In the face of soaring drug overdose deaths, Mayor London Breed and Supervisor Matt Haney on Thursday announced legislation that would permit nonprofits to open safe injection sites where people can inject drugs under medical supervision.

Breed has advocated for safe injection sites, also called safe consumption sites, as an effective way to reduce the spread of diseases like HIV and to reduce fatal drug overdoses. But The City has stalled efforts to open them due to legal concerns and threats of prosecution from the Trump administration.

This week’s announcement came after the nonprofit Safehouse in Philadelphia won a legal battle this week against the federal government to open the country’s first sanctioned safe injection site. The U.S. District Court in Philadelphia ruled Tuesday that Safehouse’s plan to open a safe injection site would not violate a provision of the federal Controlled Substances Act, as federal prosecutors had argued.

Additionally, the California state legislature will once again attempt to pass a bill this year, Assembly Bill 362, providing legal protections for those involved in operating these facilities. A number of safe injection sites are operating in countries outside of the United States and studies have shown they are effective in combating the spread of disease and preventing overdoses as well as connecting people to services to help them stop using drugs.

Under Breed and Haney’s legislation, which will be introduced next week, the Department of Public Health would establish regulations and a permitting process for nonprofits to open safe injection sites. The City is not expected to begin issuing permits until the passage of Assembly Bill 362. If approved and signed into law by Gov. Gavin Newsom, the state law would not go into effect until Jan. 1, 2021, which means the earliest The City would open a site is next year.

“This is about not just the conditions that we are tired of seeing out on our streets, this is about saving people’s lives,” Breed said when announcing the proposal at Glide Memorial Church in the Tenderloin. “This is the direction we need to move in.”

She said that “this is an opportunity to do something different that may make people uncomfortable but could actually turn things around for this city and for the people we are trying to help.”

Haney said during a Board of Supervisors committee hearing Thursday on separate legislation to require more frequent reporting of overdose death data — the medical examiner would report the data every four months — that the number of deaths, which reached at least 330 in 2019, is “shocking.”

“They should lead to urgent, immediate and swift action to prevent further loss of life,” Haney said.

In joining Breed to make the announcement, Haney called the proposal “not a radical idea.”

He said the more than 100 safe injection sites that operate in 65 cities around the world have proven the model works.

“This is the right thing to do, it is the smart thing to do,” Haney said. “It could not be more urgent for us right now as we face this most deadly epidemic.”

The safe injection site legislation is backed by Public Health Director Dr. Grant Colfax.

“Safe consumption sites are a proven strategy to save lives,” Colfax said in a statement. “Research shows that the presence of these sites and services does not increase drug injecting, drug trafficking or crime. We need to continue to create more places where people who use drugs can find support and be connected to services like primary medical care and housing.”

Asked what The City is doing to address the challenge before it can open a safe injection site, Colfax said that “we are scaling up our overdose prevention programs.”

He pointed to the increased distribution of the overdose reversal drug Narcan and education.

“The biggest predictor for overdosing is using alone,” Colfax said. “We strongly send out the message to people, don’t use alone and make sure you have Narcan available.”

The City is also working to launch a overdose prevention program for those living in single room occupancy hotels and a meth sobering center at 180 Jones St.

There are an estimated 24,500 people who inject drugs in San Francisco.

There were 222 fatal drug overdoses due to cocaine, methamphetamine or opioids in 2017, 259 in 2018, and in 2019 there were at least 330, according to the latest data released by the department and presented to the Health Commission last week. The 2019 data is partial and health officials said significantly more cases of fatal drug overdoses are expected once all the data is in.

The spike in overdose deaths is blamed largely on fentanyl use. In 2017, there were 36 drug overdose deaths attributed to fentanyl, but that increased to 89 in 2018 and in 2019 to at least 165, according to the department’s latest data.

Alex Kral, a longtime researcher of substance use in San Francisco, said at the committee hearing that it took longer for fentanyl to take over the drug market in San Francisco than in other cities but it is now “what is leading to this huge uptick in overdoses.”

“It came here late mostly because it is a powder and they couldn’t bake that into the tar heroin that we have here,” Kral said. “That’s what they were able to do on the east coast. Because heroin was a powder there you could just put the fentanyl in with the powder. You wouldn’t be able to see the difference between them. In some ways we were lucky , if you will, that we had tar heroin here.”

“But what’s now been happening over the last couple of years is essentially it’s being sold separately,” Kral continued. “People know they are buying fentanyl. We are seeing a lot of that in the streets at this point.”

Meth-related fatal overdoses are also on the rise, but that could also include the combined use with fentanyl.

“Fentanyl is such a deep low, if you will, much more so than heroin, that people actually use methamphetamine in order to be able to stay awake during it,” Kral said. “What we are seeing in our studies is that actually the majority of people injecting drugs right now in San Francisco are doing a combination of fentanyl and methamphetamine and so the two are quite linked.”

City officials said the Philadelphia ruling does not apply directly to California, but the legislation that Breed and Haney will introduce is consistent with the ruling.

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