January 11, 2022
California State Assembly Committee on Health
California State Capitol
1315 10th St, Sacramento, CA 95814
Dear Assembly Member Wood:
I am writing on behalf of R Street Institute (R Street) in support of Senate Bill 57, which would allow some localities to operate overdose prevention programs (OPP). These innovative programs will help combat California’s growing drug overdose crisis. We believe that harm reduction strategies, such as OPPs, provide a vital lifeline to communities by reducing the number of drug overdoses and public intoxication; keeping law enforcement and citizens safer; saving taxpayers money; and facilitating treatment for those suffering from substance use disorders. SB 57 is of special interest to us as a right-of-center public policy research organization that promotes free markets and limited, effective government.
Public-health officials have made a lot of progress in understanding substance use and abuse, as well as how addiction can best be treated and managed. However, no cessation or prevention program is 100 percent successful, and many people are often left behind. While society continues the search for more just and effective ways to reduce supply and demand for illicit substances, harm reduction helps people who use addictive substances live long enough to access treatment, providing them with the knowledge and tools needed to protect their health and lives. Existing harm reduction initiatives such as expanded access to overdose reversal drugs and syringe services play an important role, reducing disease transmission and overdose death, but they are insufficient in the current situation.
A Growing Overdose Crisis
More than 100,000 people died of drug overdoses during the 12-month period ending in April 2021.  During this time, California experienced one of the largest increases, with overdose-death numbers climbing more than 50 percent annually in recent years.  A novel approach is desperately needed to combat this crisis as the current one, which emphasizes incarceration, has proven ineffective. Rather than targeting high-level traffickers, enforcement-driven efforts too often focus on street-level, substance-dependent buyers and sellers, an approach that does little to curb supply, but that strains local jails and pretrial services.  Furthermore, incarceration and fear of law enforcement increase the risk of overdose by pressuring people to consume drugs too quickly, reducing the likelihood of seeking emergency medical care and disrupting access to treatment and harm reduction services.  These consequences disproportionately affect people of color and individuals living in poverty or experiencing homelessness. 
While evidence-based treatment options exist for substance use disorder, they can be hard to come by. In a given year in the United States, only about one fifth of adults deemed in need of specialized substance use disorder treatment are able to access it.  Individuals who are uninsured or privately insured access needed treatment at the lowest rates, often citing cost and underinsurance as substantial barriers to care. 
Overdose Prevention Programs Save Lives and Improve Health
Overdose prevention programs—also known as safe consumption sites or supervised consumption facilities—represent a promising, evidence-based tool to reduce overdose risk and more efficiently mitigate associated fallout. The National Harm Reduction Coalition defines overdose prevention programs (OPP) as “designated sites where people can use pre-obtained drugs under the safety and support of trained personnel.” Since their inception more than three decades ago, OPPs have been implemented in more than 60 cities in 11 countries.  During this time, OPPs have been extensively studied, and research indicates that the programs consistently meet their objectives. One survey of 39 sites operating in Europe found no reported overdose deaths.  Data from a Sydney, Australia OPP suggest that in addition to reducing overdose mortality, the facility cut the need for emergency response to overdose by 67 percent.  Other studies have found reductions in skin infections, hospital stays and incidence of HIV and hepatitis C.  In addition, OPPs reduce the potential for negative interactions between clients and police by reducing stigma and providing access to personnel trained to work with substance use and mental health disorders.
Overdose Prevention Programs Benefit Communities
In addition to directly improving the well-being of clients served, OPPs benefit communities more broadly. By reducing the need for emergency responses and other medical care, the facilities have been shown to save taxpayers money. A model of a San Francisco OPP predicted that a single 13-booth facility would generate $2.33 in savings for every dollar spent, for an annual net savings of $3.5 million.  Similarly, a model of a hypothetical OPP in Baltimore projected $7.8 million in savings for a cost of 1.8 million. 
In addition, contrary to popular assumptions and some of the concerns raised in objections to this proposed bill, OPPs can lead to a reduction in public drug consumption and many of its consequences. Research shows that the presence of an OPP does not lead to an increase in drug-related crime in the surrounding area. After a site was introduced in Vancouver, British Columbia, car break-ins and vehicle thefts in the neighborhood actually declined.  Indeed, harm reduction programs can even improve police-client interactions by reducing stigma and allowing individuals to be more forthcoming about paraphernalia possession, thereby reducing officers’ risk of needlestick injuries. 
Furthermore, because OPPs predominantly serve marginalized people–many of whom lack private spaces in which to consume drugs–they lead to less public consumption and extreme public intoxication, while reducing the likelihood that needles and syringes will end up in parks or playgrounds. 
Overdose Prevention Programs Facilitate Treatment
Though abstinence is not the primary goal of harm reduction efforts, it is, very often, a welcome outcome. OPPs have been associated with increased initiation of treatment for substance use disorders.  This is consistent with a substantial body of evidence showing that harm reduction programs effectively connect those they serve with a wide range of resources, including treatment and detox programs.  Harm reduction is a step in the right direction, but California needs a multi-pronged approach. There is no question that treatment and prevention programs are important tools in our efforts to stop substance use disorders and their consequences, including the current overdose crisis. However, on their own, these approaches leave too many people behind. With overdose deaths spiking around the country, the situation demands an approach that is both practical and rooted in evidence. OPPs fit this bill.
R Street believes that government should not interfere with people’s ability to protect their health, and that public health initiatives should benefit the communities in which they are located.  In addition to saving the lives and improving the health of populations they directly serve, harm reduction programs such as OPPs reduce public disorder and ensure efficient use of shared resources. It is critical that the Legislature pass Senate Bill 57 to protect the health and welfare of Californians.
Stacey McKenna, PhD
Integrated Harm Reduction
R Street Institute
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