Necessarily mean fatal overdoses. And a lot of people overdose. Thank got they dont fatally. If we had supervised Consumption Services it would reduce those fatal and nonfatal. Commissioner chow we have norman tanner, shawn laura and dr. Alex crowell. Hi, im clara nichols. Im a pharmacy student at ucsf. I have a comment and then question. My first is my comment. I wanted to thank everyone for coming up today and sharing their story. It gave me a more humanistic perspective on the need for injection sites which is different than the perspective i walked in here with today. The task force recommended an integrated model with staffing. They mentioned differences with Behavioral Health and also recommended Community Engagement and education. My question is what role do you see pharmacists playing within Health Care Services and are going to be offered and also what role do you see Health Care Providers playing with the education piece of it as well. Commissioner chow thank you. Next, please. Hi, my name is alexi and im also a ucsf pharmacy student and i wanted to voice my support for everything previously brought up in terms of the safe space injection and would like to advocate for safe needle disposal specifically. A potential to keep in mind for the future is the vending machine needle dispensers used in europe and las vegas and more ease of location placement and the benefit of the safe needle disposal as well as clean needle use. Thank you. Commissioner chow thank you. Good evening, commissioner. Im norman tanner. Im a community activist. The city and county of San Franciscos fault because these people who use the drugs on the street do it pause they dont have no place to live. It cost too much for them to have a place to live. I dont like seeing them use on the street. You have to think about the kids, the elderly. I support them having a place they can come and use safely and get the service they need. But the housing here its the biggest reason why we got homeless people. The reason why theyre using drugs on the street. We need to take a look at that. Thank you. Thank you. Next, please. Good evening, commissioners. Its great to see you here. I want to thank the leadership from the department of Public Health with Barbara Garcia and others folks in the department who have taken the lead and thank you for that. I encourage the Health Department and city and county of San Francisco to be bold on this. We know what works and saves lives and its a supervised Consumption Services. In canada, for example, theyve gone from one to over 25 this year and theyve done that because they had a change in their federal government and a change of approach and change of political will and its become essentially noncontroversial there and i look forward to when that happens here. I think it is incumbent on San Francisco to lead the way. You heard earlier we dont have the overdose and Opioid Crisis they do in other parts of the country but thats a matter of time and a matter of fentanyl making its way to the drug supply as it has in other parts of the country. We need to step up and provide these services and increase access to treatment before its too late rather than after. From the Drug Policy Alliance perspective, were delighted to continue to partner with the department of Public Health and support you and help figure out how to make this happen in San Francisco as well as across the state and country. That includes bill 186 and we hope to have the full support of the Health Department. This is an intervention thats been supported by the american medical association, the California Society of addiction medicine, the San Francisco moran Health Society and its a Public Health intervention and thank you for taking the lead on this. Commissioner chow following the next speaker will be elaine chan, tiffany tron, annie park and grace leh. Im alex carl. Im an epidemiologist and work here in San Francisco. Ive been conducting regarding people injecting drugs in San Francisco since 1993. I want to thank you all for the time and thank you the department of Public Health. I was a Task Force Member and it was a wellrun task force and productive as well. Half a million americans have died of overdose since 2000. Thats 500,000. Its really ridiculous, 500,000 people. Were in the situation here where we are in a crisis. What we need is innovative solutions. Heres one that the been shown to work throughout the world. All over europe, australia, canada. The research is very clear on this. You reduce Overdose Deaths and reduce hiv and hepatitis c and you link people into drug treatment. We have a tonne of research thats shown all of these things and the other side it helps the community. You reduce the number of discarded needles and crime and violence around the sites and Public Perception increase once you institute them. In sydney, the site there they were concerned about in the neighbourhood and then they had a model and asked a year after that and Public Perception in the neighbourhood was higher than before about these sites. Its something thats a good part of Community Practice in general. The research is clear on it. The research shown here a lot of our research it would save 3. 