11/12/17 Doug McVay

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The San Francisco Board of Supervisors is looking into setting up supervised consumption facilities for people who use drugs. The Board's task force on supervised consumption facilities delivered its report to SF's Health Commission on November 7th, so this week on Century Of Lies we listen to portions of that commission meeting.

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NOVEMBER 12, 2017


DEAN BECKER: The failure of drug war is glaringly obvious to judges, cops, wardens, prosecutors, and millions more now calling for decriminalization, legalization, the end of prohibition. Let us investigate the Century Of Lies.

DOUG MCVAY: Hello, and welcome to Century Of Lies. Century Of Lies is a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I'm your host Doug McVay, editor of DrugWarFacts.org.

Sanitary consumption facilities and supervised injection facilities are innovative harm reduction strategies that are intended to prevent overdose deaths, prevent the spread of blood borne diseases, and to bring healthcare services to populations that may not have regular access to healthcare.

Dozens of these facilities are in operation around the world. There is no question that they’re an effective intervention. Unfortunately, in spite of the so-called opioid crisis, there are still no authorized consumption facilities in the United States.

At least, not yet. Several communities around the US are exploring how to set up sanitary consumption facilities and supervised injection sites. One of those communities is San Francisco, California. San Francisco’s Board of Supervisors recently set up a supervised injection facility task force to examine the issue. That task force delivered its report to the Board’s Health Commission on November Seventh.

Let’s hear now from Eileen Loughran, Community Engagement Liaison with the San Francisco Department of Public Health's Community Health Equity and Promotion Branch.

EILEEN LOUGHRAN: I was fortunate enough to partner and work on the safe injection task force with Colleen Chawla, Patrick Chang, Israel Navares Rivera, fifteen task force members, and the direction of Director Garcia.

I want to -- before I start presenting, I want to just acknowledge Supervisor London Breed, who really supported this, and for her leadership for convening the task force, to explore just innovative and creative interventions to address the issue that's happening on our streets.

I also want to acknowledge the Board of Supervisors Public Safety Committee, which was really in full support of us, which was really in full support of the recommendations. So, moving forward, I'm going to present the recommendations and then, if there's any questions, we can ask them at the end.

I also, before I begin, want to acknowledge the task force members. We had 15 task force members that gave their time and commitment, and just a lot of enthusiasm and very thoughtful discussion, for us to be able to come up with this document to share today. And, most importantly, the direction of Director Garcia in chairing the task force.

So, we know that there are an estimated 22,500 injection drug users in San Francisco. What's happening on our streets is the same thing that's happening nationally. There's an opioid epidemic, and out on our streets, people are injecting primarily. People who inject drugs are in the Tenderloin, South of Market, the Mission, and Bayview/Hunter's Point.

Injection drug users are often male, 41 to 60 years of age, and often have multiple health issues. They're at risk for HIV and hepatitis C, as well as chronic health conditions, as well as overdose. So, we are continually seeing -- oop, I'm so sorry. I'm spacing out. I apologize if I get nervous or ahead of myself, I'm very enthusiastic about this topic.

So, we're continually seeing overdoses on our streets, from heroin and methamphetamine, and also more recently with the drug supply just being poisoned, contaminated with fentanyl. We do a really great job in San Francisco with getting naloxone into the hands of people who use drugs. Our syringe access and disposal programs have been ahead of the curve in that, and that's why we've been pretty stable with our overdoses since 2006.

There's a proximate range of 160 to 200 overdoses per year. Fortunately, we haven't seen the spikes in deaths that are happening nationally, and again, that's because we're getting naloxone into the hands of drug users and the communities that it's most important that they have.

So, harm reduction is the philosophy of our public health programs, and basically, harm reduction is a philosophy that we meet people where they're at. We recognize that everyone's not at the same place and it's really important for us to recognize that we have to work with people until they're at a place to make changes, and that includes meeting people with respect, and dignity, and kindness, and helping people move along the continuum.

That might mean abstinence for some people, it might not, but we know that this is a really difficult, challenging group to work with for many reasons. People have challenged relationships with the healthcare system, and it's really important that we step back and meet people where they're at, and in San Francisco, we've been doing this for over a decade, and the way that we would see safe injection services is just another piece of our harm reduction model, in our system of care.

In San Francisco, we have a very comprehensive harm reduction program, right, which includes our syringe access and disposal programs, naloxone distribution, medicated addiction treatments, such as methadone, suboxone, our sobering center, and again, the task force really sees this as kind of another tool in our continuum of services, and our spectrum of care.

