>> supervisor haney: and

respond respond respond to what we've seen here in this report, so yeah, i believe we have a presentation from d.p.h. >> thank you very much, supervisor haney. i'm just making sure the slides are up. okay. so thank you very much to the board of supervisors for their attention to this urgent matter, and thanks for the information from dr. rhoda. i'm katie barrett. i sit in the community health equity and promotion branch of

the population health department of san francisco. i'm here to speak with my colleague, eileen mogren, about the strategies with community funded agencies, and i have the honor of presenting some of the work as part of that. so the increase in overdose mortality has unfortunately been a national trend for several years now, in large part because of the presence of the powerful synthetic drug fentanyl, and we heard a little bit about this from dr. rhoda already. while one death is one death too many, i also want to share some data from our partners, the dope project, on our long-standing response to overdose prevention in san francisco. we'll share some targeted

programs in housing settings and s.r.o.s as well as substance abuse treatment. i want to acknowledge the important work that's being done in the community, and together, the interventions that we'll be prescribing today have actually protectioned san franciscans for higher death tolls. so while we're mourning those that we have lost, i want to hold those up that are working hard during this crisis. so thank you to dr. phillip coffin for this slide.

the san francisco department of public health was actually among the first health departments nationally to fund community based naloxone distribution, and you can see that this program goes back to 2003-2004, and the dope project at the national drug coalition has led this program for 17 years in san francisco, and that's why we've fared better than many of our national counterparts in overdose deaths. the bars that you see on the left are new cases, people that go to get trained on naloxone, and the red bars are refills,

people that say i used my naloxone, and i need another dose, and the blue lines are the overdoses that were reported. we know that the reversal reports are really grocery underreported because folks need to come back to us, they need to tell us about the reversals, and oftentimes people aren't able to do that or don't do that or get their refills in other places. but what i think these data clearly demonstrate first is the more naloxone that we put into the hands of the people that use drugs, the more lives that they save. and also, again, as we're talking about the tragedy of lives lost, with you also want to celebrate the life saving work of the community that people that use drugs do every single day to take care of themselves and take care of their friends. we also see every year that this program has grown and has grown a lot to meet the demands

of the community, and in fact, at the end of sept 2020, if you look at the kind of gray boxes on top, the dope project had already reported almost as many reversals as they reported for the entire year of 2019, despite the shelter in place orders that we were under for much of 2020, despite reduced mobility of a lot of the folks that are utilizing this program, and reduced access to services for significant portions of the years because of the covid-19 pandemic. we're shown that 5,200 lives were saved by people who use drugged in 2018 and 2019 alone in people that use drugs in san francisco, so thank you to the community for that. one of the most significant causes of mortality is using drugs alone because there's no

one to administer the naloxone or provide care. once the shelter in place hotels were he beeestablished, started implementing these projects in that setting, where people were more apt to use alone. that's always been a core strategy of our overdose prevention aresponse at d.p.h. we know that naloxone access alone is insufficient if folks aren't trained to use it and if there aren't supportive harm reduction services in place for folks to reach out to without fear of losing services.

we've been doing a lot of work with service providers, with housing providers about a wraparound culture and how to react should an overdose occur. we'll also be talking about our dealing prevention tragedy, including access to naloxone and buprenorphine. so this has demonstrated the particular vulnerability of single room occupancy or s.r.o. residents because of their tendency to use alone in single room hotel rooms. and understanding this, we in san francisco had looked to national models on how this was addressed and focused on the vancouver tenant overdose

response organization, or t.o.r.o., doing a lot of work with their residents around overdose recognition and response and sort of changing the culture of the way the buildings are dealing with overdose risks and drug use. so we're fortunate that the california department of public health funded a pilot project in san francisco that is currently underway. san francisco department of public health has contracted with the dope raj and the national drug coalition project with this work, and we are in the midst of year one, having by surveyed all permanent supportive housing providers on overdose intervention providers. we are piloting projects at two sites with a plan to expand locations in 2021, and we are having discussions about doing some top down policy work and kind of supply and being assess and readiness work in all the permanent supportive housing

sites. i will share that just as we were gearing up to launch this pilot, covid-19 hit, which necessitated a lot of adjustme adjustments to our work plan, and our initial plan had been to train residents in person in groups, and that is not feasible nor safe at this time and in fact is not permitted due to the local health orders. so we've shifted our focus in a number of ways in the first year so as not to lose the time no, s nor the funding for the projects. we've done a lot of training in shelter in place hotels. we've started working with s.r.o. staff in shelter in place buildings around preparedness, around having

supplies on-site, about having that equipment around for overdose risk and safer use. we're working with ucsf that will involve some preand post intervention qualitative data collection, and there this be phone -- this will be phone interviews with residents to get in to talk with folks. one of the permanent supportive housing sites is piloting the use of brave buttons. these are buttons that residents can push in the request of an overdose for response from staff. s.r.o. staff are trained in sort of how to respond when the buttons are pushed, and we're certainly going to be looking at expanding this program based on the outcomes of the pilot.

so i'm going to allow or ask my colleague, eileen, to jump in more and tell a little bit more about our s.i.p. hotel work. thank you very much. >> good afternoon, supervisors. my name is eileen lofgren, and i also work in the community health equity and promotion branch of the department of public health. i am the drug user health community programs coordinator, so i work closely with many of the programs that supervisor haney mentioned that are doing on-the-groundwork. so i just want to thank you for the opportunity to come back and present on the work that we're doing, and always keep this issue that is always such a crisis at the forefront and allowing the opportunity to create awareness.

so katie mentioned the shelter in place sites. so back in march or early april, there had been some overdoses or overdose deaths at the shelter in place sites. at that time, there was no plan for harm reduction strategies in the hotels, and myself along with the dope project and san francisco aids foundation were able to set up a mechanism where we would go to the sites, assess them, and determine a harm reduction plan. we were actually called the harm reduction team at the sites. initially, the plan was only to have naloxone available and syringe disposal, but as the relationship grew, it became very clear that safety supplies needed to also be available, and that there was definite

training needs amongst the various c.b.o.s that were in the shelter in place hotels that were doing the staffing. one of the things that did become very clear is that a lot of the staffings or different agencies involved in the process had different understandings of harm reduction, and how harm reduction is part of the continuum, and abstinence can be a part of that continuum and really engaging in those conversations. as our time evolves in the s.i.p. sites, it began to grow a relationship and really provide more of an understanding of the work. next slide, please, katie. this is an example of the naloxone stations that are set up at the sites.

there are 150 stations set up over 27 sites, and this provides access to naloxone without judgment, without stigma. people can just help themselves, and it has been modelled from what has been done at hotels in vancouver, and just really, again, providing an opportunity to reduce barriers because here, we know we were taking people off the streets and putting them in hotels, where the message has always been don't use alone, and here, they suddenly have doors. so this was somewhere where we could do our work and provide access. next slide, please, katie. so as katie mentioned, d.p.h. funds the dope project to provide naloxone supply

overdose outreach, and technical stance. they have expanded their work as far as the agencies that are able to distribute naloxone. since 2018, there's additional sites. three of them are in the southeast section of the city, and i think that that's key because we really want to ensure that there's coverage citywide. the dope project is able to do this and work with these various agencies in culturally informed and culturally appropriate ways, recognizing that there's a lot of trauma around drug use, and that one strategy does not work the same for all c.b.o.s or agencies, just like for an individual. the goal, of course, as katie mentioned, is to asaturate the

community with naloxone and get them to people who use drugs. one agency location in san francisco had nearly 70,000 visits or contacts at their harm reduction center on 16 street in 2019. they also trained thousands of people in a year in the use of naloxone. the behavioral health pharmacy at 1380 howard also distributes naloxone. you can do a five-minute training, and they will distribute naloxone to you, and in 2019, they distributed approximately 900 kits. and another group distributed

more than 1300 kits in 2019, and they've also been partnering with the addiction care team at san francisco general to connect patients to long-term harm reduction programs and medication assisted treatment. next slide, please, katie. oh, one other thing i wanted to add is that we're also participating in a national project which is a mentorship project, and it's called the overdose prevention and response project. we are partnering with the dope project on that, and really, it's working with other health jurisdictions to share best practices. and while san francisco is a mentor in this project, it's really about learning and growing and sharing best practices because we're all dealing with this

crisis. d.o.p.e. proje while i do not have data to report back yet because it's still new, perhaps when there's questions, that's something that judy can jump in on. also, one of the things that we realized at the shelter in place sites, just like street medicine on the streets, they were able to get people started on bupenorphine, but they weren't showing up, so we were able to get the substance to