5 million a year. Thats beyond the cost of running these and thats probably an under estimate. Were going to save money along the way. Thats all i have to say. I hope you approve these as soon as possible. Thank you very much. Good evening, health commissioners. Im elaine chan on behalf of myself and my partners. Were Health Care Professionals and want to express our support for safe injection facilities in San Francisco. S as you are aware theres a growing Movement Across the United States for the services in seattle, new york, baltimore and new mexico. We believe now is the time for us to be bold and to be trailblazers. Lets bring safe injection facilities and services to the city. Be the first city to demonstrate the success of the model in the United States. Commissioner chow thank you. Next are varsha, pandi, angie and dr. Christie warn are warner and lauren kohn. Im dr. Christie waters. Im a member of the California Society of addiction medicine. We have over 400 physician wrong to the group in california. They dont all live in the San Francisco but we all support this idea. Were all working hard to support ab186. We appreciate your hard work and would urge you to push on. Thank you. Commissioner chow thank you very much. Good afternoon, commissioners. Im a thirdyear farm d candidate at uc fresno. My question is on how the city of San Francisco can be more proactive. The act ab182 was to increase education on opioid and heroin. Trumps attempt launched a Prevention Campaign to educate the public about the dangers of opioid. My question is why we cant do both. Warn of the dangers and informing the vulnerable and already addicted individuals who take opioids on the Services Available to them. Theres an excellent presentation on what is already being done and how theyre doing a good job getting naloxone out there but i think there needs to be more information on followup and ensuring these people are seeing Health Care Professions to professionals and taking steps to become clean. And i want to thank the brave people who shared their stories because its impactful and increases my drive and passion to act on the issue. Thank you very much. Commissioner chow thank you. Hello. My name is rasha pandi. I hoped to speak during the Public Comment section but i was called now so is it okay if i share something alternative. Commissioner chow were sorry. Im here to advocate for the family Pact Programme established in 1996 to provide Reproductive Services to lowincome families with an income of 200 or less of the federal poverty limit and ensure optimal Reproductive Health but it doesnt include lgbtqi individuals because its only accessible for those for a medical need for Reproductive Services. What we know is sti screening is essential for ensuring optimal Reproductive Health because chlamydia and gonorrhea can cause infertility and gay men are at greater risk than heterosexual men and im bringing this issue forth. I know its poor timing, i apologise. Im bringing it forth so it can be addressed in the future and the disparity can be addressed. Commissioner chow thank you. Before we proceed to the next speaker let me call several other names. Polly gray, Scott Steiger and otto duffy. Im lauren kohn from health way 360. We provide treatment and services to over 300 people from San Francisco annually and we were happy to have the opportunity to contribute to the task force in part by serving the people in early recovery in our programs to find out what they thought about Safe Injection Sites. It occurred to us maybe they would not be in favour of the idea of allowing people to continue use and one of the responses we received is if it saves lives its good for everyone. Also i wanted to pick up on the id idea that people who use outside are pariahs. If people are feeling theyre rejected from society, it absolutely drives them further away from seeking help and treatment. Its really important to consider Safe Injection Sites not only for the dignity they provide and as an important way to come into Substance Abuse treatment. Thank you. My name is pauly. Im reduction work for almost two decades and been on the other side of it before that. A lot of the things that have been said are things i was going to say and want to echo them. Sometimes things are repeated because theyre true and i want to say quickly, four things. One is this is not a radical idea. This is just common sense. It makes common sense economically and financially and medically and as far as us being human beings. Its a matter of stigma. If you believe in god were all equal and we can agree on that. Second is numbers from 2016 showed if you add all the deaths called by speed, heroin, crack, all of it together, they dont equal 18 of the death caused by alcohol. They have safe injection spaces for people who drink, theyre called bars. Its common sense we need a place if you dont want people to shoot up on the street give them a place. Ive been to montreal and it works. San francisco and california, ive been here 35 years and people say those whacky californians and on the they do the same thing and i know someone who was infected with hiv. If people arent chaotically using and terrified in the situation where its dirty they make decisions they wouldnt normally make. In a safe injection facility you have options. On the street its survival only. No