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SF loses lead on safe injection sites

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Needles, sharps containers, metal tins for cooking heroin, alcohol wipes and fentanyl detection strips are just some of the items that would be available at a safe injection site simulation at Glide Memorial Church’s Freedom Hall on Wednesday, Aug. 29, 2018. (Kevin N. Hume/S.F. Examiner)

The governor’s veto of a bill that would have authorized safe injection sites appears to have stalled San Francisco’s plans to open them, but those involved in the multi-year effort say there are other possible options ranging from making an emergency declaration to taking the risk of erecting an illegal pop-up tent site.

San Francisco was poised to become the first city in the nation to open safe injection sites, but it may now be upstaged by other cities such as Philadelphia. The City was relying on the passage of Assembly Bill 186 to lower the legal risk of creating such programs. The sites, which would allow people to inject drugs such as heroin under medical supervision, would have remained illegal under federal law even with the bill’s passage.

With Gov. Jerry Brown’s decision last Sunday to veto the bill, supporters of the effort expressed frustration that momentum had been lost at a time when the nation is facing an opioid epidemic and fatal drug overdoses reached 72,000 last year. Supporters of the sites argue they save taxpayers money, reduce the risk of communicable diseases like HIV, prevent overdoses and steer people toward services that will help end their addiction.

One doctor based in the Tenderloin, where drug injectors are among the most prevalent, suggested The City turn to safe injection tents after Brown’s “uninformed” decision.

“I work in the Tenderloin and step over active injectors everyday,” said Dr. Andrew Desruisseau, with HealthRight360. “As do police officers and children. It affects all of us in the community. What is to prevent our harm reduction teams from setting up ‘Overdose Prevention Tents’ out in the streets ravaged by addiction and our lack of courage? If we are already standing by helpless watching this happen, then maybe we just need to do what we know is the right thing to do.”

That wouldn’t be unheard of. In a downtown park in Toronto, Canada, activists set up an unsanctioned safe injection popup tent last August.

Mayor London Breed has said she was disappointed by the veto, but also vowed not to give up hope.

“There is still work to be done in that effort,” Breed said during a press conference Thursday.

“The Mayor is still committed to finding a way to move a safe injection site forward,” Breed’s spokesperson Jeff Cretan told the San Francisco Examiner. “We are working with departments and non-profit community partners and advocates on possible solutions, and those meetings have taken place and are ongoing.”

San Francisco’s state Sen. Scott Wiener, who co-authored AB-186, told the Examiner Thursday that The City needs to take “bold action” to address what he called a “public health crisis on our streets.”

Wiener pointed to other cases when San Francisco defied the law, such as needle exchanges and medical marijuana before they were both legal. “The sky didn’t fall when we did so, and we achieved positive health outcomes,” Wiener said.

“If the mayor decides to open safe injection sites this year, I will fully support her in that effort,” Wiener said. “However, if the mayor decides to wait until we can pass state legislation, I will also completely respect that choice.”

The nonprofits who had expressed interest in opening safe injection sites in San Francisco had viewed the protection afforded by AB186 as vital to moving forward, particularly as the federal government has vowed a “swift and aggressive” crackdown on the sites.

Joe Hollendoner, chief executive officer of the San Francisco AIDS Foundation, which had identified a possible site to serve as a safe injection site, said the veto of the bill has “caused our momentum to halt in San Francisco.”

“We felt AB 186 would provide us with some of the legal protections to minimize the risk to our organization. Without AB186 I can say we are not prepared to take on the risk of opening a [safe injection site],” Hollendoner said.

Vitka Eisen, chief executive officer of HealthRight360, said she had considered locating a safe injection site in their facility at Mission and South Van Ness that currently houses other services, but even if AB186 has passed they weren’t prepared to do it “tomorrow.” She said they would have needed funding for renovation to create space for the facility.

Eisen said at this point they will continue to advocate for state law changes next year and await further direction by city officials.

She also said that there remained unanswered questions, such as whether The City would indemnify the nonprofits should federal law enforcemet crack down on them for providing the services.

Other cities around the nation are pursuing safe injection sites by exploring a number of options and about 100 exist in other countries.

San Francisco could also attempt to reduce legal risks by declaring a state of emergency, which is what then Mayor Frank Jordan did in 1992 to fund needle exchange programs, which were illegal at the time, to combat the spread of HIV.

Hollendoner said an emergency declaration “was something worth considering again.”

New York City, which is also looking into safe injection sites, said in a report one possible way to do it legally is to apply for a research license through the state and federal government.

As San Francisco deliberates it’s next move, Philadelphia is now positioned to become the first in the nation to launch a safe injection site, with city officials endorsing the idea this year. Former Pennsylvania Gov. Ed Rendell, who when mayor of Philadelphia in the 1990s sanctioned the city’s first needle exchange program, is now raising money through the nonprofit Safehouse to privately fund a safe injection site in Philadelphia, the Associated Press reported on Wednesday.

“I see the ability to save lives and get people who are addicts exposed to treatment,” Rendell told the Associated Press. “Having me involved, I think it reduces the chances that there will be arrests. It’s not likely, but it’s somewhat possible they will come and arrest me.”

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