When Mayor London Breed announced the opening of the Tenderloin Linkage Center in January, she touted it as “a safe, welcoming space for those ready to access San Francisco’s health and human service resources easily and quickly.”
The idea, Breed and other city officials said, was to create an easy path for people suffering from drug addiction or mental illness to be “linked” to services.
The change is about much more than a word. From the very start, many of those involved in creating the facility viewed it primarily as a place where people could consume drugs in relative safety—an “overdose prevention site” or “safe consumption site,” to use the parlance.
City data indicates that few people have been linked to services. Journalists have been barred from the center, but in interviews with The Standard, guests who had visited the site confirmed that they had witnessed or partaken in illegal drug use there. Some weren’t even aware that drug rehabilitation services were offered at the linkage center, seeing it primarily as a safer and more private place to use drugs.
The Tenderloin Center’s emergence as a de-facto safe consumption site puts the city in a tricky legal position; federal and state laws prohibit such facilities. And San Francisco voters have mixed views on whether they should be allowed, according to The Standard’s Voter Poll, with many residents opposing the idea as one that condones drug use rather than combating it.
The legal situation could soon change. The U.S. Department of Justice is weighing a possible legal path forward for supervised consumption sites, and engaged the mayor’s office on the question of “appropriate guardrails” for such sites this year. It’s unknown what those guardrails would look like, but harm reduction advocates expect a decision to come down in the next few weeks.
In the meantime, the city is in an awkward position. It has a plan for a full-blown safe consumption site at a different Tenderloin location, but in the meantime has to explain its interim solution.
“I don’t think we would characterize the linkage center as the same thing as an overdose prevention site,” said Jen Kwart, a spokesperson for the city attorney’s office, in an April 25 interview.
Breed’s Announcement Sparks a Scramble
In the following days and weeks, employees of multiple city agencies, including the Department of Emergency Management, Department of Public Health and the Department of Homelessness and Supportive Housing, scrambled to pull together a plan, according to emails obtained through public records requests.
The emails show a disconnect between how the site was discussed among a small group of top public health officials and how it was discussed more broadly, both with other city agencies and in communications with the public.
In a Jan. 7 email to Andrea Tenner, the Department of Public Health’s head of emergency preparedness, an official at a HealthRIGHT 360, a nonprofit with a key role in the center, referred to it as the “Tenderloin Overdose Prevention Site,” or TOPS for short. The email from Britt Miazgowicz, vice president of contracts for HealthRIGHT 360, detailed the challenges of having to redirect staff from another planned drug crisis response center.
Another Jan. 3 email from HealthRIGHT 360 CEO Vitka Eisen, addressed to Tenner along with DPH head of behavioral health Hillary Kunins and other top public health officers, urged the parties to host the overdose prevention site in an outdoor tent rather than inside to “manage smokers.”
“For a host of reasons, HR360 would strongly prefer to offer harm reduction/overdose prevention services in an outdoor/tented structure,” said Eisen, citing the pandemic and the nonprofit’s expectation that it would be servicing smokers. HealthRIGHT 360, which specializes in addiction services, has received more than $53 million in payments from the Department of Public Health in the current fiscal year.
The city relied on a collection of nonprofits as it raced towards the center’s Jan. 18 opening date. According to a document laying out assigned roles, HealthRIGHT 360 was responsible for “medical, behavioral and mental health support” for guests along with “overall harm reduction and monitoring.” Another nonprofit, Urban Alchemy, was responsible for “general staffing” and de-escalation. Other organizations set up at the site to act as service liaisons.
Grand Opening Draws Scrutiny
After the linkage center opened, it didn’t take long for things to veer off course.
On Jan. 20, author and gubernatorial candidate Michael Shellenberger published an article claiming that he had witnessed guests smoking fentanyl in an outdoor area at the linkage center. Breed, for her part, appeared to flip-flop on whether drug use was permitted at the facility, a fenced-off and partially tented area at United Nations Plaza.
In December, Breed made sharp statements that the city would no longer “let someone use [drugs] in broad daylight.” But in late January, after the center opened, she appeared to walk back that statement, asserting at a press conference that the city “cannot control who does or does not use drugs in any given location.” In February, Breed told Fox KTVU in a live interview that drug use is not “authorized” at the linkage center.
Staff at the Department of Public Health meanwhile were fretting about possible legal liability.