So, safe injection services, it's nothing new. There is, it's an evidence based intervention. They are, while there's none in the US, there are programs nationally, internationally, in over a hundred countries. The way that safe injection services work is that people go to the service with their pre-obtained drugs, and they go, and are able to inject in a clean, safe space, where other services are available.

There's the opportunity to link and connect people to services such as substance use treatment, mental health services, et cetera. So there's several different types. There's the integrated model, which is basically -- includes services, so their safe injection services is looked at just another piece of the comprehensive services that are available. The specialized model is something that would be more of a stand-alone sort of site, and then there would be linkages available to services.

What we do know is that safe injection services promote safer injection practices, and are an opportunity to pull people in, to get people connected to services. These services have been shown to just really be able to engage people that are hard to reach, and might be injecting on the streets, and again, like I said, have challenging relationships with the healthcare system.

One of the things about safe injection services is that we do know that this would probably reduce the number of outdoor injection that's happening on our streets, and will also just create a cleaner and safer environment by perhaps reducing the syringe litter that we see on the streets.

So the next few slides are pictures of different types of safe injection services that are international, and we thought that it would be a good idea to show these, to show that the sites, they don't all have to look exactly alike. It can really just depend on the location and the availability of the space.

So, this is the safe injection room in Montreal, and so the way it works is that people check in, and they get the supplies to safely inject. You can see that there is a mirror that people can inject, and there's a disposal box right next, and I think that that's really important, that used syringes don't leave the site with people, and I think that that's key.

Here's the safe injection room in Vancouver. Similar sort of setup, with several different cubicles, and again, someone at the front desk area where you would check in, and so that there's that level of observation.

And then finally, the last site is in Australia, and this is, again, it's a clean space. This is a little different in that the injection space has a cubicle that has two seats, and again, it's just to show that there's different models, and it can be done with what would work best for the community.

So, just to give a little bit of an overview of the task force, Supervisor Breed introduced Resolution 123-17, urging the Department of Public Health to convene a task force to just explore the research and to investigate operating safe injection services in San Francisco, and to make policy recommendations.

There were fifteen members on the task force, and the group brought expertise from many different areas. We had members of the community, people who had former relationships with using drugs, current drug users, doctors, researchers, and just a really diverse group of people that brought something really special to the conversation.

And this was determined by the Board of Supervisors. And again, the task force was chaired by Director Garcia. So, there was -- there were many opportunities to get input into the process. So, before the beginning of the task force, an issue brief was released that just outlined what the challenges and the issues are in San Francisco.

Again, as I said, there were 15 members on the task force, and there were three meetings that went from April through September of 2017, all of the meetings had an opportunity for public comment, all of the meetings were open to the public, and we did surveys with people out on the streets that used drugs, asking them would they use a safe injection service.

There were interviews with people new to recovery, what were their thoughts on safe injection services. There were focus groups with businesses and residents of San Francisco, and finally there was an online survey that reached 500 residents of San Francisco. Gathering that input and all of that was considered in developing these recommendations.

So, everyone has, I believe, Commissioners, you all have a copy of the full recommendations in your packet. I'm going to just highlight the over-arching themes, and not go into all of them in detail.

The first and over-arching recommendation from the task force is for the city to support safe injection services in San Francisco. We have to recognize that the traditional care and services of how we address substance use, we do so much, and we call on people to come to us, and stepping back, there's a way that we can be more inclusive, and just expand the services that we currently do, by considering safe injection services as another piece of our comprehensive tools.

We believe that this could probably be done with existing services that we already have, with services that already work with people who use drugs, and again, just expand on the services that we have.

So, the potential benefits to San Francisco of having one thirteen booth safe injection service site would have multiple benefits to the city. We were very fortunate to have Doctor Alex Kral as one of our members on our task force, and he and his collaborators did an analysis of the health benefits of a safe injection site, and what that demonstrates in San Francisco would be 415 fewer hospital stays, 3.3 fewer HIV cases, 19 fewer hep C cases, 110 people who inject drugs entering treatment, one life saved every four years.

Now, the reason that this number is low is because, as I mentioned, in San Francisco, we do such a great job in getting naloxone into the hands of people who use drugs, that we're not seeing the mortality that is happening nationally. But overall, it looks to be that there would be a savings of $3.5 million with one thirteen booth safe injection service site. And again, that would depend on what the total cost would be, but we know that it would have an impact.

The key recommendation in the category of program planning was to just really be thoughtful in the process. We really need to plan for the legal and the real estate barriers, knowing that there's constraints. There's -- there are legal issue -- federal prohibitions related to controlled substances, and we need to prepare for that. We need to explore that.

