With a bill that would allow San Francisco to pilot safe injection sites awaiting the governor’s signature, advocates and critics alike this week are being offered a glimpse of what a controlled space where drug use is allowed and supervised could look like.
A prototype safe injection site opened its doors Wednesday to the public at Glide Memorial Methodist Church in the City’s Tenderloin district — the neighborhood where, taken together with South of Market, some 33 percent of The City’s overdose deaths occur. The site will remain open for four days.
The site’s opening came just days after the state legislature passed Assembly Bill 186, which will allow cities to implement safe injections sites as a three-year pilot if Gov. Jerry Brown grants his approval by the end of September.
However, federal officials this week sent chilling warnings that such sites are illegal, and that any city officials planning to implement them could face criminal prosecution.
There are currently no safe injection sites in existence in the United States, although more than 120 are operational in 12 other countries including Canada.
“It is a federal felony to maintain any location for the purpose of facilitating illicit drug use,” wrote U.S. Deputy Attorney General Rod Rosenstein in a New York Times editorial on Monday.
Rosenstein warned that violations are punishable by “up to 20 years in prison, hefty fines and forfeiture of the property used in the criminal activity” as well as civil injunctions against violators.
“Because federal law clearly prohibits injection sites, cities and counties should expect the Department of Justice to meet the opening of any injection site with swift and aggressive action,” wrote Rosenstein.
The program’s advocates acknowledge that prosecution is an area of concern, but maintain that the benefits of safe injection sites far outweigh that threat.
“It’s kind of crazy because people who don’t work with drug users don’t really understand it,” said Paul Harkin, harm reduction programs manager at Glide. “What we do is we enable them to not get HIV, to not get Hepatitis C, and we enable them not to die from an overdose.”
According to Harkin, injecting indoors is just “a medical part of the intervention.”
“Through the connection of giving them a safe space and reducing some of that chaos that their substance abuse disorders are causing in their lives, we give them pathways into other services that further stabilize them and move them along,” he said.
Harm reduction advocates providing tours of the mock site described a scenario in which clients would be greeted by a receptionist standing behind a table laden with different-sized syringes, fentanyl detection strips, cotton swaths, saline solutions and “ cookers” used for mixing and heating drugs for injection. Narcan, a substance used to reverse opioid overdose, is also on hand, as well as kits used for safe disposal of syringes.
On Wednesday, the “safe injections supplies” were offered by a Glide service provider named Linda Mantel.
After choosing receiving their tool kits, clients would then be directed by Mantel to one of seven booths designated for consumption.
“It’s very succinct, warm, open, welcoming and quiet. We are trying to create a sanctuary here,” said Mantel.
Upon completion, clients are ushered into a furnished “chill-out” room to relax and receive referrals to services.
Opening and operating a safe injection site in San Francisco is expected to cost between $3 and 4 million annually, according to Andrew Desruisseau, an infectious disease physician who operates a Healthright 360 clinic on the sixth floor of Glide.
That amount comes with a cost saving of “$2.33 for every dollar you spend on it,” said Desruisseau.
“That’s a big challenge — it’s still illegal federally, so where do we locally come up with the funding and work out some of those potential liability issues,” he said.
After touring the mock site herself, Mayor London Breed said that she hoped it would help to dispel stigma associated with the harm reduction initiative. She said she wants to see a real safe injection facility open “as soon as possible,” but added that “it’s going to be important that we protect the people who will be working at these facilities.”
“We have got to get creative and we have got to come up with a solution and try to address this. We know that New York has made the request to use [its site] as a research location,” said Breed. “There is strength in numbers. We are talking to other cities who want to consider this as an option. Part of what we want to do is continue to work together to try to focus on the policy and deal with some of the challenges that we know will come from the federal government.”
If approved, a potential site in San Francisco could be operated by organizations that “already work with drug users on a daily basis,” such as Glide, the San Francisco Aids Foundation and St. James Infirmary, according to Harkin.
“There are a lot of nonprofits that would like to do this. We are looking at the mayor and the city attorney for some kind of legal coverage,” he said.