In a text message conversation on Jan. 22, DPH medical director Deborah Borne expressed concern that she could be held culpable after Shellenberger’s article on drug use at the site published.
“The mayor is going to need to defend us,” Borne said to Paul Harkin, director of harm reduction services at HealthRIGHT 360. “If DPH throws me under the bus, please vouch for me when I’m looking for a new job.”
Linkage Center Yields Few Links
From the start, it was unclear whether “linkages” were actually happening. An initial report published on the city’s website showed 33 completed linkages in the first week. But because the category grouped together medical treatment, behavioral health care, substance use treatment, shelters, food security programs and housing into a category called “completed linkages,” it wasn’t possible to tell how many people were connected to drug treatment.
To date, despite thousands of visits per week, the site has only reported 31 completed linkages to addiction treatment.
In response to a Feb. 15 inquiry from The Standard seeking clarity on visitor outcomes at the linkage center, Zoe Harris, a spokesperson from the Department of Public Health, wrote to a group of city officials that she hoped to redirect reporters from their “focus on linkages.”
Other questions arose around the site’s use of “meaningful engagements” as a metric of success. According to February email exchanges, HealthRIGHT 360 reported hundreds of “meaningful engagements” that did not square with observations of other staffers and led to an artificially high count.
A Feb. 8 email from Department of Public Health special project coordinator Robert Hoffman speculated that Gary McCoy, the vice president of policy and public affairs for HealthRIGHT 360, was “making up numbers” in light of confusion about seeming sharp discrepancies in statistics about linkages week over week.
In an interview, McCoy said that HealthRIGHT 360’s involvement with the linkage center happened “with almost no notice” and pointed to the last-minute scramble as a reason for the center’s struggle to produce coherent data.
“There were a lot of ideas from the higher-ups on how we should provide metrics for this type of program,” McCoy said. “There was certainly not enough time to ramp up or redeploy staff from other programs.”
Despite all the problems, the center may indeed be saving lives as an overdose prevention facility: Since its January launch, 78 overdoses have been reversed there, among 982 reversed citywide by emergency personnel.
Hopes for a Change Under Biden
The confusion surrounding the linkage center’s primary purpose mirrors a lack of clarity around what “overdose prevention sites” or “safe consumption sites”–terms often used interchangeably–ought to entail.
The term safe consumption site has a broad meaning and is used to describe any facility that provides supervision for drug use. Overdose prevention site is a phrase more commonly used to describe a social gathering place for people to use drugs with supervision and access to overdose-reversing drugs.
All such facilities remain illegal under the federal Controlled Substances Act. But New York City has forged ahead anyway, opening two safe consumption sites in November and no deaths have occurred at those facilities. City officials in San Francisco have said they want to move ahead, too, with the Board of Supervisors approving a purchase in December of two buildings in the Tenderloin to serve as SF’s first sanctioned safe consumption site.
A bill to legalize safe consumption sites under state law is now making its way through the legislature. The author of the bill, state Sen. Scott Wiener, told The Standard in January that “if San Francisco decides to move ahead of the state and open up a safe consumption site before SB 57 passes, that’s a decision for San Francisco.”
The U.S. Department of Justice, meanwhile, is considering carving out an option that would allow overdose prevention sites to operate under some set of conditions.
That’s because the justice department is nearing a settlement with a Philadelphia-based nonprofit called Safehouse, which it sued in February 2019 over plans for a safe consumption site. That settlement is expected to set terms that could allow Safehouse to operate legally, and a judge this week extended a deadline to determine the terms of that settlement until June 23.
In San Francisco, longtime recovery advocates and some policymakers say they’re supportive of overdose prevention sites and other harm reduction practices, but hope to see those techniques balanced with more services for people seeking sobriety and abstinence from drugs and alcohol.
Providers at the linkage center are missing a “golden opportunity” to provide a productive environment for people who want to stop using, said Richard Beal, a recovery advocate and a director at Tenderloin Housing Clinic.
“They do a lot of good work, but what about the people who need to be in a different modality,” Beal said. “They’re doing a great job meeting people where they’re at, but they’re doing them a disservice by leaving them there.”
Annie Gaus contributed to this report.
Corrections: This story has been updated to delete an inaccurate paraphrase of a comment from Gary McCoy of HealthRIGHT 360, and to reflect that Paul Harkin is director of harm reduction services at HealthRIGHT360.David Sjostedt can be reached at [email protected].