We need to conduct needs assessments, and planning. We need to make sure that programs are thoughtfully planned, so that they can meet the need, and so that we can ensure that we're reaching the community, and addressing this.

And then, finally, our -- the focus groups with community groups and neighborhood groups was really pushing that we had to have metrics. We have to have measurements of success. If we're going to do this, how can we know that it is a successful intervention?

The model that the task force recommends is that it be an integrated model, and what that means again is that it's included with service, other services for people who use drugs. There would be onsite access to services and linkages to substance use treatment, behavioral health referrals, and healthcare referrals.

And again, just to kind of coordinate that care, so that it's again just another tool within our comprehensive system of care. Additionally, the task force felt very strongly that it needed to include peer staffing. It needed to include people that have life experience or lived experience using drugs, so that that can just ensure that people feel welcomed and safe in the space. We heard that consistently through the surveys that we did in the community, well, how will I know that I won't get judged going in there? There needs to be someone who's like me, who understands my issues, and the things that I'm dealing with.

And then, excuse me, and then location. The location, this is not mutually exclusive. The task force recommended opening multiple sites in the city where drug users already are, where overdoses are happening, or where discarded syringes are already occurring. And this is key, because again, it falls within the harm reduction of meeting people where they're at, and so, that's really important.

It's really also important that we locate these services within services that are already happening with the community, because there's already that trust. There's already that relationship. And that is so key to just making that connection, and moving people along.

The next recommendation was just to, the task force felt really strongly that there had to be a very strong engagement and education component to safe injection services, and that includes engaging several levels: the public, which includes residents and business owners, and neighborhood groups; law enforcement, because if these services are going to set up in neighborhoods, we need to have that strong relationship and partnership, so that we can ensure that there's sustainability, and that we're all on the same page of what we're doing, and how this is operating as a partnership.

And then, most importantly, city agencies and community organizations, that may already be providing services or that are also dealing with the same issues out on the streets. We recognize that this is not a stand alone issue that just falls within one department or one organization. It has to be a collaboration to be really effective, and that communication and that education has to happen.

And then the one thing that's not up here is the importance of it also engaging people who use drugs into the conversation, and that's just a given, to have a strong, effective program is there needs to be that level of dialogue as we move forward.

And then finally, the last recommendation is to identify populations that are at greatest risk for health disparities, and just to ensure that a place is welcoming to everyone, and we know that again, out in our community surveys, it came up, well, will I feel comfortable there? And we have to acknowledge that a lot of groups -- people of color, women, LGBTQI, people involved in the sex trade, people who have relationships that may be challenged with law enforcement, we have to consider that in our programming, and that's really important.

And so the next steps for us is continuing the legal analysis, exploring the laws, having conversations with the city attorney, advocating for AB186, which is going to reappear in January of 2018. Investigating potential partnerships and service sites, and thinking through, very thoughtfully, how we can do this, the importance of having a very comprehensive work plan is key so that we can, we can do this right, and just really meet the needs of the community.

DOUG MCVAY: That was Eileen Loughran, Community Engagement Liaison with the San Francisco Department of Public Health’s Community Health Equity and Promotion Branch. She was testifying before the San Francisco Board of Supervisor’s Health Commission regarding the report of the supervised injection facility task force. You are listening to Century of Lies. I'm your host Doug McVay, editor of DrugWarFacts.org.

We still have a few minutes left in today’s show so let’s hear some of the public comments about a supervised consumption facility that's being proposed for San Francisco. These comments were made at that Health Commission meeting on November Seventh.

HOLLY BRADFORD: Hi, my name's Holly Bradford, I'm, I work at the San Francisco Drug Users' Union. I just wanted -- first of all I want to thank you for being here and for listening to us today. I want to like, like -- I want to beg you to please, like, let this happen in San Francisco. A supervised injection facility here is so needed, there's such a street based drug using population here.

Like, I travel all over the world, I've lived in Cambodia for seven years. I've never seen anything close to what we have in America, like we have in San Francisco right now. I think it benefits the drug users and it benefits the population that lives in San Francisco. They don't, the population doesn't want to see people in the street injecting drugs, and needles in the streets, and the drug users don't want to be seen injecting drugs and needles on the streets.

