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Task force set to recommend SF provide safe injection services

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No U.S. city has sanctioned a safe injection site, but San Francisco may change that. The S.F. Safe Injection Services Task Force has recommended The City provide safe injection services alongside medical care and counseling. (Jessica Christian/S.F. Examiner)
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San Francisco should provide safe injection services together with other services like medical care and mental health counseling, according to draft recommendations presented on Thursday by the S.F. Safe Injection Services Task Force.

The task force’s position has come into focus after the last of its three meetings on Thursday. Final recommendations are expected to be submitted to the Board of Supervisors next month.

The effort comes as there is increasing pressure for U.S. cities to open safe injection sites as the nation struggles with an opioid crisis.

The sites allow health professionals to monitor injection by drug users and provide clean needles. Studies of the facilities, of which there are about 100 in other countries, show they reduce HIV and Hepatitis C transmissions, increase safe disposal of needles and steer users into treatment programs.

The task force, called for by Board of Supervisors President London Breed, was seen as a step forward toward making a reality such facilities. To date, no U.S. city has opened a sanctioned one, but an underground one was revealed this week in a medical journal.

While Seattle approved in January opening two facilities, the plan has seemingly stalled amid controversy over where they would be located, and the debate is expected to continue into next year, the Seattle Times reported on Tuesday.

Task force members said on Thursday they wanted to avoid Seattle’s situation. One way to lessen the siting controversy may be by adding safe injection services to already existing service sites for drug users.

The City has contracts with about 60 organizations for services related to drug use, according to Barbara Garcia, Department of Public Health director and task force chair.

The San Francisco Police Department said it is willing to work around whatever The City decides. Lt. Troy Dangerfield said the Police Department is “flexible” based upon what The City decides to do.

Dangerfield suggested that there be an alternative agency to contact instead of the police to respond to non-emergency issues in and around such sites, otherwise police could end up charging people using the services for a felony if they are found in possession of drugs like heroin.

“We don’t want to police a system that is trying to keep people safe,” Dangerfield said.

Jim Lazarus, senior vice president for public policy at the San Francisco Chamber of Commerce, told the San Francisco Examiner after the meeting that he supports the concept, but The City would need to ensure the conditions on the ground improve where they are opened.

“It’s a health service that we are probably going to have to provide,” Lazarus said. “If we are going to create these services, then as a community we can’t tolerate people shooting up on the street and potentially dying.”

Laura Thomas, deputy state director for the Drug Policy Alliance and a task force member, said the way to see an improvement on the streets comes down to capacity.

The task force supports multiple safe injection facilities in areas with the highest concentration of people who inject drugs, which are the Tenderloin, Civic Center, Mission, Bayview and Haight-Ashbury neighborhoods. Task force members would also like to see mobile pop-up injection services.

“One of the biggest challenges is indeed this one around insufficient capacity and resources to meet need,” Thomas said. “What drives people to continue using drugs outside of the site is when there’s too long a line and too long a wait.”

This week, the American Journal of Preventive Medicine published research by UC San Diego medical sociologist Peter Davidson and RTI International epidemiologist Alex Kral (Kral also serves on the task force) on an unsanctioned, or what some call underground, safe injection site operating in an undisclosed U.S. urban area by an undisclosed social agency.

The site opened in September 2014, and in two years served mostly white males who are homeless. Of more than 100 users of the site, there were 2,574 injections and two overdoses that were reversed by staff. More than 90 percent of those shooting up drugs on the site said if they weren’t in the facility they would have been injecting drugs in a public restroom, street, park or parking lot.

Nearly 70 percent of the site users said they had recently unsafely discarded syringes, but now that they were using the site, the researchers concluded 1,725 needles were safely disposed of that otherwise may not have been.

Breed told the Examiner on Thursday that she plans to call for a board committee hearing on the task force’s report, which would likely occur at the end of September or early October.

It seems unlikely San Francisco will open a facility before the end of the year, but it could be possible in early 2018 if there is the community and political support.

“This is a process and it can’t be rushed in an irresponsible way,” Breed said.

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