Overdose prevention reaches a crossroad in San Francisco

Kids and drug customers stuffed United Nations Plaza by the Tenderloin on a current Saturday afternoon, the place up till a number of weeks in the past, the town operated an overdose prevention website.

Little women in flowing costumes got here spilling out of the close by Orpheum Theater, excessive off the fantasy of magical royalty after a matinee of “Frozen: The Musical.”

They skipped by a person sprawled on the sidewalk consuming a strawberry ice cream cone, support employees handing out the overdose reversal remedy Narcan and police halfheartedly rousting road distributors promoting oranges, Christmas lights and cigarettes.

These utilizing unlawful medication weren’t onerous to identify. They burned fentanyl and meth off squares of tinfoil, sucking the smoke by way of glass straws as dad and mom pulled youngsters alongside, eyes averted.

A lady and little one stroll handed a homeless drug person at UN Plaza in San Francisco.

(Josh Edelson / For the Occasions)

“It’s such as you’re a illness,” Richard Okeefe informed me as he rolled by way of in a wheelchair. He’s a former customer to the overdose prevention website and an opioid person, and his ft are too swollen from congestive coronary heart failure to stroll. “You’re telling me my existence isn’t value a good day.”

The way you react to this description of a typical day in San Francisco — outrage or sorrow — in all probability sums up your view of secure consumption websites and our dealing with of the newest drug disaster to hit American streets.

Ought to we spherical up the customers within the plaza, demand they enter therapy or go to jail? Wouldn’t it be higher to allow them to do medication someplace secure and out of the general public view, till they select to give up — or don’t?

Of all of the polarities that divide our politics proper now, these dueling responses to the opioid addictions of unsheltered folks carry among the strongest feelings. Nobody thinks the catastrophe enjoying out in locations just like the Tenderloin is suitable, however there appears to be no center floor on options.

And nowhere is that sorry fact enjoying out with extra urgency or publicity than San Francisco, the place the destiny of overdose prevention in California will doubtless be determined in coming weeks by one girl — San Francisco Mayor London Breed.

San Francisco Mayor London Breed has said she favors drug consumption sites.

San Francisco Mayor London Breed has mentioned she favors drug consumption websites.

(Gary Coronado / Los Angeles Occasions)

Breed is both going to buck state and federal regulation and the loud disapproval of the crackdown crowd to open one other secure consumption website, or she’ll cave to mounting political stress and gained’t, which is able to doubtless kill the idea within the Golden State for the foreseeable future. This resolution is a fork within the street, a dedication to 1 aspect or the opposite.

For years, Breed has mentioned she helps overdose prevention websites, at the same time as she closed this one down earlier this month. Two formidable ladies — Vitka Eisen and Lydia Bransten — are forcing the problem by holding Breed to her claims.

Since visiting Vancouver earlier this yr, the place overdose prevention websites have operated for many years, I’ve come to see that these amenities make sense, even when they’re uncomfortable to witness. They aren’t an answer. They don’t deal with dependancy. But it surely’s false to say they encourage folks to make use of medication or to fake you possibly can’t have overdose prevention websites work hand-in-hand with therapy and restoration packages.

Overdose prevention websites are crucial as a result of lifeless folks can’t change — and since youngsters need to stroll round with out concern of stepping on needles.

Greater than 550 folks have died of overdoses in San Francisco this yr, in keeping with a coroner’s report. About 107,600 Individuals died of an overdose between July 2021 and June 2022, in keeping with the Facilities for Illness Management and Prevention.

Drug users smoke at UN Plaza in San Francisco.

Drug customers smoke at UN Plaza in San Francisco.

(Josh Edelson / For the Occasions)

Greater than 330 overdoses have been reversed on the plaza heart, in a courtyard hidden from passersby. Generally all it takes is shaking a shoulder to evoke somebody sufficient to remind them to breathe. Such slightly factor to save lots of a life, however somebody must be there to do it.

Although there was discuss of a similiar challenge in Los Angeles, it hasn’t been a precedence for brand spanking new mayor Karen Bass, who is concentrated on shifting folks off streets and into shelters and houses. She has goodwill from advocates, and it’s unlikely they’d get forward of her on such a risky problem.

