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Update, 2:10 p.m. Monday: With the recent closing of the Tenderloin Center, local officials have expressed support for opening overdose prevention programs in the city.
“The city attorney has been clear that he would support a nonprofit moving forward with New York’s model of overdose prevention programs, which the U.S. Department of Justice has not taken action on,” said Jen Kwart, spokesperson for San Francisco City Attorney David Chiu. “Under New York’s model, the sites are not operated on city property, with city staff, or with city funding for that use. We continue to await guidance from the U.S. Department of Justice on how local jurisdictions can operate overdose prevention programs consistent with federal law.”
According to officials in Mayor London Breed’s office, she is waiting for the Department of Justice to provide legal guidelines on opening an overdose prevention program and defers to the city attorney’s office on legal questions around these sites.
“The Tenderloin Emergency Initiative has helped us move forward a lot of positive efforts and outcomes, like deploying Urban Alchemy ambassadors to help stabilize many blocks in the neighborhood, helping hundreds of people into shelter and housing, and preventing overdoses that have saved countless lives,” according to a statement from Breed’s office. “The Tenderloin Center has supported this work, and it has provided a respite from the street for many, helped prevent many overdoses, and connected people to services. We tried something new, knowing there will be successes and lessons learned, and an opportunity to build and grow from there.”
Former staffers of the Tenderloin Center shared their concerns about the closure and the impact it could have on people seeking harm-reduction services.
“We refer people to other organizations … that provide similar services. But the main attraction, possibly the most important service, I would say that we provided isn’t happening anywhere, which is safe consumption,” said staffer Bill Buehlman. “We revived people almost every day. I think the most amount of people reversals on one shift that I supervised was six overdose reversals.”
Cleo Jenkins, manager of HealthRight 360’s program at the Tenderloin Center, was saddened by the closure.
“You don’t feel the impact of the closure until you actually see it come to the end. It’s horrible. It’s despicable,” said Jenkins.
Original story, 3:09 p.m. Friday: On Sunday, Dec. 4, the day the Tenderloin Center closed, Vitka Eisen saw people she hadn’t seen in months. Visitors who had come to the site when it first opened in January stopped by to deliver thank-you cards, or give social workers updates on their housing situation.
“It was really poignant,” said Eisen, president and CEO of HealthRight 360, one of several nonprofits that provided housing and drug treatment services at the walk-in facility, the city’s only supervised drug-consumption site, located in United Nations Plaza.
Eisen noted that many of the regulars she spoke to said they were disappointed but not surprised.
“People talked about their experiences there. There was also sadness and anger, and a sense of resignation because … the experience of life [for unhoused people] is to be so marginalized and not seen as people,” she said, of those who paid tribute this weekend. “So I think it was kind of like, ‘Yeah, this is happening to us again.'”
Opened as part of Mayor London Breed’s emergency declaration to tackle the high rate of overdose deaths, crime and homelessness in the beleaguered Tenderloin neighborhood, the center has provided showers, meals, housing referrals and — most controversially — drug-consumption services to an average of 400 people every day over the last 11 months, according to Dr. Hillary Kunins, director of behavioral health services at the San Francisco Department of Public Health. Workers at the center have used the medication naloxone to reverse more than 300 opioid overdoses this year, she said.
The center, Kunins said, was always intended as a temporary site. But it also proved costly to operate — to the tune of about $22 million — and faced considerable criticism that likely hastened its closure.
Despite a city-funded report showing that neighborhood conditions around the site had improved since the center opened, some nearby businesses complained that it resulted in long lines of people on the street waiting for services and intensified drug use and dealing in the immediate vicinity.
The center also became the target of critics of safe consumption sites, who said it had failed to get many visitors into longer-term treatment and, in some cases, had even encouraged more drug use.
In moving to close the center, Mayor London Breed largely agreed with the criticism. Last week, she told The San Francisco Chronicle that it “was designed as place to try and meet people where they are, but get them into some sort of help, some sort of support, and that wasn’t really happening in the way that it should have been happening, and that was part of the problem.”
With the site now shuttered, the city plans to increase police presence in the public plaza and limit open hours in an effort to “address harmful behaviors,” The San Francisco Examiner reported Friday.
But harm-reduction advocates argue that the center provided essential services to a population in desperate need of help, and warn that its closure will have dire consequences. Among the likely impacts, they say, will be a spike in unsupervised drug use on the streets, where the risk of overdose is significantly higher.
“People have come to depend on the kind of care that they have been receiving, and without it … they will become unhealthy [and] they will literally die,” said Sarah Shortt, director of public policy and community organizing at HomeRise, a supportive housing nonprofit that helped run the center. She said the city has a responsibility to immediately provide replacement services in the neighborhood.
In 2021, 641 people in San Francisco were known to have died from accidental drug overdoses (PDF), a slight decline from the previous year, according to data from the San Francisco Medical Examiner’s Office. Of those deaths, 128 — roughly 20% — occurred in the Tenderloin, more than in any other neighborhood in the city. This year, overdose deaths have largely kept pace, with 501 recorded in the city from January through October, 102 of them in the Tenderloin (PDF).
A transitional team is scheduled to offer support services outside the closed center through Dec. 11, according to the city’s closure announcement. In the 48 hours after the center closed, Eisen said the team had already reversed three overdoses in the plaza.
Breed has said the city expects to open at least one new center in a different location, but specific details have yet to be announced.
“We are seeking sites for future centers,” said Kunins, of SFDPH. “Space can be difficult to identify that is appropriate for such a center. Additionally, we know that we need to work with community members and communities to make sure it is sited in an appropriate way and works to extend and complement already existing services in any given neighborhood. So we are eagerly and aggressively continuing to work on that.”
But advocates say that even if the city does open another center in the coming months, the gap in services will be detrimental.
“I’m incredibly proud of the work we did at the TLC, and I’m also heartbroken,” said Eisen, adding that until two or three weeks ago, she had maintained hope that the city would open another location before closing this one. She also emphasized that the center was designed as an outdoor pop-up site, which could be easily and quickly replicated at a new location.
“I don’t understand why you would close a program that was doing a number of things that were necessary, one of which was preventing overdose deaths, and two, moving people who were using drugs on the street or in public spaces into less public spaces,” Eisen said. “If it was effective, why would you close one without opening another?”