did open up a safe consumption site line the main one in vancouver it would save the city one large site would save the city over 3 and $3 and a half million per year so the cost savings i think are a important part of this and think we should talk about them in terms of saving lives and improving lives of people there and also the savings that had has to the city. >> that study that you did in the $3 million estimate that is net? that is after the cost of this facility? >> exactly. >> thank you. one thing i have been very struck by in digging into the research around safe consumption sites and talking to experts is the-i should say, pretty much every time i read an article, it is written or cowritten by you so thank you pr your extensive work in the field. the

disconnect between the public discussion sometimes which i think tends to frame safe consumption sites is very controversial thing. we see vetoed at the state level and different camps on this. from my impression seems to be absent from when i talk to public health folks, i am trying to think if i encountered any serious research or-that makes a case against safe consumption sites or not from the politics, just saying from in terms of the impact preventing overdose, preventing fatalities and wonder if you studied these extensively i think around the world, definitely around the country, can you speak to that and am i right-curious when you write a article about safe consumption and these are peer reviewed things, is

there a split opinion on whether these are impactful in the way that you described it or is there a consensus or emerging closer to consensus among public health? >> yes. safe consumption sites have existed around the world since the mid-1980 so been around a long time, exist in 13 different countries. they have been evaluated in many different countries over the years, and then our own research you were referring to evaluating unsanctioned site in the united states as well. the research is really unambiguous on what it is finding in the sense that every study that is found has found that these sites do reduce overdose deaths. in fact there is never a overdose that lead to death at one of the sites around the world and there are over 200

sites around the world. in the u.s. as dr. kunins was talking about, we are at hundred thousand deaths in the community a year in the u.s. there are none in the sites anywhere in the world. they also have been determined to and the science is unequivocal reduce hiv risk, help titeing and enhance people who go into drug treatment so these are places that also help people get into medically assisted treatment and those type of important services. and finally, the research that both we conducted and that is conducted up in vancouver and also

sydney austrailia crime goes down. there is less public drug use and less drug equipment around the sites, less crime around the sites and i think the last piece of it in termsf othe public perception piece you spoke to, in the sydney site which has been around since i think 2006 or something like that, people actually had neighborhood assessment whether they like the sites or not before they opened the site and after they opened the site and the community approval of the site went up a year after opening one of the sites opposed to going down in any way. you are right, i never found a peer reviewed study that has shown any negative impact or effects of safe consumption sites and to the contrary, all of the studies show both benefits for the people who use them as well the neighborhoods in which they are

placed. >> thank you for that clarification and information. i say i know that the generally speaking the media loves a good controversy and there are plenty things to argue about. this isn't it and just struck by that. sounds like every peer reviewed article, every study is finding these successful and within city government i will say that from certainly mayor and i have our disagreement on a lot of policy issues, this isn't one of them and all my colleagues i have spoken with share that very so hopefully that-that is reflected and important it is reflected in the plan that dph brought forward and released yesterday. vice chair chan. >> thank you chair preston. this is a question for dr.

kunins. i want to thank you for articulating the plan. i think we have been having these conversations both during the tenderloin emergency as well as during the budget process, so i am going to kind of refer back to conversation we had during budget committee, trying to help me understand just-we talk about-which i appreciate. you talked about-because we originally at budget committee had talked what is our goal for reduction and by what percentage. if you could walk us through in context and if you actually have it on you, is the overdose death in 2020, 2021 and to date in 2022. >> let me start from the top. i'm not sure i have the exact

numbers with me. i will flip to my charts as i do. i think setting targets and i know you were one of the people who set forth this challenge. if you notice, i think in the national literature that those targets often dont get set and i think it is because there are so many drivers to the overdose epidemic and what is characterized is succession of waves driven by prescription opioids and then heroin and sythetic opioids particularly fendinal fentanyl so that challenged us in public health to set targets we think we can meet. we through a series of i would say-i dont want to diminish to say back of envelope calculations, but to say if we could get

