The nation's most populous state is on the verge of approving safe injection sites in some of its largest cities. A bill that would do just that, Senate Bill 57, narrowly won its final vote in the legislature Monday, and Gov. Gavin Newsom (D) has previously signaled that he was "very open" to the law.

The bill authored by Sen. Scott Wiener (D-San Francisco) authorizes what it calls "overdose prevention programs" (or safe injection sites) as pilot programs in San Francisco, Oakland, the city of Los Angeles, and Los Angeles County. In each of those jurisdictions, city councils or boards of supervisors have requested inclusion in the bill and will decide whether and how to participate. The pilot program will run for five years, through January 1, 2028.

The legality of safe injection sites under federal law remains unclear. During the Trump administration, the Justice Department strongly opposed them and successfully blocked an effort to open one in Philadelphia, but the Biden administration Justice Department has expressed openness to the harm reduction intervention.

That uncertainty did not stop New York City from opening the first government-approved safe injection sites last November or Rhode Island passing legislation and following suit in March, although the Rhode Island sites are being hobbled by a lack of funding after legislators mandated that no government funds be used to operate them. And that uncertainty has not deterred lawmakers in Sacramento, either.

The California bill overcame extensive pushback, primarily from law enforcement, which argued that the sites failed to provide a strong enough path to drug treatment. Similar objections killed three previous attempts to pass safe injection site legislation by Sen. Susan Eggman (D-Stockton), including a 2018 bill that passed the legislature only to be vetoed by then-Gov. Jerry Brown (D).

It was supported by a broad coalition of organizations including the Drug Policy Alliance, San Francisco AIDS Foundation, California Society of Addiction Medicine, National Harm Reduction Coalition, Healthright 360, Tarzana Treatment Center, and the California Association of Alcohol & Drug Program Executives.

Support for the bill was also heightened by significant increases in drug use and overdoses since the beginning of the coronavirus pandemic. San Francisco saw a record number of overdose deaths in 2020, with 711 deaths total. In 2021, 640 people died of overdoses, and the city is on track to exceed that number this year. Statewide, approximately 10,000 people died of drug overdoses from April 2020 to April 2021.

"California -- like our nation as a whole -- is experiencing a dramatic and preventable increase in overdose deaths, and we need every available tool to help people stay alive and get healthy," said Senator Wiener after the final vote. "Safe consumption sites are a proven model to help people avoid overdose deaths, reduce HIV and hepatitis transmission, reduce syringe litter, and help people access treatment. This legislation isn't about whether we want people to use drugs. Rather, it's an acknowledgment that people *are* using drugs, and our choice is whether we want to make every effort to help them survive and get healthy. The time has come for California to adopt this proven overdose death prevention strategy."

Safe injection sites have been operating for decades in Europe, Canada, and Australia and have a proven safety track record. At the 170 safe injection sites that have operated around the world, not a single overdose death has been reported. In New York City, in the first three months of operation, staff at these sites were able to halt over 150 overdoses.

Safe injection sites are a proven harm reduction intervention that saves lives without increasing crime or disorder. The Biden administration does not appear to be inclined to claim they violate federal law and has made no move against the sites operating in New York and Rhode Island. It appears the path is open. All Gov. Newsom has to do is pick up his pen and sign the bill.