the sites. additional, we continued to make low barrier medical services available at some of our syringe sites because that's where people who use drugs go, and it's a perfect way to connect with people. we've been really successful with our program, homeless youth alliance, at our site that's behind safeway at duboce and also the 6 street harm reduction center. unfortunately, a lot of expansion of a lot of these programs are contingent on funding, and the need is growing, and that often puts pressure on us and also on our community programs. next slide, please. so some of our new initiatives is just, as katie mentioned, really expanding on our work at

permanent supportive housing. some doors opened because of covid, and i think that that becomes very clear because of the work that we have been able to do at the shelter in place sites, and just thinking through how we can expand -- expand that model. there is a new pilot that is providing training to housing sites, shelter sites, shelter in place sites. it is a training collaborative that is being provided by the national harm reduction coalition, but the work is being driven by d.p.h., h.s.a., and h.s.h. it's a pilot, and it's in the pilot phase right now, but this is something that would be an example that would be something great to see as a standard of practice. the levels of training offered are foundations of harm

reduction, deescalation and conflict management, and self-care for frontline workers. something else that we have learned from our work at the shelter in place sites, and i had mentioned this to you months ago, supervisor haney, is establishing what we call a harm reduction liaison, and that's something that's at shelter in place sites engaging in conversations with people about safety and taking care of themselves and providing access to supplies. at some of the sites, we have a liaison, and they're able to engage in conversation about low barrier treatment and connect people directly to medical services. currently, we have harm reduction liaisons as six of the shelter in place sites, and that's for a few hours a week,

but it has really made a difference in engaging, who is not connected to service at the site, not connected to medical, but it sort of facilitate that linkage. something else that we've done that is coming out of the shelter in place sites is working with the covid command center to make that sort of standard best practice, and as i mentioned, we are working with a lot of city agencies and c.b.o.s that have a different undering of what -- understanding of what harm reduction is and not understanding the continuum of services. and so at the covid command level, we are engaging in conversations of, well, can we make the harm reduction policy a citywide policy because currently, it is just the health department policy, but

that would help just systematize some of the work and breakdown barriers when we've tried to engage with residents and make some change. another change is the addiction care team at zuckerberg has access to harm reduction supplies now, and what they've found is by having access to harm reduction supplies, it allows them to have conversations with the customers around drug use without stigma. and we are looking at how we can expand that program into more hospitals and primary care. next slide, please. so looking ahead, there's

still -- there's still things to be done, of course, and needless to say that d.p.h. strongly supports the creation of overdose prevention programs and will continue to ad -- and we'll continue to advocate at the state level to continue to bring these life saving programs to san francisco? last spring, we presented in support of the legislation that supervisor haney brought forth that outlined the permitting process and, i mean, we really look forward to making progress on this issue in 2021 and recognize that this is definitely a strategy that will help us address this crisis? additionally, the -- the street crisis team launched on november 30, and so we've heard good things as it started to roll out slowly.

it is going to be amped up over the course of a few months, and i think that that's also another strategy that we hope to build on in addressing the needs in the community. i think, also, we need to acknowledge that there is the common vision of just linking prevention and treatment and really focusing some of our efforts on making that connection through the next steps? the drug sobering center was halted because of covid-19, and now, there's work in exploring potential sites that are -- that would be safe, given the pandemic, but that conversation is happening, and we look forward to moving that forward. and then, just hearing from our community providers and

clients, participants, about reducing barriers to access and providing more opportunities to connect with people and make services low barrier so that they're easier for people to get in. and let's see -- again, to get in, some of the efforts are contingent on funding, but we are continuing to just think of ways to look at data to better inform our programming, and needless to say, working very closely with our community providers because supervisor haney started off your opening -- you said, how do we stay informed? well, our providers are out there, and when there are things happening on the streets, that there's a flurry of overdoses, we get that

information from them and think through how can we strategize? dr. barry levin gets an updated report, and they're still going through the final phases in medical examiner's office. we are able to determine if there is a death at an encampment and the age of the person and send a team out to respond proactively and just engage with people around drug use and make sure that naturca is in the community at that encampment. so we're happy to answer your questions, and we have dr. judy martin available to answer your questions, as well.

thank you. >> supervisor haney: thank you for your presentation and all your work. i also want to echo your gratitude for all the work you do a all do, and all the work you do around saving lives. i have some big picture questions, which i would love if you might give a shot at, and then, i have some specific questions. maybe there's some colleagues that want to jump in before the more specific questions. one of the things was asking about san francisco as it compared to other cities and the rest of the country. miss burke, you mentioned at the beginning that this was a nationwide epidemic, which it is. with that said, i do not

believe that what we have seen in san francisco over the last three years in particular, a tripling of overdose deaths in two years, is consistent with the trends that are taking place in most places or across the country. the -- the number of overdose deaths nationally went up very slightly between 2018 and 2019 and actually dropped a little bit between 2017 and 2018. i couldn't find any other city, and i know especially the west coast cities have been especially impacted over the last couple of years. they've never seen anything like this increase in such a short amount of time, so i wonder if you could speak to what is happening in san francisco? and again, i don't want to discount the very good work that is being done that is saving many more lives than this, but there is no denying that this very rapid increase

in the number of people in our city that are dying is happening at a rate and at a pace and trend in san francisco that feels unlike anything we've seen here and anything that i've identified anywhere else. >> sure, i can take a shot at that. so i think that -- i think that, actually, the east coast was -- was much harder hit with overdose a few years earlier than we were because the fentanyl influx happened a little earlier for them? i think that what we're seeing now in terms of the stark increase that is so alarming is kind of fentanyl having a stronger foothold in our drug supply, coupled with the covid-19 crisis and the way that sort of all of our overdose safety tips are kind of at odds with our covid safety tips.

and so just as sort of we were getting hit harder with fentanyl being part of our drug supply here in san francisco, we were also telling people to -- to isolate, to stay away from each other, so there were fewer folks to respond to overdoses that happened. i don't know if you have anything to add, dr. martin? >> thanks, katie, and thanks for this hearing. i agree and totally support this sense of serious urgency with this problem. my understanding is part of what's -- san francisco is definitely different from what happened on the east coast. part of it is because it comes later, but there's speculation why we aren't just mixing -- often in other cities, the fentanyl was just mixed with heroin or mixed with other pills, where here, people are using fentanyl on purpose.

in other words, it's being sold as fentanyl, not as a kind of -- something that you'd mix with other things. so that's one thing that's slightly different. but in terms of the steep rise, some cities have actually seen that. i don't know -- i think vancouver might have seen that a few years ago, and what we see here in san francisco is that we have a lot of opiate overdos overdoses that are leftover that were started during the aids epidemic. we have a history to naloxone and we have a history of using community funded bupenorphine,

so a what we're focusing on is where is that getting to, where people show up to get needles and get naloxone, why shouldn't there also be available of bupenorphine at that site? at least at the first site, to full treatment, and then, once you've started it, what can you do to continue people in the treatments, and that's similar to the cascade model that was used for hiv where you not only start it a whilfor a while, bu take it long enough to suppress the virus. what we're thinking about is how many people are at risk?

how many of those are using? how many of those are in treatment, and how many of those have the best chance to prevent overdose? and then, also a lot of overdose deaths that include methamphetamine we're including in our overdose response, a lot of things that were suggested in the methamphetamine task force. things such as the drug sobering center and contingency management which is a good treatment for drug management use disorder. >> supervisor haney: and kind of in response to some of the things that we've been doing here for a long time, can you describe a bit for me how the increase, as you said, in the intentional use of fentanyl,

which, of course, is connected to the dramatic rise in the number of people being saved? how is that has changed what we are doing here? all of the things that you have outlined, what are we doing to respond at scale to respond to the problem that you have acknowledged, in many ways, is now different? >> so i'm not sure if it's specifically fentanyl, but the increased number of overdoses. looking at things that work and making sure that that they are preserved and expanded, and

that, of course, means working with our contracting partners and getting proposals from them of where they could expand to and looking at where the high risk populations are. for example, if you heard in the presentation, permanent supportive housing cited are considered high risk population, and the s.i.p. -- sites are considered high risk populations, and the s.i.p. hotels and safe sleeping sites. i feel the need of doing it fast and also increasing for people who aren't taking advantage of the treatment that exists, increasing ways to help them get there, like navigation, like delivery to their s.i.p. hotels or navigation. one of the things that's interesting is about half of the people that use fentanyl, if they get onto the treatment,

