Newsom’s veto bids undermine safe injection sites

Last week, California Governor Gavin Newsom (D) vetoed a bill that would have allowed 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 has long been a supporter of harm reduction strategies, but argued he was concerned about launching such sites without “committed local leadership” and plans to maintain the Site (s.

He warned that the “unlimited number” of sites the bill would have allowed “could bring about a world of unintended consequences” in San Francisco, Los Angeles and Oakland, and exacerbate “problems with drug use”.

Melissa Moore, JD, director of civil systems reform at the Drug Policy Alliance, said the bill allows “four specific jurisdictions” — San Francisco, Los Angeles, Los Angeles County and Oakland — to open centers overdose prevention, and would not. caused the kind of explosion of sites described by the governor.

“Unfortunately, what we’re doing now is the kind of worst-case scenario that Governor Newsom and others are trying to use as a scare tactic… We’re already living this reality, where public restrooms are closed, because there’s a concern that people are going to use 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 of the benefits of state authorization would have been the legal protection given to doctors, nurses, social workers and other state-licensed individuals, explained Alex Kral, PhD, an epidemiologist at the Institute for Research in health non-profit RTI International.

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

Although clinicians can work in these settings, they can put their careers at risk, Kral noted.

Additionally, without authority to release city, county and state public health funding, it will still be difficult for programs to open and cover the costs of the work they do, Moore said. .

Newsom said he would direct the city’s health and human services secretary and county officials to determine “minimum standards and best practices” to develop safe and sustainable programs that could be recommended to the legislature of the state.

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

(MedPage today previously covered some issues regarding the debate over the merits of the harm reduction model.)

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

New York

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

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

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

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

“The fact that OnPoint not only offers the overdose prevention center but also has on-site showers…has laundry facilities, a drop-in center and many comprehensive 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 it really shows the potential of overdose prevention centers,” said Moore.

New York Mayor Eric Adams voiced his support for the sites and in late May tweeted about the move to a 24 hour model.

“For this to happen, getting permission from the state in New York will be really important,” Moore said, something advocates have been asking New York Governor Kathy Hochul (D ).

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

philadelphia cream

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

Provisions of the Controlled Substances Act, dubbed the “Crack Houses Act,” prohibit operating, owning, or renting a site for the purpose of using, selling, storing, or manufacturing dope.

The Biden administration appears less “antagonistic” toward these sites, compared to the Trump administration, Moore noted. Under President Biden, the White House funded harm reduction programs for the first time in its budget, and although the amount fell short of what was needed, Moore was encouraged.

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

While New York City didn’t wait for DOJ approval, Safehouse always believed it was best to open “in the light,” Goldfein said. Not only will this reduce stigma, but it will also facilitate the search for institutional partners and funding, to ensure the sustainability of the program, she said.

And as she said MedPage today previously, the band is also not inclined to ignore a court ruling.

“Ideally, we come to an agreement, which allows for appropriate boundaries,” or “guardrails” as the DOJ calls 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 postponed several times since the end of 2021).

While Goldfein said she doesn’t expect the deal to close by September, she expects a response “by the fall.”

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

Rhode Island, Other Cities

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

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

“It will be a month-long process, considering all the approvals required at the municipal and [s]state level, as set forth in Rhode Island regulations. The current pilot program ends in 2024,” she noted in an email.

Momentum around expanding overdose prevention sites continues to build in cities like Chicago and Baltimore, Moore said.

In July, local activist group BRIDGES Coalition set up a “fictitious 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 the city lost more than 1,000 people to overdoses in 2020. “It’s one intervention, one of many, and it can save lives. “, she said.

  • Shannon Firth has reported 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