Now, these experiences have led Cofer, currently a senior policy director at the organization Public Health Advocates, to seek the top job of California’s capital city. Cofer came in first in the nonpartisan mayoral primary in March, an upset victory for a young, Black, female first-time candidate running against several established politicians. In the general election in November, she is facing off against Kevin McCarty, a former Sacramento city council member who more recently served several terms in the state legislature. 

If she wins, Cofer has vowed to take a public health approach to setting policy in Sacramento. “Public health is about maximizing the two things that matter most to humans: the number of years in your life, and the quality of life in your years,” she told Bolts. “And I see that as the major charge of every public-facing institution.” 

For Cofer, this means seeing the city as an ecosystem, understanding homelessness, gun violence and other social problems as akin to infectious disease, and zeroing in on preventing their spread rather than simply treating its effects. “It’s one thing to fight a symptom, it’s another thing to eradicate a disease,” said Asantewaa Boykin, a nurse and activist against police violence who has worked with Cofer on community issues. 

While McCarty has espoused a fairly standard Democratic vision for homeless policy, speaking of the importance of services while also working on laws to restrict where unhoused people can camp, Cofer has called for stopping sweeps of homeless encampments and expanding and improving “safe ground” camping sites. She has also advocated for more funding for violence intervention networks, overhauling the city’s well-meaning but flawed alternative crisis response system, and using the budget to advance a set of clearly articulated values around health and welfare. 

As the primary results showed, hers is an enticing pitch to many in the city who are frustrated that the conventional solutions—a jumbled mixture of services, imperfect temporary shelter options, and homeless sweeps—aren’t working. But Cofer faces various barriers to realizing her vision: a $60-odd-million budget deficit, a district attorney and a state government bent on enforcing the criminalization of homelessness, and housed and homeless residents alike who are deeply mistrustful that anything will meaningfully change. 

In response to an affordable housing shortage and a growing number of people sleeping outdoors, Sacramento has, like many of its counterparts, tried everything from services and temporary housing to criminalization. In 2021, now-outgoing mayor Darrell Steinberg unveiled a costly plan to increase shelter options, but the following year, the city and county each passed ordinances restricting camping on sidewalks or near businesses, infrastructure, and the city’s American River Parkway. 

Then, in the fall of 2022, voters approved Measure O, which outlawed camping on public property. Cofer opposed Measure O, while Cofer’s mayoral opponent McCarty worked on a bill to outlaw camping on the parkway that he suggested could work in tandem with these other restrictive measures. McCarty did not respond to a request for comment for this piece.

Homeless advocates like Anthony Prince, a lawyer for the Sacramento Homeless Union, whose 2,800 members represent nearly half of the city’s unhoused population, argue that the city has wasted much of the money it has spent under Steinberg’s plan. “It was about pop up tents, mass congregant shelters, a few tiny homes scattered here and there, some so-called safe parking sites and safe camping sites,” he said. “This is not housing.”

Charley Willison, an assistant professor at Cornell’s Department of Public & Ecosystem Health, called shelter “a really important first step—if it is used as a transitional housing mechanism. We can’t have shelter being used as the final step.” But she also noted that too many cities create behavioral requirements, like curfews or complete abstention from substances, for shelters that disqualify whole swaths of people. 

Niki Jones, the Executive Director of the Sacramento Regional Coalition to End Homelessness, believes that the city’s vast expenditures have accomplished little and left housed residents pessimistic, inclined to blame their unhoused neighbors, and thus more likely to support punitive measures against them. “There’s this idea that all this money has gone into homelessness—why isn’t it solved?” she said. “There’s a woman who lives outside who says it really well—she says, ‘They treat us like we blew $80 million.’” 

Meanwhile, homeless advocates in Sacramento say that the municipal government’s repeated  sweeps of unhoused people continue to be destabilizing and traumatizing. It’s a practice that Willison says has been proven ineffective over the long term. “The evidence base shows us that these punitive policies, whether that’s arrests, encampment closures, without links to housing, all make homelessness worse,” she told Bolts. 