they require a form of treatment called microdosing, which is a gradual increase in the amount of buprenorphine that's used. it's done rather th, rather th few days, it's done over about a week. and the other thing that we've found that we've heard about fentanyl is that perhaps in a way to try and stay safe, people are smoking it instead of injecting it, so that we definitely have to consider that when we're considering

supervised consumption sites and how to do that safely. >> if i can add another, like, harm reduction points, there are folks that are -- phenyl anyls that he drug of choice, and there are other folks that are overdosing because fentanyl was infecting the drug they were using. they didn't know that fentanyl was in the drug they were using. they were giving out fentanyl test strips to see if any fentanyl was in it, and they've used that as part of a counseling tool. i think that part of ways that counseling has changed is requesting staggering use, not

just using with friends, but staggering, so if something happens, there's something there to respond, so i think the methods have shifted to respond to the current trends at the moment. >> i just want to add that has come to the community. when the syringe program started providing foil, it was because community members were asking for foil. and we have to recognize that fentanyl is the drug of choice for many people, and so how can we reduce harm in that sense, and that's, like, if people -- community members, people use dr drugs are coming up with their own method -- smoking rather than injecting -- that's a step, and it's up to our job as community providers to just engage in those conversations

about safety strategies within the realm of smoking fentanyl and the seriousness related to it. >> another thing i wanted to mention because it's really important to notice and pay attention to is the rates of overdose among black and african american people in san francisco. 6.3 times higher than the rates of other ethnicities combined. it's always been high, but it went up really high. so we want to make sure that all of these activities that we're doing are done closely with our community partners in areas of the city where there's a high concentration of people who are black and african american, that they're able to

provide all of the services, naloxone and buprenorphine, to help them stay alive. >> supervisor haney: thank you for those answers. i wanted to ask you a question on this. you all are experts on the frontlines of responding to this, along with our community partners, and we are at a point now where, you know, nearly two people a day are dying. the majority -- the large majority are somehow connected to fentanyl. in the area that i represent, within six blocks of me, it's nearly one person a day. we are on track now, if this continues, that it'll be two people a day just in this area that i live and in the area that i represent. how do we stop that? how do we -- it seems to me --

and i appreciate everything that you said, and all of those things are good things -- that there is a sense that it is going to continue, particularly as it relates to fentanyl, and we are going to see more and more people dying, and that there doesn't feel to me to be a plan to prevent that from happening. and i'm not putting that just on you all. i think it's on everyone, the entire city, but 700 potential people dead this year. it could be 1500 next year. where -- what more do we need to do to stop this devastation and death that is taking place in our city? >> i appreciate you calling that out, and i think that that's where the -- the work that we've done at the s.i.p.s has really highlighted that

city agencies working together, and you -- you said something like that at the start of your opening about this is not just a public health issue, it's, like, a city agency issue that we need to work together to address, and that's why i think that the steps that we've been taking with the covid command center about trying to move along the harm reduction policy and what harm reduction means. it is way more than giving out supplies. it is the continuum of services and really ensuring that framing is understood amongst our city partners and embraced. because people who use drugs, whether they're on the streets or they're at a congregate

site, they touch many different points of agencies, and i think that would be something that would be a step in the direction. now, behavioral health contracts and hiv prevention contracts have language specific about overdose prevention and having an overdose prevention plan and having training for staff, and i think that's something else that can kind of help move things along because we can breakdown one barrier, but then, there's often another barrier, and so i do think that in the time of the covid crisis, we have been able to make a lot of progress with the s.i.p. sites and some of the dialogue, but it needs to continue, especially as we think through the conversations about overdose prevention sites and how we can all work

together as a citywide system. >> yeah. i'll just add to that, and i'll channel kristin marshall, maybe, from the d.o.p.e. project, that it's connected to income inequality, it's connected to homelessness, it's connected to racism, it's connected to sort of our punitive system around substance use, so i think if we can make advancements in those areas, as well, that we'll see reductions in overdose deaths. >> supervisor haney: thank you. again, i don't want to take this out all on you, but the frustration, i hope you can understand my frustration. these are people who i represent largely. they're dying, they're dying at rates we've senever seen, and seems they're going to continue to die at higher and higher rates, and we need to

understand how we can save them. we cannot help them, we cannot do anything for anyone if they're no longer with us. i appreciate and i understand your work, but as a policy maker who represents all of these folks and their friends and their families and their neighbors, i think that we need to have a more comprehensive plan here to -- to prevent these overdoses, and all of these things are good, but it's -- i'm having a hard time feeling like it's coming together in the sort of coordinated comprehensive plan that we would need to feel confident that we are moving in a different direction. i have a number of questions about the s.r.o. program, and also around referrals to -- to treatment and how we are doing that, but i'm going to pause my questioning. i see supervisor stefani, so i'm going to different different. >> supervisor mandelman: yeah,

and before we allow vice chair stefani to speak, i have one last question, and i have a housekeeping matter for my committee members. i am on the t.a., which begins at 1:00, so it seems highly likely to me that this is going to go past 1:00, at which point vice chair stefani, you would become the chair of the committee. i'm making sure that is okay with you. >> supervisor stefani: yes, that's okay. >> chair mandelman: and what -- the things that will need to happen at that point are, you know, any further questions, comments from committee members at this hearing. and then, there's one more item on the agenda, which is a hearing on sb 1045. but because of the covid surge,

and that this is probably not the right moment to haul dr. colfax in and yell at him about s.b. 1045, and the failure to implement that, i think we should continue that until after the current surge, and i so i would ask the committee, when we get to that point, to consider a motion to -- to continue it until -- continue that hearing until february 11, which of course, we would have to take public comment on, as well, just on that continuance. does that -- and clerk carroll looks like he wants to interject on that, as well. >> clerk: the hearing item number 5 has not been called. if you want me to, i can call that, and you can discuss your comportment on it, as well. >> chair mandelman: well, i think i've said everything i want to say on that. i just want to make sure that supervisor stefani is ready to

take over the agenda. >> supervisor stefani: i'm ready, chair. >> chair mandelman: this is a fascinating hearing, and i feel, like, supervisor haney and i, like, sort of move around these issues and sort of parallel and sometimes intersecting and often experiencing similar frustrations. i don't know if this is where he's going, but it's paradoxical and frustrating to me that a city that prides itself on its public health orientation and public health response that has such great sfrist indication on harm reduction and that -- sophistication on harm reduction and that holds itself up as a leadership on substance

abuse treatment, there is a paradox of having hundreds and hundreds and hundreds of overdose deaths which are not thousands and thousands apparently only because we're giving out narcan like candy and, you know, have this have narcan everywhere -- and of course, it is better to be giving out narcan than having people died, but i am perplexed that we seem to have developed this robust comprehensive harm reduction approach that seems to be resulting in so much failure and it is totally possible that these two things are coincidental, and that the

harm could be so much worse. i know that there are people out there in the public, and i think we have the obligation to explain to them that -- that the -- that the -- that statistics, like the statics around death overdoses are not a result of our sophisticated harm reduction approach. i'm not saying that it is, but i know there are people out there that believe it is. and just one other -- a question that i sort of thought of was do we as a public -- i mean, as a public health matter, we all know that we are trying to reduce covid in the city and county of san francisco. as a public health matter, are we trying to reduce active substance abuse disorder in the city and county of san

francisco? i understand that we are trying to pursue harm reduction strategies, but is it a goal of our public health response to have fewer people using substances that may kill them? >> absolutely. so our goal is to reduce the overdose increases and to reduce the disparity of those increases; to increase people who are in treatment for opioid, and to keep them in treatment for at least six months, and make sure that there's equitable and plentiful distribution of naloxone. and right now, in our response team, we're looking at and we have detailed proposals from our contracting partners, from

primary care, from whole person integrated housing. we're looking at 19, and most of them are in the form of expansion of what we do already. they've been proven in other cities where they're having managers like buprenorphine, and then, there's other things that we need programs to do them, things like safe places for people to use while under supervision, so that's the way that we've laid out our plan. so we hope it's a five-year plan, wibut to kick in, we do need some funding. >> chair mandelman: and the view is, just to put a final point on it, if we knew what we were doing, we would have better results.

