Cost-Benefit Analysis of Opening a Safe Consumption Site in San Francisco
Evaluating the impact of the SCS model on the national opioid epidemic
Since the year 2000, over half a million people in the United States have died of opioid-related overdoses. The White House estimates that the opioid epidemic cost the U.S. over $500 billion in 2015—six times more than the most recent estimate, according to the Council of Economic Advisors. And while the health consequences of illicit opioid use and drug injection are undeniable, this epidemic also wreaks havoc in communities, causing crime, disorder, and a breakdown of the social safety net.
One potential model for mitigating the effects of the opioid epidemic is safe consumption sites (SCS), safe, clean spaces where people can consume pre-obtained drugs while being observed by trained staff. This transformative approach provides a nonjudgmental environment; protected time and space for injecting drugs hygienically and safely; appropriate guidance and equipment to reduce harms (e.g., clean needles, naloxone); proper disposal of used equipment; and access to medically assisted treatment, medical care, and social services. SCSs can be a powerful first step from chronic addiction to recovery, bringing a highly stigmatized and marginalized population into the fold of health services.
While there are currently more than 100 SCSs operating in 10 countries (including Canada, Australia, and Europe), this model remains unsanctioned in the United States. To demonstrate the potential financial costs and benefits of the SCS model, we partnered with the Criminal Justice Policy Foundation, Law Enforcement Against Prohibition, the University of British Columbia’s Centre for Disease Control, and the University of Southern California to produce a cost-benefit analysis of a hypothetical SCS in San Francisco, where there is a large, ongoing opioid problem.
Projecting the Costs of a Hypothetical Safe Consumption Site
We modeled our San Francisco SCS after an existing facility operating in Vancouver, Canada, that occupies roughly 1,000 square feet, provides 13 booths for clients, operates 18 hours per day, and serves about 1,700 unique individuals per month performing roughly 220,000 injections per year. Given the higher cost of living in San Francisco, we adjusted the budget for the hypothetical site, resulting in a conservative cost estimate of $2.6 million per year.
Next, we used evaluation data from Vancouver to estimate the expected reductions in negative health consequences due to the opening of an SCS, and applied these to the baseline prevalence of health consequences in San Francisco. We found that the hypothetical San Francisco SCS would prevent 3.3 cases of HIV and 19 cases of hepatitis C virus (HCV) per year, reduce skin and soft tissue infection hospital stays by 415 days annually, save an average of 0.24 lives per year, and facilitate 110 people to enter medically assisted treatment.
To put these numbers into perspective, three HIV infections represents roughly 6 percent of San Francisco’s total annual injection-related HIV infections, and 19 HCV infections represents 3 to 5 percent of San Francisco’s total annual injection-related HCV infections. Overall, we found that a single San Francisco SCS like the one in Vancouver would result in $6.1 million in health savings per year, with a net savings of $3.5 million annually.
Taking the SCS Model Nationwide
In 2017, government and public health officials in San Francisco announced plans to open an SCS in the fall of 2018. Mayors in New York City, Philadelphia, Seattle, and Ithaca, New York have also declared their intentions to open SCSs in the near future. Based on our study, it is reasonable to expect that each of these cities would also experience large health and cost savings should they open these facilities.