEnigma]

Sounds good. Go Commiefornia.

[Diane Reynolds (Paul.)]

The facilities will be funded from private sources, though Garcia declined to say where specifically the money will come from.

My guess is the money will come from local non-profits who receive grants from the city of San Franciso-- or perhaps state and federal programs.

[SIV]

Yup, guaranteed

[Diane Reynolds (Paul.)]

I'm not saying they absolutely will, but there's a strong indication of it when the program coordinator is quick to say that the funding will be private, but declines to name the source.

Honestly, I don't really care that much about where the funding comes from. I think it makes a mountain out of a molehill. I care about the residents of the neighborhood who see a dramatic turn for the worse in the local living conditions for a program whose benefits are questionable.

Vancouver's experience with Insite isn't rosy at all, and even the people running the program admit that it essentially becomes a revolving door of people ODing on drugs who are kept supplied with drugs with an ongoing welfare system. Insite sees only a very small percentage of users ever successfully complete rehab, drug overdose deaths have gone up dramatically (after an initial report of them dropping).

If your goal is compassion it seems to aid in people living on a very thin thread for decades at a time.

[Diane Reynolds (Paul.)]

The safe injection sites could mean fewer dirty needles on the streets, since they'd be collected inside.

I'm not sure if that has been Insite's experience. There are a lot of drug-users that shoot up outside of Insite (the current North American example). People shoot up all over the neighborhood in Vancouver.

Public health officials believe that 85 percent of the city's intravenous drug users would use safe injection sites and that the city could save $3.5 million a year in medical costs.

That is definitely not Insite's experience. I can't speak for the monetary savings, but 85% of a cities drug users don't pivot to the safe injection site. They're serious drug users, just because you build it, doesn't mean they'll come.

[silver.]

if I was an IV drug user shooting up in public I'd be going nowhere near the building where all the local police know where to find me.

I lived a block away from a methadone clinic for a few years, and a lot of people would sleep in the area around it, waiting for 7AM when they could get their dose. Worst they'd do is hit us up for a slice of pizza from the adjacent Domino's. Many panhandlers are a lot more aggressive. Good anecdotal evidence that an ultra-powerful, long-lasting, full-?-agonist opioid at least decreases criminal behavior, although it indefinitely extends addiction.

[Diane Reynolds (Paul.)]

if I was an IV drug user shooting up in public I'd be going nowhere near the building where all the local police know where to find me.

If they run it anything like Insite, the whole neighborhood will become a no-arrest zone. And, as the article points out, the entire city of SF is already an open shoot-up free-for-all. No one's getting arrested now. So that probably won't be a major concern.

[Rhywun]

85% of those 22,000 users are gonna flock to this building on a regular basis? Yeah that sounds either ridiculous or a recipe for disaster.

[Diane Reynolds (Paul.)]

They won't. They're fudging statistics to 'sell' the program. I posted a link on Reason the last time and there was some indication that a lot of drug users chose to not bother to travel to the site itself.

[Diane Reynolds (Paul.)]

Sixty-seven percent of respondents said they back the idea ? 45 percent strongly and 22 percent somewhat.

That's an interesting way of saying 65 percent 'back the idea'.

I would argue that I fall into that 22 percent. I back the idea 'somewhat', but the details of how the program would be run give me major pause.

And yes, I do say that the ONLY goal of the program should NOT be stopping adults with agency from killing themselves by sticking needles in their arms. That's only one goal in several.

[Diane Reynolds (Paul.)]

67 percent. Sorry.

[Diane Reynolds (Paul.)]

I've posted this before, but here's a good (and fair, in my opinion) run down on Insite. I think it's informative and helps people realize just what they're signing up for if they go all in on a safe injection site.

The article seems to lean 'pro-Insite', but it doesn't spare any of the awful reality of the downtown eastside.

[JoeBlow123]

""The neighbourhood will look worse than what you remember from 14 years ago [when Insite opened]," acknowledges Patricia Daly, chief medical health officer for Vancouver Coastal Health, the public authority that oversees and funds Insite. "But people forget. The Downtown Eastside existed long before Insite was established. Now, it didn't solve the problems in the neighbourhood. But it didn't make things worse."