this many more people receiving medication treatment for opioid disorder we can get out this many naloxone doses that reverse this many death. we have high impact to have quantified impact. what is harder to quantify is by opening more residential step-down treatment beds, which serve primarily to create a sense of stability while people are receiving formal treatment to address drop in centers. there isn't as much literature (inaudible) turning to my colleague. so, i think to some extent we are making estimates and looking at the last couple years and i'm getting some numbers in my phone. we know we saw

a peak in 2020 of 700 that was the final count not the office of the chief medical examiner, but close of 7-11. we saw a decrease in 2021 to the mid-600. we are waiting for those final certified numbers from the state department of health and colleagues. we try to estimate that trajectory. that was our thinking. we will revise as we go. i think we want to be self--critical if we are not achieving goals what else we can do. to your earlier points supervisor preston, we would like to look for opportunities to be more aggressive to drive those deaths down even lower, whether it is new strategies or new resources needed. >> roughly saying we

want to reduce our overdose deaths by 15 percent by 2025 and i think that is a really good goal because either way you are between 700 deaths-anywhere between 600-700 deaths at least now per year and that's a good roughly hundred something people. so, the question is, with that plan, with this plan you presented today to reduce deaths by 15 percent by 2025, roughly what is the overall budgetary investment? >> so, it is a great point that i don't have at hand for-what i think we should consider is all the current investments and of course investments are directed at opioid use disorder directly and other substance use. most overdose deaths

which we have not made the point today involve more then one substance so by reduces other substance you reduce risk. as you heard from morese bird, addressing mental health concerns as well can help both youth and adults reduce risk of overdose. for the moment and we'll come back to you with more information, we had a number of investments through prop c funding. we have in this budget year we have a number of new investments using-thank you for your approval from the mental health services act, which for the first time allows for investment in substance use related issues, and so using those funding for the moment we believe we can do what this plan lays out with what is available to us right now. i guess we'll

say we'll come back and continue the conversation. >> just also help me understand about i think your four strategies-just really throughout the four strategies talk about the wellness hub. i love to understand a little more about just the approach-i think your strategy 4 talks whole city approach. help me understand what that means when we talk about wellness hub areas and service area versus a whole city approach and i know that there is also--i think in your presentation you made a point also about focusing on area of use and/or high needs so help me understand how do we have a whole city approach but also focus on high needs and with these

wellness hubs. >> i think our use of the term whole city just-and i hear feedback here, is really thinking about ways that city entities touch people at risk of overdose, directly or indirectly and to see this as overdose prevention all work on, whether in a social service agency, educational entity, and not (inaudible) solely public health problem to solve so by whole city thinking how we can for example do more overdose prevention in supportive housing would be a whole city approach. thinking about how we might get naloxone in bars and clubs, that is a whole city approach. looking for innovative ways to reach people. working with

organizations serving families who maybe the young people are low risk of overdose but maybe family members and others need to have more information about what effective treatment is. looking at ways to touch san franciscans through the reach of the city structures. that is what i think we mean by whole city approach. at the same time, we know overdose deaths are concentrateed in 6 neighborhoods in the city and we need to in our view when we think locating services such as wellness hubs we want services convenient to people and located near where they are high risk. one of the findings from dr. carl's work and others is locating for example safe consumption we know people are willing to

travel only small distances to use them and so we want to make sure regardless of what the intervention is that it is located conveniently for people at risk. >> i think you actually answer most of what my next question is. my next question is community engagement. i think you really answer most of it, but i just wanted draw down more specific when it comes to community engagement, because i think part of it in your presentation you had talked about just education as well just for the general public to understand. i think that tackles what chair preston also talked about. just both in the media or the general sentiments sometimes that i think that the controversy on safe consumption sites also has a lot to do with community engage ment

