Illustration by Leo Gordon
Drug abuse has become a crisis in San Francisco. There are estimated to be 22,000 users of intravenous drugs in the city, and in many neighborhoods, used needles have become a common sight on the streets. The problem exists throughout the country, with over 60,000 drug overdose deaths in 2016.
The city of San Francisco has proposed an unorthodox solution to this problem. Mayor London Breed has proposed opening two “safe injection sites,” where drug addicts can inject under supervision and with safe materials. The sites also have information about safe injection practices and referrals to treatment services. Safe injection sites might sound radical, but the evidence shows it’s worth a shot.
According to their backers, this drug use will happen no matter what. Safe injection sites just ensure that it happens without the risk of blood-borne disease. When tested in Sydney, Australia, nearly half of users reported safer injection practices. Another trial in Vancouver, Canada, was estimated to save between $1.50 and $4 in health costs for every dollar spent.
They certainly seem effective. Why don’t we have them already? For one, not punishing drug users is a shift from decades of policy. But another reason is the sites may be illegal under federal law.
Since San Francisco’s sites will be the first in the nation, no court has yet ruled on their legality. However, the sites could be construed to violate the Crack House Statute, which makes it a felony to “knowingly open, lease, rent, use, or maintain any place, whether permanently or temporarily, for the purpose of manufacturing, distributing, or using any controlled substance.” The Justice Department certainly intends to construe it that way; Deputy Attorney General Rod Rosenstein pledged “swift and aggressive action” against any city operating a safe injection site. Many activists argue that since the Crack House Statute clearly referred to, well, crack houses, it doesn’t apply to safe injection sites.
Just because there are murky legal concerns, does not mean that we shouldn’t move forward with a lifesaving program. Safe injection sites aren’t a cure-all. Less than one in 200 visitors to the Sydney site were referred to treatment and followed up on it, and there’s no indication the U.S. would be any different.
Although they actually saved more in reduced health-care costs in Sydney and Vancouver then they cost to operate, it’s questionable that those savings could be replicated in the U.S. But just because safe injection sites aren’t a cure-all is no reason not to try them. They’ve saved lives in Sydney and Vancouver, and they’ve saved lives in the myriad other places they’ve been tried. They might not be perfect or traditional, but they work. At the very least, they’re worth a shot.