There is no legal or procedural obstacle to setting up safe drug-use sites in San Francisco except the political intransigence of the mayor, the city attorney, and maybe the district attorney.
Those sites would, by all accounts, save lives, reduce drug use, help thousands of people, and cut the cost of emergency medical care.
That was the clear result of a stunning hearing today before the supes Budget and Finance Committee.
The hearing featured Sam Rivera, who runs On Point, a nonprofit that operates the nation’s first two overdose prevention sites, in New York City. It started with a clip from this powerful documentary.
Rivera described how his centers provide wrap-around services, from showers and meals to mental-health counseling, along with a safe place to smoke or inject drugs. In the less than two years that the sites have been open, the services have been used 54,000 times, the staff have prevented 700 overdoses—and not one person has died.
When the sites opened, he said, he and his staff were told there were risks, that he could get arrested for violating federal law, that the feds could shut the places down … “and the sky didn’t fall. It didn’t happen.”
He noted: “The federal government is not going to defund a city like New York or San Francisco” for opening these centers.
The directly contradicts the only rationale Mayor London Breed has offered for putting the brakes on a program that was ready to go in the fall; she said it was too legally risky.
But under the New York model, Rivera explained, no city money goes for the safe-use part of the facility; the city funds other services, but private grant money and donations cover the $1.4 million it costs to keep the use rooms open.
That’s such a tiny amount of money. If the program could expand to be open 24 hours a day seven days a week, the cost would be $4.3 million, Rivera said.
In the process, New York saved $20 million in emergency room visits, since the On Point staff are trained to reverse overdoses without needing to call an ambulance.
Meanwhile, the centers have had a dramatic impact on surrounding communities: The local parks in Harlem and Morningside Heights, where the sites are located, were dumping grounds for more than 13,000 used needles, he said.
“Then all of a sudden, those needles aren’t there, because they are in our sites,” he said. A playground for children that was closed for decades is now open again.
Alex Kral, a nationally renowned epidemiologist who has studied the impact of safe-use sites around the world, told the supes that the scientific evidence was rigorous, extensive—and 100 percent consistent:
These sites prevent deadly overdoses, reduce HIV and viral hepatitis transmission, reduce the frequency of drug use, save cities money, help addicts get into treatment, and do not increase crime or drug dealing.
There is, he said, not one study that shows any negative impacts of safe-use centers.
Ronen did something unusual—and profound—with this hearing. Instead of asking city staff to report on what they are doing, she turned it over to Rivera and Kral, and asked representatives of the Mayor’s Office, the Department of Public Health, the City Attorney’s Office, and the Police and Fire Departments to sit and listen.
Then she turned it over to Kral and Rivera.
Rivera’s testimony was riveting. “If you use and you come to the Overdose Prevention Center, you don’t have to die,” he said.
He described how, with the support of then-Mayor Bill DeBlasio, he worked with the New York Police Department and formed a close partnership. The cops asked him to give officers a card directing them to his services; they use that instead of arresting drug users.
He also said that four of the five district attorneys in New York, including the Manhattan DA, signed off on the project and said they would not prosecute anyone for drug possession or use if they are at or on the way to the On Point centers.
The drug use, he said, is “the least important” part of his program, which connects people with a wide range of services that can be life changing. But the opportunity for a safe place to inject or smoke drugs brings them into the building.
He said San Francisco could easily create a similar program, particularly given the city’s history as a leader on these issues. “Just be San Francisco,” he said.
Ronen noted that Breed was until recently a strong supporter of safe-use sites. The Department of Public Health, as a part of an overdose prevention plan, called for 12 new wellness centers.
“Then all of a sudden, she pulled the brakes with no explanation. No plans for how to deal with this.”
She told Anna Duning, the mayor’s budget director and representative at the hearing: “We will find you the money, we will take on the naysayers in our districts.” To the city attorney, she said, “Sam Rivera is not getting indicted.”
She said that despite all the rhetoric, “there is no evidence that we are open to the New York model. … I want to be working with [the Breed Administration], to do this together. But I am getting the runaround.”
The city operated a safe-use site in the Tenderloin last year, she said, “and the legal terrain hasn’t changed. We have just seen the mayor slamming the brakes on opening these sites.”
She challenged the department heads to disagree.
Duning said that Breed was still open to the idea, and that the details had to be worked out with the city attorney. Chiu’s deputy said he was in favor of the idea, too. “But they keep pointing their fingers at each other,” Ronen told me.
Chiu, for example, would have to sign off on any nonprofit contracts with the city—and two nonprofits have offered to operate the sites—but that hasn’t happened.
And of course, DA Brooke Jenkins would need to agree not to seek prosecutions.
The cops don’t seem to be an obstacle; Chief Bill Scott’s policy director said he was in favor.
“We will be judged on what we do, not what we say,” Ronen said. “Both the mayor and the city attorney have said they are okay with the New York model,” Ronen said. “So why aren’t we opening these centers and save the approximately two San Franciscans we lose to overdose each day, and simultaneously improve the abysmal street conditions in several neighborhoods including the Mission in my district, where open air drug use is common?”
Everyone should watch the hearing on sfgovtv. It was a clear example of how the supes—even the more conservative supes like Ahsha Safia and Matt Dorsey—are overwhelmingly in favor of a life-saving approach that is bogged down in Breed’s Office.
