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In Act of Civil Disobedience, Activists Set Up Safe Drug Consumption Site in San Francisco

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A person with long hair smokes meth through a red pipe.
David Helgren smokes meth at a safe drug consumption site created by volunteers with Concerned Public Response in San Francisco on Aug. 31, 2023. (Martin do Nascimento/KQED)

At least two lives were saved on Thursday at a supervised consumption site in San Francisco, also known as an overdose prevention site, where residents can consume drugs in a safe environment and trained staff are able to prevent overdoses. With the city on track this year to record the highest number of overdose deaths yet, the site was organized by public health advocates as a way to put pressure on leaders to open such a facility permanently.

“This is a public response to the fact that there are nearly three people a day dying of overdose in San Francisco. While we continue to talk about how to best prevent loss of life, people continue to die,” said Lydia Bransten, who was volunteering at the event. “So today is a day of action, where we are saying ‘Look how easy this is.’ It’s a very simple response to a complicated issue.”

A person with blue-rimmed glasses stands beside some tents outdoors.
Lydia Bransten, a member of Concerned Public Response, volunteered at the safe consumption site. (Martin do Nascimento/KQED)

The set-up was simple: Two E-Z UP tents were stationed in an alleyway between Polk and Van Ness on Willow Street, and underneath, people could smoke or inject their pre-obtained drugs in a safer and more private setting than on the sidewalk or elsewhere out in the public. Trained staff were present to supervise and provide water and snacks, or to administer Narcan and respirators in the event of an overdose.

Organizers set up the site after long delays by city leaders in opening planned “wellness hubs” with these safe consumption services. The city has already allocated $18.9 million to open the wellness hubs, which would include a variety of health and hygiene services for people experiencing homelessness or substance use disorder. Private funding would then be used to support safe consumption services, which research shows help reduce overdose deaths and operate in nearly 200 places around the globe.

Supporters like Bransten said that the sites are meant to be one part of a broader coordinated response to overdoses and substance use disorder, alongside expanded treatment options, mental health care and housing opportunities.

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The pop-up event, held on International Overdose Awareness Day (Aug. 31), comes as San Francisco is currently on pace to have its highest year for overdose deaths, exceeding the record set in 2020 when 725 people lost their lives to drug overdose. In the first half of this year, 473 people died from accidental drug overdose in San Francisco, according to the medical examiner’s office.

The majority (80%) of those deaths involved fentanyl, an opioid 50 times stronger than heroin.

In addition to the safe consumption site, volunteers spoke with people in the area about safer ways to consume drugs, treatment options, and handed out donuts and water to anyone who was simply hungry.

A group of people congregate around a table in an outdoor setting.
Michael Scarce (second from left) greets a community member visiting the safe drug consumption site created by volunteers with Concerned Public Response. (Martin do Nascimento/KQED)

The site was not only a demonstration of civil disobedience — Gov. Gavin Newsom vetoed a bill in 2022 that would have allowed San Francisco to pilot the sites — but also a functional facility. At least two overdoses were reversed at the site on Thursday.

“This is exactly what we are here to do. If we can prevent even a fraction of the overdose deaths, that’s important,” said Eli Smith, an EMT who helped reverse an overdose at the site on Thursday. “It was really great to be able to help out.”

J.M., who did not use a full name to protect his privacy, was staying in the alley where the demonstration took place, and noticed his friend stopped breathing after consuming fentanyl. So he hurried down to the other side of the alley, where the site was set up, and grabbed Narcan. Smith, the EMT, grabbed his medical kit and ran to follow J.M. to the friend, who was lying unresponsive on the sidewalk behind a concrete divider.

J.M. administered two rounds of Narcan, a nasal spray that can reverse an opioid overdose, and Smith followed with a respirator pump to provide oxygen. Soon, J.M.’s friend was breathing and slowly back on his feet, and paramedics arrived on scene to follow up. The friend chose not to leave with the paramedics, and walked away on foot.

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“You saved his life,” Supervisor Hillary Ronen, who was at the safe consumption site on Thursday supporting the volunteers, told J.M.