Part of the underlying issue, Cofer argues, is that the city has never set explicit priorities for what it wants to accomplish each year, instead opting to create a “status quo budget” based on the previous year’s expenditures. “Unfortunately, when you do that, you keep getting what you’ve always got,” she said. 

To address the root issue of affordable housing and stop people from falling into homelessness in the first place, Cofer supports Sacramento Forward, a policy package put forth by several current city council members that aims to enact “Just Cause” renter protections, mandate a certain percentage of new housing be reserved for low- and very-low-income residents, and prevent corporate purchases of existing housing by giving priority to tenant buyers. If elected, Cofer says she’ll use her power as mayor to expand support for the package and place individual policy items on the agenda for direct approval or an eventual ballot initiative. 

But then, of course, there is the issue of the nearly 9,300 people currently homeless in Sacramento County. Prince has recently served as the lawyer for Camp Resolution, a “safe ground” site that allows people to camp without police interference at minimal expense to the city. Prince stresses that this is not a permanent solution for his clients—“they don’t want to stay there forever,” he told Bolts—but it is safer and more stable than sleeping alone on the street. 

The city initially signed and then renegotiated a lease with the organization Safe Ground Sacramento that promises it will not clear the camp until all of its residents get into permanent housing, but Prince says that officials have also intensified sweeps around the camp and sought various ways to compel residents to leave. Last week, Safe Ground announced that it cannot fulfill the terms of its lease, including providing water and electricity, which Prince worries will give the city another reason to void the agreement.

Cofer has praised the “safe ground” concept as a low-cost interim solution and said she’d extend Camp Resolution’s lease, open more sites around the city, and ensure that any sites have running water, electricity, shower services, and other amenities that allow the people there to live with dignity. She sees the sites as a form of stabilization that might allow people a moment to breathe and get connected to resources that can pave the way for more long-term stability. “60 percent of our unhoused folks have disabilities,” she said. “Are they all receiving disability? Are they all receiving food stamps? Are they all receiving the services that they’re eligible for?”

Cofer also criticizes the city government’s reluctance to robustly fund a suite of programs that could prevent violence, homelessness, and unnecessary police encounters. In 2018, Cofer and others advocated for the passage of Measure U, which would have doubled an existing half-cent sales tax. The revenue from the first half-cent, around $50 million per year at that time, went largely to the police department, but the city said the additional half-cent would go toward things like inclusive economic development targeted at historically redlined neighborhoods, and an affordable housing fund. “That was the campaign promise and that was the way that this measure was marketed to voters,” Cofer said. 

But after the measure passed, most of the revenue from the tax ended up going back to the police department—not illegal, Cofer stressed, but “a breach of trust.” She advocated for the creation of a committee that would advise the council on how to better invest the funds from Measure U, and ended up chairing it from 2019 until the end of 2022. During her time there, the committee piloted a participatory budgeting process that invested money in community-led projects in two Sacramento neighborhoods, which Cofer hopes to continue and focus on youth-related projects if she’s elected. 

Cofer is clear-eyed about the way that Sacramento’s policing budget strains the city’s coffers and takes resources away from other departments. She notes that it’s gone up around $100 million in just four years to reach over $250 million today, and proposes a realignment of the Measure U dollars towards their intended purpose and a return to the 2018-2019 police budget of around $150 million. McCarty is clear that he will not cut police funding if elected. 

But Cofer is also leery about being portrayed as anti-police. She stresses that she empathizes with law enforcement officers and compares their plight to that of teachers: public sector employees burdened with the effects of social issues far outside their remit. 

One attempt to disrupt this paradigm came in the form of the Department of Community Response (DCR), which Mayor Steinberg debuted during the 2020 protests. The idea was to form a team of social workers and mental health specialists to respond to 911 calls related to mental health and homelessness instead of police. But Boykin, whose organization Mental Health First was already doing similar work, told Bolts the department engaged with her only superficially, and conversations soon ended. Jones, who has volunteered with Mental Health First, said that DCR has since betrayed its initial mandate as a police alternative and become imbricated in the broader apparatus of sweeps, displacement, and criminalization. 

