San Francisco's Tenderloin Center Operates as De Facto Drug Consumption Site, Records Show

San Francisco's Tenderloin Linkage Center, which opened in January with the promise of steering people toward health and social services, has quietly become something different. By May 11, 2022, the city had dropped "linkage" from the name on the facility's dashboard, referring to it simply as the Tenderloin Center. Records and interviews suggest the change reflects a deeper shift in what the site actually does.

When Mayor London Breed announced the center, she described it as a safe, welcoming space for people ready to reach city health and human service resources quickly. The idea was to give those struggling with addiction or mental illness an easy path to care. But many of those involved in creating it viewed it from the outset as a place where people could use drugs with some measure of safety, in the language of the field an overdose prevention or safe consumption site.

Journalists have been barred from the center. Guests interviewed by The San Francisco Standard said they had seen or taken part in illegal drug use there, and some did not know addiction treatment was offered at all, regarding it mainly as a safer, more private place to use. That puts the city in a difficult legal position, since federal and state laws prohibit such facilities, and The Standard's Voter Poll found city residents divided on the idea.

Emails obtained through public records requests show a gap between internal and public descriptions. In a Jan. 7 message, a HealthRIGHT 360 executive called the project the "Tenderloin Overdose Prevention Site." The nonprofit's CEO, Vitka Eisen, had written days earlier that it would strongly prefer to offer harm reduction services in an outdoor tent, citing the pandemic and an expectation that it would serve smokers. HealthRIGHT 360 has received more than $53 million from the Department of Public Health this fiscal year.

Problems emerged soon after the Jan. 18 opening. Author and gubernatorial candidate Michael Shellenberger wrote that he had seen guests smoking fentanyl outdoors at the site. Breed's public statements shifted: in December she said the city would no longer let people use drugs in broad daylight, in late January she said the city cannot control who uses drugs in any location, and in February she said drug use is not authorized at the center. Privately, DPH medical director Deborah Borne worried about personal liability, texting that "the mayor is going to need to defend us."

The center's results are hard to measure. Its first weekly report counted 33 completed linkages, but the category lumped together medical care, shelter, food programs, housing and addiction treatment. Despite thousands of weekly visits, only 31 completed linkages to addiction treatment have been reported to date. A DPH spokesperson hoped to steer reporters away from their "focus on linkages," and one DPH official speculated in a February email that a HealthRIGHT 360 executive was "making up numbers." That executive, Gary McCoy, said the organization joined the effort "with almost no notice" and lacked time to build proper data systems.

The site may nonetheless be saving lives. Since January, 78 overdoses have been reversed there, out of 982 reversed citywide by emergency personnel.

The legal picture could change soon. The U.S. Department of Justice is nearing a settlement with Philadelphia nonprofit Safehouse, which it sued in February 2019, and a judge this week extended the deadline for settlement terms to June 23. San Francisco has also approved buying two Tenderloin buildings for a sanctioned safe consumption site, and state Sen. Scott Wiener's SB 57 would legalize such sites under state law. New York City opened two in November without any reported deaths.

Some recovery advocates support harm reduction but want more options for people seeking abstinence. Richard Beal of the Tenderloin Housing Clinic said providers are doing good work meeting people where they are, "but they're doing them a disservice by leaving them there."