So, now I'm going to talk a bit about efforts to establish safe consumption spaces in the US; in San Francisco, Seattle, Ithaca, and New York City, as well as talking about our activities in Baltimore. In 2007, San Francisco started having a series of community discussions about establishing a safe injection facility there. There was serious backlash at the federal level. A few years later, there was a Hepatitis C Task Force that was established by the city of San Francisco owing to the high rates of Hepatitis C among people who inject drugs. They recommended a safe injection facility as one of the prevention interventions among others. Four years later, the San Francisco City Commission on Human Rights, the city actually has a Human Rights Commission, recommended safe injection facilities, bringing a really different kind of argument about why safe injection facilities should be provided to people who inject drugs. In 2016, the San Francisco Board of Supervisors, that's the local city council, passed legislation that allowed for the establishment of safe injection facilities, and the Mayor gave his support in 2017. There actually was, hopefully that year, going to be protection from the state. The California State Assembly passed a bill, Bill 186, that would allow for the establishment of safe injection facilities in five locations with high rates of HIV and overdose. Unfortunately, it didn't pass in both houses of the assembly, and it failed. But back in San Francisco, in January of 2018, the Board of Supervisors overwhelmingly voted to implement not just their support as they had done in 2016, but to actually implement a safe injection facility in the summer of 2018. So, hopefully, this will happen soon. In 2014, in Ithaca, a commission that was charged with responding to the overdose epidemic developed "The Ithica Plan", which was a public health and safety approach to drugs and drug policy, recommended the establishment of a SIF. In 2016, the Mayor, Mayor Myrick became the first mayor to openly call for the establishment of a SIF. Partly inspired by this in Ithaca as well as a lot of work that's been done in New York City, I'll talk about momentarily, the New York Assembly passed the Safe Consumption Act in the summer of 2017, which allows for the establishment of a program that includes safe injection facilities. It hasn't passed both houses in New York yet, but it has in one. A lot of organizing has occurred in New York City over the past several years to establish a safe injection facility in New York. There's a great website www.sifnyc.org, which provides information about the various activities. A coalition was developed in 2014 across a number of organizations, medical, harm reduction, legal, criminal justice, law enforcement, to talk about the establishment of a SIF in New York City. In 2016, the City Council pledged $100,000 to conduct a pilot study to determine the feasibility of establishing a safe injection facility in New York. After a bit of political posturing, the state and the city are on board, and they actually moved to establish five sites across Manhattan and the other boroughs. But there are lots of politics around how and where to establish these, so the story continues to unfold. Last but not least, I want to talk a little bit about what's been going on in Seattle, which very likely could be the first safe injection facility in the US. In September of 2016, the Seattle/King County Heroin and Prescription Opiate Task Force issued recommendations to address the ongoing heroin epidemic, including the establishment of a safe injection facility. In January of 2017, the Seattle and King County Board of Health endorsed establishing two sites, one in the city and one in the surrounding King County of Seattle. One hindrance to establishing safe injection facilities in Seattle and King County is that of a conservative state assemblyman who contacted the Department of Justice to get a legal rid on the establishment of these facilities, which really could bring it to another level. It's important to note that all of the examples that I've given have been activity at the city and state levels because it's unlikely that there'll be approval federally of safe injection facilities in the near future, and of course, the federal government can be a great obstacle. Very exciting, in the first week of August 2017, an article came out in the American Journal of Preventative Medicine, that was a preliminary evaluation of an unsanctioned supervised injection site that's been happening in the last few years in the US. The location is not disclosed, but it's been happening, it's been run by current and former drug users, and it was evaluated by Alex Kral of RTI, and Peter Davidson, who works at University of California, San Diego. So, the space is one large room, it's opened four to six hours a day, five days a week during the work week, by invitation only. They're about 60 people who actively have privileges, about 100 people have used the space, and it's supervised with the staff on site. It looks like a room similar to what is in Vancouver or in Bonn, Germany, a room with eight stations where people can inject. The demographics of people, it was all anonymous. So, it's guesstimated that there are about 100 people who've used the space, but all of these surveys have been anonymously collected when people have come into the space. There have been close to 2,600 injections, largely with white males who are homeless and inject a median of four times a day. There have been only two overdoses that have happened on site, and both have been reversed.
