SAFE INJECTION SERVICES TASK FORCE MEETING 1 JUNE 15 TH , 2017 - - PowerPoint PPT Presentation

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SAFE INJECTION SERVICES TASK FORCE MEETING 1 JUNE 15 TH , 2017 - - PowerPoint PPT Presentation

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SAN FRANCISCO SAFE INJECTION SERVICES TASK FORCE MEETING 1 JUNE 15 TH , 2017 9AM-11AM 25 VAN NESS AVE RM 610 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH AGENDA WELCOME & OPENING REMARKS INTRODUCTIONS TASK FORCE PROCESS

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SAN FRANCISCO SAFE INJECTION SERVICES TASK FORCE

MEETING 1 • JUNE 15TH, 2017 • 9AM-11AM • 25 VAN NESS AVE RM 610

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH

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SLIDE 2

AGENDA

  • WELCOME & OPENING REMARKS
  • INTRODUCTIONS
  • TASK FORCE PROCESS & OVERVIEW
  • OVERVIEW OF ISSUE BRIEF
  • DISCUSSION
  • PUBLIC COMMENT
  • CLOSING & NEXT STEPS

2 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

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INTRODUCTIONS

3 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

  • NAME
  • AFFILIATION
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SLIDE 4

TASK FORCE PROCESS & OVERVIEW

4 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

  • Board of Supervisors resolution #123-17, introduced by Supervisor London

Breed

  • Passed April 21st, 2017
  • Urges SFDPH to convene a safe injection services (SIS) task force to make

recommendations regarding

  • The potential opportunities and obstacles associated with safe injection facilities
  • The community need for such facilities
  • The feasibility of opening and operating such facilities.
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SLIDE 5

TASK FORCE ROLE

5 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

ADVISORY

To develop recommendations to the Mayor, the Board of Supervisors, and City departments

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SLIDE 6

TASK FORCE KEY DATES 2017

6 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

JUNE JULY AUGUST SEPTEMBER

JUNE 15

MEETING 1

JULY 21

MEETING 2

SEPTEMBER 2017

RELEASE FINAL REPORT

■ DISCUSSION

  • Injection Drug Use and

Harm Reduction in San Francisco

  • About Safe Injection

Services

  • Benefits and Risks

ACTIVITIES TOPICS

■ DEVELOP POLICY

RECOMMENDATIONS

  • PWID Survey Results
  • Safe Injection Service

Models

  • Operations and Service

Considerations

■ DEVELOP & FINALIZE POLICY

RECOMMENDATIONS

  • Business & Neighborhood

Focus Group Results

  • Location and Siting

Considerations

AUGUST 10

MEETING 3

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SLIDE 7

TASK FORCE FINAL REPORT

7 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

COMPONENTS PER BoS RESOLUTION #123-17

  • Information on individuals who inject drugs in SF
  • Information on safe injection services in other jurisdictions, including program

models, effectiveness, outcomes

  • Potential risks and benefits of safe injection services
  • Considerations for SF regarding safe injection services, including legal,

community, and operational considerations

  • Policy recommendations for consideration
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SLIDE 8

TASK FORCE INPUT & OUTREACH

8 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

  • TASK FORCE MEMBERS’ EXPERTISE
  • PUBLIC COMMENT (@ 3 TASK FORCE MEETINGS)
  • COMMUNITY SURVEY WITH PEOPLE WHO INJECT DRUGS (PWID)
  • BUSINESS & NEIGHBORHOOD FOCUS GROUPS
  • SIS TASK FORCE WEBPAGE
  • DEDICATED SIS TASK FORCE EMAIL (SIS.TASKFORCE@SFDPH.ORG)
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SLIDE 9

MATERIALS

  • BOARD OF SUPERVISOR RESOLUTION #123-17
  • PRESENTATION SLIDES
  • ISSUE BRIEF
  • INJECTION DRUG USE IN SF (INFOGRPAHIC)
  • TASK FORCE ROSTER
  • 3 X 5 CARD

