A heroin dealer pulls into the parking lot. Astride G., a freshman at SF State, has a feeling of euphoria wash over; it was as though she was already high, knowing that she was going to get her fix after hours of anticipation.
She and her friends receive their drugs and scramble to get prepare their cookers and other paraphernalia. The group has one common goal—to get high as quickly as possible.
Next, finding a place to shoot up.
“I ended up in bathrooms sitting on the floor,” Astride G. said. “Definitely not using the cleanest (needles). I’ve shot up in alleys and ditches before. I never thought I would be in a place where I was so desperate to find a place to use.”
It is experiences like these, endemic to San Francisco, that have led organizations such as the Alliance to Save Lives, the Drug User’s Union and the Harvey Milk LGBT Democratic Club to advocate for supervised using or injection sites in the city, primarily the Tenderloin district.
The advocates for the safe use site hope to have a public hearing with the San Francisco Board of Supervisors by the end of the year.
The supervised using sites would be similar to the Insite facility in Vancouver, British Columbia, which has been operating since 2003. Insite is a place where people can inject drugs and connect to health care services that range from primary care to treatment for diseases and infection, as well as addiction counseling and treatment.
“It helps them to trust and open up to other people,” said Anna Farrant, a former nighttime shift supervisor at Insite. “And then they can trust you to refer them to other services, and it creates a chain.”
Proponents of safe injection sites believe they save lives. Since the opening of Insite in 2003, there have been no deaths caused by an overdose, despite the fact that there were 336 overdoses reported in one 18-month study.
The Tenderloin is the most logical place to begin opening safe injection sites. A few years ago, the De Marillac Academy, a school in the Tenderloin, had to have a drain sealed due to drug users dumping needles in front of the school and its students. The school eventually had to hire security, according to Tenderloin Police Station Sgt. Kevin Phipps, who has worked in the Tenderloin for more than 20 years.
Besides the safety of community members, the main arguments for the establishment of a supervised injection or using site is to prevent the spread of disease, primarily HIV and Hepatitis C, as well as save lives from overdosing. According to studies produced by Insite, overdose is the leading cause of death for injection drug users.
“And these were the people I was putting my life in the hands of,” said Astride G.
Astride G. then attempted to get clean, during which time five of her close friends died within a seven-month period.
Astride also remembers friends telling her that if she overdosed, her boyfriend would just leave her in the ditch behind his house.
“That was scary to hear,” Astride G. said. “But the scariest part about it is I could totally see him doing it.”
While San Francisco Police Department Sgt. Phipps agrees that an injection site may help get users off the streets, he doubts it would have any affect on drug related crimes in the Tenderloin.
“The basic problems don’t come from when people are using drugs,” Phipps said. “It’s when people are buying and selling drugs that brings in the violence and gangs. Where the drug users go, the dealers are going to go.”
The concept behind safe injection sites has some strong supporters. Glendon “Anna Conda” Hyde, a 2010 candidate for District 6 supervisor, has long petitioned for the implementation of safe use sites. In fact, during his campaign he ran on a platform of creating such areas.
Yet his opponent during the election, current District 6 Supervisor Jane Kim, has yet to take an official position, according to members of her office.
Despite the benefits of allowing drug use under safe circumstances, there is a common belief that the establishment of a supervised injection site would enable drug use. At Insite, this concern was investigated over a two-year period and found that the average Insite user had been using for 16 years and only one person out of 1,065 used for the first time at the facility.
Insite researchers also found there was a 33 percent increase of clients checking themselves into detoxification services and were 3.7 times more likely to enroll in additional forms of addiction treatment. Of those who enrolled in additional services, there was a 43 percent completion rate. Just having the knowledge that the services are available may be enough for some people.
“When I was on drugs I couldn’t see a way out of it,” Astride G. said. “I thought this was just what I was going to do for the rest of my life. I couldn’t stop because it was just so painful to get off of the drugs.”
Advocates argue that in addition to saving people from pain and the spread of disease through a supervised injection site, the decrease in the numbers of those suffering from HIV and Hepatitis C would help alleviate the city’s suffering budget.
However, according to Eileen Shields Public Information Officer for the San Francisco Department of Health, those numbers are very hard to weed out of the budget and not a priority with the current status of the budget.
The argument over safe injection sites often comes down to an argument between the illegality of drug use and the benefits of preventing addicts from using unsafe methods.
The other major health risks for Injection Drug Users are HIV and Hepatitis C. According to the Hepatitis C Task Force established by Mayor Gavin Newsom, which issued its findings in 2010, 90 percent of injection drug users are infected with Hepatitis C, and 25 percent of those are also infected with HIV. The task force also found that Hepatitis B and C kill more people in the San Francisco Bay Area than anywhere else in the country. The long-term effects of Hepatitis C include liver disease, cancer and cirrhosis, liver failure and death.
“It’s like having the flu all the time and constantly being in pain,” says Trish Calcote, who has had Hepatitis C since 1978. “I feel tired all the time. I’m not going to die any time soon, but it’s a quality of life issue.”