Drug users say they will use them, health professionals say they will work.
Safe injection facilities could soon have a place in San Francisco, after more than a decade-long discussion.
The most recent discussion took place Friday during a meeting of the Safe Injection Task Force.
The group is to make recommendations to the Board of Supervisors and Mayor Ed Lee on how best to proceed with these facilities that allow drug users to inject drugs under supervision.
While other countries have successfully opened safe injection facilities, the United States has not, despite the rise in opiate abuse, public injections and needle litter nationwide. Seattle recently approved opening two sites, but has yet to do so.
But Board of Supervisors President London Breed, who had called for the establishment of the task force to examine opening such facilities, is speaking favorably of safe injection sites. Last week, she met with Police Chief Bill Scott to discuss the issue.
In addressing the task force on Friday, Breed said she initially was not open to the idea until she learned more about it. “Will it work in San Francisco like it works in other countries? I’m not certain,” Breed said. “But to do nothing is just not an option at this time.”
Sonja Trauss, head of pro-development group BARF and candidate for the District 6 Board of Supervisors seat to represent the Tenderloin and SOMA, isn’t shying away from the issue.
She told the task force on Friday that safe injection sites will bring an immediate benefit.
“I hope they are not only in District 6. I hope that The City can open many of them and also some in the western neighborhoods. I hope they can be 24-hours,” Trauss said.
Safe injection facilities have sterile desktops in semi-private booths facing a wall where people can inject drugs while staff members are behind them, monitoring their use. Used syringes can be discarded safely in bins.
The task force, chaired by Department of Public Health director Barbara Garcia, held its second of three meetings on Friday. Final recommendations will come in September.
Like other city officials — including Breed — have done, Garcia and San Francisco Police Commander Ann Mannix plan to visit Vancouver, Canada next month to have a first hand look at a safe injection facility there called Insite.
The task force members in attendance on Friday signaled their support of the effort, but how that support translates to facilities on the ground remains unclear. Discussions over the number of sites needed, their locations, the range of services provided on the premises and hours of operation will continue.
There are 22,500 people who inject drugs in San Francisco, of which 71 percent are male, 55 percent are aged between 41 and 60, 50 percent inject heroin and 34 percent inject methamphetamine, the department estimates based on 2015 data.
Injection drug users are most prevalent in the Tenderloin at 31 percent, followed by SOMA at 24 percent, Mission at 9 percent and Bayview-Hunters Point at 8 percent. There have been about 200 annual fatal drug overdoses for the past decade.
Dr. Barry Zevin, a Department of Public Health who provides medical care to the homeless, said San Francisco has a unique substance abuse population. “A great many of our substance users are using both opiates and methamphetamine. That is not the pattern of drug use that is actually seen across the country. That does add a level of challenge to our harm reduction.”
Zevin also noted there is a need to make the facilities compelling enough for homeless drug users, a “large part of the target population.”
“A chance to take a shower, that can be pretty compelling,” Zevin said. “The street situation is very compelling. There is a stimulation to it that is hard to step away from.”
Nearly all the drug users surveyed in a recent, small sample size study conducted by the department said they would use safe injection services if offered. More than half of those surveyed also said they’d like to see the facilities open 24-hours. There was also strong support for keeping the facilities opening during normal business hours . When asked what other onsite services would make the safe injection site more inviting, the top three responses were food, showers and mental health counselors.
An Australian facility cited as an example in Friday’s meeting has clients go through three stages. The first is the waiting room, where staff intake clients and provide an assessment of their condition. They then go into one of the eight booths where staff observe them inject drugs. Afterwards, they go to an after-care room where they can be connected to services, like welfare benefits or housing.
Mike Discepola, task force member with the AIDS Foundation, said the supervised injection sites provide a chance of “building serious relationships with people at important moments in their lives when they are fixing.” But, he said mobile services are necessary to maintain those relationships because The City is “shuffling our homeless around.”
The concept may be a tough sell to some residents but supporters say critics should make their decision based on the studies. Paul Harkin, head of the Harm Reduction program for the Glide Foundation in the Tenderloin, said that there was “no downside to any of these facilities.”
“It seems that there’s a moral objection but when you look to the science, the science is compelling,” Harkin said. “They work.”
A study based on using the Insite model in San Francisco, which was published in the Journal of Drug Issues in December, found it would reduce HIV and hepatitis C infections and prompt more than 100 drug users to enter treatment annually.
As for drug user behavior in and around the sites, Holly Bradford, a program coordinator for the SF Drug Users Union which offers needle exchange services, attempted to allay concerns.
“Drug users are going to be so grateful for this service that they are going to want to protect it. If you tell tell them ‘No drama’ — that’s my rule ‘no drama’ — they will respect ‘No drama’. They don’t want their services closed down,” Bradford said. “Drug users care about their health.”
The task force will review the results of surveys conducted of business owners and residents at its next meeting Aug. 10 beginning at 9 a.m. at 25 Van Ness Avenue in the 610 Conference Room.