San Francisco Considers Nation's First Safe Injection Site for Addicts

City health officials took the first tentative steps toward opening America's first legal safe-injection room, where addicts could shoot up heroin, cocaine and other drugs under the supervision of nurses.

Hoping to reduce San Francisco's high rate of fatal drug overdoses, the public health department co-sponsored a symposium Thursday on the only such facility in North America, a 4-year-old Vancouver site where an estimated 700 intravenous users a day self-administer narcotics.

Hundreds of community activists and health workers attending the forum also discussed what it would take to get a similar service going here and heard recovering addicts talk about why they think it is a good idea.

Organizers of the daylong forum, which included a coalition of nonprofit health and social-service groups, acknowledge that it could take years to get an injection facility up and running. Along with legal hurdles at the state and federal level, such an effort would be almost sure to face political opposition.

Bertha Madras, deputy director of demand reduction for the White House Office of National Drug Control Policy, called San Francisco's consideration of such a facility "disconcerting" and "poor public policy."

"The underlying philosophy is, 'We accept drug addiction, we accept the state of affairs as acceptable,"' Madras said. "This is a form of giving up."

Sixty-five similar facilities exist in 27 cities in eight other countries, but no other U.S. cities have considered creating one, according to Hilary McQuie, Western director for the Harm Reduction Coalition, a nonprofit that promotes alternative drug treatment methods.

"If it happens anywhere in the U.S., it will most likely start in San Francisco," McQuie said. "It really just depends on if there is a political will here. How long it takes for that political will to develop is the main factor."

Drug overdoses represented about one of every seven emergency calls handled by city paramedics between July 2006 and July 2007, according to San Francisco Fire Department Capt. Niels Tangherlini. At the same time, the number of deaths linked to overdoses has declined from a high of about 160 in 1995 to 40 in 2004, he said.

Colfax estimated that there are between 11,000 and 15,000 intravenous drug users in San Francisco, most of them homeless men. Like many large U.S. cities, the city operates a clean-needle exchange program to reduce HIV and hepatitis C infections.

In Switzerland, Spain, Australia and other European countries with such programs, the sites have been placed in existing public health clinics and created as stand-alone facilities, said Andrew Reynolds, a program coordinator with San Francisco's city-run sexually transmitted diseases clinic.

Possible locations for opening one in the city include homeless shelters, AIDS clinics or drug treatment centers, he said.

"They aren't these hedonistic dens of iniquity," Reynolds said. "There is no buying or selling of drugs on the premises. Staff do not assist in injections."

While it's too early to tell what the room in San Francisco would look like, Vancouver's InSite program is located on the upper floor of a low-rise building in a downtown neighborhood where drug users shoot up in the open.

The site, exempt from federal drug laws so users can visit without fear of arrest, has 12 private booths where its 8,000 registered users inject drugs such as heroin, cocaine or crystal meth, running through as many as two million needles a day. They can use equipment and techniques provided by the staff, and then relax with a cup of coffee or get medical attention in the "chill out" room where they are observed, said program coordinator Sarah Evans.

"It looks kind of like a hair salon," Evans said of the bustling space. "If we were a restaurant, we would be making a profit."

Thomas Kerr, a University of British Columbia researcher who has studied the program, said that while 800 overdoses have occurred on the premises, none resulted in death because of the medical supervision provided at InSite. His research also has shown an increase in addicts seeking drug treatment and a decrease in abandoned syringes, needle-sharing, drug-related crime and other problems since the clinic opened, he said.