HAS THE TIME COME FOR SUPERVISED CONSUMPTION SITES?

In 2020 and 2021, there were a total of 1,365 fatal drug overdoses in San Francisco. For context, compare that with the approximately 725 deaths from COVID-19 that occurred during the same period. Overdoses from drugs like fentanyl are one of the most severe public health epidemics of our time.

In 2022, the San Francisco Department of Public Health presented to the San Francisco Board of Supervisors the city’s plan to prevent fatal overdoses. At the core of the city’s plan was the establishment of several 'Wellness Hubs,’ which would scale up services provided, at that time, by a drop-in center in the Tenderloin neighborhood of San Francisco.

There were many services available at the Tenderloin drop-in center: food, laundry, and linkage to drug abstinence programs, to name a few. Also available at the Tenderloin site was ‘supervised consumption’ services, whereby individuals would be permitted to use illegal drugs under the supervision of trained staff, so staff could intervene with Naloxone in the event of an overdose to prevent it from becoming fatal. In 2022, 333 overdoses were reversed at the Tenderloin drop-in center because of the supervised consumption services it provided.

Supervised consumption is not currently legal under California state law, or federal law, though it is an accepted harm reduction strategy in many other countries. A state bill authored by San Francisco’s State Senator, Scott Wiener, which would have authorized the piloting of these sites in San Francisco, Oakland, and Los Angeles, successfully passed the Senate and Assembly in 2022, but was vetoed by California Governor Gavin Newsom. Had the bill been signed into law, supervised consumption services at the Tenderloin center, and the Wellness Hubs that were to follow, could have been routinized, improved, and made long-term.

In November 2022, the funding for the Tenderloin center lapsed. The Wellness Hubs were intended to begin in time for a seamless continuation of services to at-risk individuals. But the veto of Senator Wiener’s bill threw into question the ability of the city to support such a model. SFMMS wrote to city officials at the time encouraging the appropriate funding and support for comprehensive harm reduction strategies. As of this writing, there are no supervised consumption services available in San Francisco.

In New York, a supervised consumption site operated by the nonprofit OnPoint NYC (www.onpointnyc.org) is funded using private dollars. They operate because of unofficial commitments from the New York City Mayor’s office and local District Attorneys not to prosecute. Similar commitments have been provided by San Francisco Mayor London Breed and City Attorney David Chiu. The nonprofit infrastructure also exists to operate such a site in San Francisco. As a result, OnPoint NYC represents a model that could be replicated in San Francisco. What is required now is the funding.

OnPoint presented to the Supervisors in San Francisco in early 2023. Among the statistics shared was that the costs of running their centers is 1.3 times less than continuing to fund the cost of the status quo, which involves police, ambulance, and emergency medicine departments and response services required to intervene during a potentially fatal overdose.

Momentum and support have been gathering for supervised consumption as an evidence-based harm reduction strategy in cities that continue to grapple with fentanyl addiction and abuse. Organized medicine, from local, to state, to national, has policy in support of this care model. At SFMMS, we’re eager to work with legislators, regulators, funders, and nonprofit organizations to help support the emergence of this model in our community.

More Graduate Medical Education Residency Positions

CMA successfully urged Congress to provide 200 new GME residency positions; half of the positions are dedicated to psychiatry and psychiatry subspecialties to meet the nation’s growing mental health needs.

Disappointing Medicare Payment Cut

Congress stops 6.5% of the 8.5% Medicare Payment Cut – Allowing a 2% Cut to Take Effect

CMA aggressively fought to stop the entire 8.5% Medicare payment cut facing physicians and we are extremely disappointed that Congress came up short and allowed a 2% cut to take effect in 2023.

Physicians will also experience a 1.25% cut in 2024. However, CMA is grateful to California physician Congressman Ami Bera, M.D., for his legislation (HR 8800 – “Supporting Medicare

Providers Act”) and strong advocacy to stop the entire cut.

The expiring 5% bonus payment for Medicare Advanced Alternative Payment Models, including

Accountable Care Organizations was extended for one year at 3.5%.

CMA Newswire Article and Statement:

Physicians React to Congress’ Plan to Cut Medicare Payments in 2023

Congress Fails Patients During Unprecedented U.S. Health Care Challenges

The United States Congress passed their year-end omnibus legislation last week, which includes a

Medicare physician payment cut of 2% in 2023. Physicians had been staring down cuts as much as

8.5%, but a nationwide advocacy campaign by the American Medical Association, California Medical

Association (CMA) and more than 150 organizations representing over 1 million physicians helped stave off many of the reductions. However, physicians who care for Medicare patients and CMA are very concerned about how the cut will impact patient access to care.

“Congress’ plan to cut Medicare demonstrates a lack of understanding of the access barriers already plaguing our health care system,” says CMA President Donaldo Hernandez, M.D. “Physicians are frustrated and demoralized because, at a moment when the entire health care system is stressed to its limits, both parties in Congress have decided to ‘thank’ physicians working on the frontlines with cuts that will have devastating impacts.”