>> yes. it's deemed that high risk people that we've treated with harm reduction to now. it's almost some somebody has in a locks -- almost as if somebody has naloxone [inaudible] is completely different than when i was trained in 2002. >> chair mandelman: all right. >> things have changed. it's not as dramatic, but because we're doing so many good things, a lot of it is expansion, and that's to our advantage. a lot of it is going to be contracting with our partners. >> and, supervisor, mandelman, i think you just highlighted the problem of he diction.

what was it at that point that made you just say i'm done and make that lifestyle change? and like most things, like, one model does not work for everyone, and that's what makes it just so hard, and i think we just have to acknowledge that that's why it's so important -- maybe we need to do a better job of our framing of what harm reduction is because it really is the continuum. i said this before, but, like, many of the people that work on the our syringe programs may -- their harm reductionist at work, and in their personal life, they may have their own views on recovery, and we have to just really just engage in that dialogue. i mean, certainly, if someone is at a place where they're, like, i am done, no, here's some supplies. cool, let's go. a friend of mine said when he

was ready to make that change, he went to the syringe site at 16 and mission and said to the staff that are working there, i am done, and they helped him get into walden house. i'm dating myself, but it's a complex issue that requires many strategies. >> chair mandelman: well, thank you all. thank you, supervisor haney, for bringing us this message. i'm sorry that i can't stick around, but i want to thank d.p.h. and all of our service providers who are doing this heartbreaking work every day. with that, vice chair stefani, you are in charge, and you are in the queue. >> supervisor stefani: thank you, chair mandelman, and supervisor haney, are you okay with me asking some questions at this point? >> supervisor haney: yeah. i have more at this point, but i'll jump in at this point.

>> supervisor stefani: they're more high level, and i love the discussion just in terms of supervisor mandelman's question. and in harm reduction, i want to mention that i'm having a hearing on basically what you just said: what does it take from a recovering addict's perspective in terms of what helped them get clean and sober. that's not making a judgment, that's the only way to deal with addiction and overdose, but i think it's not clear to me what exactly are the pathways to recovery -- abstinence-based recovery in san francisco? and like i said, it's one of many ways to deal with addiction, but i am just

wondering if overdose prevention includes and has a plan to actually figure out what those pathways to recovery are? supervisor haney started this conversation by saying, what do you need from us, what do we need to do? fentanyl is a whole other issue. just what are we doing to increase those pathways to recovery? >> can i ask supervisor

stefani, when we use medications to help people, we define abstinence as being on a medication and taking it as prescribed. we have almost 6,000 people who are abstinent in the city because they're on maintenance medication. >> supervisor stefani: okay. if they're on maintenance medication, one would assume there wouldn't be an overdouse resulting from that. and if you think there are people on maintenance medications that could still have overdose, and that would be -- and die because of it, it seems like another intervention would be necessary rather than just maintenance medication. so if there's 6,000 people who are on maintenance medication that aren't in danger of overdosing, that's great, but if there's 6,000 people that

are on maintenance medication that could still result in overdose and death, something else needs to be done. >> yeah, we have armys of counselors in the methadone clinics, for sure, and there are -- of course, some people are addicted to other things and might need to be in residential treatment in addition to medication, and some people -- it's sort of -- if you think about diabetes, some people just have to cut out sugar from their coffee, and they're fine, and others cut out all sugar and junk food, and lose 50 pounds, and they're not fine. recovery support is something that is a part of our system, and we have it set up as a kind of continuum of services from

very high intensity services to step down to intensive outpatient and outpatient and then recovery support, and we're -- you know, that's what we're always aiming to provide, and that's what the -- even the drug medi-cal health plan is set up that way. . >> supervisor stefani: i'm still not clear. how does abstinence based recovery and people that don't want to use the drug, how does that fit into harm reduction prevention in san francisco? is it a method that's being explored? because we need all hands on deck here. supervisor haney just said it,

supervisor mandelman just said it. i am wondering how that plays into this conversation? >> i think, supervisor, that goes to what i was saying to supervisor mandelman about the continuum and recognizing that there's low barrier treatment, and there's lock -- lockdown live-in treatment facilities, and recognizing that there's places all along that continuum, and what's right for someone. one person, they may be, like, i don't want to go to treatment, i don't want to quit using. in t and there may be people like my friend who says, i'm done, and residential treatment and ongoing meeting is what works for them. there's other people that may go through treatment and strong

harm reductionists but no longer use, and that works for them, and i think that's what makes it so complicated. but the conversation and the framing is always the continuum, and that's where i said that we could all do a better job of just making it clear that it's really the spectrum of services that are available, and it's not just one or the other; it's the whole continuum. >> supervisor stefani: is there an emphasis placed on one more than the other or is there one that's easier to provide than the others in terms of harm reduction? i know that people who want to get clean and sober, they have to have that moment of clarity or that moment of willness, and you can't make someone get clean and sober if they don't want to get clean and sober. i totally get that, and i know

more about addiction than you would know. but i need to know, what are we doing in san francisco to help those individuals. for people who say they don't want to continue drug use, you say that there's a continuum, and i want to know, how does this work? we have people in s.r.o.s that are addicts, and isolation is one of the worst things for addicts. are we checking on them? locking someone up -- not locking someone up, but putting someone in a room without that fellowship that has a drug problem, that -- or an addiction -- i don't want to characterize it as a problem, kbu what are but what are we doing to make sure that if they want help, what are we doing to help them?

what programs do we have? who are the frontline providers? who are going into the s.r.o.s to see if people are ready to get clean and sober? if they're ready to get clean and sober, are we not there? are we bailing? >> judy, can you talk about if healthright 360 has outreach, and safe harbor, they have outreach, and they're able to facilitate people to residential treatment, aif that's what they're interested in? can you speak more to that? >> yeah. i think there are devly people that want to get off drugs, for sure, and the path to that is through counseling and mutual -- definitely people that want to get off drugs, for sure, and the path to that is

through counseling and peers that have a few more years under their belt of being sober. and peer navigators are a big backbone of the system. so covid has been hard on those groups, and sometimes in the residential programs, they can do the groups because people are in quarantine for a while before they join the milieu, the congregate setting. otherwise, what our programs are finding is that even though they can advertise to do zoom groups, some of our clientele doesn't even have cell phones. so some places have booths that you can see people through glass, almost like a phone booth, and they have a pad inside where you can video

visit with people in the waiting rooms. people are creative about it, but another thing that's been discussed is in the supportive housing locations, to allow people to visit each other on the floors even after it's dark, even after lights out, so that they can give each other that kind of support. and then, that group can sometimes consider themselves "a bubble" within the housing group. i don't know of any s.r.o.s that do that, though, but certainly in permanent supportive housing is one place that does that. and you know in san francisco, we have millions of 12-step programs, all kinds, a variety of 12-step programs. >> supervisor stefani: [inaudible] i'm wondering, and maybe i'll get into it more in

my hearing on february 11 in terms of the summit working group and the recommendations that they made. i have a lot of questions around this. i feel like we need to include all methods of getting -- of addressing addiction and, you know, i think -- i don't know if it's just maintaining -- like like, if there's a particular philosophy, whether or not somebody can be on a particular drug, and whether that drug -- in the recovery world, people have a saying, using time and time again a drug that doesn't work for you leads to three things: jail, institution, or death. there's people that can maintain on a certain drug to the end of their life and do it well. maybe that's the case, or if

there's a difference in thinking that some people continue to use that drug because certain drugs cause them to do certain things they have to make amends for later in their life, or whether that drug can intervene in their life so badly that they have to make amends for. i don't know if there's two different things that could be competing in their lives. i know that only one in ten addicts go to recovery or beat or recover from their

addiction. [inaudible] and whether or not there should be a focus there. and i don't want to take up too much of supervisor heaney's hearing on this because we could probably discuss this for hours and hours shlgs but, but make sure that when we're talking about overdose prevention, we talk about it all. we can't talk about overdose prevention and getting people into the treatment beds, and to look at how many beds are actually left empty. and also, we cannot talk about overdose prevention without talking about how easy it is for people to get drugs on the street, how easy it is to find fentanyl because an addict is going to find his drug, an addict is going to find her drug. overdose prevention in my opinion includes it all. i can't thank you enough four the work that you do.