9 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

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SLIDE 10

ISSUE BRIEF

INJECTION DRUG USE & HARM REDUCTION IN SF

10 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

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ISSUE BRIEF: INJECTION DRUG USE & HARM REDUCTION IN SF

11 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

The estimated 22,500* people who inject drugs (PWID) in SF are:

*2015 estimates

71%

MALE

55%

AGES 41-60

69%

HOMELESS

50%

USING HEROIN

34%

USING METHAMPHETAMINE

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SLIDE 12

ISSUE BRIEF: INJECTION DRUG USE & HARM REDUCTION IN SF

PWID in SF primarily reside in:

12 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

31%

TENDERLOIN

24%

SoMA

9%

MISSION

8%

BAYVIEW- HUNTERS POINT

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ISSUE BRIEF: INJECTION DRUG USE & HARM REDUCTION IN SF

SUBSTANCE USE DISORDER

13 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

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ISSUE BRIEF: INJECTION DRUG USE & HARM REDUCTION IN SF

  • A medical disorder that is a primary, chronic disease of brain

reward, motivation, memory and related circuitry

  • Characterized by:
  • inability to consistently abstain
  • impairment in behavioral control
  • cravings
  • diminished recognition of significant problems with one’s behaviors and

interpersonal relationships

  • dysfunctional emotional response
  • cycles of relapse and remission

14 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

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SLIDE 15

ISSUE BRIEF: INJECTION DRUG USE & HARM REDUCTION IN SF

PWID have multiple health needs that must be addressed in

  • rder to support their health and well-being, including:
  • High prevalence of other health problems
  • High prevalence of mental health issues
  • High prevalence of trauma
  • Poor social supports
  • Poor relationship with healthcare system
  • Higher level of homelessness
  • Higher level of previous incarceration

15 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

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ISSUE BRIEF: INJECTION DRUG USE & HARM REDUCTION IN SF

HUMAN IMMUNODEFICIENCY VIRUS (HIV)

16 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

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ISSUE BRIEF: INJECTION DRUG USE & HARM REDUCTION IN SF

  • PWID account for 21% of people living with HIV in SF
  • less likely to be virally suppressed than the overall populations living

with HIV

  • lowest five-year survival out of all others living with HIV

17 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

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ISSUE BRIEF: INJECTION DRUG USE & HARM REDUCTION IN SF

HEPATITIS C VIRUS (HCV)

18 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

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ISSUE BRIEF: INJECTION DRUG USE & HARM REDUCTION IN SF

23,000

estimated SF residents who have antibodies to HCV

19 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

70%

active HCV infections are among PWID

13,000

estimated SF residents with active HCV virus in their bodies

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SLIDE 20

ISSUE BRIEF: INJECTION DRUG USE & HARM REDUCTION IN SF

OVERDOSE DEATH

20 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

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DRUG OVERDOSE DEATHS IN SAN FRANCISCO (2006-2016)

21 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

50 100 150 200 250

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Total Opioids Heroin Fentanyl Methamphetamine Cocaine

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ISSUE BRIEF

HARM REDUCTION

22 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

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ISSUE BRIEF: INJECTION DRUG USE & HARM REDUCTION IN SF

  • public health philosophy that promotes methods of reducing the

physical, social, emotional, and economic harms associated with harmful behaviors that impact individuals and their community

  • free of judgment and directly involve clients in setting their own health

goals

23 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

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ISSUE BRIEF: INJECTION DRUG USE & HARM REDUCTION IN SF

HISTORY OF HARM REDUCTION IN SAN FRANCISCO:

  • 1993 – SF formally sanctioned syringe access
  • 1997 – SFDPH launched its Treatment on Demand initiative
  • 2001 – DOPE Project began piloting training of community and government

partners on overdoses

  • 2000 – SF Health Commission unanimously passed a resolution adopting a Harm

Reduction Policy

  • 2003 – SFDPH began to provide prescriptions for Naloxone

24 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

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ISSUE BRIEF: INJECTION DRUG USE & HARM REDUCTION IN SF

EXAMPLES IN SF:

