San Francisco Board of Supervisors

RE: Safe injection sites in San Francisco

Dear Supervisors,

We write on behalf of the R Street Institute, a Washington-based nonprofit public policy research organization dedicated to free markets and real solutions, to ask that you support the findings in Resolution No. 123-17, which call for implementation of safe injection sites in the City of San Francisco. In addition, we ask that the board act quickly to allow efficient openings of such facilities to prevent transmission of infectious diseases and fatal overdoses in areas of the city where injection drug use is particularly prevalent.

Unfortunately, as the current epidemic of opioid addiction continues, so do fatal overdoses and disease transmission among the most vulnerable users. Syringe access and naloxone distribution programs, such as those operated by the 6th Street Harm Reduction Center, are invaluable to those who benefit from their services. But as such facilities are not designed to include supervised use, users remain at risk for fatal overdose if and when they are alone without naloxone and unable to secure medical attention.

The benefits of supervised injection facilities outlined by the task force cannot be overstated. InSite—a well-established facility in Vancouver, British Columbia—has many proven successes that could easily translate to a city similar in scope, such as San Francisco. Since its opening in 2003, InSite has had no fatal overdoses, has positively affected the health and lifespan of people who use intravenous drugs and has saves the City of Vancouver approximately $6 million a year in medical and criminal costs.

These benefits have been realized without the increased crime and drug use that many fear would accompany such programs. Consistent with other harm reduction programs—of which San Francisco has been a pioneer—safe injection sites demonstrate that providing more points of intervention actually leads more users to initiate treatment and stems crime associated with drug use. They provide a net community benefit.

There is no doubt that recent increases in rates of opioid overdose are directly attributable to increases in adulterated heroin or other opioids. Fentanyl-contaminated heroin was first noted on the East Coast and is quickly migrating to the central United States and further west. Unfortunately, the presence of fentanyl in cities and states is usually discovered by public health officials only once overdose deaths have occurred. The potency of fentanyl and the ease with which it can be distributed requires that something else needs to be done to prevent overdose fatalities.

It is the duty of cities to be proactive in addressing public health crises. We feel that establishing safe injections facilities in areas of concentrated drug use is the most proactive way a community can prevent overdose deaths in the face of uncertainty. San Francisco has a proud history of being a leader in disease prevention and we hope that it continues to pave the road for other cities in addressing the opioid epidemic.

We thank you for your consideration with this important issue and hope that you will positively review the task force’s findings.


Carrie Wade, Harm Reduction Policy Director
Steven Greenhut, Western Region Director
Arthur Rizer, National Security and Justice Policy Director