Gov. Gavin Newsom led the way on same-sex marriage and legal pot, but supervised drug sites pose a far different issue.

Gavin Newsom is facing one of the toughest political decisions of his career: whether to grant state permission for San Francisco, Oakland and Los Angeles to open experimental safe injection sites as a way to curb California’s overdose crisis.

Most elected leaders couldn’t veto something like this fast enough. Condoning illegal drug use — even if it is supervised by professionals — sounds politically insane.

But since his first days in elective office, Newsom has been at his best when he’s looking around the corner and leading on a controversial issue, long before it’s well understood, much less politically popular. Think about his leadership on same-sex marriage, the legalization of cannabis, rolling back the death penalty, toughest-in-the-nation gun safety laws and making California an abortion rights sanctuary.

Newsom was out front early and loudly on those issues — even when the rest of America thought he was nuts and the moves jeopardized his career.

“SF Mayor Gavin Newsom Risks Career on Gay Marriage” blared a Newsweek headline in January 2009, two months after California voters backed Proposition 8, which banned the same-sex marriages that Newsom had approved weeks after beginning his stint as San Francisco’s mayor in 2004. After the loss, Newsweek wrote that “Newsom has become a joke to Democratic insiders, a man whose bright national future ended before it began.”

So much for predictions. Score one for being ahead of the curve.

But this decision is different, which may be why insiders say Newsom is hesitating about whether to approve the pilot program to allow people to inject or smoke drugs in the presence of harm-reduction specialists in controlled settings. As my colleague Heather Knight has written about extensively, it is a way to address the overdose epidemic that is out of control. Since 2020, 1,649 people have died of overdoses in San Francisco, nearly twice as many as those who have died due to COVID-19.

Syringes for use at OnPoint NYC, a supervised consumption site in Harlem.

This is not an untried idea. Similar sites have been operating in Canada and Europe. New York has been running two since last year. The city’s new mayor — former police officer Eric Adams, hardly a progressive — likes them so much that he’s considering keeping them open all night.

Every single day, overdose prevention centers are giving people in pain another chance. It's time to go further — this administration fully supports making overdose prevention centers accessible 24 hours a day. A crisis doesn't wait and neither should we. https://t.co/EWHKS12XsI

It seems like the exact type of cutting-edge idea that Newsom would leap to support, said Kim Nalder, a professor of political science at Sacramento State University.

“With so many issues, he’s shown that he’s willing to blaze a trail, so it's already his brand,” Nalder said. “Californians already expect him to do things that are out of the mainstream that might be ahead of the rest of the country. So I don't think it hurts him to do more bold actions because that’s part of his logo already.”

There’s one problem. In raw political terms, it’s a loser.

Unlike Newsom’s move to legalize same-sex marriage or put his weight behind cannabis and abortion rights, there’s no constituency for needle drug users. After Newsom permitted San Francisco to start issuing marriage licenses to same-sex couples, there was a long, joyous line of loving couples snaking around City Hall, eternally grateful to Newsom for enabling them to do something they thought would never happen in their lifetime — get married.

Politically, he was prescient. Then, about 42% of Americans supported gay marriage, according to Gallup. Now, 71% of the country — including a majority of Republicans — support same-sex nuptials.

Newsom was also ahead of the curve when he led the drive to legalize cannabis in California in 2016 while he was lieutenant governor, becoming one of the highest-ranking officials in the country to back legalization. Longtime former GOP operative Tim Miller praised Newsom for his weed work and said he could take it even further.

“Running a national ‘Legalize It’ (cannabis) campaign would be really popular,” said Miller, who was a bare-knuckled political operative when he worked on presidential campaigns for John McCain and Jon Huntsman.

“But needle drugs?” Miller said and shook his head. “This is just a different, different animal.”

I was asking him about Newsom’s national political considerations. Newsom has been boosting his national profile in recent months. He’s running ads in Florida, tweaking GOP Gov. Ron DeSantis, a likely 2024 presidential candidate, and has been making regular appearances on Donald Trump’s Twitteresque social media platform to troll Republicans. His supporters say he’s doing it to stand up and loudly support Democratic values.

