Diamond Mendoza rolled up the sleeves of her shirt—a yellow T-shirt decorated with a gorgeous rendering of the Mona Lisa—to show off the scars of the abscess that had been punctured and healed.

She wanted to quit heroin. Decades ago, she turned to heroin for the first time after a broken heart. She wants to obtain a certificate to prove herself to the employer, perhaps to become a blood draw doctor or nurse. She liked to hand over the paper and said, "Hey—I may be a drug addict, but I got the certificate."

But most importantly, Mendoza said, "I want to live longer."

According to federal data, during the pandemic, the number of deaths caused by drug overdose has soared. Last year, more than 90,000 people died across the country. As the numbers soared, many experts, advocates, and legislators came up with an idea that is still new to the United States: to provide people with a safe place to inject drugs under supervision.

In California, this will be the most compelling step in the pursuit of harm reduction by governments and health officials to date, which seeks pragmatic ways to reduce the harmful effects of drug use. This idea was vetoed by Governor Jerry Brown three years ago. He vetoed a bill to try such websites in San Francisco and stated that "allowing illegal and destructive drug use will never work."

Now state Senator Scott Wiener (D-San Francisco) and other lawmakers are pushing to allow San Francisco, Oakland, and Los Angeles cities and counties to approve entities to run such projects. The latest California Act SB 57 envisions them as "a sanitary space supervised by trained staff" where people can use "pre-obtained medicines", obtain sterile supplies and connect to treatments for substance abuse disorders.

When Melvin Latham heard that the idea was airing in Sacramento, it sounded like an impossible dream. A safe, supervised drug place? The staff there is to save a drug overdose?

"That's something in the movie or something!" Latham said, leaning back in disbelief.

Many "supervised consumption" or "safe consumption" websites exist legally around the world, including the Netherlands, Germany, and Canada. These projects are believed to prevent death, reduce the risk of HIV and other infectious diseases, and reduce public nuisance and hazards, such as discarded needles.

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In Switzerland, researchers have found that these facilities help reduce fatal overdose and reduce drug use in public places. In the United States, researchers discovered that an unapproved site located in an undisclosed location supervised more than 10,000 injections in five years. During that time, there were 33 opioid-related overdose—all of which were reversed by well-trained staff with medication.

"The crime rate in the neighborhood where the site is located has not increased. No one died from overdose at the scene," said Peter Davidson, an associate professor in the Department of Medicine at the University of California, San Diego, who helped evaluate the plan. "It usually seems to be beneficial to the outcome of public health and social order, just as it is in other parts of the world."

The California Act has aroused opposition from groups including the California Narcotics Officers Association. They believe that “SB 57 is not a vigorous effort to get drug users to receive treatment, but a shocking recognition of the inevitable and unchangeable nature of drug addiction and abuse. Nature.” It pointed to a controversial report from Alberta, Canada, which raised concerns about police calls, needle fragments, and overdose deaths near these locations.

Shaun S. Rundle, deputy director of the California Association of Peace Officials, another group opposed to the bill, said the creation of such sites "will only promote drug consumption." "We prefer to promote the resolution of dependency issues rather than promote it."

Janet Zanipatine, director of the California Drug Policy Alliance, countered, "What we are doing so far is not working." She believes that in addition to preventing drug overdose, these sites can also build trust when people really want to seek treatment. Provide support for it. Healthcare providers, advocacy groups such as the California Addiction Medicine Association, and local jurisdictions that will host the new site all support the proposal.

Researchers at the RAND Center for Drug Policy Research carefully studied the research published on regulated consumer websites and found that it was "almost unanimously supported, but essentially limited." The director of the center, Beau Kilmer, said that "there seems to be no reason to worry about side effects," but most studies do not have a "reliable control group" to measure whether the results are caused by the facility itself.

Kilmer said: "We have started to pilot regulated consumer websites in the United States and learn from them," including the time to evaluate how they affect referral treatment.

Latham, 43, lives in a downtown tunnel near Bunker Hill. He and Mendoza take care of each other, but he said that for anyone taking drugs outside, “you always look back,” worrying about someone trying to harass or hurt them.

Then there is the threat of fentanyl, a powerful opioid drug that has killed many drug users, including some who do not know they are taking it. Los Angeles County officials have linked synthetic opioids to the surge in overdose deaths among the homeless in recent years. Latham and Mendoza said they tried to avoid fentanyl because of its effectiveness, but it was often mixed with other drugs.

"A person is here, and then you will know that he is gone," Latham said of the death in downtown Los Angeles. "It's really scary."

In the slums of Los Angeles, Darren Willett imagined that if allowed, the harm reduction center could set up compartments to allow people to inject drugs under supervision, and then let them be in another room under the supervision of staff Hang out.

The center is operated by the Los Angeles Homeless Health Care Center, the director of the center Willett said, "There will be no such thing as drug overdose death." "The first reason people die from drug overdose is to use it alone. Why do they use it alone? Because it is convicted and stigmatized."

