San Francisco moves to allow non-profits to operate supervised drug injection sites

By Sydney Kashiwagi, CNN

San Francisco is in the process of allowing local non-profits to open so-called supervised injection sites in the city, a step that local Democratic leaders say would limit overdoses among drug users but a program that has been met with opposition by the state’s leadership.

The areas, also known as overdose prevention sites, allow users to bring previously obtained drugs, such as heroin and fentanyl, under the supervision of staff trained to respond in the event of an overdose or other medical emergency. They also provide counseling and referrals to other social and health services. Opponents, however, are concerned such sites would promote and normalize drug use and attract crime.

A bill introduced on Tuesday that has the support of Mayor London Breed, a Democrat, would repeal an existing 2020 ordinance that would have allowed the city to issue permits for “overdose prevention programs” in compliance with an effort then underway in Sacramento.

But a bill in the state Assembly died in committee that summer — the sites remain illegal at state and federal levels and are thus ineligible to receive public funding — so San Francisco’s Board of Supervisors will now decide whether to move forward on its own by allowing local non-profits to operate the sites with private funding “before federal and state legal issues are resolved.”

“Overdose prevention sites can be part of a comprehensive strategy that can save lives and address open-air drug use in our communities,” Breed said in a statement last week. “Fentanyl is challenging us like never before, and in addition to opening up these sites, we have to work with law enforcement to close the open-air drug markets and ensure that our neighborhoods feel improvements as we bring these resources to bear.”

The city bill is now before a committee ahead of a full vote by the 11-member Board of Supervisors. If approved, the mayor’s office believes non-profits could immediately move to open sites.

So far, the city has not received any formal site proposals but has had ongoing conversations with several groups that are interested in opening them, Jeff Cretan, a spokesman for Breed, told CNN.

Newsom has opposed previous efforts to open sites

Last year, Gov. Gavin Newsom, a Democrat, vetoed a bill that would have created supervised injection sites in San Francisco, Los Angeles and Oakland.

“It is possible that these sites would help improve the safety and health of our urban areas, but if done without a strong plan, they could work against this purpose,” Newsom said in a veto letter at the time. “These unintended consequences in cities like Los Angeles, San Francisco, and Oakland cannot be taken lightly. Worsening drug consumption challenges in these areas is not a risk we can take.”

Newsom’s office declined to comment to CNN about the pending ordinance in San Francisco, including whether the state would stand in the way of potential sites opening in the city.

Cretan, however, expressed confidence that Sacramento would not interfere in the city’s plan if implemented.

“While there might be questions about how these sites can operate, I think that there (is) strong support in the state for finding innovative solutions for preventing overdoses and we’re hopeful that, if and when a non-profit opens, one of these sites and they show the results that we’ve seen in other places, that people will ensure that this public heath solution can continue to move forward,” Cretan said.

From 2020 through the 2022 calendar year, San Francisco recorded at least 1,985 overdose deaths, according to city data.

Non-profit groups in New York City opened supervised injection sites in late 2021 using private funding, similar to the model being considered in San Francisco, and more than 603 overdoses were reversed in the first year, according to the Drug Policy Alliance, a non-profit that advocates for such sites.

Philadelphia has attempted to open such sites but a non-profit that had sought to open a site has been tied up in an ongoing legal battle with the federal government dating back to the Trump administration. CNN has reached out to the Biden administration about its current position on the sites.

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