Not exactly a ringing endorsement.

It sucks these dudes get welfare then turn around to spend it on drugs.

[Leo Kovalensky]

Great article, thanks for sharing.

What a horrible existence. Why people would use heroin is simply beyond me.

I personally believe that the only way to solve the overdose problem is to legalize, commercialize, and allow people to at least know what it is they're injecting. A privately funded, safe place for people to shoot up with medical care available, is a pretty good first step to reducing overdoses and the spread of disease at least. This alone won't solve the problem like legalization though, IMO.

[silver.]

This is indeed the pure libertarian position, and many of us agree with it. I think there's a major knee-jerk reaction to the "big three" of heroin, coke, and meth (the latter of two are legal, though rarely prescribed) even among socially liberal folks. The data about Portugal is very good to know. I've had trouble digging up data about how during decriminalization there is an initial uptick of use (mostly without addiction or complications, exploratory use), followed by a drop back to previous levels and a steady, slow decline, but I'm fairly confident that I'm not misremembering it.

Cigarettes are a great example of a drug being phased out socially, even without criminalization. Most of us don't avoid drugs because they're illegal, we avoid them because they lead to a 'horrible existence,' as you've said.

[JoeBlow123]

Why does anyone need to solve the overdose problem? Legalize it as you say then let themselves shoot themselves up into oblivion if they decide down that road. It is their own choice.

[silver.]

This is another valid position.

An adult has the right to choose to shoot up heroin and die in a ditch. They also have the right to use around intelligent people and buy Narcan auto-injectors to save them in case of an overdose. I suppose it's not very humanitarian of me, but I can guarantee that overdose deaths would decline.

Lost in the current "addiction is a disease" argument is the acknowledgement that there is a definite component of willful self-neglect. Even in people prone to addiction, the desire and discipline to quit is the most important factor to successfully getting clean. Some people never will quit, and if they can hold down a job and do about their life without bothering me or mowing down a kid in their car, then that's respectable.

Now, the additional healthcare resources that these people consume is a worthwhile debate. In a totally private system, the additional costs would be reflected in their premiums, and maybe that'd be further incentive to quit. Incidentally, long-term opiate use has very few detrimental physiological effects other than testosterone decrease, which reverses after cessation. It tends to slaughter sex drive, and that works out well as they're less likely to have kids when they can't fully support them.

The single most dangerous thing about opiates is the unpredictable potency.

[Leo Kovalensky]

I don't really make the contention that it needs to be solved, but I think we can all agree that it's desirable to solve the overdose portion of it. It would be pretty callous for anyone (even a libertarian) to have total disregard for human life. But as you say, some people in a free society are bound to "shoot themselves up into oblivion".

My main point, that Silver has also mentioned, is that a lot of people are OD'ing not due to a desire to die or even necessarily a long history of drug use... many are dying because they think they're shooting the same heroin they shot last week, when in fact they purchased fentanyl or some cocktail of high strength opiates. This is primarily an effect of the black market aspect of drugs. If the user could go to the pharmacy down the street and get the same dose of a known potency every single day then ODs would be far less likely.

Decriminalization isn't going to make drugs go away. But Portugal's experience has been generally positive, with death rates down significantly.

[DonHonda]

SISs are a bad idea. They perpetuate the misery of the addict by giving up on them and expect that there is no help for them except to die an eventual early death. The 100% "positive" studies for SISs are unscientific at best, self-serving at worse. They increase public overdoses, public deaths, public use, needle litter, homelessness, crime.

My arguments against SISs are in the comment section here:

http://www.eastbaytimes.com/20.....-epidemic/

[ellascottgm123]

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[Big Ed's Landing]

It's illegal. Time for the feds to step up and bust these people.

[Leo Kovalensky]

Yeah, I mean it's been such a successful strategy to date. I'd much rather see the feds bust into these houses and shoot these people before they can shoot up themselves. Drive those overdose statistics way down.

Maybe they could team up with local law enforcement. The number of dogs lost in the raids would have the double benefit of helping to control the pet population.

[FullHands]

City will still smell like piss.

[FullHands]

City will still smell like piss.