Newsom has told The Chronicle he has “sub zero” interest in running for president. But, as we’ve said before, if President Biden decides to change his decision to run for re-election, Newsom is warming up in the bullpen just in case.

Green-lighting safe injection sites, Miller said, could hurt his national reputation. The TV attack ads would write themselves, with scenes of open air drug use in “Gavin Newsom’s San Francisco,” as conservatives are fond of describing the city.

“Ron DeSantis would turn him into the pro-heroin governor,” Miller told me this week after appearing on The Chronicle’s “It’s All Political on Fifth and Mission” podcast.

“You pair that with scenes of (drug users) in San Francisco and talking about this head-to-head with like a DeSantis-type — combined with what's going on with the drug crisis in the country — and it becomes very, very challenging to message around,” said Miller, who left the GOP in 2020 and is now one of the nation’s most pointed Donald Trump opponents.

Plus, injection drug use is an obscure issue to many Americans. Many people knew a gay couple who wanted to get married or a dope smoker who craved legal weed.

“But most people don’t end their evenings poring over policy analysis journals to find out that this might be the wisest policy decision, that it would save lives,” Nalder said. If, however, Newsom could show how the policy saved lives or decreased ambulance rides or saved public money, then he could “reframe the debate and control the terms of it going forward and get credit for being a trailblazer.”

State Sen. Scott Wiener, D-San Francisco, the author of the safe site legislation, believes the political fears are overblown. Anybody who wants to attack a California politician for the open air drug abuse that’s going on doesn’t have to wait for a safe injection site to open. That footage is available right now. Republicans are already seizing on the crisis to jab Newsom.

California is a place where you can “walk down streets that double as restrooms and injection sites,” Sacramento-area Republican House candidate Kevin Kiley told the Conservative Political Action Conference last week. “Gavin Newsom’s California is not a model to the nation. It is a warning to the nation.”

Wiener, who has known and supported Newsom for 25 years, has long respected Newsom as someone who makes a decision after examining the evidence. “Even when I disagree with him, I’m confident that we simply had a disagreement on the merits” of an issue, not the politics.

“Gavin Newsom is the evidence governor,” Wiener told me. “The evidence is overwhelming. It's not even a close call.”

Newsom may respond to this issue in the same way that he did when considering whether to support legalizing cannabis.

Newsom didn’t support Proposition 19, the failed 2010 ballot measure to legalize herb. Instead, a few years later, he led the Blue Ribbon Commission on Marijuana Policy, which held hearings and focus groups around the state. I even accompanied Newsom on a marijuana-fact-finding trip to see illegal grow operations Humboldt County. The group eventually produced a 93-page report that formed the backbone for Proposition 64, the legalization measure voters approved in 2016. Maybe he’s thinking of a similar path for safe sites.

Wiener doesn’t need a blue-ribbon commission to make up his mind.

“I don't need a blue-ribbon panel, because we have 30 years of evidence, including peer-reviewed studies, about these sites and their effectiveness,” Wiener told me. “We don't need a blue-ribbon panel. We don't need further study. We have all the information we need. We just need to make the right choice.”

Joe Garofoli is The San Francisco Chronicle’s senior political writer. Email: jgarofoli@sfchronicle.com Twitter: @joegarofoli

Joe Garofoli is the San Francisco Chronicle's senior political writer, covering national and state politics. He has worked at The Chronicle since 2000 and in Bay Area journalism since 1992, when he left the Milwaukee Journal. He is the host of "It's All Political," The Chronicle's political podcast. Catch it here: bit.ly/2LSAUjA

He has won numerous awards and covered everything from fashion to the Jeffrey Dahmer serial killings to two Olympic Games to his own vasectomy - which he discussed on NPR's "Talk of the Nation" after being told he couldn't say the word "balls" on the air. He regularly appears on Bay Area radio and TV talking politics and is available to entertain at bar mitzvahs and First Communions. He is a graduate of Northwestern University and a proud native of Pittsburgh. Go Steelers!