Advocates planted 712 white flags in a grass field at Civic Center Plaza Tuesday evening, each representing a death from an overdose last year in San Francisco. Side by side, demonstrators carried signs: “Every overdose is a policy failure.” “How many have to die?” “The price of waiting.”
It was the latest public demand for San Francisco to create safe consumption sites. These are facilities in which people can use drugs they obtained beforehand while a trained staff member is present to halt potential overdoses; provide guidance and equipment, such as a clean needle; to provide a syringe disposal; and to help direct people to treatment and social services.
A crowd of around 70, including doctors, nonprofit workers and directors, nurses, city legislators and community members, listened to speakers intimately familiar with overdose deaths as they insisted on the need for these sites now, especially as the number of deaths from overdoses citywide exceeded that of those from Covid-19 last year.
“I’ve lost so many of my patients to overdose, so many of them. They were all loved, they all had families, they all had friends and their deaths were preventable,” said Dr. Leslie Suen, an internal medicine physician at the University of California at San Francisco, who works at San Francisco General Hospital.
“There’s a phrase on the street, modeled after that movie “Gone in 60 Seconds” — that’s what’s happening out there. From the time you put that needle in, if it ain’t the right stuff, you’re gone in 60 seconds. I’ve seen it. Many, many times. Too many times. This is real,” said Del Seymour, who was addicted to drugs for 18 years before founding the workforce development nonprofit Code Tenderloin.
Demonstrators called upon San Francisco officials to build the sites in a defiance of federal and state laws that restrict them. The demonstration was organized by Safer Inside Coalition, a group of nonprofits, community organizations, activists and others, including the health nonprofit HealthRIGHT 360, The Gubbio Project, the SF AIDS Foundation, GLIDE and St. James Infirmary. It took place on Overdose Awareness Day, Aug. 31.
The mayor and Board of Supervisors unanimously approved legislation for safe consumption sites last year, but none have been built due to legality issues on the federal and state levels.
A public health emergency
Last month, event co-organizer Gary McCoy, a former aide to Rep. Nancy Pelosi, held a hunger strike in front of City Hall to demand city officials tackle overdose deaths. He ended the strike 60 hours in after the Board of Supervisors said that they’d issue a resolution calling for a state of emergency and the creation of safe consumption sites.
Supervisor Matt Haney, whose office is drafting the resolution, told Mission Local he’ll have a resolution showing support for this introduced by Sept. 7, and likely passed as early as Sept. 14.
Haney said declaring a public health emergency would allow the city greater authority to take action but noted that he could see the city moving forward with opening a safe consumption site even without the declaration.
“If the federal government or state government disagrees with us, which I’m not sure that they do at this point, then we should vigorously defend ourselves; we have done it before,” he told Mission Local.
This, noted he and many others, would be very San Francisco, not unlike how the former Mayor Gavin Newsom, in 2004, allowed for same-sex marriages ahead of the law, or how former Mayor Frank Jordan created a syringe access program in 1993 during the AIDS epidemic.
Supervisors Hillary Ronen and Rafael Mandelman, who attended the demonstration, confirmed they, too, support the resolution. McCoy, a former city legislative aide for three city supervisors, told Mission Local that every supervisor except Catherine Stefani, who he says hasn’t gotten back to him yet, had told him they supported the resolution.
With 10 or 11 votes, it would then pass to Mayor London Breed.
Getting around the Controlled Substances Act
The demonstration follows the July postponement of Sen. Scott Wiener’s Senate Bill 57, which would have legalized a pilot program allowing supervised consumption sites in San Francisco, Oakland and Los Angeles. Now, the earliest the state bill could be passed is in January, 2022, meaning it would not take effect until a whole year later.
Meanwhile, state and federal laws, including the Controlled Substances Act, could potentially be used to shut down sites, according to a 2008 study on the law and politics of safe injection facilities nationwide.
Codified within that law is a provision known as the “crack house statute,” which renders it a felony to knowingly open, lease, rent, use, or maintain any place for the purpose of manufacturing, distributing or using any controlled substance.
That’s why the site would need to be city-owned, says Lydia Bransten, executive director of the Gubbio Project, the Mission sanctuary for unhoused residents. Otherwise, nonprofits providing services would have to put their own property on the line in the event that the federal government attempts to seize it.
Safe consumption site could save SF $3.5 million annually
Studies have shown that safe consumption sites are effective at preventing overdose deaths and getting people into treatment for substance use.
A 2007 study of one of these sites in Vancouver, British Columbia, found that its opening was associated with a 30 percent increase in the use of a detoxification service, behavior further associated with a higher rate of the beginning of long-term addiction treatment and reduced injecting at the site.
Another study in Vancouver conducted over four years, ending in 2008, found that eight to 51 overdose deaths may have occurred had they happened outside of the facility.
And, as of August, 2017, there were around 98 sites operating in 66 cities across Canada, Denmark, Switzerland, Norway, the Netherlands, Australia, Spain, Luxembourg, Germany and France. No overdose deaths have been reported at these sites.
A 2016 study that analyzed the cost benefit of placing one of these sites in San Francisco found that the city would net total savings of $3.5 million annually for one 13-booth site due to averted HIV and Hepatitis C infections, averted overdose deaths, fewer skin and soft tissue infections, and more people taking of medication-assisted treatment.
Bransten, the executive director of the Gubbio Project, said the sites should offer wound care, counseling and detox treatment on demand.
Angelica Mirsoian, a nurse at Tom Waddell Urgent Care Clinic, near City Hall, said they’ve reversed many overdoses at the center, and it’s especially important to include case management, wraparound services and other nursing services.
“It’s not just the substance use. There’s a lot of other stuff that goes along with substance use, like wounds and other physical issues,” she said.