engagement and education. the question lump into i think you do talk about overdose prevention, community engagement, so then i think i want to go beyond the overdose prevention, but a little bit about overall community engagement and education that are also just those who are maybe not users themselves, but they know the users or that they come across users that they are not-may be strangers to them, what about that piece of the community engagement? >> i want to say i agree. we need to do more community education and engagement and i think there is profound stigma around people with addiction and they face

discrimination, hate, lack of empathy. i have a personal goal of helping all of us humanize folks with addiction, and many of us have family members loved ones ourselves who face this serious but treatable problem, and i think bringing community members along in that understanding, giving first knowledge about what resource s are available, what we are doing to improve outcomes, improve health, reduce public drug use, support people getting into care is vital. i think also teaching community members action steps they can take, whether it is how to know where to help someone get help or reverse a overdose is part of working together, and we intend to do more in community engagement i

think with the additional resources i just mentioned, mental health services act funding and so forth, we will have more capacity to do that more fully. i will say that our teams have been doing this. i want to acknowledge also past work, and arkticulate the commitment to continue to do more in multiple languages, multiple communities as part of our approach here. >> will the wellness team be part of this or is this actually something completely separate? >> well, i think back to your point, i'm getting notes in my phone. i think this sp part of when we say a whole city approach is working with all of the teams and all the services to aim to have everyone be part of the overdose response, and so i don't know this specifically, but what i imagine is all our

teams need to be able to have information about overdose, be able to at a minimum tell people where to go to get help or reduce overdose and including giving out naloxone themselves. >> i want to give you one example that i'm wincing in the richmond, which community i represent and i think that i want to say i'm very grateful for majority of constituents i think they are very compassionate and trying to figure ways to support and help while you're right, there is still of course some stigma. i also think the lack of education and understanding what to do, i want to give a example. i look forward to working with your team to help us problem solve in the district. on my way to work i was driving and seeing there is a individual on the curb of the

bus stop and not sure if the individual could be overdosing or just you are seeing a individual wasn't sure if this person is suffering overdosing or whatever that is. obviously half awake and half not. it is right at the curbside by the bus stop while we have a group of people waiting for the bus. and everyone is looking at this individual and they are concerned and they were not sure what to do and i wasn't and i was thinking i need to call 311 and wasn't sure what could be happening to the individual if i make the call or if this individual was okay. just not sure that was the moment i realized the lack of education i have the people at the bus stop have that our community has. how do we be compassionate and are think they were very

compassionate to just kind of concern about the individual but not sure what to do. i think probably many of us in san francisco so i think that's the reason why i ask about the community engagement question. i think that we have advocates that doing their best to help educate and also themselves out there to help and support the individuals, but i think it seems the mass require a lot more education and i want to be-myself included that i want to admit my ignorance and i need better education as well. >> i appreciate hearing the story and the feedback and also acknowledging that we as a city not even just specific to overdose but behavioral health need to help people know concerned neighbors and community members where to call and get the help and increasingly help is available and more services are available

to connect people to. >> thank you. i just are love to see more details in that plan. because i think that is part of the plan but want to learn more details on that. thank you. >> thanks. >> thank you vice chair chan. one last question before we head into public comment. dr. carl referenced the brave button program and wondering if you can elaborate on that program, what it entails, the effectiveness and plans for expansion. that is for either of you. he referenced it, but you are at the mic, if you want-either of you. >> it may be that dr. carl has more deiltas in his head. it is a program we have supported as engaging people in-i'll stop so i don't get it wrong, but in supportive housing to become over-dose responders if someone is in trouble or to ask for help and let me turn

to alex. >> this was a program that was a pilot project funded i believe by the department of public health and it was carried out by the drug overdose prevention education project that is part of the national harm reduction coalition as well as dish in two different hotels and evaluated by kelly knight at ucsf. we were fortunate to see some of the qualitative results from that at a seminar last week at san francisco general hospital, but essentially it did involve both installing these buttons like a emergency button in two hotels as a pilot and training residents from what i understand residents in the hotels how to respond to overdoses and providing them with narcan as well.