“What really came into being was actually just a team that responded to unhoused folks, usually sent there before police,” she said. “They don’t respond instead of police. They respond as a precursor.” 

Cofer wants CDR properly staffed and resourced—she said it needs at least $7 million in additional yearly funds—so that it can fulfill its initial mission of taking over various 911 call types from the police department. This would, in turn, free officers up to respond to calls that involve violent crime, and leave the department less reliant on overtime. “If we’re talking about baking this into 911 response, that means that we have to have staff available 24 hours a day,” she said. “You kind of have to commit.” She also says she’d more closely collaborate with community partners like Boykin’s Mental Health First that have experience doing this work already.

In interviews, both Prince and Willison emphasized that any lasting solutions to the city’s homelessness crisis must come from listening to the people most impacted by it, rather than simply following housed residents’ complaints. 

Generally, Willison said, “the needs, rights and preferences, including the health and well being of people experiencing homelessness, get completely circumvented” in policy discussions around homelessness. A public health approach must prioritize “being responsive to the needs of people experiencing homelessness themselves.” 

Of course, Cofer would also have to contend with the many constituents who want some measure of criminalization, if only because they’re exasperated by the city’s lack of progress on reducing homelessness. Cofer says that it’s understandable that Sacramentans have looked to fixes like the 2022 ballot measure that ramped up enforcement, which she framed as well-meaning but misguided. But convincing residents to be patient as the city attempts to implement longer-term solutions will be a challenge. And it could be a lonely fight, too. 

Sacramento’s District Attorney, Thien Ho, has sued the city twice for failing to enforce its anti-homeless ordinances, and has also threatened a lawsuit over Camp Resolution. And the recent Grants Pass decision by the U.S. Supreme Court has made it harder for officials to argue that their hands are tied when it comes to criminalization. Shortly after Grants Pass, California Governor Gavin Newsom ordered state agencies to begin clearing encampments on state-owned land, and strongly suggested that local leaders follow suit. This could further alarm individual council members reluctant to assert the political will to oppose sweeps or build new safe ground sites in their district, leaving it harder for Cofer or any future mayor to get the votes they need to make significant changes on this front. 

Cofer said that she’ll try to work around these challenges by encouraging collaboration and setting an ambitious affirmative vision for Sacramento. “I want us to set the benchmarks. How many people are we going to house this year?” she told Bolts. “And I want the media and advocates and everyone to be able to call in, or go to the city’s website and see how are we doing towards that goal, and I want us to be unafraid of setting an ambitious goal and potentially failing.” 

The post The Epidemiologist Running for Mayor to Bring Public Health to Sacramento Politics appeared first on Bolts.

At first glance, a Dutch safe consumption site looks like any other clinic. Patients walk into a sterile medical environment and are taken to a cubicle with a sink to wash their hands. From there, they approach a metal table, where they take illegal drugs, under supervision from trained medical professionals.

Each of the more than two dozen safe consumption sites across the Netherlands provide a hygienic, judgment-free space where drug users, typically five at a time, can bring their drugs and consume them without having to worry about legal repercussions while under the care of medical staff who help minimize risk. 

“Suddenly, people that are normally out on the street who are completely alone and isolated find a place where they actually have a connection,” says Roberto Pérez Gayo, a policy officer with Correlation European Harm Reduction Network, and coordinator at International Network of Drug Consumption Rooms. His research into dozens of safe injection sites has found that, besides protecting people’s lives who may otherwise overdoses, these spaces can also at their best provide other services that meet clients’ various needs in tandem: addiction, the need for housing, medical care and mental health challenges.

Safe consumption sites have helped the Netherlands reduce overdose deaths since a peak in the 1980s, and the nation has since become a global leader in the movement for safe consumption. But as overdose deaths spike more than 5,000 miles away in California, Governor Gavin Newsom just this August killed legislation that would have allowed cities to set up similar safe consumption sites. 