  • Syringe Access & Disposal
  • Naloxone
  • Medication-Assisted Treatment (e.g. methadone, buprenorphine)
  • Sobering Center

25 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

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ISSUE BRIEF

ABOUT SAFE INJECTION SERVICES

26 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

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SLIDE 27

ISSUE BRIEF: ABOUT SAFE INJECTION SERVICES (SIS)

27 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

SIS are part of the continuum of evidence-based harm reduction services and are shown to:

  • promote safer drug injection practices
  • enhance health-related behaviors among PWID
  • connect PWID with external health and social services
  • attract hard-to-reach populations of drug users
  • reduce morbidity and mortality
  • reduce drug use in public
  • improve public spaces in areas surrounding urban drug markets
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ISSUE BRIEF: ABOUT SAFE INJECTION SERVICES

28 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

  • Five countries (Spain, Switzerland, Germany, the Netherlands, and Denmark)

reported having multiple locations (ranging from five to 37) with varying services at each.

  • Spain and Denmark each reported having one mobile drug consumption room

in addition to fixed sites.

  • Norway and Switzerland reported restricting eligibility to person 18 years or
  • lder
  • Spain and the Netherlands reported that eligibility differed based on the

location.

SIS AROUND THE WORLD:

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ISSUE BRIEF: ABOUT SAFE INJECTION SERVICES

29 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

  • Five countries (Australia, Canada, Luxemburg, Norway, and France)

reported having only one location.

  • Australia, Luxemburg, and Norway restrict eligibility to person 18 years or
  • lder.
  • All five are in fixed locations using an integrated model with a mix of

services and linkages to other community services.

SIS AROUND THE WORLD (CONTINUED):

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ISSUE BRIEF: ABOUT SAFE INJECTION SERVICES

30 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

  • Jan 2017 – Seattle, King County, Washington State approved opening safe

consumption facilities in their jurisdiction

  • Published Safe Consumption Facilities: Evidence and Models
  • Opposition by some members of the community seeking to ban heroin injection

sites

SIS IN THE US:

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ISSUE BRIEF

31 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

BENEFITS & RISKS

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ISSUE BRIEF: BENEFITS & RISKS

32 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

  • effective in attracting the most marginalized PWID
  • promoting safer injection conditions
  • enhancing access to primary health care
  • reducing overdose frequency
  • not found to increase drug injecting, drug trafficking or crime in the surrounding

environments

  • associated with reduced levels of public drug injections and dropped syringes
  • provide greater opportunities for health workers to connect with injectors

BENEFITS

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ISSUE BRIEF: BENEFITS & RISKS

33 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

POTENTIAL HEALTH BENEFITS TO SF*

0.24

LIVES SAVED

110

PWID ENTERING TREATMENT

3.3

HIV CASES

19

HEP C CASES

415

HOSPITAL STAYS

*Source: Irwin, A., Jozaghi, E., Bluthenthal, R. N., & Kral, A. H. (2017). A Cost-Benefit Analysis of a Potential Supervised Injection Facility in San Francisco, California, USA. Journal of Drug Issues, 47(2), 164-184.

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ISSUE BRIEF: BENEFITS & RISKS

34 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

POTENTIAL SAVINGS TO SF*

$2.33

SAVINGS FOR EACH DOLLAR SPENT ON SIS

$3.5M

TOTAL ANNUAL NET SAVINGS FOR A SINGLE 13-BOOTH SIS SITE

*Source: Irwin, A., Jozaghi, E., Bluthenthal, R. N., & Kral, A. H. (2017). A Cost-Benefit Analysis of a Potential Supervised Injection Facility in San Francisco, California, USA. Journal of Drug Issues, 47(2), 164-184.