>> thank you. let's open up public comment on this item. >> thank you mr. chair. any members of the public in the chamber who would like to make public comment for item number 3? please line up to your right. remote public call in members press star 3 to be added to the queue. those on hold please continue to wait until the system indicates you have been unmuted. thank you. please proceed. >> welcome. >> thank you. good afternoon. appreciate the time. tom wolf a recovery advocat in san francisco and a native san franciscans too. i appreciate the presentation i have a lot of respect for dr. kunin sirks and what she is trying to do. i can't help to notice all the presentations never mention the word recovery. recovery as a solution to this

crisis that we are having on the streets. i used to be homeless. i was addicted to heroin and fentanyl living in the tenderloin. recovery got me out of that so we are talking about all these different things and the way we are talking about it is so ambiguous. we talk about wellness hubs. why don't we just call a safe consumpson site. we are doing the stuff in the shadows and breeding suspension among the public. not just lack of education but breeding suspension and maybe because it is against federal law or because the governor vetoed it. not sure. if we are going to move forward with these things we have to be honest and talk about what is really happening out here. we have 500 organized drug dealers on the streetd in the tenderloin and soma. they are not drug

users mptd they are part of the car tell and need to be held accountable. they are selling kilos and kilos of fentanyl that are killing people that literally meet the definition the legal definition of involuntarily manslaughter and we are not doing anything to stop. now we have a new da so might change. all the overdose prevention things i appreciate it but what is difficult to me i had a statement but after listening to this i had to say we are not talking recovery. let's promote drug treatment. where is treatment on demand dph? you have a mandate to provide that. >> i apologize for interrupting the speaker. >> are thank you for your comments. next speaker.

>> (inaudible) first permanent supporting housing provider to have narcan available at the sites as we partnered with the (inaudible) secure narcan and training for all the staff. i applaud the commitment on the board and department of public health to address the crisis but i want to emphasize the need to investm in meaningful overdose prevention driven by the expert (inaudible) we lose residents to overdose every month sometimes every week. we have narcan available 24/7 including dispensers throughout the building. as you may remember from the budget process we have a pilot program that alex mentioned we look to expand to other sites. it was not funded fully so i want to tell you about the (inaudible) a partnership with national harm reduction coalition, dph funded one portion which was training for

our residents-we want to see narcan satchuation not just in the hands of staff but residents. we want to say (inaudible) press the button and staff or another peer responder can go to the unit after they use make sure they are okay, make sure they have the support they need. those should be standard issue just like we have fire detection, sprinklers we need these ways people can get help and we need to fully fund peer based response and trainers so pay them to do the work, they are recognized as the experts and can help save the lives in their community. alright. thank you. >> thank you. next speaker. >> good afternoon. my name is maddie (inaudible) the community development manager at dish delivering invasion

and supportive housing. here to speak and add to the testament lauren just made specifically to speak on the peer responders and peer overdose responders and trainers we have at the site in connection oo the brave button program. i would like to read a quote from one of the peer responders named susan. this community has a high level of mistrust based on the background. we have been judged by so many who know nothing about what we have been through. we may never admit to a staff person we use or need help but we will always rely on each other. being able to give my neighbors narcan and know when they need help saved lives. i can testify that at the (inaudible) reversed over 8 over-doses due to capacity to respond to overdoses specifically through the brave button. i want to emphasize peer response and education and training networks are specifically impactful different from having staff

relationships. i also want to name 4 people that passed away within our dish sites. not specifically on site. i mean people of the resident community within the last week specifically. the names are oatis, cent, jimmy and andy. i believe if there were more capacity to support specifically peer lead expertise and programs beyond just giving narcan that being able to offer residents the opportunity to educate one another and support one another in a thorough way we would be able to reverse more overdoses and prevent them. thank you. >> my name is (inaudible) president nixon that in the late 60's early 70 started the war on

