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A Supervised-Injection Site Could Save San Francisco Millions

Every dollar spent on a place where drug users legally inject would create $2.33 in savings, researchers say.

Jacky Naegelen/Reuters

If San Francisco were to give addicts a medically supervised place to inject drugs, it would save the city $3.5 million a year and prevent chronic diseases, debilitating skin infections, and overdose deaths.

That’s the takeaway of just-released research from Maryland’s Criminal Justice Policy Foundation, UCLA, RTI International, and others, who have investigated the possibility of opening the United States’ first supervised-injection facility (SIF) in the Bay Area. Such facilities provide a regulated space for hardcore addicts to shoot up with sterile equipment, with medical staff on hand to administer overdose-blocking drugs like naloxone. To date, there’s been no known overdose death at the roughly 100 SIFs operating around the world.

San Francisco’s drug activists have long lobbied for such a facility. Despite opposition from Mayor Ed Lee—he has decried people “literally destroy[ing] their bodies and their minds in a city-funded shelter”—this month the city’s top health official endorsed the idea of at least six local SIFs. Operating the sites would reportedly cost millions each year, but to believe the new research (as described in the Journal of Drug Issues) the expense could be worth it.

An employee of Greece's Organization Against Drugs holds a syringe and a spoon for single use next to a supervised-injection facility in Athens. (Yorgos Karahalis/Reuters)

“The cost-benefit analysis study found that establishing even one [SIF] in San Francisco could save the city $3.5 million annually,” RTI International writes in a press release. Here are some highlights from the study, which relied on mathematical models, public-health data, and findings from other SIFs:

  • Fatal heroin overdoses in the U.S. rose about 250 percent from 2010 to 2014. While intravenous drug users represent less than 1 percent of the national population, they suffer from about 56 percent of new Hep C and 11 percent of new HIV cases, and their combined medical costs probably exceed $6 billion a year.
  • Each dollar spent on one 13-booth SIF in San Francisco would create $2.33 in savings from things like less crime and first-responder calls, prevented HIV and Hep C infections, averted overdoses, and fewer nasty soft-tissue infections (which are so prevalent in the city’s drug-using population that the Zuckerberg San Francisco General Hospital and Trauma Center has a special clinic just to deal with them all).
  • Because SIFs aren’t just about injecting drugs—many often have staff or social workers who connect users with psychological, housing, and other forms of assistance—the researchers believe one facility could steer an average of 110 people a year away from IV drugs and toward less-risky management regimens, such as methadone.

There’s also evidence that San Francisco’s progressive practices are helping drug users. “By already implementing forward-thinking naloxone access and Good Samaritan policies,” the researchers write, “San Francisco reduced heroin overdose deaths from 120 in 2000 to 13 in 2012.” But other cities haven’t been so lucky—Baltimore saw 192 people die of heroin overdoses in 2014—and they warn that serious consideration of how “SIFs fit into the national effort to combat the heroin epidemic in the United States is desperately needed.”

About the Author

  • John Metcalfe
    John Metcalfe is CityLab’s Bay Area bureau chief, based in Oakland. His coverage focuses on climate change and the science of cities.