Some California cities could soon have overdose protection programs to reduce opioid overdose deaths


Soraya Marashi


Overdose protection programs (OPPs) with safe injection zones could soon be established in the County and City of Los Angeles, as well as the County of Sacramento and the City of Oakland, if Sen. Scott Wiener’s (D–San Francisco) Senate Bill 57 passes. 


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Last month, the bill passed the California Assembly in a 42-29 vote and now awaits reading in the Senate. The bill would allow the specified cities and counties to approve entities to establish and operate OPPs until Jan. 1st, 2028. The OPPs would be required to provide a hygienic space supervised by trained staff and provide sterile consumption supplies where people can consume controlled substances.

Though the bill made it to Gov. Gavin Newsom’s desk after making it through the legislature last year, Dr. Randolph Holmes, Chair of the California Society of Addiction Medicine Public Policy Committee, said Newsom wanted sponsors of the bill to delay it until this year due to “bad optics” during the recall election year. 

Holmes told State of Reform he believes these safe injection zones will save lives. 

“Part of the reason to have a pilot project is to see how it will impact [communities], and these programs will have oversight and reporting responsibilities to the cities that sponsor them,” Holmes said. “We think that this will reduce overdoses on the street and that it will certainly reduce deaths and hospital visits, because people are supervised. So when they inject [something] and they overdose, they’re given something to reverse the overdose right away. They’ll have access to counselors and be connected to the treatment system.”

Overdose deaths in the US have been steadily increasing in recent years. According to CDC data, there were an estimated 100,306 overdose deaths in the US during a 12-month period ending in April 2021. This marks an increase of 28.5% from the same period in 2020. 

Holmes emphasized that California is following the same trend. According to data from the California Department of Public Health, there were 5,502 deaths related to opioid overdoses in 2020 (3,946 were specifically fentanyl overdoses) and 16,537 emergency department visits for opioid overdoses.

“We’re seeing an increase up and down the state of California,” he said. “[We’re seeing] huge increases in overdoses, with large increases in indigenous, Black, and brown populations. Disadvantaged socioeconomic groups have an even larger death rate than the general population.”

Opposition to the bill has come from organizations such as the California Coalition Against Drugs, California District Attorneys Association, and the California Narcotics Officers’ Association (CNOA).

In their opposing argument, the CNOA states that the bill fails to employ strategies to actually intervene in the cycle of addiction.

“Rather than a robust effort to get addicts into treatment, this bill alarmingly concedes the inevitable and immutable nature of drug addiction and abuse. For example, missing from this bill are any strategies to appropriately utilize methadone alternatives, mandatory treatment protocols, on-site drug counseling, or even efforts to gradually wean an addict off the cycle of dependence. In effect, the unintended consequence of this bill is to normalize substance abuse and leave the addict at risk.”

Holmes said much of the opposition stems from a stigma against addiction in general.

“These programs offer treatment and access to state-of-the-art care, so we are certainly not missing opportunities or strategies. We are employing all of the strategies that we currently know. I think you have a group of people who are just absolutely opposed to allowing people to use drugs, [people that think] it’s a moral failing and implies a weakness or character defect, and that we should just not be coddling people who use drugs. 

The other group is a group of people who say ‘not in my backyard,’ I don’t want these things around me where there are businesses and whatnot. So they object to it from more of an aesthetic point of view.”

He also highlighted that California is at the forefront of legislative efforts to establish safe injection sites—New York City was the first in the nation to establish safe injection sites in late 2021. He believes that California can lead the way for other states.

“Other states will move forward,” he said. “We hope we can demonstrate that this is evidence based, meaning that there is good research-based data saying that this does save lives and saves money. San Francisco commissioned a study to look and see if [these safe injection zones] would save money for the city of San Francisco, and it turned out they would save over $2 for every dollar spent in terms of reducing the city’s cost for hospitalization and police. It’s the humane thing to do to get people in and convince people to come into treatment.”