Safe consumption sites in the Mission? Panel tackles contentious topic.

A community panel in the Mission Wednesday night continued the hard conversation on establishing supervised drug use sites in San Francisco. As effective as the experts in the room might have been in showing that the sites mitigate drug deaths, residents challenged the model with myriad concerns.

“We found that people who went to the site were about half as likely to go to the emergency room, half as likely to have any kind of hospitalization,” said Alex Kral, an epidemiologist and fellow for RTI International who has been studying safe-consumption sites in San Francisco for a generation. 

Kral spoke to concerns about crime increasing near a site, saying the slope of crime in the neighborhood where sites were implemented looked like the roof of “a San Francisco house.” Crime rates showed an increase in the five years prior to implementation and a decrease in the five years following implementation.

Sam Rivera, the executive director of two sites in New York, the only two in the United States, described the way his New York sites are run as “loving and caring.” Visitors not only use drugs inside, but also have options for coffee, movies and mental health services. 

“Meeting people through this process is most amazing,” Rivera said. His group keeps track of the amount of drugs each person takes, and notifies them when their usage decreases. Rivera said his organization, OnPoint NYC, negotiated with the New York Police Department on ways of working with drug users. They too, he said, are happy with their new relationship with drug users. 

He has witnessed a positive change in his visitors. “When we first opened, people were embarrassed to use in front of us. We had these screens, and almost everyone asked for a screen,” he said. “And now, we never see the screens, everybody’s comfortable.”

Similarly, when the first site in New York opened in November, 2021, female visitors felt uncomfortable looking at themselves in the big mirrors on site, particularly because of the bright lights. But changes were made. “Those mirrors went from, ‘I don’t want to look at myself’ to using them to put makeup on,” Rivera said. 

“My favorite data point is zero: You get over a year and not one death, not one,” he said. To date, his site has witnessed 2,300 registered individuals use the space 54,000 times. “What that means for the community is, 54,000 drug usages did not happen in your community. They happen indoors, with us,” he said. 

A significant reason for San Francisco’s difficulty in making progress on the project stems from the “serious legal issues that have not been addressed for city-operated or city-funded sites” cited by Mayor London Breed, who also says that she is very supportive of safe-use sites. When asked if there were any legal repercussions for Rivera as a result of the sites, Rivera quickly answered, “zero,” his favorite number. 

His advice for San Francisco is simple: “Be San Francisco,” he said, emphasizing that the city always has the gall to “do things really radical and really righteous.”

Leslie Suen, physician and specialist in addiction medicine, stressed the ease with which diseases can be transmitted through shared equipment and the importance of providing medical care at the right time, which is part of the services safe consumption sites plan to offer. 

Tyler TerMeer, chief executive officer of the San Francisco AIDS Foundation, said that seeing the city’s discussions over the sites in the past few years feels like riding a “roller coaster.” The San Francisco AIDS Foundation was slated to run a safe-consumption site in SoMa, but recently learned that the Mayor’s office had indefinitely postponed the plan. 

TerMeer blamed the city for dodging its responsibilities. “I think, when they say ‘New York Model’ for us to move forward in finding a solution for the city, that they are not willing to take risk and liability for it, and they want nonprofits who are doing hard work every day to take on that risk,” he said. 

In response, several members of the audience shouted, “We are willing to!”

District 6 Supervisor Matt Dorsey and District 9 Supervisor Hillary Ronen — who represent two parts of the city that experience disproportionate overdoses and drug use — were both present at the panel, moderated by Heather Knight of the San Francisco Chronicle.

Dorsey explained that the legal fear centers around the statute of limitations for violating the federal “Crack House Statute,” which has run for five years. Considering San Francisco officials countenanced drug use at the since-closed Tenderloin Center for 11 months, the city remains on the hook until on or about Dec. 4, 2027. 

Dorsey, a recovering drug user and longtime former spokesman for the San Francisco City Attorney’s office, said that it’s understandable that there’s extra caution from the City Attorney — who, after all, is an elected official. Nevertheless, “There is a model for doing this. The fact that we didn’t do it doesn’t mean it can’t be done,” he said. 

The audience at the scene gradually became a bit agitated.

“Even the thought of a Tenderloin Center opening in my neighborhood is terrifying,” said a resident of the Mission, where a site has been proposed. “So, I need to know what the difference is gonna be, and why should I trust you?”

Dorsey referenced priority enforcement legislation he’s working on, which means that in certain zones that are applicable, “if there’s drug dealers there, they’ll be subject to custody arrest. And if there’s public drug use, that will be subject to confiscation,” he said.

District 9 Supervisor Hillary Ronen sees the audience members’ worries about the Tenderloin as contrary to “the whole point of safe consumption sites,” which, “aside from saving lives and offering a ton of really important services,” is to “get drug use off the street, and inside, away from our kids from our families.”

Ronen is pushing to fast-track a January hearing on safe-consumption sites. She promised to hold meetings with neighbors around the possible location of the site, if it does go ahead in the Mission, at St. John the Evangelist Episcopal Church, at 15th and Caledonia streets.  

“What is San Francisco’s plan if other states, other neighborhoods and counties decide to send their drug users over here?” 

Rivera dismissed the possibility. “I’ve proven it numerous times that a drug user won’t go further than 15 blocks,” he said. “People who are using drugs oftentimes need to use them pretty quickly.”