How many more fentanyl overdose deaths before San Francisco opens safe injection sites?

SF Board of Supervisors declares local emergency, activists call for Mayor Breed to act

by Gil Duran

Examiner Opinion Editor

A few weeks ago, I took a long walk through the rotten heart of San Francisco’s drug overdose epidemic.

On one block in the Tenderloin, three drug users – arms pocked with sores – openly injected on the sidewalk. Nearby, a man with a plastic baggie sprinkled meth crystals into the palms of desperate people who flocked to him like pigeons. Around us stood some of The City’s most forgotten souls, awaiting their turns to keel over in filth and misery near the corner of Eddy and Polk.

Last weekend, just three blocks to the south, an oil heiress named Ivy Love Getty got married. The wedding at San Francisco City Hall, officiated by House Speaker Nancy Pelosi, was a spectacle of opulence and power. The bride wore a Margiela gown decorated with broken mirrors. A tuxedoed Gov. Gavin Newsom attended, as did Mayor London Breed. Vogue Magazine published a photo spread.

The wedding seemed to take place in a dreamy world millions of miles from the festering scene up Polk Street. But the specter of the overdose epidemic was present there, too. People Magazine reported that the bride’s veil featured embroidered guitars to honor the memory of her father, musician John Gilbert Getty, who died from complications related to an accidental drug overdose in Texas last November.

In San Francisco, fairy tale riches tower over apocalyptic scenes of needles, tents and bodies. But in this Dickensian metaverse of stark deprivation accented by mega-wealth, both the rich and the poor know the destructive power of the synthetic opioid called fentanyl.

Over 700 people died of drug overdoses in San Francisco last year. That’s more than double the number of people who died of COVID-19 in 2020. A disproportionate number of the victims were Black, and many of the deaths took place in neighborhoods not far from City Hall.

“In 2020 and 2021, about 23% of the overdose deaths have occurred in the Tenderloin district and about 18% in SOMA, with many of the deaths occurring outdoors and on sidewalks in front of buildings,” reports the San Francisco Chronicle.

Over 500 more people died of overdoses between January and September of this year, according to the San Francisco Medical Examiner. Fentanyl – exponentially more potent and more deadly than heroin – factored into most of the deaths.

Last month, the Board of Supervisors voted unanimously to declare a local emergency due to the surge in overdoses. Breed, whose sister overdosed in 2006, returned the resolution without signing it. Her office said that’s standard practice, but she clearly lacks enthusiasm for the emergency declaration.

That’s because supporters of the emergency declaration want Breed to open facilities called safe injection sites. These are places where drug users get high in a supervised environment with professionals standing by to intervene in case of overdose. The sites can also connect drug users to counseling and medical assistance to break the cycle of addiction. Studies show this harm reduction approach can reduce overdose deaths, ambulance calls and HIV infections.

“A 2016 cost-benefit analysis of potential safe injection services in San Francisco found that The City would save $3.5 million per year if one safe injection program were opened, or $2.33 for every dollar spent on the services,” wrote Breed in 2017, after convening a task force to study injection sites. “Meaning, effective, alternative solutions can end up saving taxpayer dollars while also saving lives.”

A 2018 poll by David Binder Research found 67% of The City’s residents supported overdose prevention sites, but not everyone embraces the concept. Earlier this year, the California State Legislature delayed the passage of a bill to sanction safe injection sites in certain cities, including San Francisco. Senate Bill 57, authored by state Sen. Scott Wiener, stalled after passing the state Senate and won’t be heard in the Assembly until 2022. Gov. Jerry Brown vetoed a similar bill in 2018, accusing it of “enabling illegal drug use in government-sponsored injection centers.”

“If we are going to stop the drug use we see in public every day and get the needles off our streets, we need proven public health solutions,” said Breed in response to Brown’s veto. “We have seen these sites work in cities in other countries and we know they not only save lives, but they can save our city money by reducing costs for healthcare and emergency services.”

Some local leaders and activists want Breed to press ahead without federal or state approval.

“We should be working every day just to save more lives in our city,” said Supervisor Matt Haney, who represents the Tenderloin and SOMA, during a recent Public Safety Committee. “The prevalence of fentanyl has changed things. Fentanyl is more deadly and our response has to meet the scale of the problem that we’re facing.”

The push for an emergency declaration started on the steps of City Hall. In August, Gary McCoy – a gay activist and policy expert who once worked as an aide for Pelosi and Breed – launched a hunger strike there to demand urgent action. He ended the strike three days later, after supervisors expressed support for an emergency declaration and Haney promised action.

“I was afraid that everybody, myself included, was relying very heavily on SB 57 passing this year,” said McCoy, who said he struggled with addiction on the streets of San Francisco as a young man. “Everybody sort of took their eye off the ball hoping this particular bill would pass and, when it didn’t, I was scared and fearful that … we were already setting records, even locally, on how many people are dying from fatal overdoses … that we were just going to have nothing to do but sit back and watch it continue to happen.”

A spokesman for Breed said the emergency resolution does not allow her to defy state and federal authority, but McCoy remains optimistic. He pointed to previous San Francisco mayors, like Frank Jordan and Gavin Newsom, who pursued maverick strategies despite legal challenges.

In 1992, Jordan used emergency declarations to support a public needle exchange program to help prevent the spread of HIV. In 2004, Newsom overstepped his legal authority by issuing marriage licenses to same-sex couples at City Hall.

“We’re losing two people a day in San Francisco,” McCoy said. “I can’t imagine any other health crisis that would cause that type of loss of life where we wouldn’t try anything that we can.”

Opening injection sites could entangle Breed in legal battles, but such risks have not stopped other mayors. Breed earned national plaudits with her no-nonsense COVID response, and her history with the overdose issue suggests she understands the severity of the crisis. But while The City is spending millions of dollars to deploy special teams to prevent overdoses, the death toll continues to mount.

San Francisco already allows open drug use. A stroll along the sidewalk shooting galleries near City Hall makes that clear. The question now is: How many more people will die preventable overdose deaths in the absence of urgent, necessary and brave action?

Gil Duran is the editorial page editor of The Examiner.

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