What Do Supervised Injection Sites Look Like, How Do They Work?

The NBC Bay Area Investigative Unit traveled to Canada to get a firsthand look at supervised injection sites, which supporters say have helped reduce overdose deaths and the number of used syringes discarded on streets and sidewalks.

NBC Universal, Inc. On Tuesday, San Francisco lawmakers unveiled plans to “fast track” the opening of supervised injection centers, where people can openly use illegal drugs under the care of trained professionals. The NBC Bay Area Investigative Unit traveled to Canada to get a firsthand look at supervised injection sites, which supporters say have helped reduce overdose deaths.

San Francisco lawmakers unveiled plans on Tuesday to "fast track" the opening of supervised injection centers, where individuals can openly use illegal drugs under the care of trained professionals.

"It's a continuum of care to treat this epidemic illness in society," Supervisor Hillary Ronen told a crowd of supporters along the steps of City Hall. "We need to do everything we can to help and these proven centers are just a step in that process."

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Ronen said she has "veto-proof" support from the majority of the Board of Supervisors to push ahead with calls to hold a hearing to investigate why the city isn't further along in opening up supervised injection sites, which have also been dubbed "wellness hubs." In addition, Ronen said the board will request $5.5 million in city funds be dedicated toward opening wellness hubs in neighborhoods hardest hit by overdose deaths and open-air drug dealing.

In September, the city's department of health and the mayor's office unveiled "a strategic roadmap to address drug overdose deaths," which noted plans to open a supervised injection site by the end of this year, followed by the addition of two more centers in 2023. Those plans, however, are now on hold, according to a mayor's office spokesperson, as the city continues to wait on legal guidance from the federal government.

The Drug Enforcement Administration has long maintained that supervised injection sites violate federal law, meaning anyone using them or even working inside could face prosecution.

While Mayor London Breed has continually said she supports the centers, her administration maintains it is not ready to move forward with opening sites in the city until the federal government releases specific guidelines and an actual framework that would provide the centers legal cover to operate.

"There remains serious legal issues that have not been addressed for city operated or city funded sites ... including the potential criminal liability for city employees, including the possibility of people losing their medical licenses," Breed told the city's Board of Supervisors when questioned about the issue during Tuesday's board meeting. "I believe in overdose prevention programs, but we continue to wait for this guidance and we are working aggressively with the Department of Justice on this issue."

While San Francisco had long hoped to open the nation's first supervised injection sites, New York opened its own centers last year. Similar sites have been operating in other countries for decades in an effort to reduce drug overdose deaths. To better understand how these centers work, the NBC Bay Area Investigative Unit traveled to Canada in 2018 to get a firsthand look at the sites and speak directly with center staff and drug users who utilize the facilities. Today, Vancouver has roughly a dozen supervised injection sites.

San Francisco has long hoped to open what are known as supervised injection sites, where addicts can shoot up indoors under the care of trained medical staff. The plan, both controversial and illegal in the U.S., aims to reduce the number of overdose deaths in the San Francisco as well as the staggering amount of used needles scattered across the...

In an April letter to U.S. Attorney General Merrick Garland, Breed wrote, "we urge you to issue a public statement on behalf of the U.S. Department of Justice to institute a new policy that deprioritizes federal enforcement of the Controlled Substances Act against medically supervised overdose prevention programs."

The mayor's office had expected to receive those new guidelines earlier this year, according to a mayor's office spokesperson, but is still waiting.

"These are difficult situations because this involves legal advice, significant legal liability, which we cannot just ignore," said Breed. "This is one of the biggest holdups to why we have not moved forward."


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