It also saves the city a lot of money, because we get them right into healthcare. But I don't want to talk too long because I only have two minutes. What I do want to just say before I step away is that behind me, for the first time that I know of, are injection drug users from the streets of San Francisco here to talk to you today, and to tell you, like, from their heart, why they feel supervised injection services are so important to them, and it takes a lot of guts to come up here. You're a hidden population and to come out here and then put themselves in front of you guys, I just, I ask that, you know, you listen to them with like open hearts and please pass this on to the mayor, and thank you so much for listening to us today. Thank you.

LAURA THOMAS: Good evening, Commissioners, I'm Laura Thomas, the Interim State Director for the Drug Policy Alliance. It's great to see all of you here, and I want to first of all thank the leadership from the Department of Public Health on this issue, with Barbara Garcia, Colleen Chawla, other folks in the department who've really taken the lead on this, and say thank you for that.

And I encourage the Health Department in the city and county of San Francisco to be bold on this. We know what works, we know what saves lives, and it's supervised consumption services. In Canada for example they've gone from one to over 25 this year, and they've done that because they had a change in their federal government, and a change of approach, and a change of political will, and it's become essentially non-controversial there, and I look forward to when that happens here.

And, I think it is incumbent on San Francisco to lead the way for that. You heard earlier that we don't have the overdose and opioid crisis that they do in other parts of this country, but that's a matter of time. It's a matter of fentanyl making its way into our drug supply and poisoning the drugs here as it has in other parts of the country.

We need to step up and provide these types of services and increased access to treatment before it's too late, rather than after. So, you know, from the Drug Policy Alliance perspective, we are delighted to continue to partner with the Department of Public Health, support all of you, help figure out how we can make this happen here in San Francisco, as well as across the state and across the country. That includes Assembly Bill 186, which we are happy to have co-sponsored and hope to have the full support of the Health Department as it moves forward.

You know, this is an intervention that has been supported by the American Medical Association, the California Society of Addiction Medicine, thank you, the San Francisco Marin Medical Society. It's a clear public health intervention, and thank you for taking a public health lead on this.

ALEX KRAL: Hello, my name's Alex Kral. I'm an epidemiologist, work at RTI International here in San Francisco. I've been conducting research respecting -- regarding people who inject drugs here in San Francisco since 1993. I want to thank you all for the time here, and I really want to thank the Department of Public Health under Barbara Garcia's leadership, the whole team there's been fantastic through this. I was a task force member, and it was just a very well run task force, and very productive, I think, as well.

You know, half a million Americans have died of overdose since 2000. I mean, that's just, I mean, half a million. It's really ridiculous, half a million people. We're really in a situation here, well, we are in a crisis, and what we need is innovative solutions, and here's one that's been shown to work throughout the world. Right? It's in, all over Europe, Australia, Canada. The research is very clear on this, right, you reduce overdose deaths, you reduce HIV, viral hepatitis and hepatitis C, abscesses, you link people into drug treatment.

You know, we have a ton of research that's shown all of these things. And then at the other side, it really helps the community. Right? So you reduce the number of discarded needles in the streets, you reduce crime, violence around these sites, and also public perception of the sites increases actually once you institute them, so in Sydney, the site there, they were all concerned about it in the neighborhood, then they actually had one of these models start, and after -- a year after that, public perception in the neighborhood was actually higher than before, about these sites.

So, it's actually something that's a good part of community practice in general, and I think we've seen that, the research is very clear on it. And the research that's been shown here of course, a lot of it's been our research. We would save three and a half million dollars a year, that's beyond the costs of running these, and that's probably an under-estimate.

DOUG MCVAY: You just heard Holly Bradford, Laura Thomas, and Alex Kral, speaking at the San Francisco Board of Supervisor’s Health Commission meeting November Seventh regarding the report by the supervised injection facility task force.

And for now, that's it. Thank you for joining us. You have been listening to Century of Lies. We're a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I’ve been your host Doug McVay, editor of DrugWarFacts.org. The executive producer of the Drug Truth Network is Dean Becker. Drug Truth Network programs are available via podcast, the URLs to subscribe are on the network home page at DrugTruth.net.

The Drug Truth Network is on Facebook, please give its page a like. Drug War Facts is on Facebook too, give its page a like and share it with friends. Remember: Knowledge is power. Follow me on Twitter, I'm @DougMcVay and of course also @DrugPolicyFacts.

We'll be back next week with thirty more minutes of news and information about the drug war and this century of lies. For now, for the Drug Truth Network, this is Doug McVay saying so long. So long!

For the Drug Truth Network, this is Doug McVay asking you to examine our policy of drug prohibition: the century of lies. Drug Truth Network programs archived at the James A. Baker III Institute for Public Policy.

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