Newsom vetoed Senate Bill 57, which would have created a pilot program allowing Los Angeles, Oakland, and San Francisco to open safe, supervised spaces for people to use drugs without violating state law. After his predecessor vetoed a similar measure, Newsom told voters during his 2018 campaign that he would be “very, very open” to safe consumption sites if elected. But in a letter explaining his own veto this year, he claimed that opening the sites “could induce a world of unintended consequences,” such as “worsening drug consumption issues.”

However, study after study has found the opposite; that offering people a safe place to use drugs can significantly improve public health. Indeed, there has never been a reported overdose death in any official safe consumption site in the world. Advocates for harm reduction in the Netherlands say the country’s experience shows the importance of working collaboratively with policymakers, law enforcement, city leaders and most importantly, local residents to create places where potentially harmful drugs can be used safely. 

Machteld “Mac” Busz is Executive Director of Mainline, a quarterly magazine and advocacy organization that was founded in 1990 on the principle of harm reduction, encouraging the safer use of drugs instead of abstinence, and advocating for the treatment of addiction through a public health approach instead of incarceration. 

“We know that [safe consumption is] going to prevent all sorts of infectious diseases. It improves people’s quality of life, and it reduces overdose death,” said Busz.

While the Dutch have famously tolerated cannabis use and in the 1970s decriminalized use of many hard drugs, few services existed for those seeking to consume drugs safely at the height of the crisis in the mid 80s. An estimated 25,000 people used regularly, sometimes in public, and often shared needles, which littered parks and city streets. HIV spread to as many as a quarter of the country’s intravenous drug users; overdoses were a top health concern and drug-fueled street crime was rampant. 

On display in the hallway leading to Mainline’s offices is one portion of a multipart photo exhibit “House of HIV” exploring the HIV epidemic through the lens of the communities affected by it, created on the 40th anniversary of the first reported case of HIV in the Netherlands. 

House of HIV chronicles how activists mobilized to distribute clean needles and methadone, educating users about high-risk behavior. One black and white photo shows an activist giving a police officer a copy of Mainline, part of a years-long campaign to convince officials to abandon the criminalization of addiction for a harm reduction approach. Law enforcement officials went on to become important advocates of harm reduction and safe consumption sites, Busz says. 

After a decade of advocacy from organizers and lawmakers, the Netherlands authorized safe consumption sites in 1996. By 2019 there were 37 operating across 25 cities, the highest concentration in the world. 

While selling drugs like heroin remains illegal today, drug users in the Netherlands are met with resources, not incarceration. The sites offer access to clean needles and alternatives to heroin, such as methadone, as well as educational materials about harm reduction, social services, housing and healthcare. Proponents say this approach is responsible in part for the Netherlands having a tenth of the overdose rate that exists in the U.S., as well as a far lower crime rate.

“People resort to crime out of necessity,” says Busz. “If people instead can access a substitution program where at least they don’t have to chase after their drugs and money anymore, that leads to a significant reduction in crime,” she says, noting studies that have shown these alternatives to incarceration are also far more cost-effective. 

But it’s a mistake to think simply opening safe consumption sites can solve the opioid epidemic, says Gayo. The Dutch experience has found that these sites are most effective when paired with comprehensive social services, such as housing where consumption is allowed, and mental health support. 

Some sites operate within existing housing or medical facilities that serve areas struggling with addiction. Others serve marginalized populations, such as migrants or those experiencing housing insecurity, by offering a place to foster community. Once inside, users find a space that resembles a living room with couches and tables where they can consume drugs, rest, or listen to music with others. Staffers stand by in case of emergencies and build relationships with clients.

This communal environment helps officials connect clients with medical, mental health and drug treatment as well as educational and employment opportunities.

“Each of these facilities has to be contextualized within particular communities,” says Gayo. “Drug consumption rooms work, but in order to work, we need to have a bigger conversation about how to tackle the social inequality that produces negative health outcomes in marginalized and underserved individuals and communities.” 