drugs. i researched this. he started it. (inaudible) he targeted the african americans and heroin and hippies and marijuana. going along with that-what i like to say, i think one of the things we have to find out is why they are using the drugs, because i think the growing (inaudible) here in the city with the care-(inaudible) i think the fact we are told we cannot have posters no fliers, i remember when i came people ask (inaudible) that's fasism. (inaudible) and i like

to close by saying that in (inaudible) i don't know why people use drugs, i have feelings why they use drugs, but i think capitalism is going to eradicate the reason why people use drugs. >> thank you. next speaker. >> thank you. my name is leah branson (inaudible) 35 beds where people can sleep in the day. i'm here in support of the comprehensive plan. i wanted to address the question of recovery. recovery starts when someone walks through the door of a opioid overdose prevention site. one thing we know about people who use harm reduction

sites is they care about their health. this is a great thing to know about someone you are trying to assist. it is not about taking tools out of a box, it is adding more tool s to the box to help people struggling with substance use disorder and it is time to stop listening to the contversery who are making a living around what (inaudible) listen to doctors and scientist and people in recovery through harm reduction and the people who are working with folks every day and say this works, it is helpful, it is kind, people's dignity doesn't start when they stop using drugs. respect is acknowledgment of the dignity of the human being in all their forms. i want to say thank you. >> thank you for your comments. next speaker.

>> my name is robert young. i worked for (inaudible) pest control, a company that went into sro units, people that generally got the ability from the city to sit in a room and do drugs all day long. for nothing. we get into the rooms and help clean the room out. anyway, one of the coworkers stold a large amount of money from these people and overdosed and when i reported the employee he spent a day making fun of me for shit that happened. coming here to say i asked all the supervisors and news people if somebody can help me. i was harassed at work and there is nothing i can do and they fired the wrong person. i was a great employee. i think everybody else on the team would say i was a better employeeing just felt uncomfortable in the situation. i liked to help those epipooal. thank you for your time. >> thank you. next ecspooer, please. >> good afternoon. laura thomas, the

director of hiv and harm reduction policy at the san francisco aids foundation and resident of d10. also a member of the safer inside coalition and treatment on demand coalition and want to thank for visor preston for calling this meeting and for your leadership. i know you just included the tenderloin recently in your district but you made great efforts to understand the issues of theteneder tenderloin. i want to thank department of public health and mayor office for the fast work on compiling what the city has been doing on overdose into a overdose prevention plan and really excited about a lot of what is in there. i also want to acknowledge the enormous amount of very hard and traumat ic work done by people who use drugs harm reduction advocates people in recovery

reversing overdose, distributing (inaudible) seeing a much more significant total toll if not for those folks. we need to take bold action. (inaudible) i will leave the rest of that comment. i also think that it is extremely important that we make sure the other things we are doing in the city are not increasing vulnerability to overdose. that includes aggressive policing, market disruption incarcerating people increase epipooal overdose vulnerability. we can't do that with one hand and try to stop them with the other. finally, with my entertainment commission hat on i want to say we are very proud partner with dph getting

naloxone into bars and (inaudible) >> thank you, next speaker, please. >> hello supervisors. my name is (inaudible) a public policy (inaudible) permanent supportive housing provider in the city here today as a treatment on (inaudible) urging to support the opening of overdose prevention centers in the city. in 2008 san francisco voters passed propition somewhere t yet in the last 14 years san francisco failed to provide enough low cost low barrier substance use treatment and support services to meet increasing demand. research shown overdose prevention center provide linkage to service use trument and access to primary health care which reduce public drug use. over the last few monthss we heard change in narrative about public dug use and housed community. going so far to claim passing by unhoused folks using drugs in public is more traumatizing to those

housed individuals passing by. those who are living on the cold conveet streets of the city. it is time to bring public awareness to how the city one of the most expensive cities in the world failed to help our most vulnerable. we notice how the city leaders are pushing legislation to protect private property over the preservation of human lifeism we know the criminalization of those who use drugs who will not get where we need to be and every day we delay the implementation of life saving strategies san francisco losing at least 2 members of the community. tenderloinsenter has proven the urgency of opening overdose prevention center city wide. they work, they provide safe spaces that reduce stigma of public drug use and safe hygienic places to use safely without shame and dignity. support the immediate implementation of overdose prevention program city wide. thank you so much. >> thank you for your comments. next speaker, please.

