by Seth Katz
At the heart of San Francisco’s ongoing struggle with drug-related issues lies a promising yet elusive solution: the establishment of overdose prevention (ODP) centers. While public health experts and advocates champion these centers as vital tools for mitigating the harms of substance use, attempts at opening them have been marred by political backlash and indecision. The result is a troubling gap between ODPs’ potential benefits and the concrete actions taken to bring them to fruition.
The premise behind ODPs is simple yet impactful. These facilities offer a supervised environment where individuals can consume drugs in the care of harm reduction professionals and medical experts. With essential resources such as oxygen and naloxone on hand, ODPs provide a space for people who use drugs to receive sterile equipment, medical attention and access to referrals for services like HIV care, hepatitis C virus treatment and medication-assisted treatment. The ultimate goal is to mitigate the risk of overdoses and other drug-related harms, consequently relieving the burden on emergency services and removing open drug scenes from the public eye. Public health authorities and officials have rallied behind these centers, especially in New York City and Canada, recognizing their potential to save lives and alleviate the strain on critical resources.
However, the seemingly straightforward solution has become caught in a complex web of politics and divergent viewpoints. Despite a mounting body of evidence demonstrating the success of such centers in other regions, San Francisco’s endeavor to establish these life-saving spaces has encountered significant hurdles. As the city grapples with this nuanced challenge, it’s becoming clear that the path to implementing ODPs isn’t necessarily a straight line
The most recent controversy surrounding San Francisco’s ODPs stems from Supervisor Matt Dorsey’s proposal to reallocate $18.9 million from these centers toward jail settings.
However, before diving further, it’s crucial to contextualize ODPs and their significance in San Francisco. The now-closed Tenderloin Linkage Center—which later became just the Tenderloin Center—serves as a familiar reference point for many residents and has played a pivotal role in discussions surrounding supervised consumption and harm reduction. Established as an emergency response to surging drug overdoses, the center offered essential services to City resources. However, it also faced criticism, with some alleging it functioned as an unsanctioned ODP. Its closure in December 2022 reverberated across the landscape, leaving those who relied on its services in a challenging predicament. The Department of Public Health’s plan to establish smaller linkage sites remains uncertain, while Mayor London Breed’s office continues to flip-flop between public health and policing approaches.
In a recent SF Chronicle article, Supervisor Hillary Ronen emphasized the impact of the linkage center’s closure on other San Francisco harm reduction initiatives. She highlighted the increase in demand for voluntary services: “[…]The request for voluntary services at the one harm reduction center that currently exists has risen from 150 people a day to 500 people. These are 500 individuals with a drug addiction illness seeking voluntary help every single day from just one center in his district that cannot meet the demand. The funded wellness centers are designed to meet this demand.”
The challenges surrounding the establishment of ODPs are multifaceted. At its core, a combination of stigma and fear intersect with funding sources and allocation methods, complicating the process. The journey towards implementing ODPs in San Francisco has been a roller-coaster with highs and lows that reflect the city’s evolving approach to harm reduction. Pivotal events, such as Gov. Gavin Newsom’s veto of SB57, a bill that would have allowed San Francisco and other cities to operate ODPs, and Mayor Breed’s ever-shifting stance, have indelibly shaped the trajectory of this critical initiative.
In 2020, Mayor Breed’s office touted the potential life-saving impact of safe consumption sites. However, despite her vocal support for ODPs, her budgetary priorities have prompted scrutiny. While affirming the importance of safe consumption sites, her decision to allocate significant funds to policing—marked by a stark increase in the police budget from $50 million to over $700 million this year—sparked discussions about the city’s true priorities. Mayor Breed’s policies have also sparked debates on whether coercion or voluntary treatment is more effective in addressing substance use. Her advocacy for arresting and forced treatment for people who use drugs underscores the delicate balance between harm reduction ideals and the pragmatic concerns of public sentiment and resource allocation.
The pursuit of overdose prevention centers in San Francisco is indeed a bumpy road, where progress is ever entwined with challenges. The evolving nature of this journey illustrates how policy, public health and community dynamics intersect As San Francisco navigates this path, it grapples with the vital task of transforming ideals into practices that effectively address the drug crisis while also upholding the dignity and autonomy of its residents.
Seth Katz (he/they) is a San Francisco-based harm reductionist. He works and lives in the Tenderloin and is deeply impassioned about transformative justice, low-barrier access to care and meeting people where they’re at.