The United State’s First Supervised Drug Injection Site in San Francisco

This summer, San Francisco is on track to open two supervised injection sites that will serve around 22,000 people in the Bay Area.

These sites were unanimously voted for by the local Health Commission, whose ultimate goal is to equip these facilities with clean needles, medical staff trained in responding to overdose or other medical emergencies, and resources for people who want treatment: all in order to help end the opioid epidemic. According to the US Center for Disease Control and Prevention, over 63,000 people have died from drug overdose in the United States. Last year alone, over 100 people died in San Francisco from drug overdose.

The San Francisco Department of Public Health stated that the locations are meant to not only help improve the public health of the residents of San Francisco, but also save the city about $3.5 million annually in drug addiction costs [CNN]. The two locations are set to be open by July, and will be run by a combination of six to eight non-profit organizations that already focus on drug addiction services and needle exchanges in the city.

The facilities will be funded by the private sector so to avoid any liability issues for the city, since intravenous drug use is against both state and federal law. Regardless of state law, San Francisco still plans to open the facilities this summer to help the health and safety of their residents. In addition, the state of California is currently trying to pass legislation to help protect all individuals, drug users, employees, and property owners,  who will deal with these safe injection sites.

Other than San Francisco, there are currently over 120 of these sites all over the world [The Fix]. The idea of setting up supervised injection sites has spread to cities such as New York City, Seattle, Philadelphia, Boston, and Denver [Vox]. At the end of January, Philadelphia announced that it will host private companies that are willing to create safe injection facilities.

The goal of these supervised injection sites is to help people safely use drugs while also readily giving them access to treatment, consequently leading to a decrease in drug use. The locations will also contribute to a decrease in outdoor, public use of injections, thus reducing the amount of unsafely discarded syringes in places such as parks and alleys. Individuals, who have obtained their own drugs such as heroin, can visit the facilities to safely inject themselves under the supervision of staff and gain access to other social and health services.

By using these sites for safe injection, there will also be less HIV and hepatitis transmission. Based on a study conducted by David Binder Research, out of 500 registered voters in San Francisco, 67% supported the implementation of these sites while 27% opposed it and 6% abstained. This currently seems to be the most ideal solution to help curb the opioid epidemic until policy interventions are made to increase harm reduction and treatment accessibility in the United States.

At Workit Health, we meet people where they are in recovery. That means helping them moderate or quit, or stop using a drug like heroin while they continue to smoke marijuana. This goes against traditional, abstinence-based models of treatment. But we believe that each person deserves a chance at recovery, and we allow recovery and success to be defined by the individual.

Benefits of Safe Injection Sites:

• These facilities use a harm reduction approach by creating a safe space where individuals can use drugs with supervision.
• Studies consistently prove that facilities with supervised consumption are effective.
• The opening of these facilities leads to a decrease in:
  • drug overdose-related deaths, up to a 35% drop in a community
  • related emergency care calls
  • HIV transmission
  • Hepatitis C transmission
  • public displays of drug usage
• Even though law enforcement officials are some of the biggest critics of these sites, they only have sway in locations where the police control most of policy-related public safety.
• Philadelphia was able to gain the support of their Police Commissioner when he switched from “dead-set” against the sites to “keeping an open mind.”
• Studies show that these supervised injection sites do not relate to an increase in drug use and actually lead to a decrease in drug-related issues.
• The sites help to make drug addiction treatment more accessible.
• Areas around the facilities had less public injections and inappropriately discarded syringes.
• The sites were not linked to any increase in crime in Australia and Canada and even reduced street disorder.
• In Philadelphia, there was a study that proved that as many as 76 deaths could be prevented with the creation of supervised injection sites.
• Alongside San Francisco’s saving of $3.5 million annually through the reduction of drug addiction costs with these sites, Philadelphia can save $1.8 million annually in hospitalization.
• According to a study done by UC San Diego, facilities that have been tested in the U.S. have shown results similar to those in the rest of the world by reducing the harm that comes from drug use and reducing the social nuisance of the drug.
• The facility in Vancouver, Canada has a record of zero deaths in their location.

So what is the debate surrounding Safe Injection Sites?

• These facilities face some opposition from the federal government.
• The idea of not-in-my-backyard (NIMBY) opposes these facilities because individuals are scared of allowing drug usage in their communities since it could attract drug users and increase crime, although the research shows this isn’t true.
• Critics believe that these sites can lead to an increase in drug usage by removing some of stigma around injecting.
• The Justice Department has stated that if these facilities operate they may encourage individuals to use opiates and maybe even push people to switch from snorting to injection which has a greater overall risk of overdose.
• Since addiction and homelessness have a connection, if these sites increase drug usage it may have an indirect effect on an increase in homelessness.
• The ethical dilemma that doctors have to face by facilitating drug usage on individuals who do not have to commit to detox or treatment.

Regardless of your feelings about Safe Injection Sites, in the midst of the opioid crisis, harm reduction strategies are here to stay. Workit Health will be watching San Francisco and supporting its endeavors to provide safe and humane treatment to drug users in the city.