david elliot lewis long time tenderloin and city resident. thank you for holding the critical hearing. we lost more people to overdose then covid. or most other causes. it is tragic i things need to be done. 15 years ago when i needed help with my own issues i needed recovery and treatment, i sought treatment on demand and i did not get treatment on demand but i did get treatment after persistence and if i wasn't persistent and made repeated calls and vidsts i wouldn't have got connected to a treatment program but i did and finally helped and it saved my life. i wouldn't be here talking today if i did get that the treatment 15 years ago, not on demand but after persistence. we are in 2022 and we have a wellness center concept in development at um plaza that

works. it is helpful to people, but because of neighborhood push-back mainly from trinity towers, the market rate building across the street and influential members was it was not refunded for next year. it closes in december. my concern is that as department of public health plans to reopen or create new wellness centers in a one to two year timeline which is way too long because they stood up this one quickly, how are you going to handle the not in my backyard push back you will get no matter where you place the wellness center and want to ask the sitsy to stand up to these not in my back yard push back and stands up wellness centers the city needs, overdose prevention and treatment on demand without hesitation low barrier low threshold.

dave thank you for holding the hearing. >> thank you for your comments. next speaker, please. >> hi. my name is (inaudible) a home rise public policy community organizer community organizer, sro tenant here to give you a dose of dope hope. envision a future where society address the root cause of social and health care consequence of drug use and overdose. let's create solutions that address social economic and racial disparities and recognize this crisis stems from decades of generational class and racial trauma and intentional malignment of system of care justice. the spectrum of care needs to include economic reparation housing stability verses criminal code of conduct. envision the streets safe and lively (inaudible) is a living space social sphere and underground survifenl ecornomy where communal support system exist. where

is the talk of replacing and supporting with something healthier for all? i hear fix already proven to be broken mean while the (inaudible) worries its way into the heart and soul (inaudible) push for a new way of thinking about the crisis. bring about new trees of thought where we feed the heart and soul and are how we turn overdose and death into hope and growth. here are pathways to success. create a pathway economic opportunity and support that goes above and beyond survival needs. address habitth and limited space (inaudible) cultural relevant spolesh social engagement opportunities not profit driven on sidewalks vacant businesses and housing communities and prioritize solutions and alternative to

substance use in social economic and health care realms and leave punitive measures for criminal issues. thank you for your time. >> thank you next speaker please. >> my name is colleen rebecca (inaudible) i wanted to speak specifically about overdose prevention and permanent supportive housing. i want to associate my comments with those that lauren hall made earlier. i think it is really important that when we think preventing overdose in permanent supportive housing that we really have a coordinated approach with hsh, ocd and department of public health to make sure that our interventions can be fully funded and actualized for all residents not just a

certain percentage of them. i think that if we dont have a coordinated plan, the responsibility for overdose prevention could fall on the already over-tax case and social workers. what about a full time overdose prevention coordinator in each building? what about actually fully funding the peer base program lauren described earlier that actually trains peers so that other residents of permanent supportive housing have a non staff person peer who is another resident they can to for help, support, narcan and overdose prevention. making that program fullyfunded and operational in all permanent supportive housing and compen ensateing residents as a peer (inaudible) it

needs to be fully funded and fully implemented not just a pilot. thanks and i hope i'll have a more robust conversation about this with you as we move forward with this new exciting plan. thanks. >> thank you for your comments. next speaker, please. >> good afternoon supervisors. i'm sarah short home rise and treatment on demand commission and safe inside. thank supervisor preston for calling the hearing and requesting this plan from the department of public health. i'm just so pleased that it produced results that we are here discussing today. i do actually want to thank department of public health. dr. kunins and mayor for producing this plan. i applaud it since it

