Opioid-drug abuse in the United States is now recognized as a national crisis. Over the past two decades, opioid overdose deaths have quadrupled and become a leading cause of death for adults under the age of 50. The Centers for Disease Control and Prevention estimate that 115 Americans fatally overdose from opioids every day.
To tackle this epidemic, lawmakers, healthcare professionals and the public have proposed a slew of solutions. Safe-injection sites are just one of many ways that cities and governments around the world have already begun to approach the problem. Cities in Canada, Australia and Europe have created locations with medically trained staff and clean equipment where drug users safely inject their illicit substances. Some have been in operation for more than a decade, and more are opening all the time.
It has proven a controversial solution; no such site has ever existed in the United States. But this summer, San Francisco plans to open two safe-injection sites downtown, with more to come.
Administered by the San Francisco Department of Public Health, these new sites have been met with expected criticism. If the city allows illegal drugs to be injected freely, even in a controlled environment, the argument goes, it may lead to more injecting and even attracting new users. But Barbara Garcia, the director of SFDPH, sees the sites as a positive step in the right direction to curtailing drug use in the streets.
“The whole reason to open these is to help our community members engage in healthcare. And as we go through the process of opening these up, the individuals going to these locations will have the opportunity to engage with physicians and other medical personnel to seek treatment,” Garcia said.
In short, it isn’t just a space to inject heroin or fentanyl and leave. People will come for that purpose, but they will stay for the help they receive. Employees are there to oversee injections and make sure they’re done safely and cleanly, connect with drug users and help them in any way possible.
The SFDPH assembled a Safe Injection Services Task Force comprising local business owners, department heads and community leaders to assist with the planning of the sites. Members met periodically throughout last summer to debate and brainstorm ideas. In September, the department released the San Francisco Safe Injection Services Task Force 2017 Final Report.
Board of Supervisors President London Breed said in the report that “approximately 100 safe injection sites now operate in over 65 cities around the world. No site has experienced an overdose death and many have transitioned thousands of clients into detox services.”
The international sites San Francisco is studying have helped “promote safer injection conditions, reduce overdoses, enhance access to primary care and reduce public injection and outdoor syringe litter” without increasing crime or drug trafficking in the surrounding areas, Breed said.
Safe-injection sites will also provide a designated place for disposing used needles, which has become a major problem on San Francisco’s streets. According to the San Francisco Department of Public Works, more than 4,000 publicly discarded syringes were collected in a one-week span during March 2017. When drug users leave behind dirty needles, dangerous blood diseases can be spread.
In addition to reducing overdose deaths and public health, the new sites will also help trim San Francisco’s bottom line.
“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,” Breed said. “[That means] effective, alternative solutions can end up saving taxpayer dollars while also saving lives,” Breed said.
According to studies detailed in the report, after one year of having just one safe-injection site, San Francisco on average will see 415 fewer hospital stays, 19 fewer hepatitis C cases and 110 more drug users entering treatment.
Erick Arguello was a member of the task force, as well as co-founder and president of Calle 24, the Latino cultural district of San Francisco. He attended the meetings last summer and helped draft recommendations for the board of supervisors.
“From a business perspective, I think the injection sites are going to be a good thing for everyone. I think right now, the way things are, it’s a hazard,” Arguello said. “Injection sites will actually create more safety in the neighborhood, a place for the individuals to be able to inject safely, not harm themselves further, and also to dispose of the needles so they’re not in front of businesses and parks.”
Not every business owner may be as on board with the idea as he is, Arguello admits, but each one can decide the level of involvement. Arguello said he expects more community hearings and meetings in the coming months as the SFDPH scouts locations for the sites. The department has already conducted online surveys and focus groups with area small-business owners, residents and neighborhood groups.
But even with these concrete solutions and an uptick in community engagement, a major part of addressing the opioid crisis is reversing the stigma that drug users face. The way the world views those battling addiction is something more than a few town meetings can fix.
The SFDPH and Barbara Garcia have been working for more than six years to make these safe injection sites a reality, despite the federal and public pushback they have received because they see the potential change.
“Drug users are coming and talking to policy groups. We have never seen that before. They’re telling us, ‘We don’t want to be using drugs. We need help.’ But the addiction is not allowing them to do that,” Garcia said.
She continued: “We have to recognize this as a chronic disease. It’s a brain disease, and we should be treating it like any other chronic disease.”