Safer. Injection. Site. Demonstration. Flags.
At Tuesday evening's demonstration, 712 white flags were planted on Civic Center Plaza — one for each San Francisco overdose death in 2020. Photo by David Mamaril Horowitz

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.

Overdose. Safer. Injection. Site. Demonstration.
Demonstrators on Tuesday night called for a San Francisco safe-injection site. Photo by David Mamaril Horowitz

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.

A die-in was held at Tuesday night’s demonstration. Photo by David Mamaril Horowitz.

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.

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David Mamaril Horowitz

David’s one of those San Francisco natives who gets excited whenever City College is mentioned. He has journalism degrees from there and San Francisco State University, graduating from the latter in May 2021. In college, David played five different roles as an editor at student news publications and reported as an intern for three local newspapers, mostly while waiting tables at the Alamo Drafthouse. His first job was at Mitchell's Ice Cream.

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  1. I do not understand why some people feel the need to denigrate individuals with addiction problems. More compassion and less judgment is needed to turn things around. So let’s not lose sight of the greed driven manufacturers and distributors of fentanyl that literally prey on the lives of substance users. The local dealers need to be held accountable as well. These sites may be an unpopular idea for now but at least you are making an effort.

  2. If the city opened “safe” injection sites, drug dealers would crowd around them like Grand Central Station at rush hour. And the District Attorney won’t prosecute drug dealers, who he says are “victims” too. Why make it convenient to be a drug addict? Drug addiction is a VOLUNTARY decision. You don’t HAVE to be a junkie. People who die of drug overdoses are winners of the Darwin Award, nothing more.

  3. Our District Supervisors and Mayor want everyone else to host while the rest of us have to put up with this in our neighborhoods. I am a neighbor of the D6 Supervisor and he can have his side of the street clean while those of us across the street have to put up with this behavior and he does nothing about it.

  4. I don’t think they’re comparing gay marriage to drug addiction. Probably they’re just saying San Francisco has a history of taking the lead despite state and federal red tape.

  5. So let’s say someone goes to the safe injection site and still overdoses and dies. I assume then their family will then sue the city, for negligence and Sf will settle? Seems like a terrible idea.

  6. Crazy talk. Not a shred of evidence such a ploy would prevent deaths. Love the completely hypothetical model you cited stating: “We find that each dollar spent on a SIF would generate US$2.33 in savings.” That is awesome. Like minting money.

    Then your Seattle study claimed its safe injection facility prevented OD deaths, yet OD deaths in its neighborhood remained the same each year. They served quite a few people, averaging some 250 addicts coming in to shoot up twice a day.

    Oh, and: “on-site non-fatal overdoses were common during the first 18 months of Insite’s operation”.

  7. This has to be a far right conspiracy. Who else would want to destroy the most diverse and liberated city in the world?
    An army of MAGA hat wearing goons couldn’t do a better job at destroying this place. Sometimes it does feel like we are a dominated
    MAGA society.

  8. Wait. Tell me again how supporting these injection sites is analogous to supporting gay marriage. So, gay marriage is an addictive self-destructive rat hole, just like drug addiction? Yeah, didn’t think so – try again Haney, Ronen, et al.

    1. I don’t think they’re comparing gay marriage to drug addiction. Probably they’re just saying San Francisco has a history of taking the lead despite state and federal red tape.

  9. This needs to be done now, regardless of the law. People should talk to Chesa and see if he’ll agree to not prosecute anyone arrested for running/staffing/etc a safe injection site.

  10. Y que? What are these criminal minds gonna do if you don’t accede that they haven’t been doing for 30 years in needling?

  11. I can’t stress enough how beneficial these sites can be. Addicts are going to be addicts until they decide not to be. Would you rather find your child dead in an ally way, on a filthy mattress in some abandoned building? These sites can’t save everyone, but I guarantee if properly staffed and equipped any number of people using it can and will reach out for help. My child didn’t have access to anything like this, now after years of sobriety I’m learning bits and pieces of the horror they lived. It doesn’t have to be like that for everyone.
    A Very Lucky Parent

    1. Ok, I’ll play. If we have safe injection sites, and homeless addicts refuse treatment, let’s send them to prison where they can get clean. Why should these folks continue to get the red carpet rolled out for them while they continue to terrorize neighborhoods? Enough is enough. Why should decent tax paying citizens have to put up with this?

      1. Amen. The problem starts with the police not aggressively going after drug dealers. The drug addicts know that SF is the place to go buy because the dealers are here. If the police need to know where they are failing, head over to Hyde Steet around Ellis I guarantee you can find drug dealers. I drive by there every day and it doesn’t what time of day it is, it is the Walmart of drugs.

      2. Part of the reason why so many addicts are overdosing all over the city & with the increase in crime is due to the lack of options & services SF fails to provide. Is it unfair to tax payers for having to deal with this problem ? Sure but this is the sad reality we have to deal with in SF. We can either work together, rebuild our communities and save lives or we can continue to pretend this issue will solve itself and just push it aside hoping one day we’ll wake up and poof no more drugs. WRONG! We don’t live in a perfect world. People wake the f*ck up and face reality! One of the big issues of why the city hasn’t found a long term solution to this crisis is because of waisted resources & lack of community involvement and care. Theres too many people offering judgement & criticism and not enough people willing to step up & come together to find solutions that would help rebuild our community & save lives from deaths that were preventable. Step over the homeless & criticize their way of life without fully understanding each persons struggle and not every “homeless addict” is the same. We cannot continue to sit by and point fingers & complain about how terrible the quality of life is with the homeless & drug users as more people continue to die on the streets throughout SF. This is what we’ve been doing and why we haven’t seen any progress. Placing blame on cops not arresting enough drug dealers is not the reason why our neighborhoods are a mess. It’s the lack of options of help. Drug dealers will continue to be the only option until our city leaders decide to provide others. It’s mind boggling how the city loss more than 700 people from OD related deaths. Absolutely sad that we have more deaths from drug overdoses (that were preventable) than the COVID-19 pandemic. What does that say to the country about how SF handles certain health crises? We have the lowest number of COVID related deaths in the US but have the highest amount of deaths from drug related overdoses? That should tell you everything. Embarrassing and Sad

  12. “A crowd of around 70, including doctors, nonprofit workers and directors, nurses, city legislators and community members, listened to speakers…”

    That’s 70 people who aren’t volunteering their own neighborhoods for this experiment.