is evidence based and racial lens and not punitive which icmas it more likely to work. some components i like about it is increase naloxone access, there is a requirement to measure demand for treatment which is consistent with treatment on demand law. it contains contingency management programs, medication assisted treatment, drop in spaces is absolutely huge. these wellness centers we lost too many drop in spaces and i want to say here, but we really need explicitly safe consumption sites. we absolutely need to have that in place so still pushing for more there. also the drug checking, and just it is atrue public health response to a public

health crisis which i was happy to see. while others are suggesting we put city resources into approaches that have been tried and failed some city leaders looking to the police to solve the problem despite the research which we heard showing the methods actually undermine efforts to reduce death. dph is taking-- >> thank you for your comments. madam clerk, can we turn to callers. >> remote callers please send the first caller through. >> good afternoon chair and committee members. (inaudible) and a member of the safer inside coalition and treatment on demand coalition. calling to urge the city wide implementation of overdose prevention centers as part of san

francisco prevention strategy. opc already exist in more in the 65 cities around the world include two successfully in new york city. the lessen from the tenderloin center demonstrate the need for the every day services in san francisco and how powerful these interventions can be. there is extensive communication in san francisco and mullple commissions and task forces that concluded these programerize necessary and will benefit san francisco. as we heard during the hearing, there are overwhelming benefits of proven public health interventions. the city support and collaboration is required to make this happen including the mayor, board of supervisors and city attorney especially to open to scale city wide to meet the level of need. to meet the goal of san francisco overdose prevention plan the city also needs to address the

shortage (inaudible) front line providers are facing the task of rationing narcan due to lack of supply. we should have coordination with local and state government so we never have to deny access to life saving supplies. lastly, grateful dph has the need for drug checking programs to empower people who use drugs and save lives. dph should lead on all the strategies because overdoses are a public health issue. and should be able to use the settlement dollars to truly implement a very truly comprehensive overdose prevention plan. thank you. >> thank you for your comments. next caller, please. >> good afternoon chair and supervisors. wesley (inaudible) speaking on behalf of the safer inside and

(inaudible) as well as the rest of district 5 office dph and mayor for the dignified user approach. i want to especially specifically recognize dr. (inaudible) engaging with the community in crafting the strategy. in support of the plan and urge the city to immediately implement overdose prevention centers. as a plan rightly states overdose deaths are preventable knowing what works and we know what is not data informed and proven to exacerbate risky substance use and increase death. the approach of racist war on drugs does not work and out of touch with this plan. electronic monitoring as proposed by the san francisco recover resolution is irrefutbly proven to be a failed counter productive program and need look no earth ifer then a harvard (inaudible)

criminalize the community leads to marginalization. (inaudible) does not make us safer. coerced treatment is not care, it is experienced as trauma. the overdose crisis you are hard pressed to find anyone not touched by the tratagy but substance use and overdose are public health issue. require the (inaudible) expanded harm reduction infrastructure proceeding with the public health lead community driven plan implementing opc. thank you. >> thank you for your comments. before we continue with the call in members we have one person in public. >> thank you. hello supervisors. thank you so much for the hearing today. thank you supervisor preston calling for the hearing and moving towards a plan and thank you dph coming up with a plan and mayor office as well. (inaudible) cochair of the tenderloin people conference. one of

the neighborhoods most impacted by the issues we are discussing today and i all most wasn't going to say anything because wes was so eloquent in the way he presented the argument now, i say ditto to everything he said but i want to raise a couple things that come to mind is one is the scale of the response compared to the actual crisis we are in. when i heard the plan today say they were talking about opening one wellness hub by the end of the year and maybe one some time next year, it just felt the scale of that response didn't feel adequate to the need. especially when we are talking closing the treatment center. the tenderloin center before the end of the year. how is that-it feels like a net loss rather then gain. we heard they reversed over 200 overdoses at the tenderloin center. we can't get safe consumption sites but