this is personal to me in terms of just knowing too much about it. i wish i didn't know as much about it as i do, and i -- i just grieve for the families and especially the parents of those that have their kids or -- you know, on the streets that are addicted and can't get the help that they need. it's just -- it just breaks my heart, and i thank you -- i do. i want to thank you all for doing the work that you do because there are a lot of people that are able to turn their lives around and lead a better life, but i think we need to do everything we can. and it's not just about harm reduction, it's about doing so much more. again, i'm not going to take up too much time, but i think my hearing on february 11 will provide more on the recovery-based side of this in terms of what those who have been on drugs -- what finally

worked for them in terms of no longer being in danger of overdose and what worked for them. i'm not going to ask anymore questions. supervisor haney, i'll turn it back over to you, and yeah, that's it for now. >> supervisor haney: thank you, supervisor stefani. i appreciate those questions. i had a few more kind of specific questions, both about the -- what we're doing in the s.i.p. hotels and what we're doing in the s.r.o.s. in the s.i.p. hotels, i know there have been naloxone stations set up across the sites. i wonder what other type of education and outreach is being done in those sites. are we assessing people in the sites and providing counseling

or referrals to treatment and other types of support in addition to the naloxone and harm reduction kits, and if so, do we have numbers on how many people have been referred from the s.i.p. sites to substance use disorder treatment and escalating lef effecti escalating levels of care? >> i'll start with that. i think that starts with the harm reduction liaisons that i mentioned, specifically at some of the larger sites, like site ten that you were at for a while, site a, which is moscone west, have harm reduction

liaisons. one of the liaisons works very, very closely with the medical staff and has engaged in conversations about connecting people to medical care. currently, this is something that is just, quite honestly, sort of piecemealed together in terms of this is something that all of these harm reduction liaisons are either staff that work for me or have other duties, and so we have them at these sites for two hours one or two days a week, but that is a day to completely engage with people and have those conversations.

>> supervisor haney: so just -- just so i'm clear on what has happened, there was a program that was announced in the s.r.o.s, and for the most part, there was a reprioritization to focus more on the s.i.p. hotels -- i mean, the s.i.p. hotels, it sounds like, based

on the presentation, have become a priority this year, and of the -- i know there have been 30-plus sites, there's a harm reduction liaison to six of the sites? >> mm-hmm. mm-hmm. >> supervisor haney: so are there broader sets of trainings or policies that would be standard across all of the sites? and are we tracking both the trainings as well -- it seems like we have 2400 people, you know, in the s.i.p. hotels. it would seem reasonable that we would have some universal policies or approaches to connecting those folks with both harm reduction as well as potential referrals to treatment or other placements. i'll give you an example, and

this is anecdotal, but i was at harbor lights on thanksgiving at salvation army, and they told me that they have, i believe, 40 -- at least 40 residential treatment beds empty, and that they had been trying to get referrals from the s.i.p. hotels, and they have had no referrals from the s.i.p. hotels. are we accepting, counseling, as well as providing harm reduction to the people in s.i.p. hotels? i i'm understanding the broader picture of what we're doing for people, and i understand there's been overdoses in the s.i.p. hotels? >> yeah, there's several points there that you touched on.

the way that the s.i.p. hotel and the s.r.o., they're both separate things that were happening. the s.i.p. hotel, and myself, the d.o.p.e. project and the foundation just kind of pushed through. and over here, katie and the s.r.o. project, things were halting, and then, there was the revolution of oh, this is kind of similar in the work that we're doing, given the covid crisis.

if there are unfavorable comments about a program, it goes really far. i think of one example, we had health care, and we only had one bed, and it was harbor lights. and the woman who wanted to go into treatment goes, i can't go there because my sister, my street sister said i should only go to healthright 360, and they'll treat me right there. and, like, that was where this woman was coming from. and i think that, like, that --

you know, we can't -- well, this is an empty bed, and you have to take this. what can we as a is being do to break this down so that all systems are looked at as equally inviting. katie, i don't know if there's anything you want to add about the connection with the s.r.o. and the s.i.p. stuff. >> so we have one staff funded for this project at d.p.h. and one staff fully handed at the national harm reduction coalition, and so one of the things that happened early on were -- excuse me -- the harm reduction coalition in partnership with the san francisco aids foundation made some official harm reduction videos that were intended to be training for all the shelter in place sites, and so those were

kind of foundationali training that were made available to all of the staff there. and we are talking to h.s.a. and meeting with them this afternoon about what sort of top-down trainings that we can implement now. there have been some specific trainings that we're piloting, but what sort of can we do beyond the trainings around [inaudible] overdose prevention at these sites. it's already in production at the sites that we are at, and there's plans to expand it. >> supervisor haney: so i know at certain locations, there's standardized trainings around reductions and narcan, but does every staff member who's at the

s.i.p. hotel or a provider, are they having some sort of training in narcan or other types of -- >> yeah. it's not mandated, and that's why the work that we're doing around the standards with the command -- the covid command does, like, make this a standard practice of what we did at the s.i.p. hotels is so key, because now, it's, like, well, it's given the option well, i'm really busy too. so sometimes trainings, i just don't have the time, but we all have mandatory city trainings that we have to do, so you set aside the time to do them, and i think that's something that we need to think of. and, you know, there have not always been welcoming policies at shelters. just a few years ago, there was

a policy at a shelter that said they used syringes as weapons, and if you had syringes on your person without checking them in at the front desk, you could get removed from the shelter, so the fact that we've been able to make this progress inside the shelter in place hotels is huge. but how can we standardize this work so it's the standard practice, rather than just something we were able to do during a pandemic? and i think they're the conversations that we are engaging at the covid command of different levels, and i think would greatly impact the work. >> supervisor haney: right. i mean, i think that these sorts of things absolutely have to be standardized, and i'm absolutely in big shock that they were not. we've had these shelter in place hotels open for eight

months. in fact, some of these are being demobilized or attempted to be demobilized. when something is this deadly or can potentially take lives, it needs to be standardized across the whole system. we are learning so much about masks and hand washing and social distancing and all of this, but meanwhile, all of these people are dying because of overdoses, and there's things that we can do with education, with tools, with consultations and referrals, you know, to save lives. i want to ask just real quick about the -- what is the status in a little bit more detail of the s.r.o. program. so are you currently working with specific s.r.o.s or s.r.o. service providers, and if so, how many, and what are you doing with them? i didn't fully>> where our stad

technical assistance. we've also provide sd some policy technical assistance from sharing some off the contractual requirementstu that our division had put into some of its contracts around mandating overdose response policies on site and where to get additional. our staff in two buildings at this point working around doing this policy work. training the staff around overdose readiness and response. the third sro is where the project has been working with them about installing the brave

button. those are the three site dollars we'rs we'rein now. our sro project staff at dph had been doing a lot of the shelter in place work at site ten in terms of being the reduction rates in this role. piloted that role there moving into 2021. i think that's contingent on additional funding. >> the two that you are in are those srh funded? >> they are all hrh funded sites. i think some sro's have some nursing support involved in them. what dph has been doing again is providing the training and

technical assistance and the policy work around support of policies for overdose prevention. >> i know dph has a certain set of contractual obligations and responsibilities for providers support of housing providers as well. does srh have similar policies for prevention. >> i can't speak to srh policies. >> this is something we have also brought up at the covid command. i think that if we were able to move forward with the policy being a city wide policy the other pieces would be able to fall into place. yeah.

it's not my understanding that they have anything as concrete as what we have at behavioral health and dph. i just want to add as something else we have in our brand at the health department. we not only have those requirements but established what we call the reduction training institute where with the national harm reduction coalition, we have specific trainings that are available to our dth funded providers so they and their staff can have that capacity and several times a year. >> thinking through if other city agencies are going to have some contractual language they have to have some built in support. when i mention the support training that's being piloting right now if that could be a

standard of practice, that would be great. again, it's about being able to fund that. >> right. one of the things i'm processing here. i know this program was announced over a year ago. it was announced to some degree as though it was a very large thing that was going to help us really address the overdose epidemic in our city in the sro's, it was a big proclamation. it was on the front page of the newspaper. it's a little-i'm a little surprised to hear that we are in just two sro's. i believe there are over five hundred sro's in san francisco. the last set of data said that 30% were in sro's is the challenge that we've been under staffed or had to divert people.