Outdoors of San Francisco and L.A., the idea of overdose prevention hasn’t roused a lot curiosity in California. A number of months in the past, Gov. Gavin Newsom vetoed laws that may have allowed pilot websites in San Francisco, Los Angeles and Oakland, claiming the thought might spark “a world of unintended penalties.” Not many appeared to care.

“The governor clearly learn the political winds,” Dean Preston informed me. Preston is the San Francisco supervisor whose district included the overdose prevention website, and he’s a robust supporter of the idea. He thinks the identical pressures and criticism which will have swayed Newsom are nonetheless “dominating the problem” right here, although different locations are shifting ahead.

New York has two overdose prevention facilities, funded by nonprofits. Rhode Island has plans to open some.

In Philadelphia, a lawsuit that may make clear the federal place on overdose prevention websites has ambled ahead for 4 years. At the moment the websites are unlawful, underneath what is called the “crackhouse statute,” which was championed by President Biden when he was a senator battling the final drug epidemic.

Biden has moved towards hurt discount as president, however the U.S. Division of Justice has for practically a yr kicked the can on saying if it believes secure consumption websites are banned underneath the crackhouse statute. After asking courts for a number of extensions, it’s now purported to reply that query by early January.

The federal uncertainty and state disapproval present each cowl and concern for Breed, who’s left dealing with this politically explosive problem largely by herself.

Avieira Evans, of Health Right 360, passes out Narcan to a drug user at UN Plaza in San Francisco

Avieira Evans of HealthRIGHT 360 passes out Narcan to a drug person at UN Plaza in San Francisco, the place dozens of individuals eat fentanyl, meth and different unlawful substances.

(Josh Edelson / For the Occasions)


Eisen is a giant motive Breed is within the sizzling seat.

A no-nonsense girl with brief grey hair, Eisen all the time appears on the verge of both supplying you with a giant hug or telling you to buzz off. She heads HealthRIGHT 360, which offers care and different companies for very low revenue populations. Her group was in control of overdose prevention on the plaza. She personally ran that effort many days, and it’s due to her that individuals have been allowed to smoke and inject medication there.

“The mayor didn’t ask us to try this,” Eisen informed me. “We simply did it.”

Eisen started her rebel marketing campaign with issues that guests would use medication within the loos of what was thought of a “linkage” heart, meant to assist folks entry companies and housing, setting off smoke alarms or overdosing with nobody to intervene. She instructed utilizing exterior transportable bathrooms the place it will be simpler to note if somebody didn’t come out. And why not have Adirondack chairs so folks have been tilted again and will breathe higher in the event that they did OD? And if we’re doing this anyway, why not present clear foil?

Inside a month, Eisen slow-rolled into the nation’s first city-funded, semi-approved-but-not-really overdose prevention website. Did Breed know? Sure, Eisen mentioned. But it surely remained a don’t-ask-don’t-tell proposition.

Roiri Jones of HealthRIGHT 360 displays a box of Narcan that he offers to drug users at UN Plaza in San Francisco.

Roiri Jones of HealthRIGHT 360 shows a field of Narcan that he gives to drug customers at UN Plaza in San Francisco.

(Josh Edelson / For the Occasions)

Whereas Eisen was pushing boundaries contained in the plaza, the world exterior was altering, too. Weeks after she started her experiment, conservative provocateur and failed gubernatorial candidate Michael Shellenberger scaled the heart’s fence, digital camera in hand. All hell broke unfastened on social media, fueling right-wing narratives.

With midterm elections closing in, Republicans started a nationwide offensive claiming crime was uncontrolled, particularly in cities ruled by Democrats. “Failed San Francisco” grew to become a mantra for conservative commentators corresponding to Tucker Carlson, and politicians up and down the state felt the warmth of defending insurance policies that have been now labeled as being coddling and mushy on crime — regardless of statistics that don’t bear this out.

Viral movies of shoplifting mobs grabbed consideration, as did a unending provide of poverty porn that includes homeless folks in dire circumstances. Fentanyl was a serial killer on the unfastened, particularly as youngsters started dying from tablets in bedrooms and colleges.

All that grew to become proof that compassion within the face of catastrophe was a idiot’s response — or no less than a loser on the polls. In November 2021, Breed had informed media she was “decided” to open a secure consumption website.

