On Monday, a report from the San Francisco Department of Public Health disclosed that 441 people lost their lives across The City to drug overdoses in 2019. The number was a staggering 70 percent jump from the year prior, and discloses how hard the overdose crisis is to solve, even in a city with a $12 billion budget and slews of medical professionals.
But last week, a revolutionary bill that could save lives was killed in Sacramento. Assembly Bill 362, which would allow both San Francisco and Oakland to launch safe consumption sites, was killed without even being voted on.
It was a huge blow for drug policy advocates who have been working since 2016 to establish safe, sterile environments for people to consume drugs. An ever-evolving street drug supply and the continued rise of fentanyl makes the risk of accidental overdose very high.
“To get so far with the bill both within the state and nationally, then have it taken off the table, was a really major setback for us,” said Jeannette Zanipatin, the Drug Policy Alliance’s California state director. “Given the data that we’ve seen about the increase in overdoses, we’ve never been in the position we’re in now. It’s such a critical moment.”
Right now it’s largely people who use drugs who reverse one another’s overdoses. According to data from the Drug Overdose Prevention and Education (DOPE) Project, community members in San Francisco armed with Narcan reversed 2,610 overdoses in 2019. That number continues to grow; 1,600 overdoses were reversed in the first six months of 2020. People who use drugs are often the first responders to one another’s overdoses, and harm reduction workers have excelled at getting Narcan into the hands of people who can best employ it.
But despite the community’s best efforts, people continue to die, and a myriad of solutions are needed to respond to this crisis. If passed, AB 362 would have created a five-year pilot program authorizing both cities to run a monitored space for people to consume pre-purchased drugs. Trained staff would be on hand to reverse overdoses, provide immediate health care, and refer people to substance use treatment programs. Studies show that safe consumption sites reduce drug overdoses in the communities where they are built by 35 percent and improve other health outcomes. Applied in San Francisco, that means 154 lives could have been saved last year alone.
Ironically, before it’s death the fate of the bill was looking good. A previous iteration, Assembly Bill 186, passed through both the California Assembly and Senate in 2018, only to die on then-Gov. Jerry Brown’s desk.
This time around, sources say it had the votes to pass the Senate health committee, and possibly the Senate floor. And while Gov. Gavin Newsom hasn’t come outright and expressed his support for safe consumption sites, he has hinted at it, previously slamming Brown for killing the bill. If AB 362 landed on Newsom’s desk, it looked like it would get passed.
So what happened? It’s hard to say. Both Assemblymember Susan Talamantes Eggman and state Sen. Scott Wiener, co-authors of the bill, are facing re-election this year. COVID-19 limited the amount of committee hearings that were available. Lots of legislation has been pushed. But to destroy a bill that could save lives is ill-timed during a pandemic.
Laura Thomas, director of harm reduction policy at the San Francisco AIDS Foundation, has been working on getting this bill passed since 2016. She says this setback, which preceded the release of The City’s 2019 fatal overdose numbers by just a few days, really drives home the timeliness of passing this life-saving legislation.
“The urgency has gone up. How many people have died of an overdose since Jerry Brown vetoed the bill?” she said. “People are dying, and this a delay that is measured in lives lost. Particularly at this moment in time, where people’s risk is heightened, we should be doing everything we can.”
But Rome wasn’t built in a day, and that adage apparently also applies to our safe consumption sites. Despite this recent mysterious setback, no one is giving up. Wiener has already committed to relaunching the bill come December.
“I’m deeply committed to legalizing safe injection sites for San Francisco and other cities that want to implement this proven harm reduction strategy,” Wiener told me. “Due to the pandemic, the bill was not able to move forward this year, as a large majority of bills were held. We were deeply disappointed with that result, but I’m committed to reintroducing the legislation for next year.”
Thomas is also optimistic; she’s seen firsthand how dogged Wiener and Eggman are about getting this bill passed. And advocates for people who use drugs are nothing if not scrappy and creative.
“We will get there eventually,” she said. “We have other options available to us. A different federal administration will give us different options. S.F. has done things before that didn’t line up exactly with state law. We will get there.”
Moving forward with a safe consumption site without the support of the state is risky; the drugs that would be consumed in these spaces are still illegal according to the federal government, and there is valid concern that sites could be raided by authorities. A federal lawsuit against a planned safe consumption site in Philadelphia is being watched closely by harm reduction advocates across the country as an example of what’s to come.
In the meantime, people’s lives continue to be at risk. Since Brown vetoed the bill in 2018, more than 10,000 people statewide have died of preventable drug overdoses. If Wiener’s latest version of the bill passes the Assembly, Senate and Newsom’s desk, it still won’t be enacted until 2022. Predicting the number of lives lost in that time period is a hard pill to swallow.
“Is 2020 going to be double the numbers of last year?” Thomas asks, citing the 441 deaths The City saw in 2019. “I don’t know, but it’s going to be bad.”
Welcome to Hard Pill to Swallow! In 2020, issues of public health are front and center. We are in the midst of a global pandemic. A catastrophic wildfire season is impacting air quality. And Black and Brown people are dying at the hands of police at shocking rates. For many, these issues are not new — they’re just not talked about in the context of public health. This year has proven that health is not just vaccines and insurance bills, but climate change, incarceration, racism, the drug war and homelessness. In this column, I’ll dig deep into the ways class, race, gender identity and income impact the equity of public health access in San Franciscans.
Got a tip, or a story idea? Shoot me an email at firstname.lastname@example.org.