i guess i'm concerned that we haven't been able to reach more people in the last year in the worst year by far on record for overdoses including in sro's. >> just to give you a sense of the parameters of the grant. there's two full time staff on the grant. one is hired at dph and it's a part of the the dope project. it's also activated for covid at this time. the time line of the grant got shifted because of the covid crisis that pushed back our hiring several months. we were full time activated. there have been challenges getting started because of covid. we have as we said shifted our focus to do more work in the

shelter in place. there was a crisis there and they were very vulnerable. there were planned to expand in 2021. we've adapted the best we can this year given everything that was throne at us with covid and the fact that we can't meet in person with sro residents that's prohibited by the health order. part of what we're doing now with staff is brainstorming about the best ways to reach folks. generally the populations that we're trying to reach in the hotels don't have great access to technologies like zoom and conference calls and stuff like that. we're working on it and thinking about it, we're problem solving and trying to adapt to the circumstances as best we can. i think that we have-you know i can't emphasize enough that the

conversations we're having at the policy levels have been significant progress on this issue. we're providing training and it's a significant shift. >> i appreciate that and the really unique barriers and challenges that existed this year. another piece of this definitely i would like to see some more contractual obligations from providers if you operate support of housing there should be certain commitments around training, around procedures, around prevention that exist in that environment that are somewhat standardized that we know can help to save lives. there are very large support of housing providers c ht that i

hope we can have a lot of impact when we work with them directly and help to support them in developing effective policies. i hope that is happening at some level already. there are private sro's as well. figuring out how to system i hads this across, this is every bit as important as anything else they can protect lives there. maybe even more important than anything else. obviously also the consultation and opportunity dollars fories l if they need higher levels of care or treatment. all right. i could ask a hundred more questions. i won't do that. i do appreciate your work. i continue to be as i said, concerned about the level of our response and it's not questioning any way the commitment that any of the folks

here have. i know you all have devoted your life to this. i think our city needs to provide more resources and support and coordination and urgency to address this employ demic. we've seen this year what it looks like to respond to an epidemic and tracking data and seriousness and training and data all of our departments working together. frankly i have not seen that when it come it this epidemic which continue it tragically take many many lives. i know there are folks who have called in. i do want to here. there are people who are part of the dope project and drug users themselves. i want to hear from them and what they think are the solutions and what we can do better as well. i will pause if supervisor

stephanie questions or comments. i'll open it up to public comment as well. >> no questions. >> i think that are you muted. >> thank you. yes, we can open this up for public comment. each person will have two minutes. i don't have the script in front of me. clerk. if there's anything else you would like to say about public comment, please do so. >> i'll give the spiel so everyone knows how to call in. operations is checking to see if there's any caller nz the queue. press star followed by three to be added to queue.

please wait until prompted to begin. you'll be prompted that your line has been unmuted. for those watching by streaming link or sfgov dot org. if you wish to speak, this is your opportunity. call in the number enter the meeting today's meeting id. press pound symbol twice followed by pressing star and three to enter the queue to speak. could you connect us to our first caller, please. >> i'm the director of affirmative actions policy. i want to say a huge thank you

to the supervisors for having this hearing and a huge thanks to the san francisco of public health team for understanding this prodpram. program. i do want to emphasize consumption services as one of the necessary tools that we need to have addressed, overdosed here now we have a different administration. i would hope that the supervisors and ask the city attorney for a new analysis and see if they need to wait for sb57. i also want to make sure that we are thinking about things that decriminalizing drug use and what that has on racial disparities on our streets

everyday. give people immediate information about the drugs that they are about to consume. especially in this context. how do we ensure that we have full coordination across the system. alternative to policing they are all really essential important initiative. they need to be coordinated as much as possible to ensure that we are getting the most for these funds and that it's a principle from the ground up. ensuring that a significant percentage of these new funds for behavioral health are harm reduction services that help people find a way into other services. thank you again and i look forward to hearing more. >> thank you for sharing your comments.

could you bring us the next caller please. >> i'm a front line provider serving as a health educate at the aids harm reduction center. overdose rates are extremely high right now and only getting worse. currently in san francisco two people are dying each day in san francisco. that would be extremely higher if it wasn't for harm reduction programs. at the center we are getting reports from folks of two to five overdoses a week. people are scared and they need support. the community knows exactly what we need to do to support people who use drugs. a safe sanitary place for people to use. it was mentioned earlier that

only one in ten people who struggle from drug use recover. we know that there's never been a single fatal overdose in any safe consumption site. waiting to open these services is costing the lives in our community every single day. we don't have time to waist. waste. the city of san francisco believe that people who use drugs deserve to live. thank you. >> thank you for sharing your comments can we get the next caller please. >> good afternoon supervisors. i'm a policy manager for glide. i appreciate the attention you've given this today. it was only a few months ago that they released the death data. at the time as providers we knew

we surpassed those figures this year. we've lost five hundred seventy of our neighbors and loved ones mpleones.i suspect the figures e rest of this year will be grim and next year as well. i don't think this comes as a surprise either. last september they warned that increased death in 2020 and that overdose contributes to death. this year it's even more overwhelming. i also want to highlight and thank the community of people who eudz drugs and experiencing homelessness. they've done a tremendous job of limiting the transmission of disease in the middle of a pandemic. if it were not for this work,

the city would be losing thousands more people each year. we cannot end overdose until we end structural violence like poverty and racism. we need bigger structural change. this includes housing and economic disparities. drug testing and supervise advised consumption services. please listen to people who use drugs and provide them with what they ask for. thank you.

>> this is not about saving money. this is about saving lives. san francisco has been a leader in the home reduction and compassionate services for people who use drugs. opening and operating safe consumption space will improve the quality of life of all san franciscans. >> thank you for calling and sharing your comments. next caller please.

>> [indiscernible] our own agency -- we talk with people everyday who are able to save lives. some of the community based life saving has been complicated by police operations focused towards people without housing, split up groups of people that may have life saving ability of narcan on them. as certified counselor, i think this city should be -- [indiscernible]. obvious harm reduction intervention all the way to treatment. more options for social model

and medical detox programs with loving, care and finding 24 hour access to vending machines with education and care. >> you got about 20 seconds. >> we need compassion and evidence-basted care and access to voluntary substance abuse and mental health services. thank you. >> thank you for sharing your

comments. next caller please. >> i actually -- i think that the role of law enforcement could be used. i don't think that necessarily need to be sending people to jail or anything. i know it's not necessarily fashionable to talk about law enforcement these days. police could be used to direct drug users to services, whether it's harm reduction services or

people end up in jail -- i was talking to someone recently who been to jail multiple times. every time he was released from jail, he thrown out on the street and left to fend for himself. he didn't have an i.d. without an i.d., he wasn't able to get access to services. he resorted to stealing to support himself. integration for services needs to be a lot better. i don't think we should view the prison system as the enemy here. they need to be seen as a partner. they need to connect drug users to services, not just drug users

by all prisoners. the d.a.'s office needs to be involved in the discussion about -- >> thank you for sharing your comment. next caller please. >> i appreciate -- i want to recognize all of the presentations today devoting their life work to reducing the harm these addictions are causing in our city. they are really showing the way forward. i wanted to say that i appreciate them for doing that. as politicians, i want to say i find it frustrating that

regularly we end up debating the significant increases in funding that these programs will need from the alternative. our police state is hugely expensive. it takes a huge portion of resources way more than these devoted medical professionals are suggesting that we use utilize to save lives. i'm calling on the supervisors today to recognize that this is both more helpful, kinder and more benevolent and the police forces. thank you again doctors for devoting your lives to solving this problem. it's a vital concern for all of us. >> thank you. next caller please.

>> good afternoon supervisors. my name is andy stone. i'm with the sa san francisco of the ed foundation. as you heard today, this problem is getting more worse. in the city of san francisco we had more folks die from preventible overdoses than covid-19. i want to reiterate, home reduction is a treatment option. one of our programs works with people at their own goals related to substance abuse management. which includes not just substance abuse but abstinence from certain substances. i wanted to talk about one

option. these services that can save lives and prevent the transmission of hiv. i want to thank this board for how important this intervention can be coming to san francisco that can save lives. now that we have a new presidential administration, i urge the board to act to address this problem that we're seeing by implementing -- [indiscernible]. thank you so much for your time. >> thank you for sharing your

comments. next caller please. >> hello. i'm an outreach worker out in the street everyday. i was shaken by one of the callers comments about the police. i'm going to say that you can't provide services all over the area. it's not possible. safe consumption site is an excellent first step. when i heard you talk about liaison on harm reduction, most -- we need to pay the people. the right people that can deliver conversations that bring in other service providers to do

actual home reduction work that delivers compassion. that's how we arose to structural violence that we see now. starts long before we get to this point. i find is disturbing that we have more overdose deaths than covid deaths. we're spending all the time and money to address that. thank you for your time. i thank you for listening. >> thank you mr. castro for your comments. next caller please. >> that completes the queue. >> thank you. supervisor haney, do you have any comments to wrap up? >> i want to thank everybody who

