panel on safe consumption site
An expert panel discussed safe-consumption sites in the Mission on Jan. 11. Photo by Yujie Zhou.

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. 

“What that means for the community is, 54,000 drug usages did not happen in your community. They happen indoors, with us.” 

Sam Rivera

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.”

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REPORTER. Yujie Zhou is our newest reporter and came on as an intern after graduating from Columbia University's Graduate School of Journalism. She is a full-time staff reporter as part of the Report for America program that helps put young journalists in newsrooms. Before falling in love with the Mission, Yujie covered New York City, studied politics through the “street clashes” in Hong Kong, and earned a wine-tasting certificate in two days. She’s proud to be a bilingual journalist. Follow her on Twitter @Yujie_ZZ.

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  1. By all means let’s continue and increase San Francisco’s decline by making it even easier to be both a vagrant and drug addict.

  2. If you can’t have a safe consumption site next to a child’s school, then it’s Not a safe consumption sites, it’s an Opium den.

  3. 2300 registers users using 54,000 times, over a year. That averages about 25x per person per year, which is once every two weeks. Addicts typically use several times daily. So a site is actually catching users one out of 50+ injections. That’s about a <2% chance of preventing death. Is this really a justification for concentrating drug use/sales/habitation in a populated neighborhood?

  4. If you put an injection site @ 15th & Julian, drug users will congregate there.

    If you put an injection site @ Tunnel Rd or Candlestick Pt, drug users (and dealers) will congregate there.

    Which is better for the most people?

  5. Many of these comments highlight the need for more public education about the purpose and outcomes of safe injection sites (SIS). We will be stuck in place if we continue to respond to the humanitarian crisis on our streets out of fear and ignorance. 90% of drug addicts don’t want to be drug addicted and a SIS offers a potential path out of drug addiction in a setting that is free of judgment or police or probation; the latter two agencies are both highly punitive. The fear that a SIS will “encourage” drug addiction presupposes that without the implicit permission an SIS gives, a drug user will not use drugs or will use them less? Not realistic or logical. A well put together SIS will greatly reduce street drug use, hence crime, and can offer a path out of drug addiction. It’s time.

    1. Of note, we can easily have a system where police pickups of consumers do not have to mean entry into the justice system / punishing machine. For all I’ve heard, that’s how it works in Portugal.

    2. Reminds me of the need for “public education” on ranked choice voting.
      “NAACP head slams ranked choice voting”
      “Some progressive white folks got together in a room and thought this would be good”

      SIS sounds like the same pabulum being rammed down our throats by white folks.
      See above pic of the community panel.

      All kudos to Sam Rivera for the empathy and super hard work to implement this vision in NY.
      We are not NY.

      The protestations of the NY program are all sunshine and lollypops.
      If you’ve been around the planet for any length of time – few things are win/win/win.
      Not a word is mentioned of unintended consequences and negative repercussions.

      First clue to be wary of the whole deal.

  6. The Inner Mission does not need a so-called “safe injection site.” The Mission should redirect our efforts toward health – rather than enabling addiction and fostering sickness. Instead of a site that encourages drug use, we should use those funds to create a treatment center, and help people escape the chains of addiction. The Inner Mission should become a hub of wellness, with housing for those who are in recovery and who want to keep themselves away from harmful influences. We could create programs – like the Homeless Garden Project, in Santa Cruz – that give people training and hope, rather than keeping them downtrodden in despair. We could make the Inner Mission a special drug-free zone, with increased penalties for dealing and using narcotics such as methamphetamine and fentanyl. Our children, our immigrant families, and our working-class communities of color deserve a safe and clean environment – and I am sorry to say, but a “safe injection site” is not something that will help.

  7. I live in the Mission and I don’t want this here. It will be a magnet that will bring drug addicts and keep them here. How will they support themselves? By stealing, right?

    I don’t want this here. Does my opinion count?

    1. I agree!!!

      How do we vote out Ronen ?

      They don’t even advertise these meetings so that we , residents, ,may protest

      Any idea where else we can register our objection to this?

  8. The unasked question in all this is since drug dealers won’t be allowed to sell drugs near the facility, where will they be allowed to sell drugs. Don’t people using drugs at the facility need to obtain them somewhere not too far away ?
    A collateral unasked question is if policy objective is totally eliminating drug dealer from the City, where will drug dependent people get the drugs they depend on?
    The final unasked question is if drug sales are completely stopped in the City, how is that better for drug dependent than inhumane incarceration with abrupt cold turkey denial of drugs resulting in painful and life threatening withdrawal?

    1. Well, um, in case you’re not being facetious: Selling drugs isn’t allowed like, anywhere. So what difference does it make to not “allow” selling near an injection site? With consideration for how much enforcement we see everywhere else, we know the answer: There would be 100% no difference. Here’s a little anecdote. Couple years ago, in Frankfurt (Germany), police busted a store that was run as a front for selling, located right next to one of the injection sites there.

  9. The City of San Francisco should not be in the business of encouraging and enabling illegal drug use, any more than it should be in the business of encouraging and enabling drunk driving, robbery, or other crimes.

  10. San Francisco’s drug problem is of its own making. The problem of open air drug use has increased since SF decided to let people shoot up in plain sight. Instead of discouraging drug use , through harm reduction we enable them to keep their addiction going. The chronicle interviews addicts on the street while they have a syringe in their hand ready for the next shot. Are they celebrities Telling us about their preferred mixture of illegal drugs. (Chronicle Jan 11). Shouldn’t we be trying to stop them from using drugs instead of enabling them?

  11. Regarding the safe injection site – “ A drug user won’t go more than 15 blocks to use drugs. I think it’s more like 3 blocks. If the drug user is homeless they will have to live close to the injection site. They may need to go quickly and often. This does not help the person who is worried about their neighborhood.

  12. Safe sites don’t encourage drug use, it just gets them off the street. Drug use goes down by half when safe sites are used.

    1. Let’s let that stand whether true or not – let me zero in on another aspect I find compelling: So you’re saying an injection site gets people off the street That’s not the larger conversation though, which is *keeping* people off the street and drugs. Unless injection sites are a meaningful part of that, I say, forget about it. And with meaningful, I’d looking for considerably better outcomes than the 1% referral rate they’ve gotten out of the linkage center they recently closed.

    2. please provide a link to evidence-based research that connects these safe sites to reduced drug use, addiction, drug dealing, and crime in the surrounding neighborhood. if you happen to work for the city, please also confirm if the city is basing its decision making around that research.

  13. The center gets people off the street, lower the deaths by half, and saves a lot of money because ambulances are not called. An ambulance ride costs $12,000.00 a pop.

    1. An ambulance ride in San Francisco costs $589.00 a pop. Where did you ever hear that it costs $12,000.00 a pop?
      Hyperbole much?

  14. If it gets the cracky wackies off the street and out of sight, I’m all for it. The bit about the screens seems odd – the expert is proud that users no longer feel shame about their self destructive behavior!?

  15. This is frightening. There is an elementary school around the corner. Why are we letting young children be subjected to this? And ,ore importantly, do residents get an opportunity to voice our concerns??

  16. Gross. Do the people get a say on this, or only the “experts?” Please don’t set up safe injection sites in the Mission. Things are bad enough. It will just enable drug abuse and encourage more drug addicts to move here.

    1. I agree with Mike. Things here in the Mission are already pretty bad. Let’s try to address the current issues impacting the community before we invite additional problems into the mix.

  17. My fear is that this us another contract with a non-profit that will get bigger every year. Every year we spend more and more with nothing to show for.