Lawmakers in California are debating whether to open sites where people can inject or snort illegal drugs under the watchful gaze of a health care worker. These facilities are an effort to save lives as overdoses skyrocket across the country.
"Instead of having people use drugs on the sidewalk when your kid is walking by, we want to give them a place where they can go inside," said state Sen. Scott Wiener, D-San Francisco, the sponsor of a bill to pilot facilities in Oakland, San Francisco and Los Angeles.
Wiener stresses that so-called "safe consumption" or "supervised injection sites" would not only prevent overdoses, but also slow the spread of HIV and hepatitis by offering clean syringes.
The last time supervised injection facilities were on the table in California, in 2018, the bill progressed all the way to Gov. Jerry Brown's desk. He vetoed it. Wiener is trying again. He points to a recent cost-benefit analysis demonstrating that every dollar spent on safe consumption in San Francisco would save the city $2.33.
"Our hospitals, our emergency rooms, our fire department, our ambulances are all spending huge resources on people who are overdosing," Wiener said.
Gary McCoy, who was formerly addicted to heroin and then methamphetamine, says he wishes he would have had a safe place to shoot up before he hit rock bottom and nearly died.
He overdosed on heroin for the first time when he was 18 years old, at a gas station. The store attendant called 911 when McCoy deliriously crawled out of the bathroom and collapsed.
"I immediately went back to my dealer's house from the hospital and bought everything that she had because it was the best heroin I had ever done," he said.
At the time, McCoy was grappling with his sexuality in a conservative town in Virginia.
"I wasn't quite in the closet," said McCoy. "But I wasn't really open about the fact that I was gay."
He spent the next decade high, homeless and near the brink. At 24 years old, McCoy learned he was HIV-positive. He was staying in a cheap hotel in San Francisco alone. It was Christmas Eve.
"I weighed 110 pounds, psoriasis was all over my body, I was injecting every day, couch-surfing when I could, and trading sex for drugs or a place to sleep."
When he didn't have anywhere else to shoot up, McCoy used bathroom stalls at public libraries.
"I think if I had a place to go where I could safely use, where people could see that I needed medical assistance, I think it would have avoided a lot of trauma," he said.
McCoy says he spent lots of time in jail spread over many arrests, and landed in the emergency department monthly for at least a decade as his drug habits and AIDS ravaged his body.
A safe consumption site can range from a converted RV to a sprawling warehouse. Inside, it typically looks somewhat like a hair salon, with mirrors lining the walls, individual stalls for each client, and sterile supplies laid out on steel countertops.
"You'll have two rooms," said Alex Kral, epidemiologist for the nonprofit research group RTI International. "The first room is where people can inject under supervision. And then you have a second room where people can basically chill out after they have used drugs and be monitored."
Health care workers equipped with "crash carts" stocked with naloxone and other life-saving tools stand by to prevent fatal overdoses. The goal is also to inspire people to seek treatment and to connect them to primary care and social services.
Rhode Island greenlighted supervised injection sites last year, but nothing has launched yet. New York City opened two sites last fall. Around the world, more than 100 safe consumption sites exist in more than a dozen countries.
"There have probably been tens of millions of injections people have done in these sites over the last 35 years," said Kral. "And no one has ever died of an overdose."
Yet, just last year, more than 10,000 people in California and more than 100,000 people nationwide died of an overdose on the streets, at parties or at home.
"That number is really underreported because there are parts of the country that don't have the resources to do toxicology screens on every death," said Ron Brooks, president of the National Narcotic Officers' Associations Coalition.
He estimates the accurate tally could be as high as 140,000 deaths nationwide, which is why he says the overdose crisis is the most significant public health epidemic facing the nation. However, Brooks does not support opening "safe consumption sites" to solve the problem because, he says, there is no safe way to do drugs.
"You can call it what you want to call it. It's an open drug scene," said Anne Marie Schubert, Sacramento County district attorney. "The fact that we're considering allowing our government to essentially aid and abet the illicit use of drugs that are killing our citizens, I find shocking."
Schubert would rather see more court-ordered treatment. She says current law does not allow judges to require nearly enough people to seek help.
However, Gary McCoy says you can't force sobriety. When he finally limped into treatment, AIDS had nearly wiped out his immune system. In fact, he was in such ghastly shape that his drug dealer finally nudged him to seek help, which is why he's now a huge advocate for supervised injection sites.
"I don't know if I would have stopped using sooner, but I certainly would have been in much better hands," he said.
These days on morning strolls through his neighborhood in San Francisco, McCoy chats with people getting high on the streets. He lets them know there's help available – that's the critical nudge outreach workers at safe consumption sites could provide.
The California state assembly must still pass the bill before it would go to Gov. Gavin Newsom, who would decide whether to sign it into law. If it passes, piloted sites would be in operation until Jan 1, 2027. While facilities are open, officials would collect data to determine how effective they are.
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