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(a) According to the San Francisco Department of Public Health (“DPH”), as of April 1, 2019, San Francisco was home to an estimated 24,500 people who inject illegal drugs. Injection of illegal drugs in San Francisco is responsible for approximately 100 deaths per year due to overdoses.
(b) An overdose prevention program is an evidence-based harm reduction strategy that allows individuals to inject or consume illicit drugs in a hygienic environment under the supervision of trained staff, who are ready to intervene if the patient overdoses. Further, overdose prevention programs offer participants a variety of services, including linkage to medication-assisted treatment, medical care, and referrals to a variety of other social services. They also provide participants with sterile consumption equipment, safe removal of used consumption equipment, and fentanyl test strips.
(c) As of 2020, there were approximately 165 overdose prevention programs operating in ten countries around the world (Australia, Canada, Denmark, France, Germany, Luxembourg, the Netherlands, Norway, Spain, and Switzerland), and numerous peer-reviewed studies have confirmed that they are effective in reducing overdose deaths and drug-related risk behaviors, and in increasing access to counseling, treatment, and other risk reduction services. Research has also demonstrated that such programs decrease the prevalence of public injection and the amount of syringes in streets, alleys, and parks, and do not increase crime or drug use.
(d) In April 2017, by Resolution No. 123-17, the Board of Supervisors urged DPH to convene a task force to advise the Mayor, the Board of Supervisors, and relevant City departments regarding the possibility of operating overdose prevention programs in San Francisco. Consistent with that resolution, DPH convened a Task Force, and on October 25, 2017, presented a final report (“Task Force Report”) to the Board of Supervisors Public Safety and Neighborhood Services Committee. The Task Force Report concluded that opening one overdose prevention program in San Francisco could result in an annual net savings to the City of $3.5 million in health care costs, and recommended that the City support the operation of overdose prevention programs in San Francisco.
(e) The Task Force Report further recommended that the opening of overdose prevention programs in the City be governed by the following principles:
(1) Overdose prevention programs offer an opportunity to affirm the humanity and dignity of people who consume drugs, and should be operated in a way that is safe, clean, and welcoming, so as to reduce stigma and build trust.
(2) When feasible, overdose prevention programs should reflect an integrated model that includes on-site services and linkages to other services.
(3) Peer staff are uniquely positioned to engage people who use drugs to use sanctioned services.
(f) In February 2019, the U.S. Attorney for the Eastern District of Pennsylvania filed a civil lawsuit against Safehouse, a nonprofit organization that had declared its intent to open and operate an overdose prevention program in Philadelphia. The lawsuit sought a declaratory judgment that overdose prevention programs violate a provision of the federal Controlled Substances Act colloquially known as the “Crack House” statute, which prohibits making a place available “for the purpose of unlawfully manufacturing, storing, distributing, or using a controlled substance.” 21 U.S.C. § 856(a)(2). On October 2, 2019, U.S. District Judge Gerald A. McHugh issued an opinion concluding that section 856(a)(2) of the Controlled Substances Act does not prohibit Safehouse’s proposed operation of an overdose prevention program because Safehouse does not plan to operate the program “for the purpose of unlawful drug use” within the meaning of section 856(a)(2). On the contrary, the court found that the ultimate goal of Safehouse’s proposed operation is to reduce drug use, not facilitate it. The government has indicated it will appeal the ruling once the district court enters judgment.
(g) Also in February 2019, State Senator Scott Wiener and Assembly Member Susan Eggman introduced a bill that would authorize the City to approve entities to operate overdose prevention programs that satisfy specified requirements. (AB 362). AB 362 passed in the Assembly in 2019, and will move to the Senate for consideration in 2020.
(Added by Ord. 105-20, File No. 200243, App. 7/10/2020, Eff. 8/10/2020)