To Open Safe Consumption Sites, San Francisco Seeks Private Donations for Nonprofits

Update, 11:30 a.m. Wednesday: A proposal (PDF) moved forward on Wednesday that could allow San Francisco Mayor London Breed and the city’s Department of Public Health to solicit donations that nonprofits and other private organizations could utilize to operate safe consumption sites, facilities where people can smoke or inject drugs in a medically supervised setting.

The proposal would waive a new governmental rule, put in place after a recent corruption scandal between Public Works staff and the garbage collector Recology, that restricts city employees from seeking private donations. The funds would go directly to the nonprofits themselves.

The city’s budget and finance committee unanimously passed the proposal. The full Board of Supervisors must still review and approve the waiver before it will go into effect.

“This is an area where it is appropriate to solicit private donations to help pay for this, and it’s important,” said Supervisor Rafael Mandelman.

If passed, it would be the second time the Board of Supervisors has made an exception to the behested payments ordinance. The first waiver occurred in January, when supervisors unanimously approved an exception to solicit donations for Civic Bridge, a 16-week cohort-based program that allows private businesses to work on innovation projects for the city.

“We are grateful to have the Board of Supervisors understand the importance of supervised consumption sites,” a member of the Safer Inside coalition, an overdose prevention advocacy group, said during public comment at the committee meeting Wednesday. “We need to do everything we can to allow for opening these as soon as possible, and this resolution represents one more step towards making that a reality.”

Original story: San Francisco supervisors this week unanimously approved a measure allowing nonprofits and other private organizations to open and operate safe consumption sites, where users can smoke or inject high-potency drugs under close medical supervision. No such sites currently exist in the city since the closure of the Tenderloin Center in December.

But without a guaranteed funding source, the timeline for when the first “overdose prevention centers,” as they’re known, might open is still largely unclear. Under the legislation, nonprofits will have to cobble together the sizable amount of funding needed to run the sites, which by one recent estimate could each end up costing well over $1 million a year.

“There is opening up a site, and then there’s opening up a site and doing it the right way with the best achievable outcomes because it’s well-funded,” said Lydia Bransten, executive director of the Gubbio Project, which hopes to open a site in the Mission District by the summer. “And we want to open a site that is adequately funded so we can have a skilled team of people, proper equipment and environment.”

Bransten’s vision hinges largely on whether city leaders will allow cash-strapped groups like hers to dip into the $120 million windfall San Francisco recently amassed from successful opioid-related lawsuits against pharmacies and drug manufacturers. The city, however, has yet to commit to making that money available, given the inherent legal concerns: The sites are still technically prohibited under state and federal law.

Without access to that, some public health advocates worry that most nonprofits won’t have the resources to quickly open and run the sites, which they argue are desperately needed to tackle the city’s ongoing overdose crisis.

Since 2020, more than 2,000 people in the city have died of drug overdoses, according to San Francisco’s Office of the Chief Medical Examiner.

“We are way over time for this,” said Supervisor Hillary Ronen, who introduced the ordinance in January, with the backing of Mayor London Breed.

Bransten, Ronen and other supporters of safe consumption sites are now urging that the city release the funds, which are specifically earmarked for overdose prevention.

“The key to open these doors is in the city attorney’s pocket,” Bransten added.

Safe consumption sites are foremost aimed at keeping chronic users alive and connecting them with rehabilitation services. Although the sites have operated for years — with mostly positive results — in Canada, Australia and multiple European countries, the concept has stoked intense controversy in the United States, and been largely left out of the overdose-prevention strategy playbook.

San Francisco’s new legislation sanctioning the sites comes just over a year after the city opened the short-lived Tenderloin Center in United Nations Plaza, its first full-scale, publicly funded safe consumption site. The hub offered meals, showers, laundry and social services, along with spaces where visitors could inject or inhale illicit drugs under the supervision of staff members equipped with naloxone, a nasal spray used to reverse opioid overdoses.

More than 330 overdoses were reversed during the site’s 11 months of operation, according to city data, and zero overdose deaths occurred on-site.

Despite that achievement, many people remained wary of the drug use happening inside the site. Critics, including a number of nearby businesses, complained the site was too centrally located, and said that the hundreds of people who lined up outside every day waiting for services caused major disruptions in the neighborhood.

The program, some argued, also lacked coordination with law enforcement, which they say was needed to keep drug dealers from swarming the area and to stop patients from consuming drugs outside with site-provided paraphernalia immediately after walking out the door.

In June, just months after Breed heralded the new program as a key part of her state-of-emergency initiatives in the Tenderloin, the mayor announced — to the dismay of advocates — that the site would be shuttered by the end of the year, arguing it was never intended to be a permanent location.

The current legislation allows San Francisco to open safe consumption sites that are run and funded by private groups, partially shielding the city from the potential legal repercussions of operating programs that violate federal law.

And rather than a single central site location, like the Tenderloin Center, the new approach would create multiple smaller “wellness hubs” in various neighborhoods throughout the city, each equipped with safe consumption services and other resources.

City Attorney David Chiu, whose office litigated the major opioid trials, said he supports the nonprofit operating model outlined in the new legislation, but has yet to sign off on allocating the funds for the sites without clear federal guidelines and approvals.

“Our office continues to monitor any developments in the law, and we eagerly await anticipated guidelines from the federal government on how local governments can operate overdose prevention programs in compliance with federal law,” Chiu said in an email. While the Biden administration has expressed some interest and support for the sites, it has yet to formally sanction them, he noted.

Chiu said he hopes those involved “can focus less on the things we can’t do that unnecessarily increase risk and instead focus on the things we can do to make this a reality in San Francisco.”

Meanwhile, other city departments are seeking ways to privately fundraise for the sites. On March 15, the city’s Budget and Finance Committee will vote on an item that would make an exception to the city’s behested payments rule and allow the mayor’s office and the Department of Public Health to solicit donations for the sites.

Bransten joined Ronen and fellow Supervisor Matt Dorsey last week on a tour of a pair of safe consumption sites in New York City — the only two currently operating in the entire country. The trip also included a visit to meet with the attorney general in Rhode Island, which in 2021 became the first state to authorize safe consumption services, but has yet to open any centers.

“It was an amazing experience and honestly I was choked up the entire time,” said Bransten of the New York sites, called OnPoint, which are also run and funded by private groups. She described them as offering a calm, clean and welcoming environment where patients appeared to be well-cared-for.

Nearly 400 overdoses were averted in OnPoint’s first year of operation, and there were no recorded overdose deaths at the sites, according to city officials. New York Mayor Eric Adams has expressed support of expanding the model.

Dorsey, who supports directing some of San Francisco’s settlement dollars to safe consumption sites, noted that the two sites in New York also appeared to have brokered a strong relationship with law enforcement, which helped maintain safety and order in the surrounding communities.

“They are a good neighbor. This is not a neighborhood nuisance at all. It’s Exhibit A for how to do this right,” Dorsey, who has spoken publicly about his own experiences with substance use disorder, said of the New York sites.

“San Francisco is a lightning rod in American politics. It can be scary to be in a position where the feds are coming after you,” Dorsey added. “But I’ve seen our city attorney act boldly and aggressively for righteous causes. I think we are in another one of those moments, and I’m hoping there is a creative solution.”

This story was originally published on March 11.