SF health director says it could take up to a year to open safe injection sites

To open sites in San Francisco where drug users could inject heroin and methamphetamine under supervision would take eight months, the Department of Public Health director said Wednesday.

Discussions about opening the facilities in San Francisco began a decade ago, but now The City is working on actually opening them, potentially within the next eight months.

The need for such facilities has grown as the nation faces an opioid epidemic exacerbated by the more deadly drug fentanyl, which is mixed in with heroin or speed. In San Francisco, people injecting drugs on the streets have become more visible in recent years, and syringe litter remains a challenge.

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The safe injection sites can also help the “Getting to Zero” campaign of eliminating the transmission of HIV infections, according to city officials.

Board of Supervisors President London Breed said Wednesday she has directed the City Attorney’s Office to provide “in-depth analysis on what our legal limitations are and what protections and procedures need to take place to respond to those legal repercussions” for opening safe injection facilities.

The possession of controlled substances is prohibited by both state and federal law, which also prohibits building owners and operators from allowing the manufacture, storage and distribution of drugs.

Breed’s request comes after the Safe Injection Services Task Force, which met between April and September, released its final report last week recommending San Francisco open multiple sites accompanied by social services in the areas where drug use is prevalent.

The report underwent a more than two-hour hearing Wednesday before the Board of Supervisors’ Public Safety and Neighborhood Services Committee, where health professionals, needle exchange providers and drug users called on San Francisco to implement the recommendations.

There are no authorized facilities in the U.S. but about 100 elsewhere in the world, where they have reportedly prevented overdoses, reduced HIV and Hepatitis C transmissions and helped steer people into rehab. They also reduce syringe litter.

Supervisor Jeff Sheehy pushed the issue when he sought clarity on the next steps. “It looks like we are aligned,” Sheehy said. “What’s our timeline? If we are here a year from now and nothing’s happened, it’s not very productive.”

Breed responded, “We want to move forward with this.”

Barbara Garcia, the Public Health Department director, said she will work on an implementation plan, including cost estimates and locations.

She said the safe injection sites would be folded into existing buildings run by nonprofits as part of their overall programs. The San Francisco AIDS Foundation told the San Francisco Examiner last week it would welcome the chance for its Harm Reduction Center on Sixth Street to pilot safe injection.

Garcia said other organizations have expressed similar interest to offer services within their existing locations.

“I do believe it’s going to take us eight to 12 months to implement these types of services,” Garcia said. “I don’t want to give the impression that we can do this overnight.”

The time estimate includes the need for interior design of sites, hiring of staff, public outreach, developing the program details such as metrics and a staffing model and securing the funding.

Some supervisors suggested mobile or pop-up services could be used to offer the safe injection sites sooner.
It remains unclear when the legal analysis would be completed and when Garcia would present a formal proposal.

Supervisor Hillary Ronen said safe injection sites are “the right intervention at the right time.”
“There should be no further delay in opening safe injection sites in San Francisco,” Ronen said.

Last year, Seattle’s opioid task force recommended opening two sites there, but ever since opposition to the plan has stalled that effort.

Laura Thomas, interim California Director for the Drug Policy Alliance, an organization that supports safe injection sites, said San Francisco is just one of many cities throughout the U.S. considering opening these facilities.

“I think that within the next few years we are going to see a number of these sites opening across the country,” Thomas said. “We may or may not be first, but probably won’t be the only one for long if we are first.”

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