The Harm Reduction Center is not asking people to stop taking drugs, but trying to help them become safer and healthier. It provides clean needles and helps people avoid infection from sharing syringes. It distributed Narcan-a naloxone spray that can pull someone out of an overdose-so people can save lives on the street.

It teaches people how to inject themselves as safely as possible to avoid infection and vein collapse. On-site doctors provide medications such as suboxone to help people control their cravings, avoid withdrawal, or if this is their goal, may reduce or abstain from opiate use.

The center helps people who are trying to detox, but its goal is to make them safer, regardless of whether they are using it or not. On a recent working day, a small board at the door read this sentence: "50% of things are better than 100% of nothing."

When a person rides a bicycle to the entrance of the center, a folding table has been placed there as a temporary window. Harm reduction expert Arlene Lemus asked brightly: "Sir, what can I buy for you? "

The slogan "We love drug addicts" was written on her shirt. Before she picked up a bag of brown syringes, alcohol wipes, disinfectant water and other "safe injection" supplies, she asked: "Drugs of your choice?" to make sure she provided the correct type of syringes. Willett explained that using something too large may damage the veins unnecessarily.

Another man approached the door and asked, "Are there any extra Narcans?"

Lemus said yes, and asked about the dose he had taken before. The center tried to track the location and frequency of drugs used to prevent overdose, marking the reversal with a blue pushpin on a map of the city center. These pins formed a blue cluster above the slide, covered with red pins that marked death.

"I took them to the tent city I often use," the man told her. "When I was there, one person used it. I saved one person's life." He began to sort out the details, and then remembered another thing.

"That's me who saved two," he said.

Willett said this is one of the main ways the center measures its success: "Can we keep them alive?"

Recently, after restricting access for a year and a half during the pandemic, the slum center has been preparing to open its "temporary center." Just before the COVID-19 hit, it had completed a new room behind it-a quiet and cozy space equipped with cribs and bean bags for rest, computer terminals and sockets for people to charge their mobile phones. Willett said that this soothing room with abstract paintings and layered artificial vines is modeled after the injection room in Copenhagen.

This is not a consumer room, and it cannot be legally. The wooden sign above the head asks people not to take drugs. But Willett believes that if such regulated places are legalized in California, then after people inject themselves into clean cubicles or smoke in rapidly ventilated rooms, a soft space like this for art and poetry classes may be Become a safe place for people to be monitored.

According to data provided by Willett, when the center investigated whether more than 500 drug users would use this regulated consumer facility, the vast majority agreed. Most people say they will do this regularly-if not every day, at least a few times a week.

When Brown vetoed regulated consumer sites three years ago, he called the idea a "carrot and stick" and warned that even if California supported it, it would not be able to protect these facilities from federal prosecution. Earlier this year, a Philadelphia non-profit organization eager to open safe injection points was thwarted in court.

The Third Circuit Court of Appeals stated in its ruling that the motives of the Safehouse non-profit organization were "admirable." "But Congress has made it a crime to open property to others to use drugs. This is what Safehouse will do."

Willett said he personally was willing to be arrested for this, but he was worried about putting others in danger. Currently, due to legal issues, slum centers are hesitant to provide "drug checks" (testing drugs to check their chemical composition and make sure users know what drugs they are taking).

However, Rhode Island, where the number of deaths from drug overdose hit a record high last year, has passed a law that will launch a pilot program to operate the Harm Reduction Center for two years from March next year. Supporters are encouraged by the fact that the Biden administration supports "evidence-based harm reduction efforts" as one of its drug policy priorities.

During a poetry class in the secret room of the Harm Reduction Center, Sheridan Budd gently wiped the shoulder of a woman who suddenly burst into tears after being prompted to write the word "family." Others bend down on their clipboards and write intently, like a ringtone playing on a smartphone, contemplative music.

A man was asked to write down "fear". He said he was worried about contracting a disease and spreading it to his loved ones. Another lady was prompted to write "friend". Bude asked what the word meant to her.

"Sorrowful." The woman replied immediately.

Bude said that in the past year, she lost four clients because of drug overdose. She has personally reversed Narcan overdose six times. She told clients that if they had to shoot, “shoot across the street so I can see you.”

"So I know you are fine," she said.

For reports and exclusive analysis by Bureau Chief John Myers, please get our California Political Newsletter.

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Emily Alpert Reyes reports on public health for the Los Angeles Times.

Since 1984, Al Seib has been a photographer and videographer for the Los Angeles Times. His photos have won many awards from the Photographers Association at home and abroad. Seib's work helped The Times staff win four breaking news reporting awards: the Los Angeles riots in 1993, the Northridge earthquake in 1995, the Southern California wildfires in 2004, and the San Bernardino shooting in 2016 event.

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