called in. i want to thank all the folks who are here for the work that you're doing. i do think that this is -- this needs to be an ongoing conversation. i'm sure there were other hearings called. there's legislation that i'm working on, work that we'll do outside the hearings. i think i said it in the beginning, i think that to truly respond to the impact and the devastating death that has been brought by this pandemic, we need to be coordinated. we need everything. we need harm reduction. we need treatment. there's aspects of the legal system that need to be brought to bear. there's every single department that needs to be involved with this. i don't want to put it on all of you. one thing i will say that this

year, we have to get these overdose prevention sites open. they are so important. folks have been working on them for so long. it's my commitment to work with all you to get that piece of it done. i want to thank the committee for holding the hearing. for everyone who works everyday to all the organizations that called in to make sure that people have support and have access to help. i think we all agree, i hope that we need to do better and more than we're doing now to save lives. thank you so much for your work. i don't think we need to keep the hearing open. i will defer to the committee on that. >> thank you supervisor haney. supervisor walton, you have anything you want to say or add? >> i want to thank supervisor

haney for all this work. this is very tragic and something that we are all working to hard to address. i look forward to really diving in and doing the work to prevent these deaths. if they are preventible. i want to thank you for all your work and commitment to this as well. >> supervisor stefani: i want to add my thanks to supervisor haney for his continued focus on this extremely important topic. talk to the presenters and all the work you're doing. someone said it best in public comment, people who use drugs deserve to live. keeping them alive, to prevent overdose, to help them lead a better life, whatever it is. no one on this committee certainly believes they deserve to die. i believe that deserve all methods to help them live.

they deserve people in positions of power to understand addiction. they deserve an environment where drugs aren't so easy to get where they aren't so reading available for them to use and to overdose and deserve people who provide pathways to recovery. they deserve fellowship, friendship and compassion. we have to find a way to work together and to get all the departments, not just public health but the d.a.'s office, other recovery providers to address this issue. it is so important. i'm looking forward to my hearing on february 11th to further discuss city response to addiction and to hear from the recovery summit group, has comprised of people in recovery who has been through the system and to hear their voices. i want to thank you supervisor

haney and if you want to file this item, downing -- we can do that or we can continue call to the chair. >> supervisor haney: you can file it. i'm sure i'll call another hearing in the future. this one was pretty specific about the overdose prevention program. >> supervisor stefani: i'll make a motion to file this hearing. >> clerk: before we take a vote on that motion, will we be closing public comment? >> supervisor stefani: yes, public comment is closed. >> clerk: motion offered by vice chair stefani the hearing be heard and filed. [roll call vote] we have two ayes.

mandelman is absent. >> supervisor stefani: this item will be filed. can you please call the next item. >> clerk: item 5 san francisco housing co conservatorship preliminary evaluation. >> supervisor stefani: thank you. it's my understanding sponsor of this like to continue until february 11.

we need to take public comment before we take that motion. >> clerk: we can do that. operations, checking to see if we have callers in the queue. for those on hold, please continue to wait until you're prompted to begin. for those watching our meeting, if you wish to speak on this item, please call in bifollowing the instructions on the screen, that will be by dialing 415-655-0001.

>> we have no callers in the queue. >> supervisor stefani: thank you. public comment will be closed. mr. carroll before i make a motion, i like to make a motion to supervisor mandelman so it's reflected that he was excused from this meeting? >> clerk: should we rescind the vote to here and file agenda item 4 and entertain the motion to accuse and take that motion again and handle agenda item 5? >> supervisor stefani: i move to rescind item number 4. >> clerk: agenda item 4 is before us. i hear motion offered by vice chair stefani that chair

mandelman be excused for remainder of the meeting. on that motion -- [roll call vote] >> supervisor stefani: thank you. my next motion is to file the hearing in item 4. >> clerk: on the motion offered by vice chair stefani item 4 be filed. [roll call vote] there are two ayes. >> supervisor stefani: thank you, next motion is to continue the hearing to the february 11th meeting. >> clerk: on the motion offered by vice chair stefani that this hearing will be continues to february 11, 2021.

[roll call vote] chair mandelman is excused. there are two ayes. >> supervisor stefani: thank you. do we have any other items before this committee today? >> clerk: there is no further business before the committee. >> supervisor stefani: thank you, we are adjourned. >> welcome everybody. i want to say thank you for

catching this important moment. this is a really very critical issue that we're all here dealing with. this is a real nationwide effort to end senseless gun violence to get guns off the street. this is our ninth annual gun buyback. we have lot of people who are on here today who want to share some information about ending senseless gun violence. before i bring on the mayor, i want to say i'm not against the second amendment, but i am against senseless gun violence. with that said, i want to bring on our mayor, fierce leader, hard working committed, intelligent, beautiful, mayor breed. >> thank you so much for joining this press conference supporting the ninth gun buyback that will take place this saturday, december 12th between

8:00 a.m. and 12:00 p.m. you don't center to get out your car no questions asked. rudy will provide the details. we want to get as many weapons as possible off the streets. many of us here have been affected by gun violence. sadly, i feel like it's been my entire life. so many of you know that i grew up in the western addition. we have lost friends, family members and this senseless violence continues. if we can get these guns off the streets, get the guns out of the hands anyone who will use them, it is in the best interest of our communities and it is in the best interest of our families and friends. whether it's a friend or family member or someone we know from the neighborhood, as we are addressing this global pandemic, we are seeing heart breaking news. there's an increase in gun related incidents in our nation. some of the victims being young

kids, children. in san francisco, we saw an increase in firearm related incidents during the first seven months of this year compared to the same period last year. although, we don't know all of the reasons, there's likely a relationship between the isolation, absence of in-person support people usually get during normal times and gun violence. sadly, many of the critical in-person support systems are unavailable to do so in person. there are fewer opportunities for intervention. what we know is that the loss of a life from gun violence has to stop. we all need to work together to save lives and keep our community safe. many of you who are here today, who have been fighting to end gun violence for years. we need you. the gun buyback program provides

people with the opportunities to get these guns out ever their hands, off the streets and out of our communities. thanks to the charitable giving and fundraising efforts of our community partner, we will be able to purchase firearms from anyone who would like to turn them in, no questions asked. this event has brought in 2000 firearms in the past, getting them off the streets. think about in. 2000 guns off the streets because of this program. that means lives saved. this year, we are still continuing this effort to make sure that we are doing everything we can to reduce the harm and the violence on our streets and in our communities as many people are struggling with so many different challenges. this is part of our broader effort both locally and nationally to end gun violence. we need to create common sense gun control legislation so these

guns don't end up on the streets. we need to engage local university and residents is so they don't feel compelled to act violently in it first place. every year in we do this gun buyback, we go and do it at the united player's office and facility location. every year, when i look at those walls, surrounded with african-american men that i grew with, that i dated, that i went to school with, that i played in the playground with, these are men that that are my age that did not center to die. this is what this is about. to make sure there's not one more black man, lost at the hands of anyone. whether that be law enforcement or any other community member. this is about changing the

future, especially because african-american men in san francisco and around this country continue to be victims of gun violence in this country at a young age. we can do better than that. it starts with each and every one of us. i don't want to see another photo go up on that wall. i don't want to see another life lost. help us change that. help us change that by turning in your guns. help us change that by making sure that you're a part of the solution and not part of the problem. thank you to rudy and the united playaz team. we appreciate george floyd brother and his friend who will be speaking with us today. we are so sorry for your loss. we are so grateful that you have taken the time to be here with

us to share your words and your advocacy for ending gun violence, especially in the african-american community. thank you to all the community partners who are here to fight against violence every single day on the streets. i hope all you will continue to join this fight to end gun violence here in san francisco and across the nation. remember, this year's gun buyback event is between 8:00 a.m. and 12:00 p.m. this saturday, no questions asked. thank you. >> thank you so much mayor london breed. this gun buyback is from different partners from music industry and mother who lost their kids to gun violence, to sfpd and to the private sector.

there's so many people here to make this happen. it's not justs doing it. it takes lot of different people to make it happen. when a bullet comes out one of those chambers, it doesn't discriminate, it doesn't matter. that's what we're doing is to make sure we end senseless gun violence. it's my honor to have this brother coming on next. he's out there in louisiana, baton rouge, he fights all over the world to make sure we end senseless gun violence. he's a good friend of mine. our brother silky. >> thank you, rudy. i want to commend you on the work in you're doing and let you know i and we appreciate you allowing us to be part of what's going on. due to covid, we have to do it virtually. it's better to do it virtually than not do it at all.