we know the wellness hubs reverse overdose and save lives so get more open and do it quicker. why can we only get one open by the end of it had year and maybe one next year? it doesn't feel like the urgency of the response doesn't feel it is there and so i ask we do that quicker and also feel i need to be fairly representing the residents that asked me to speak on their behalf which is, theteneder loin shouldn't be a containment zone so think some folks would like to close the center so it is open deeper in tenderloin to make people less visible and (inaudible) these hubs need to be open throughout the city. >> thank you for your comments. we'll return to in-call speakers. please forward the next caller. >> hello. i just wanted to thank supervisor preston for

calling this hearing. i have been anticipating it for a while now and just this morning in the new york times was an opinion piece by mia (inaudible) called the most important question about addiction. i think we need to ask ourselves what we want for the lives we save from overdoses. what do we hope that they might look like? she wrote a wonderful final paragraph that says u people use drugs for reasons. typically those who become addicted struggle with hope lessness, trauma or mental illness, often all three. it is economic and social pane pain is the commonalty. until policy makers prioritize healing distress that makes particular people and communities facing economic loss and

trauma especially vulnerable to addiction, this vicious cycle will only continue. thank you again. >> thank you for your comments. there are 19 caller in the queue. please forward the next caller. >> hi. can you hear me? hello. >> yes, we can hear you. >> can you hear me? my name is dr. theresa palmer a local retired family physician. i used to work at laguna honda and thank you the treatment on demand commission for being a valuable source of education for me as a community member and physician. adequately staffed and integrated substance abuse and overdose prevention and treatment will actually benefit everyone in san francisco including

the most privileged. look no further then laguna honda hospital, now not available to any san franciscans who needs nursing home care because of overdoses that could have been prevented. having a organized non punitive integrated ubproach to substance abuse and mental illness we will relieve all of our local emergency rooms hospitals and long-term care facilities of a huge burden of care that will ultimately not only save money but make these facilities much more available to people that need treatment for everything else. i don't know you tried to call your doctor's office lately, but i can't tell you how long i have been on hold. there is not enough providers. everyone is over whelmed and they are

sort of-rolling down hill type thing where when one thing is untreated everything else backs up and the whole city is losing for not having a state of the art integrated system. there are good examples of this in other cities that are well studied and we need to get on with doing better, and i'm thankful that i'm hearing the beginnings of this today. thank you. >> thank you for your comments. next caller, please. >> hi. good afternoon supervisors and chair preston. i want to thank you for your leadership on the issue. it is long overdue. my name is michael (inaudible). i am here district 9 resident and part of the hiv advocacy network here today to ask to (inaudible) and

support consumption sites. i think many who joined previously on overdose awareness days where we said avenue death is a policy failure. thank you for joining us and asking and pressing on the city to produce evidence based solutions. consumption sites are evidence based solutions. it is important that the city address-i encourage delegation to actually tour an actual consumption site because what we have now is short of a consumption site. these are preventable deaths. again, i am bewildered we built the golden gate bridge much quicker then we produced consumption site because we asked for years and there is push-back and (inaudible) put more effort into that then producing a result that will save lives. we can prevent it with your support and i'm

here to encourage you and thank you so much and thank you again for take thg time to hear me out. have a great day. >> thank you for your comment. please forward the next caller. >> (inaudible) >> good afternoon caller (inaudible) please forward the next caller. next speaker, please. >> supervisors, i

strongly feel that this city has made many mistakes. in order for us to have a unique model for san francisco the legislative analyst must have the supervisors understand that these (inaudible) actually have a solution with time pp lines and goals. it is a mickey mouse way of doing things. having 3 or 4 long presentations and then bringing us the people the taxpayers to give a measly two minute comment.