Overdose Prevention Centers Can Show San Francisco Still Cares

[The following opinion piece was written in December 2024. - Ed.]

There are two rooms in the United States with mirror-dotted walls and plastic chairs, carts full of medical supplies, and cinnamon-red sharps disposals. Within these walls, individuals use drugs daily, but a fatal overdose has never occurred. These rooms, under federal law, are also illegal.

 This is the perplexing reality of overdose prevention centers (OPCs) in this country. Federal law prohibits the maintenance of any place for “the purpose of using any controlled substance”—a measure that OPCs inherently break by providing medical support to individuals before, during,  and after drug use. Research has proven the efficacy of these facilities in preventing overdose deaths, and two privately funded OPCs currently operate in New York City. These centers provide services based on a tacit agreement with the government that lives saved are worth laws broken.

 On the opposite coast, similar initiatives are needed. San Francisco has spent recent years as a poster child of the U.S. opioid epidemic, and 2023 marked the city’s deadliest year with 810 overdose deaths. Despite the mention of OPCs in the  San Francisco Department of Public  Health’s 2022 plan to address opioid use, the city has yet to open such facilities. Instead,  leadership has called for increased policing of vulnerable areas and arrests of dealers and users.

 Support for these punitive measures has grown, with residents eager for change no matter the moral cost. This backing, however, is motivated by fear. Harm reduction initiatives like OPCs are supported by decades of research and deserve funding to aid San Francisco’s fight against the opioid epidemic.

 A chief concern driving San Francisans’ desire for intervention is open drug use on city streets.  OPCs directly address this issue by moving drug use indoors, thus decreasing instances of public use and potential overdose. Though there is concern that this attracts drug use, a recent study of two OPCs and seventeen syringe service programs in New York found that such programming did not increase crime or police activity in surrounding neighborhoods. Instead, the study saw an overall decrease in both 911 and 311 calls, pointing to the efficacy of OPCs in improving public safety.

 Despite supportive statistics, opposition to OPCs remains housed in beliefs that they promote drug use rather than address it. This past year has seen San Franciscans rally around measures such as Proposition F, which offers cash assistance for welfare recipients conditional on a clean drug test or mandatory treatment. Though proponents of the measure say it will aid those  “unwilling or unable” to accept help, public health research shows that conditional assistance leads to increased relapses, overdose deaths, and suicides.

 OPCs are linked to none of these devastating outcomes. As a form of harm reduction, they work with people who use drugs to promote safer use and broaden intervention beyond cessation or abstinence programs. They also save lives—in year one of New York’s OPCs, staff prevented 636 cases of overdose or other harm. In addition to supervision and care, sites connect people to social services and voluntary treatment, with research supporting an association between OPC  attendance and entry into drug cessation programs.

 OPCs are also cost-effective, reducing healthcare spending through mitigating HIV transmission and decreasing drug-related emergency room visits. Across the upcoming four years, San  Francisco will receive $2.25 million annually from the CDC to boost its response to the opioid epidemic. Though this money cannot be directly used on OPCs, it can establish “wellness hubs”  focused on harm reduction, within which privately funded OPCs can operate.

 Though the unsanctioned nature of these sites poses a statewide challenge. San Francisco has the infrastructure to support OPCs. In 2023, the Board of Supervisors passed legislation allowing privately funded OPCs to operate within city bounds. The evidence, money, and legislation for  OPCs all exist—public support is now the main barrier to implementation.

However, despite San Francisco’s progressive history, this is becoming the toughest piece of the puzzle. In November, constituents elected Daniel Lurie, who publicly opposed OPCs during his campaign for mayor. Any private organization that decides to open an OPC will likely face opposition from city leadership and a wave of community concern.

 But this does not call for a solution that abandons San Francisco’s liberal roots. Tech companies looking to invest in the city’s future can funnel funds toward organizations ready to open OPCs. Community members who believe in these initiatives should employ evidence-based arguments to advocate publicly. And those who are concerned about OPCs should listen.

 As a native San Franciscan, I take pride in the city’s open-minded reputation. Taking steps to implement OPCs successfully signifies that this isn’t just history.

 It shows we still care.