you still thinking about those that lose their lives to the violence and senseless killing that take place in the community. that's one of the things that we're very, very, pushing and i'm tearing up because i lost my brother two years ago to senseless killing in louisiana. we're very, focused on getting these guns off the streets and you know like you say, we're not against the second amendment. we want to get the illegal guns off the streets and bring awareness to gun owners that you can take your gun to work and leave it in your car and it becomes illegal gun on the street. this is important for us to make sure that we get weapons out of the hands of the criminals that's committing senseless acts of violence in our communities.

to have the police department to be part of this. even though what happenedly to george, is not something it turns either of us anti-police. we understand that we need the police and we can't let the action of one bad person turn our feelings toward the police to be negative. this is an important event this you're giving. i want to commend you on that. thanks to the mayor for her kind words to the family. we have to get the guns off the street to in order to stop the violence. rudy i commend you and thank you so much for what you're doing. >> neighboring, brother. usually around this time when we go the gun buyback, it's a nationwide effort.

this year with the covid, i believe we're like the only organization that's doing the gun buyback. it's the actual anniversary sandy hook and mayor breed and our late mayor who appointed this gun buyback. make sure we acknowledge them. i want to bring on george floyd's brother. he's been so kind and been involved in the gun buyback helping us out and supporting us. for him to take his time. brother felonious. >> how you doing, i'm brother of george floyd. happy to speak with you guys today. the buyback program, this is something that -- this is my first time being part of one. it's great knowing that you can decrease violence by taking guns off the streets. many people out in the world don't understand just because you can go get a license, it still doesn't mean you should

have a gun. they don't show when they look at your background that you have a mental problem. it's not showing certain things. just me growing up in a neighborhood where i feel -- i see my friends, it wasn't until covid didn't take them out. they died because somebody pulled the trigger, senseless violence killing young men, men that are growing up, wanting to be something in their life. me understanding that california had bad situations in the past. i look at lot of different things when it comes to the gangs and killing. i live in houston, i don't live see a lot but people are still doing it in different neighborhoods. we don't have lot of gangs and

stuff. i commend you all for doing what you are doing. we need to have many more all across this nation. not just here in the united states, we need to see it everywhere. we need to take control of our neighborhood. we need to make sure that we will be here tomorrow. me, thank you all so much by having me here. i want to decrease violence everywhere across the nation. rudy, i can see the heart and your passion. i thank you all, the mayor for participating in this event. i wish i can be there. we're going to have a good time while we're here. thank you all so much. >> we can't never forget that. it takes a hood to save the hood. the hood-to-hood connect.

>> if you turn in a thousands guns today, rudy agreed to cut it in half. [laughter] >> thank you so much. >> i appreciate you for joining us. >> rest in peace to your brother george floyd. i knew we had jamie foxx, i know he's a busy man. he provides support with us also. next, i want to bring on the ceo of empire records, one of the biggest record labels in the country. my brother who's also native of san francisco like me and mayor london breed. >> i wanted to say i appreciate

everything that you're doing for the community. i've known you for over 20 years. it means a lot to me who you're doing for the community, what mayor london breed is doing for the community in helping to keep the streets safe and better place to raise our children and conduct business and run operation in the city. i wanted to say, i truly appreciate. it means a lot to me. i lost a lot of people that i love over the years to senseless gun violence. quite few in the last 60 days. i wanted to do my part to contribute and just be a battery in your back. thank you so much for everything that you do. >> thank you so much, brother godley. he's being really humble. this gentleman here was instrumental of actually contributing to this cause and making this happen. big respect to you. i know you're going through a lot because we lost a lot of

good brothers in the music industry. thank you so much. i salute you man and look forward to working with you. >> i appreciate it. god bless you. >> i want to also bring one of our main partners to make this happen. we can't make this happen unless we got sfpd i agree with them. without them we couldn't do it. i want to bring on our captain of the southern district. >> thank you, rudy. thank you everyone who's participating making this a successful event. gun buybacks are part of a proven strategy to address gun violence and help get firearms out of the wrong hands.

we thank you, rudy for your partnership with the police thousand us to participate in providing the resources you need to make this a successful event. i like to thank mayor london breed for her leadership on this and public safety initiatives, programs like this, they are designed for the sole purpose of raising awareness about gun violence and reducing the likelihood of future gun violence by getting these firearms off the streets. that continued partnership and we at southern station are grateful for the opportunity to work with you and reach out to the community. it's not just one day. people hear about united playaz and they see the work you're doing and they start talking about gun violence. that's one of the things like to get people talking about gun buyback to make sure the word gets out. lot of people will be surprised to know how many of their friends and family members have firearms in their home. we want to make sure these guns

are taken off the streets. some people maybe they had a relative passed away and they found a gun in the house and don't know how to get rid of it. please bring it back to the gun buyback. no questions asked. we don't want guns left carelessly in homes where there can be tragedies with children find guns or if burglars get in your home and they find homes that aren't properly stored. we're glad to be working with you, rudy, the staff at city hall who are helping us with this. we will bring the resources necessary to collect the firearm safely, to get them off the streets and we'll destroy them afterwards. please get the word out and look forward to seeing you there, rudy, little before 8:00 on saturday morning at 10:30 howard street. please everyone, get the word out, get the guns out the house

and keep them out of the wrong hands. thank you. >> thank you, so much, captain. when we leave in the morning, we'll have some breakfast burritos. how about that? [laughter] thank you so much. we have one more speaker. i save the best for last you guys. before i bring the sister on, the outreach that's being done prior to our gun buyback is done by 15 people and everybody who's doing fliers or putting up the post of all ex-lifers. who did a life sentence behind murder but now they're giving life instead of taking life. when captain talked about the destroying the guns, these are the guns right here from the last gun buyback. we're actually invoicin -- destg them. with that said, my partner who

actually helped destroy the guns and creates art out of them, is a mother who lost her son to gun violence and she's the founder of the robby foundation. i want to welcome you, patty. thank you. >> thank you so much. i wanted to thank the united playaz and mayor breed for bringing us together. i'm the founder of the foundation. it's an organization i found in honor of my son robby who was shot and killed who obtained a gun illegally after the weapon was used to kill my son, it was resold on the streets where it was used to commit some other crime. i believe in gun buyback because i know firsthand that one gun has the potential to commit numerous crime and take numerous lives. the week that my son was killed, he laid out his suit on the bed in preparation for a job

interview that he was guaranteed to get the job. instead it was the suit that he was buried in. that's what gun violence does in a matter of second. it can rob someone of their life and change the life of everyone left behind and that includes the prethe perpertrator. now we're in covid-19 this existing health crises of gun violence. since the expand, we've seen sharp increase in gun sales in in june, there was 2.6 million additional sales. we now have more guns in circulation with i millions of children home from school, domestic abuse victims, we have people facing depression due to unemployment and isolation. when you add access to guns, you're facing a convergence of major health crises and more loss of life. i think we all know that low

income black and brown community suffer the most when it comes to both gun violence and the pandemic. 2020 has been a challenging year but it has been a transformative year. it's a year of reckoning where people across the country have marched against systemic racism and injustice. i believe we have to be just as passionate about preventing gun violence which disproportionately exacts -- impacts communities of color. i can do whatever i can to make sure there are fewer mother who lose their children. i want to thank mayor breed. i want thank united playaz and family of george floyd for theiring their passion. so we can put an end to senseless gun violence. i want to encourage everyone to bring your unwanted guns to buyback saturday. you'll never know how many

people lives you saved by doing so. thank you. >> real talk. thank you so much. may your son robby, prest in peace. i want to thank everyone for sharing their knowledge and experience. i'm a survivor gun violence, twice. last time i was shot at in 2012 in this neighborhood that i'm at with someone who got murdered yesterday three blocks up. one gun off the streets where people who say this doesn't work, one gun off the streets can destroy one person's life. that one person life can be the person who can save this whole planet. you never know who that can be, who that person will grow up to be. we want to make sure we get all the guns i can. i'm not against the second amendment, i'm against senseless gun violence. if shouldn't be little kids and innocent people, people going to

work working hard for their families and get killed. i'm not trying to advocate violence, i understand the streets. i understand the world that we live in. i want to be real clear. i'm not against second amendment. one gun that you may turn in, will be the life you may save this world. how about that. thank you guys for all, everybody on here. mayor london breed, patty, captain, silky, all you guys for your effort for help us end senseless gun violence. we got to do it together. united we stand and divided we play. i'm a united player for real. bullets, they don't discriminate and no namessen them.