“We’ve been wanting to do that for a very long time,” Breed mentioned on the time. “We’ve to get this website open.”

When she shuttered the very effort she had championed a yr and a month later, Eisen and others wished to know what had modified.

The reply was easy: Every part and nothing.

Persons are nonetheless dying, however the politics are totally different. A brand new Struggle on Medication is brewing, and even Democrats are shopping for in.

Enter Bransten, a blond who offers off stylish-mom vibes with brilliant blue glasses framing blue eyes. She’s head of the six-member Gubbio Mission that gives homeless companies in a wood-shingled Episcopal church the place a crow named Theodore frequents the courtyard.

Lydia Bransten stands in front of St. John the Evangelist church in San Francisco's Mission district

Lydia Bransten stands in entrance of St. John the Evangelist church in San Francisco’s Mission district, the place she hopes to open a secure drug consumption website.

(Anita Chabria / Los Angeles Occasions)

Bransten desires to open an overdose prevention website there — provided that the congregation and neighbors agree — in a fenced-in car parking zone the place bougainvillea hangs close to the cracked concrete. She would really like the town to pay for it, however she’s wonderful with the New York mannequin of nonprofit funding. She sees it each as an act of civil disobedience and of Christian religion.

Gubbio is an Italian metropolis the place St. Francis of Assisi made a take care of a gimpy wolf who was killing townspeople as a result of he was hungry they usually have been making an attempt to cease him from looking their slow-moving sheep and goats. St. Francis made the wolf promise to cease terrorizing the townspeople, and, in return, they’d feed him.

Bransten says she’s typically requested who’s the wolf and who’re the townspeople in relation to homelessness and drug use. Each, she says, are blinded by concern and the wrestle to outlive.

“It’s a narrative about discovering commonality in group,” she informed me. “We’re all of the wolf, proper? We’re all townspeople.”


For some time, Bransten mentioned Breed appeared on board along with her plan to open a brand new website on the church.

Then a number of weeks in the past, the Division of Public Well being informed her the thought was “tabled” on the order of the mayor’s workplace. Breed publicly continued to voice assist, making Bransten concern secure consumption was about to die a quiet, backroom dying.

“This was about to get buried,” Bransten mentioned.

So Bransten went public, garnering headlines for calling out the mayor.

Breed’s communications director, Jeff Cretan, informed me the narrative that Breed has accomplished an about-face is “completely false,” and any suggestion that she is extra involved about her political future than lives is “ridiculous.”

The hesitation to open a secure consumption website is concerning the authorized threat to metropolis staff, he mentioned, including Breed helps a nonprofit-funded website.

“There’s an concept that that is like homosexual marriage, when Gavin Newsom defied the federal authorities,” Cretan mentioned, referencing a month-long interval in 2004 when Newsom, then mayor of San Francisco, ignored state and federal regulation to problem about 4,000 marriage licenses to same-sex {couples}.

“The just isn’t a difficulty of the town getting sued and this not a difficulty of perhaps having some authorities paperwork combat,” Cretan continued. “It’s concerning the individuals who work for the town, and that’s an actual concern. We are able to’t be cavalier about that.”

I’ve empathy for Breed, who wasn’t obtainable for an interview. A needle sliding right into a vein isn’t as heartwarming as lovers kissing on the steps of Metropolis Corridor.

If she places herself out entrance on overdose prevention, she is going to take nationwide warmth, even from inside her personal celebration — even when the federal authorities indicators it gained’t intervene. It will likely be messy, because it all the time is when coping with dependancy. There isn’t a political upside, solely the promise of a right-wing pummeling.

However not all the things is politics, even for a politician. Breed has handled dependancy in her family and is aware of its issues and ache.

Okeefe, the soft-spoken, clever drug person I talked to within the plaza, was clear for eight years earlier than this relapse. He has a tattoo on his arm that reads “Religion, Hope, Love.” Religion he can kick this once more, hope that sometime he’ll have a household, a toddler to name him dad and love him.

However he has to outlive lengthy sufficient to get there. “We’re human beings. We’re not totally different,” he informed me of the misplaced souls within the plaza.

We’re all of the wolf, and we’re all of the villagers.

London Breed doesn’t need to be a saint. However she does need to determine which she stands for: compassion or concern.

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