Volunteers at the demonstration also handed out clean needles, which can prevent transmission of HIV and Hepatitis C between drug users, as well as other supplies to cut down on the physical harms associated with drug use, like alcohol wipes, fentanyl test strips and clean smoking supplies.

Tom, Rich and Henry, who didn’t share their last names due to privacy concerns, heard about the site after organizers reached out to people living on the streets nearby. They walked over to pick up Narcan, wipes and clean needles, and they used the supervised consumption area.

“It’s pretty incredible how accessible this is,” said Tom. “We come across people that really do need this. We need way more [sites like this].”

The three men have all lost friends to overdose. Narcan, they said, has been an incredible tool to keep each other alive, but said it can be scary to use without a medical professional present. The trained staff on site gave them more reassurance that they would be okay, Tom said.

“People are going to use drugs no matter what, you know? Why not have a safe place where you can make sure people don’t die and there aren’t predators hanging around when you’re using,” Tom said.

A sidewalk covered with people's names and drawing of hearts.
A memorial to deceased loved ones at the safe consumption site. (Martin do Nascimento/KQED)

Safe consumption sites can also provide other essential services like showers and laundry, free meals, and sign-ups to housing or drug treatment.

Sky and Q, who declined to share their last names, are currently living on the street near where the site was set up. They picked up some donuts, water and a glass pipe from the booth, and even ran into some friends.

“I try to use all the drop-in resources like this, this stuff is really helpful. I always keep Narcan on me in case someone needs one,” said Sky, 20. “I think people would see a lot less of what they don’t like seeing, like shoplifting and stuff, if we had more of this. It helps provide things people can’t get for themselves.”

More than 200 safe consumption sites operate globally, including in countries with multiple sites like France, Germany and Norway. Zero overdose deaths have been recorded in these facilities.

But San Francisco and California government leaders have long delayed opening safe consumption sites, which are also known as overdose prevention centers.

The Tenderloin Center, in United Nations Plaza, offered safe consumption services while it was open for 11 months in 2022, before city officials closed it down.

But local businesses complained that the facility drew crowds of people waiting for services just outside the Civic Center BART station, and other residents and political leaders criticized the model for failing to connect many people to longer-term drug treatment.

Inside the Tenderloin Center, however, hundreds of people arrived daily to get their basic needs met. In total, 333 overdoses were reversed by trained staff there and no one died on the premises, research on the facility shows.

Smith, the EMT who helped reverse overdoses at the demonstration on Thursday, witnessed hundreds of overdoses reversed at the Tenderloin Center while he was working there.

One woman at the pop-up site on Thursday said she would visit the Tenderloin Center “everyday” back when it was still open for a hot meal, showers and a safe place away from the sidewalk to smoke.

Two tents set up on a sidewalk on a city block.
The Concerned Public Response safe drug consumption site on Aug. 31, 2023. (Martin do Nascimento/KQED)

Mayor London Breed, whose sister died of a drug overdose, supports supervised consumption services. But opening one in San Francisco has been a slow battle. Gavin Newsom vetoed legislation that would have allowed the city to pilot the services. Meanwhile, Rhode Island and New York City have moved ahead with plans and programs despite legal uncertainties.

“The mayor continues to support safe consumption sites. These are complicated legal issues that we continue to navigate with our nonprofit partners,” a spokesperson from the mayor’s office said in an email to KQED.

After Newsom’s veto, San Francisco leaders funded so-called “wellness hubs” instead, to serve as low-barrier drop-in health facilities that could offer similar services as the Tenderloin Center, with a private nonprofit funding and running the safe consumption sites at these hubs, similar to the model used in New York City.

Supervisor Ronen stressed that opening up wellness hubs with safe consumption sites is a priority in her remaining time in office.

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“Overdose prevention sites, they are not a nefarious, scary thing. Take a look at one in public. We are offering a space where we can watch people to make sure they don’t die. That’s it, it’s that simple,” said Ronen. “We want to provide love, tell people we care about them, and want to support them to eventually get into treatment and get well. But in the meantime, we need to keep them alive to get there.”

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