(Update: On Sept. 12, the Senate voted down AB 186. Its sponsor, Assemblywoman Susan Eggman, said “I am committed to finding a way forward next year.”)
Many California communities could open centers inviting addicts to shoot up hard drugs under a little-noticed bill that has cleared the state Assembly and now awaits a vote on the Senate floor. The goal is to reduce deaths.
Here’s how the concept— modeled after a supervised drug injection facility in Vancouver, Canada—works: A user walks into a government-run clinic with some heroin in his pocket. He’s greeted by a nurse who directs him to wash his hands before offering an array of clean needles. He sits down at a sterile booth, rolls up a sleeve and shoots up. As the high sinks in, he makes his way to a chill-out room for a cup of coffee or juice. There, staff watch for signs of overdose, prepared to administer life-saving medication if needed.
Nothing like this exists in the United States.
Assembly Bill 186 would make California the first state in the nation to permit illegal drug use in designated places—and would set up a conflict with federal law, which not only forbids the use of illicit drugs but also prohibits owning or renting buildings for the purpose of consuming them.
It’s a radical response to the growing scourge of addiction and overdose that has swept the United States. Nationwide, overdoses kill more people than guns or car crashes. In California, 4,571 people died from drug overdoses in 2015, a 33 percent increase over the prior decade.
“We have an opioid epidemic. We have a public health crisis,” said Assemblywoman Susan Eggman, the Stockton Democrat who is carrying the bill and once worked as a drug treatment counselor. “We have traditionally treated addiction as a criminal issue and that has failed. We need to treat it as the public health issue that it is.”
Her bill would allow eight counties—Alameda, Fresno, Humboldt, Los Angeles, Mendocino, San Francisco, San Joaquin, and Santa Cruz—and the cities within them, to approve supervised drug injection programs. The facilities would have to provide clean needles, and be staffed with health care workers offering first aid to prevent overdose and referrals to detox for addicts who want to quit. Visitors to the clinic would have to bring their own drugs, and they would be shielded from criminal charges for using at the site.
Though law enforcement widely opposes the approach, it has gained growing support in the medical field.
Research published in the Lancet medical journal shows that overdose deaths decreased by 35 percent in the neighborhood surrounding the Vancouver injection clinic, and by 9 percent in the city overall. The New England Journal of Medicine recently published an article by a substance abuse specialist who teaches at Harvard’s medical school making the case that supervised injection saves lives and improves health. The American Medical Association, the official voice of the nation’s doctors, voted in June to support the development of pilot projects where addicts can use their own intravenous drugs under medical supervision.
“Studies from other countries have shown that supervised injection facilities reduce the number of overdose deaths, reduce transmission rates of infectious disease, and increase the number of individuals initiating treatment for substance use disorders without increasing drug trafficking or crime in the areas where the facilities are located,” the American Medical Association said in announcing its support.
Law enforcement groups argue the centers would become crime magnets that would normalize hard drugs rather than helping addicts kick them.
The California bill “does not have any robust effort to get addicts into treatment,” said John Lovell, a lobbyist for the California Narcotic Officers’ Association and the Association for Los Angeles Deputy Sheriffs.
“Instead it simply accepts that they will come to the county-operated shooting gallery, shoot up and then leave with all of the other consequences.”
Critics raise questions about liability if a drug user dies or hurts someone after leaving an injection clinic, and they say creating them would be unfair to neighborhoods already suffering from poverty and crime. A coalition of inner-city churches that works closely with law enforcement on anti-drug policies is also fighting the bill.
“The drug dealers will stand around understanding that… those that are coming out of these safe houses are not going to treatment, but they’re going to be looking for more drugs,” said Ron Allen, a Sacramento bishop who heads the International Faith-Based Coalition and described himself in a hearing as a former crack addict.
Opposition from law enforcement is usually a potent force in the state Capitol, so it’s surprising that Eggman’s bill has advanced as far as it has. A similar bill last year failed in its first committee. But this year, the bill eked out of the Assembly with the bare number of votes needed and has already passed two committees in the Senate.
The bill is sponsored by the Drug Policy Alliance, an advocacy group that works to decriminalize drugs and is funded largely by billionaire George Soros. The group has pushed, thus far unsuccessfully, for similar legislation in New York, Maryland, Massachusetts and Vermont. Officials in Seattle have announced that they want to open a supervised injection program, but they are up against local and state efforts to ban them.
San Francisco is deep into discussions about opening an injection center. Its Board of Supervisors has put together a “Safe Injection Services” task force under its Department of Public Health that is holding public meetings and developing recommendations. The San Francisco Chronicle reported that city workers in March cleaned up an average of 430 syringes a day.
“People are shooting up on the street, in people’s doorsteps, in children’s playgrounds,” said Democratic Sen. Scott Wiener of San Francisco, a co-author of AB 186. “Anything we can do to reduce the open, public shooting up that we see, we should go in that direction.”
Republican Sen. Jeff Stone of Temecula, who voted against the bill in committee, warned that the idea would put local governments in stark conflict with the Trump administration. Attorney General Jeff Sessions has expressed zero tolerance for marijuana use—much less more potent illegal drugs—although he hasn’t yet directed a crackdown against states such as California that have legalized pot.
“Whether we like or don’t like the present administration,” Stone said, “I think their reaction to recreational marijuana is going to be much different than recreational heroin, and having safe zones for that.”
After the Vancouver program opened in 2003, Canada’s national government sued to try to shut it down. Ultimately the Canadian Supreme Court in 2011 ordered the federal government to stop interfering with the clinic because it had proved beneficial to drug users and the broader community.
Gov. Jerry Brown rarely weighs in on bills before they hit his desk, and his office declined to comment on this one.