When California Gov. Gavin Newsom vetoed a bill this week that would have authorized several cities to open “overdose prevention sites”—also known as safe consumption or supervised injection facilities—he cited the risk of triggering “a world of unintended consequences.”
But unintended consequences are already unraveling in the aftermath of the veto—and perhaps not ones the governor anticipated. San Francisco leaders say they support allowing an existing overdose prevention site to continue operating in a legal gray area, but advocates told VICE News that medical personnel who participate could lose their licenses; funding and resources could become even more scarce; and Democratic support for life-saving harm reduction programs seems to be evaporating ahead of the 2024 election. If Republicans manage to retake control of the White House, the next president will have the power to roll back any progress.
“It was a bullshit veto message,” said Vitka Eisen, CEO of HealthRight360, a nonprofit that runs an overdose prevention program in San Francisco. “This is a public health crisis. People are dying. This veto has a direct impact. It’s a life-or-death matter.”
More than 1,600 people have died from overdoses in San Francisco since 2020, and death rates have skyrocketed across the country as the powerful synthetic opioid fentanyl has flooded the illicit drug supply. The idea of opening medical facilities where users can safely inject, smoke, or snort drugs under the supervision of staffers standing by with overdose-reversal medication, has started to gain traction after years of positive results in other countries.
Eisen said the facility in San Francisco’s Tenderloin neighborhood is “never not busy,” serving upwards of 400 people per day despite operating “like a MASH unit, popped up in tents—we don’t have electricity, we have a generator and make do.”
New York City allows two overdose prevention centers to operate in Manhattan, and the facilities reported saving 415 lives by reversing overdoses since opening last November. Philadelphia has been trying to open its own site but has faced a legal challenge from the federal government. Sites that allow drug use are outlawed under the so-called “crack house” statute, but so far the Department of Justice has allowed New York’s site to continue operating, and in the Philly case the DOJ has said it will soon decide on “appropriate guardrails” to help guide state and local officials wary of moving forward.
The California bill would have allowed San Francisco, Oakland, and Los Angeles to host overdose prevention sites, and included an important provision to shield medical professionals who work or volunteer at sites from criminal charges and block professional boards from revoking licenses. Eisen said doctors, nurses, and others who could provide basic medical care and referrals for addiction treatment are now exposed if they offer their services. And perhaps more significantly, Eisen added, if the DOJ’s “guardrails” end up requiring medical personnel on site, the San Francisco facility and others could face a catch-22.
“What would happen if a court ruling said you couldn’t operate the site unless you had medical providers on site, and the state was silent on that?” Eisen asked. “How would medical boards respond? You could potentially have a conflict between feds giving permission but the state not coming around to say we support it.”
In a letter explaining his veto, Newsom said that while he “long supported the cutting edge of harm reduction strategies” in cities like San Francisco, where he was once mayor, he feared that “worsening drug consumption challenges in these areas is not a risk we can take.”
There’s speculation Newsom is positioning himself for a White House run in 2024, and the thinking goes that by killing the bill today he can dodge future Republican attack ads suggesting he turned California’s major cities into dystopian drug havens where citizens are shooting up with government approval. The Trump administration fought to block safe consumption sites from opening, and conservative Republicans who have gone so far as allowing needle exchanges have mostly balked at sanctioning facilities that permit drug use.
The San Francisco site has not been without controversy, and the liberal bastion’s broader problems with public drug use and homelessness has magnified the scrutiny and led to some local opposition, with critics saying it enables drug users to keep getting high rather than getting them into rehab. (Supporters say they are focused on preventing deaths and connecting those who use the sites with other services and treatment.)
Local officials in San Francisco have been quick to speak out in support of allowing the overdose prevention site to continue operating in some form beyond its scheduled closure date later this year. Mayor London Breed said the city “will continue to explore how we can push forward innovative strategies with our city departments and community partners, while we continue conversations at the federal level.”
Breed called for “following the NYC model,” as did City Attorney David Chiu, who said in a statement, “To save lives, I support a nonprofit moving forward now with New York’s model of overdose prevention programs.”
Chiu’s spokesperson, Jen Kwart, clarified in an email to VICE News that the city attorney “supports the idea” of allowing a site to operate, but not with the city’s direct involvement.
“I don’t think this statement should be construed to mean providing financial support or otherwise,” Kwart said. “Under the New York model, these sites operate without city land, city staff, or direct city funding.”
For those in New York who support the city’s overdose prevention efforts, hearing San Francisco officials call for emulating their approach is both inspiring and disheartening. On one hand, it means there is broad support from the local leaders, but it also means state and federal officials still aren’t on board, which makes the present difficult and the future uncertain.
The New York sites are set up the way they are partly because former Gov. Andrew Cuomo was reluctant to fully get on board and cited the need for federal legal clarity before moving forward, according to Jasmine Budnella, director of drug policy at the harm reduction group VOCAL-NY.
“Can a city in California move without Gov. Newsom? Absolutely,” Budnella told VICE News. “We moved without Gov. Cuomo. It’s a moment of crisis, we knew we had to go ahead.”
One problem is that unless Congress acts to change federal law—which seems unlikely—the Department of Justice has the authority to crack down on overdose prevention sites at the discretion of the next president and attorney general. Budnella called the overdose crisis a “kitchen table” issue, and noted that Republican voters might not react favorably to a federal meddling in a local program aimed at preventing deaths.
Recent polling has shown bipartisan support for such programs, but they are also a culture war lighting rod fiercely criticized by conservatives. On Fox News, Tucker Carlson has featured as a guest on his show the head of a group called Mothers Against Drug Death, who claims San Francisco leaders are trying to keep people “chained to addiction."
The group behind the Philadelphia overdose site, Safehouse, has said it expects to reach a settlement with the DOJ that “would clear a path for these services to be offered across the U.S.,” but the details remain fuzzy.
In the meantime, there’s the issue of money. Without state or federal support, sites like the ones in New York, San Francisco, and elsewhere will be forced to rely on private donations.
“Sadly,” Budnella said, “we don’t have a bunch of billionaires ready to fund overdose prevention centers through private dollars.”
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