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ISSUE BRIEF: BENEFITS & RISKS

35 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

FEDERAL AND STATE LAWS PROHIBIT:

  • possession of controlled substances, unless the possession is with the

prescription of a licensed health professional

  • building owners and operators from allowing the manufacturing,

storing, or distributing controlled substances RISKS

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ISSUE BRIEF: BENEFITS & RISKS

36 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

“Drug, narcotic, or chemical offense is defined: drug, narcotic, or chemical offense means any offense which proscribes the possession, distribution, manufacture, cultivation, sale, transfer, or the attempt or conspiracy to possess, distribute, manufacture, cultivate, sell or transfer any substance the possession of which is prohibited under this subchapter.”

TITLE 21 OF THE UNITED STATES CODE (USC) CONTROLLED SUBSTANCE ACT (CSA), SECTION 844 (C)

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ISSUE BRIEF: BENEFITS & RISKS

37 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

““Except as authorized by this subchapter, it shall be unlawful to— (1) knowingly open, lease, rent, use, or maintain any place, whether permanently or temporarily, for the purpose of manufacturing, distributing, or using any controlled substance; (2) manage or control any place, whether permanently or temporarily, either as an owner, lessee, agent, employee, occupant, or mortgagee, and knowingly and intentionally rent, lease, profit from, or make available for use, with or without compensation, the place for the purpose of unlawfully manufacturing, storing, distributing, or using a controlled substance.”

TITLE 21 OF THE UNITED STATES CODE (USC) CONTROLLED SUBSTANCE ACT (CSA), SECTION 856

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ISSUE BRIEF: BENEFITS & RISKS

38 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

  • Federal laws are enforced by the US Attorney General
  • On May 12, 2017, Attorney General Jeff Sessions directed all federal

prosecutors to pursue the maximum penalties under the law for all crimes, including mandatory minimum sentences

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ISSUE BRIEF: BENEFITS & RISKS

39 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

CALIFORNIA CODE HEALTH AND SAFETY CODE, SECTIONS 11350 & 11377

Prohibits possessing certain controlled substances without a valid prescription. A "controlled substance" is a drug or chemical whose manufacture, possession and use are regulated by the government under the United States "Controlled Substances Act"

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ISSUE BRIEF: BENEFITS & RISKS

40 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

“No Unlawful Use or Unlawful Use Messages Regarding Drugs

Contractor agrees that information produced through these funds, and which pertains to drugs and alcohol - related programs, shall contain a clearly written statement that there shall be no unlawful use of drugs or alcohol associated with the program. Additionally, no aspect of a drug or alcohol related program shall include any message on the responsible use, if the use is unlawful, of drugs or alcohol (HSC Section 11999-11999.3). By signing this Contract, Contractor agrees that it will enforce, and will require its Subcontractors to enforce, these requirements.” CALIFORNIA CODE, HEALTH AND SAFETY CODE, SECTIONS 11999-11999.3

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DISCUSSION QUESTIONS

41 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

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DISCUSSION QUESTIONS

HOW WOULD SIS IMPACT INJECTION DRUG USE IN SAN FRANCISCO?

42 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

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DISCUSSION QUESTIONS

WHAT ARE THE POTENTIAL OBSTACLES ASSOCIATED WITH IMPLEMENTING SIS IN SAN FRANCISCO?

43 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

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DISCUSSION QUESTIONS

44 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

WHAT ARE THE POTENTIAL OPPORTUNITIES ASSOCIATED WITH IMPLEMENTING SIS IN SAN FRANCISCO?

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PUBLIC COMMENT

45 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

2 MINUTES PER PERSON

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CLOSING COMMENTS & NEXT STEPS

46 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

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SLIDE 47

47 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH JUNE 15, 2017

NEXT MEETING

FRIDAY • JULY 21ST • 2017 • 9AM-11AM 25 VAN NESS AVE • ROOM 610

  • PWID Survey Results
  • Safe Injection Service Models
  • Operations and Service Considerations