one needs to live a life survival only because they do less harmful drugs than drinking. Next, please. Good afternoon. Im the director of the Behavioral Health services in the stonewall project with the San Francisco aids foundation and oversee our substance programme and im here to represent the Aid Foundation in a statement about the fact we have as an Aid Foundation have looked at the evidence and believe in this model of care. We will sit at the table with the San Francisco department of Public Health if you decide thats the direction well be going. As a provider, ive been doing this work over 20 years. I can repeat what people said before me but what i want to say is we have to think about this, what if this is your brother, father, sister, mother, lover, many of us have lost people to drug use and drug overdose. Theres systems of care that do not accept people where they are. Nows the time to make a statement in San Francisco the lives of drug users matter. The statement goes further than you can imagine. Just saying were willing to open it tells our drug users they matter and we have hope for a better life for them. We have hope they can improve their conditions. Whether they stop using or not. The time is now. Were at the table with you to partner with you and others are as well. This is definitely a state of emergency, Public Health emergency in San Francisco. We can lead the nation and we must. Thank you. Commissioner chow thank you. Next speaker, please. Then ill call the final names, curtis bradford, jennifer kiff, ann colmes, paul harkin and lydia branston. Thank you. If youre name was not called and one more terry morris. Im a physician and i work at the Outpatient Programme at fresno general and a primary care doctor. I wanted to echo the 360 folks that the community is in favor of this. I just got back from the association of medical educators and research on Substance Abuse conference in washington, d. C. And i can tell you that organization has endorsed this effort as well. Its through the ab186 bill. Opioid overdose should be a never event whether its in the hospital or or outside the hospital. The reason is we have the antidote. People are overdosing and dont have access to the antidote or not around other people, thats how you end up with a fatal overdose. The second treatment point is we dont have great treatments for all drugs people use. Thats something we dont like to acknowledge but is true. So how do you get people to change their behavior . Well, you keep them alive long enough they figure it out on their own or you get them hooked into treatment that becomes available that arent necessarily here right now. Theyre ten years from now. Maybe there will be a more effective treatment for methamphetamine disorder. How do we keep people alive long enough . We let them use it in a secret way. From a treatment perspective were up favor of supervised drug Consumption Services. The last point ill make is from my business end, were ready for patients. They are more likely to end up in care if they are alive and more likely to end up in care if they use publicly sponsored services. Im involved in a large number of organizations in pemberline. Ill start bringing my issues with federal policy from now on and work them in substance users often use the toilet down stairs to use their drugs because if they overdose which occasionally happens its a facility. Sorry, you probably shouldnt have said that. I dont want to advertise that. Theres broad support for this among activists like myself and it extends to Service Providers as well. We want it see this work to lower addiction rates and whatever Law Enforcement is involved it will improve it. Its not counter to it. I have an application my organization put in for a 2000 grant to help with volunteer street cleaning we do. 2,000 is the amount of money your department consumes in the speech im making even if its brief. The things you run into street cleaning one isnt needles. When we started the Needle Exchange maybe this is the ultimate outcome of that. Thank you. I hope you support this. Thank you. Next speaker, please. Hi, commissioners. Thank you for your time. Im curtis bradford. I am a bord board number and for the masses coalition and tendline peoples board. I list them because each and every one of to the organizations i mentioned has seen a presentation and had a meeting specifically on this topic in the last year. I can honestly say without exception every person ive spoken to supports you. As you can see theres no opposition. Its clearly the right choice to make. And why . Because its the compassionate and humane thing to do and the right choice because its the best thing to do from a Public Health standpoint and makes sense from a financial standpoint. I would encourage you to pass this. Also as a former iv drug user myself, i would like to advocate and say strongly i support a decentralized version where services are provided already. As a drug user i wouldnt have traveled more than a couple blocks to use a safe injection site. Just being honest. I would have found an alley in between and thats how my mind worked when i was using. If there was a place within reach i would have used it. So if i can get it at a place im already getting for services i would is u