Could supervised injections help San Francisco’s homeless drug users?

published on June 29, 2016 by John Metcalfe in CityLab

Cities across the U.S. are pondering legalized, sterile street-drug injection sites to fight the overdose epidemic.

A 35-year-old man with a history of mental illness found cold on the sidewalk.

A 38-year-old man cocooned in a blanket on the street, who neighbors heard “moaning” before going silent.

A 56-year-old woman discovered in an open lot near an underpass. Another woman, age 50, found unresponsive at a friend’s home. A 32-year-old man who security guards caught passed out in an upscale shopping mall’s toilets.

These are just a few of the homeless people who recently died from drug-related causes in San Francisco. They are not the first and won’t be the last unhoused drug users to perish here. Of the 41 homeless deaths the city recorded from December 2014 to November 2015, the number one cause was accidental drug deaths.

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The facility’s various benefits are chronicled in dozens of peer-reviewed papers, many of them coauthored by Thomas Kerr. “We found there was a greater than 30 percent increase in the proportion of people entering abstinence-based treatments after Insite opened,”says Kerr, a professor at the University of British Columbia’s medical department. “We also found the site reduced overdose mortality. And in the neighborhood around the facility, overdose deaths went down by 35 percent.”

San Francisco, by the city’s own reckoning, has an estimated 6,600 people without stable housing and 22,000 who inject drugs. It’s unclear how much these groups overlap. In a study published in 2010, Kerr and others interviewed about 600 intravenous-drug users in San Francisco and found the “majority” were homeless. They were also nearly all in support of a place where they could legally inject. “Eighty-five percent of [users] reported that they would use a SIF,” according to the study, “three quarters of whom would use it at least three days per week.”

This finding backs up Kerr’s belief that most addicts don’t enjoy shooting up in public. After all, it can be dangerous. “We know that people who are homeless often inject alone in secluded, hidden environments,” he says, “which makes them very difficult to reach with emergency response in the event of an overdose.”