October 3, 2018

Safe Injection Sites Coming to the US?

Last Sunday, right on the September 30 legislative deadline, Governor Jerry Brown (D-CA) vetoed Assembly Bill 186 (AB186), a bill to approve a safe injection site pilot project in California. If passed, AB 187 would have permitted San Francisco to open a safe injection site (SIS, also known as medically supervised consumption sites) to provide overdose prevention services. In a SIS, drug users are permitted to use controlled substances (which they obtain on their own and bring to the SIS) in the presence of staff trained to treat and prevent drug overdose and link people to drug treatment, housing and other services.

A few other US cities are working toward opening legal SIS facilities, including Philadelphia, Seattle and New York. Passage of AB186 would have made San Francisco to be the first to do so. Hundreds of SIS exist globally, mostly in Europe. Vancouver, Canada opened the first North American SIS illegally in the 1990s, when users came together, formed the Drug Users Union and created one called Insite. After years of legal challenges and fierce debate, the city government made Insite a pilot project supported with federal funding. It now works closely with Onsite, a facility upstairs from the drop-in center that provides short term beds and longer term drug recovery services to users ready to accept them. Together, Insite and Onsite offer HIV and other disease testing, preventive health care, counseling, medical treatment and recovery support for those ready for it. Vancouver Coastal Health reports that “More than 3.6 million clients have injected illicit drugs under supervision by nurses at Insite since 2003. There have been 48,798 clinical treatment visits and 6,440 overdose interventions without any deaths.”

Back in California, Vox reported that the Governor opposed the bill because he didn’t believe that such services could reduce drug addiction in the absence of mandatory treatment. He also expressed concern that while passage of AB 186 would “create immunity under state law, it can’t create such immunity under federal law.” In fact,he added, “the United States Attorney General has already threatened prosecution and it would be irresponsible to expose local officials and health care professionals to potential federal criminal charges.”

Last August, Deputy Attorney General Rod Rosenstein wrote a New York Times op-ed column on the subject. “Advocates euphemistically call them “safe injection sites,” he wrote, “but they are very dangerous and would only make the opioid crisis worse.” He added that “Because federal law clearly prohibits injection sites, cities and counties should expect the Department of Justice to meet the opening of any injection site with swift and aggressive action.”

Despite this warning, California’s next step on this issue is still an open question. Politico reports that Gubernatorial candidate and current Lieutenant Governor Gavin Newsom said there was “no question” that there were bills vetoed by Brown that he would sign as Governor, including “probably some form of safe injection sites”.

San Francisco Mayor London Breed, whose younger sister died of an overdose, has said that she is not giving up and that “she is willing to trigger a legal showdown” with federal authorities on this issue. Politico also notes that “some medical groups such as the American Medical Association back pilot safe injection sites as a way of potentially reducing the nation’s rising rate of drug overdose.”

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