Newsom Veto Deals Blow to Safe Injection Sites

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Last week, California Gov. Gavin Newsom (D) vetoed a bill that would have permitted the state to launch a pilot program to open supervised injection facilities in California’s largest cities.

Sometimes called SIFs, safe consumption sites, or overdose prevention centers, these are spaces where people can legally consume or inject pre-obtained illicit drugs under supervision to prevent overdoses.

In his veto letter, Newsom said he had long been a proponent of harm-reduction strategies, but argued that he was concerned about launching such sites without “engaged local leadership” and plans to sustain the sites.

He warned that the “unlimited number” of sites the bill would have authorized, “could induce a world of unintended consequences” in San Francisco, Los Angeles, and Oakland, and exacerbate “drug consumption challenges.”

Melissa Moore, JD, director of Civil Systems Reform at the Drug Policy Alliance, said the bill authorized “four specific jurisdictions” — San Francisco, Los Angeles, Los Angeles County, and Oakland — to open overdose prevention centers, and would not have incited the kind of explosion of sites the governor described.

“Unfortunately, what we’re doing now is the kind of worst case scenario that Governor Newsom and others are trying to use as a fear tactic … We’re already living that reality, where public bathrooms are being closed down, because there’s a concern that people are going to use in there and overdose and die,” Moore said.

Allowing people who are in the most vulnerable period of their lives to receive services, “I don’t really see what the downside could be,” she added.

One benefit of state authorization would have been the legal protection afforded to doctors, nurses, social workers, and others licensed by the state, explained Alex Kral, PhD, an epidemiologist with the nonprofit health research institute RTI International.

Without that cover, licensing boards might say, “Look, we don’t approve of this,” he said.

While clinicians can work in these facilities, they may be putting their careers at risk, Kral noted.

In addition, without authorization to free up city, county, and state public health funding, it will continue to be difficult for programs to open and to cover the costs of the work they’re doing, Moore said.

Newsom said he would task the Secretary of Health and Human Services and city county officials with determining “minimum standards and best practices” for developing programs that would be safe and sustainable that could be recommended to the state legislature.

California State Senate Republican leader Scott Wilk applauded the governor’s veto. “People struggling with addiction need help, not a legal place to shoot up,” he said.

(MedPage Today previously covered some issues about the debate about the merits of the harm-reduction model.)

Moore said she was heartened by comments from San Francisco City Attorney David Chiu reiterating his support for the program and hinting that the governor’s veto would not stop the city from launching a center.

In response to the crisis there, a temporary safe injection site has operated out of tents in San Francisco’s Tenderloin District since the start of the year, but funding is expected to run out in December.

HealthRIGHT 360 CEO Vitka Eisen, head of the nonprofit that runs the site, hopes it will stay open or that multiple sites could be launched in neighborhoods where they’re most needed.

“We haven’t give up on that goal,” Eisen said.

New York

The first two publicly recognized overdose prevention programs, operated by OnPoint NYC, opened in New York City on Nov. 30, 2021.

One site, in East Harlem, is run by medical staff and has a health clinic on site. The other, located in Washington Heights, has adopted a “peer” model, which means the responsible staff have lived experience with substance use disorders.

An analysis of the first 2 months of the program’s efforts, published in JAMA Network Open in July 2022, found that staff responded 125 times to help “mitigate overdose risk”and gave naloxone 19 times and oxygen 35 times, and monitored respiration and blood oxygen levels 26 times. Staff also intervened 45 times to respond to “stimulant-involved symptoms of overdose.”

In all, emergency medical services were called to the sites five times and clients were taken to the emergency department three times. No fatal overdoses occurred at either site or during hospital visits, and more than half of those who used the sites made use of other supports.

“The fact that OnPoint not only offers the overdose prevention center but also has showers on site… has a laundry facility, has a drop-in center and a lot of wraparound services in terms of mental health support, general health and wellness, acupuncture for people dealing with withdrawal … all of those things under one roof, I think really shows the potential for overdose prevention centers,” Moore said.

New York Mayor Eric Adams has voiced support for the sites, and in late May tweeted about shifting to a 24-hour model.

“For that to happen, it will be really important to get the state authorization in New York,” Moore said, which is something advocates have been pressing New York Gov. Kathy Hochul (D) to do for some time.

Right now, private philanthropy dollars are being used to support the overdose prevention portion of the site’s programs, Moore said.

Philadelphia

Safehouse, a Philadelphia nonprofit, has plans to open its own safe injection site, but is waiting for the federal government to give the green light after the Department of Justice, under President Trump, sued Safehouse in 2019.

Provisions of the Controlled Substances Act, dubbed the “crack house statute,” make it illegal to run, own, or rent a site with the intention of using, selling, storing, or manufacturing drugs.

The Biden administration appears less “antagonistic” toward such sites, compared with the Trump administration, Moore noted. Under President Biden, the White House funded harm reduction programs for the first time in its budget, and while the amount was less than what is needed, Moore was encouraged.

Safehouse Vice President Ronda Goldfein, Esq., said the group continues to have “productive conversations” with the Department of Justice (DOJ) about opening their site.

While New York City didn’t wait for DOJ approval, Safehouse has always felt strongly that it was better to open “in the light,” Goldfein said. Not only will that reduce stigma, it also makes it easier to secure institutional partners and funding, to ensure the program’s sustainability, she said.

And as she told MedPage Today previously, the group is also not inclined to ignore a court order.

“Ideally, we reach an agreement, which allows appropriate boundaries,” or “guard rails” as the DOJ call them, that both parties can agree to.

The current deadline for the DOJ to respond to Safehouse’s claims is September 22. (The response date has been repeatedly postponed since late 2021).

While Goldfein said she isn’t hopeful that the matter will be concluded by September, she anticipates an answer “by the fall.”

She’s optimistic that a settlement for Philadelphia will encourage other jurisdictions. “If DOJ says, ‘If you do x, y, and z, we won’t prosecute you in Philadelphia,’ it’s hard to imagine that they would prosecute you in New York or California,” she said.

Rhode Island, Other Cities

In July 2021, Rhode Island Gov. Daniel McKee (D) signed a law authorizing a 2-year pilot of safe injecting sites, becoming the first state in the nation to do so.

The state began accepting applications in March, but to date, Annemarie Beardsworth, a spokesperson for Rhode Island’s Department of Health, said it has not received any applications.

“This will be a month’s long process, given all the approvals required at the municipal and [s]tate level, as spelled out in Rhode Island’s regulations. The current pilot program ends in 2024,” she noted in an email.

Momentum around expanding overdose prevention sites is continuing to build in cities such as Chicago and Baltimore, Moore said.

In July, the BRIDGES Coalition group of local advocates set up a “mock overdose prevention space” at the NomüNomü Arts Collaborative in Mount Vernon, Rhode Island, according to The Baltimore Sun.

Maryland Governor Larry Hogan called the sites “absolutely insane.”

But Rajani Gudlavalleti of the Baltimore Harm Reduction Coalition, noted that the city lost over 1,000 people to overdoses in 2020. “This is an intervention, one among many, and it can save lives,” she said.

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    Shannon Firth has been reporting on health policy as MedPage Today’s Washington correspondent since 2014. She is also a member of the site’s Enterprise & Investigative Reporting team. Follow

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