The number of safe consumption rooms in the Netherlands has fallen as intravenous drug use decreases, with the population that continues to use these drugs aging. Experts attribute this to both the success of the educational efforts of the harm reduction movement, and shifting drug consumption habits among younger generations.

Overdose has been the leading cause of accidental death in the United States since 2017, a trend largely driven by the increased use of fentanyl, a synthetic opioid that is lethal even in small amounts. In California, 10,416 people died of an overdose in 2021, nearly double the 2018 death toll. And by April 2021, the national overdose death rate had climbed nearly 30 percent from the previous year, according to the CDC. 

Meanwhile, the U.S. also has the highest incarceration rate in the world; 1 in 5 people behind bars are charged with drug offenses, or nearly 400,000 people, a disproportionate number of whom are Black and Latino.

The failure of mass incarceration to dissuade drug use, the growing rate of overdose deaths, and the ample evidence that safe injection sites can decrease these deaths has created a growing demand in the U.S. for a different model.

For years, an underground network of safe injection sites have operated across the country, staffed by trained personnel who risk legal repercussions. A 2020 study published in the New England Journal of Medicine reviewed data from one such unsanctioned site—whose location was kept secret by researchers—and found it averted dozens of overdoses over five years without a single fatality.

Last year, the U.S. opened its first two authorized safe injection sites in New York City. Facing a spike of overdoses during the pandemic and after years of planning, the city forged ahead with the plan without authorization from state authorities who said it required further study. They have reported averting 300 overdoses since opening last November. 

Critics of safe consumption sites, however, frequently invoke images of neighborhoods flooded with drug users from across an entire region who disrupt local communities. 

“Fueling the drug epidemic with drug dens and needle supplies is like pouring gasoline on a forest fire. It merely worsens the problem,” California Senate Republican Leader Scott Wilk wrote in opposition to the measure without citing any evidence to back these claims.

San Francisco is still considering moving forward with opening safe consumption sites regardless of Newsom’s veto. They would be run through local non-profit organizations in a model similar to New York’s. 

“We will keep working with our community partners to find a way forward” tweeted Mayor London Breed, who has spoken about her sister’s death from an overdose and who supports injection sites. She said she was “disappointed” by Newsom’s veto. The bill was introduced by state Senator Scott Wiener, who represents San Francisco and called the veto ”tragic.”

In the Netherlands, safe consumption activists figured out how to win over critics and helped make safe injection sites accepted as a social norm. Their placement must comply with local and regional regulations, is based on where there is need, and “is negotiated with communities,” says Gayo. “Some communities feel more comfortable having a facility close to the neighborhood, and others don’t.” To avoid overcrowding and disrupting local communities, the more than two dozen sites are distributed across the country. 

To succeed, leaders of the safe consumption sites must work in constant collaboration with their neighbors as well as authorities, who must be responsive to their needs, says Eberhard Schatz, a longtime researcher and harm reduction advocate. 

The AMOC safe consumption site in Amsterdam consults with a neighborhood commission whose members include representatives of local neighborhoods, community centers, law enforcement and the coordinator of the consumption site.

Close coordination between these stakeholders can help decrease crime and public nuisance complaints, says Gayo.

The sites maintain a close collaborative relationship with law enforcement and local hospitals and clinics, who help connect users with the facilities and can respond in case of emergencies. “The facilities have a direct line with [first responders],“ says Gayo. 

Advocates in the Netherlands offer words of support for the U.S. harm reduction movement. “These are people that are taking matters in their own hands when you have a government that doesn’t care about you and just lets you die,” said Busz, who notes the parallels between the Netherlands three decades ago and the U.S. today. 

“Here the first drug consumption rooms and needle exchange programs were all led by drug users themselves in the beginning,” taking on considerable personal risk, said Busz. Government-supported drug injection sites were the result of activists proving to opponents that they can save lives without increasing crime. 

Busz says the state support is critical to acquire the necessary funding for success. “With all everything that we know now and evidence base that it is there… they should be backed by the state from the start.”

The post In the Netherlands, Safe Drug Consumption Sites Are Saving Lives. The U.S. Is Resisting. appeared first on Bolts.