Safe Injection Sites: A Comparative Analysis of the Social and Political Factors Affecting Policy Outcomes

Abstract

Over the past decade, rising overdose deaths associated with the opioid epidemic have placed social and fiscal burdens on the government and on communities. In an attempt to reduce opioid-related mortality rates, more than 13 cities throughout the United States have proposed “safe injection sites” as a harm-reduction strategy. These are locations where injection drug users can consume pre-obtained substances under the supervision of nurses equipped with the overdose-reversing nasal spray, Narcan. Though widely accepted in international settings, U.S. cities have been hesitant to adopt this approach; to date, not one city-led effort has been successful.

This thesis seeks to understand why U.S. cities’ efforts to adopt safe injection sites have been unsuccessful. To answer this question, I performed a comparative analysis of two North American cities with varying success in implementation. In the United States, of the 13 cities that have proposed safe injection services, San Francisco progressed the furthest, but nonetheless failed. Vancouver was chosen as the contrast due to its proximity and having opened North America’s first safe injection site. I used three policy outcome theories—grassroots and community organization, messaging and frameworks, and policy windows—to conduct the comparison of San Francisco and Vancouver. Together, these predicted that San Francisco was unsuccessful on account of a social movement, framing processes or political opportunity. To test these predictions, I developed a coding scheme and performed a content analysis of two types of primary sources— newspapers and public documents.

I found that the absence of an organized social movement and political opportunity provided by the municipal government, as well as the types of frames employed, contributed to the failure of safe injection policy in San Francisco. Vancouver was successful on account of grassroots organization, government collaboration and frames that challenged the culture surrounding drug use. In San Francisco, policymakers introducing safe injection sites did not demonstrate a strong attempt at community engagement, depended on technical frames based on research and data, and could not overcome the threat of federal prosecution. Safe injection services were presented in a vacuum, detached from the other policies aimed at minimizing the opioid crisis. These findings have significant implications for safe injection policy, as well as other harm-reduction measures. Policymakers need to collaborate across federal, provincial, and municipal levels to develop comprehensive policy plans that employ traditional and progressive strategies and actively seek community support for and involvement in these plans. Overall, the results suggest that social movements and framing processes can be powerful agents for affecting policy change.