Pubdate: Thu, 24 Mar 2016
Source: SF Weekly (CA)
Column: Chem Tales
Copyright: 2016 Village Voice Media
Author: Chris Roberts


In San Francisco, no game of NIMBY bingo is complete without a 
complaint of "used needles."

In Chronicle columns, letters to the editor, and harrowing tales of 
urban living, evidence of heroin use ends up everywhere: in 
children's sandboxes, at Muni stops, and anywhere else people walk. 
For once, this problem could possibly be understated. As this column 
has pointed out before, it's a small wonder we aren't all swimming in 
discarded syringes: San Francisco is experiencing a needle boom.

In 2013, just one of the city's many needle-exchange programs handed 
out three million clean hypodermic syringes; in 2015, according to 
Department of Public Health spokeswoman Nancy Sarieh, health workers 
passed out 3.8 million. (While the city keeps a tab, most of the 
needles are paid for by nonprofits like the San Francisco AIDS 
Foundation. The city must keep its hands clean, after all.) This 
figure excludes any needles purchased at a Walgreen's when the 
needle-exchange programs, generally open just a few hours a day, 
aren't available.

This is a remarkable number, considering health officials estimate 
there are "only" between 13,000 and 16,000 heroin users in the city. 
That number, the official tally as of last summer, is likely 
outdated, if San Francisco's opiate users are following the trend 
seen around the country.

Heroin never left America. But as a topic of debate, heroin use is 
back with a vengeance. The epidemic and what to do with it has been a 
political football tossed around at the Republican presidential 
debates. The main reason why might be called the 
"pharmaceutical-police complex." For years, physicians 
over-prescribed prescription pain medication, with some docs willing 
to write a prescription for nearly unlimited Vicodin for anyone with 
a few extra dollars. Wherever police shut down one of these pill 
mills, their "success" yielded a population of opiate addicts with 
nowhere to turn for a fix other than the street. Instead of Oxy, they 
turned to heroin.

It remains to be seen whether the city's pill users are making this 
same shift. If they are, there are likely to be many more heroin 
users in town than previously thought: Fatal heroin overdoses dropped 
to about 10 a year between 2010 and 2012, the most recent data 
available. During that same time frame, there were 100 annual fatal 
overdoses from prescription pills.

To deal with this public health crisis, elected officials and law 
enforcement authorities in Seattle are taking a long, hard look at 
supervised injection sites - places where heroin users can access 
needles and even slam a dose home under the eyes of health workers.

If someone overdoses, there are shots of anti-overdose drug naloxone 
nearby. If someone decides they're tired of the life and wants 
services - the catch-all term for the government's solution to the 
decades-long economic and mental health conundrum we call 
"homelessness" - they can get that, too.

Vancouver has had supervised injection sites for some time as well. 
So far, it's the only city in North America to try them out.

In San Francisco, this notion is enormously popular - even more 
popular than legalizing marijuana, according to a recent poll.

As the Chronicle first reported last Sunday, a poll paid for by the 
Drug Policy Alliance revealed 72 percent support for supervised 
injection sites. And this from a population consisting mostly of 
white people over 65, traditionally the city's bastion of 
conservatism. By contrast, these same respondents offered "only" 68 
percent support for legalizing cannabis.

But with the man calling the shots, safe injection is a total 
nonstarter. Mayor Ed Lee has a "vigorous disagreement" with the idea 
of safe injection sites and with "wet houses," where street people 
addicted to alcohol are housed and allowed to drink. (Seattle, Lee's 
hometown, has had a wet house for several years. Health officials 
claim it's working.)

It's not entirely clear why Lee is so opposed to these 21st-century 
innovations in winning the real drug war. The city began its needle 
exchange programs to cut down on the transmission of HIV among 
intravenous drug users. By all metrics, it has succeeded. Two years 
ago, without discussion or much explanation, Lee nixed a proposal to 
do the same with crack pipes - whose users skew black, as opposed to 
heroin users, who skew white.

Christine Falvey, the mayor's spokeswoman, says Lee wants to put more 
people into treatment "and not focus on a city-funded injection center."

That appears to be happening, as the number of people in methadone 
treatment in San Francisco increased from about 2,000 in 2013 to 
almost 3,000 last summer, the most recent data available.

But incredibly, Lee is also answering the drug problem with a 
decidedly exploded 20th-century solution: more police.

In December, following a speech on homelessness, Lee directed the 
Police Department to step up enforcement and arrest people selling 
drugs near homeless "shelters and treatment centers," Falvey told SF 
Weekly on Tuesday.

It was not immediately clear if the program has launched, but the 
mere suggestion is staggering. The innovation mayor of San Francisco 
has responded to a drug problem with the Nixonian strategy of calling 
in the cops. What could possibly go right?

In a fine twist, police are some of safe injection's biggest 
supporters. "As long as there was strong, very strong, emphasis on 
education, services and recovery, I would say that yes, the benefits 
[of safe injection] outweigh the drawbacks," King County Sheriff John 
Urquhart told the Los Angeles Times.

Laura Thomas, the Drug Policy Alliance's deputy state director, 
believes Lee will "come around" on safe injection. But it seems clear 
drug reform will never be a San Francisco priority as long as Lee is mayor.

Lee has famously never visited a marijuana dispensary - and cannabis 
is at least a $150 million annual industry in the city. What are a 
couple of junkies - or a couple million needles - compared to that?
- ---
MAP posted-by: Jay Bergstrom