An influential research group that evaluates medical interventions has endorsed establishing centers where people can use illicit drugs under medical supervision.
The report from the Institute for Clinical and Economic Review, released Friday, comes as legislation to establish two such sites in Massachusetts languishes in the Legislature.
The institute concludes there is adequate evidence that such “supervised injection facilities,” or SIFs, prevent overdose deaths, reduce costs by avoiding hospital visits, may decrease public drug consumption, and do not affect crime rates.
In communities with high rates of overdoses, the institute found, “a SIF is one of the rare interventions that is not only cost-effective, but cost-saving.”
David Rind, the group’s chief medical officer, said the evidence suggests supervised injection facilities "actually prevent overdose deaths in the community rather than simply briefly delaying them, and these facilities also reduce expenditures on ambulance calls and hospitalizations. Policy makers should be aware that SIFs save lives and money.”
Although the Institute for Clinical and Economic Review is well-known nationally for evaluating the cost-effectiveness of pharmaceuticals, it remains to be seen whether its report will sway Massachusetts legislators and other public officials at loggerheads over a contentious social policy issue. Public health experts support the idea, but opponents fear an increase in addiction and crime, and object to what looks like government endorsement of drug use.
Both Governor Charlie Baker and US Attorney Andrew E. Lelling have expressed strong opposition, saying a supervised injection facility would violate federal law. The Massachusetts Legislature is considering a bill to set up two pilot programs providing this service, based on the recommendations of an advisory commission, but the proposal still has not moved forward months after it won committee approval.
The institute’s report "supports previous findings in New York City and Seattle that SIFs not only prevent overdoses but provide good value for money,” said Bruce R. Schackman, executive vice chair of the Department of Population Health Sciences at Weill Cornell Medicine in New York City, who was interviewed for the study but did not participate in preparing it.
“This means that decision makers in New England and elsewhere should be confident that establishing a SIF would be good news for taxpayers and the healthcare system,” Schackman said in an e-mail.
Supervised injection facilities, sometimes called “safe consumption sites,” provide a hygienic setting where people can use illicit drugs knowing there is medical help available to rescue them if they overdose. Such sites typically also offer clean syringes and other supplies, counseling, and links to health care and addiction treatment services.
No such facility has been authorized in the United States, but they have operated for many years in Canada, Australia, and parts of Europe.
ICER reviewed 48 studies of safe injection sites, primarily in Canada, as well as government evaluation reports in Canada and Australia. It found that no client has ever died of an overdose within a safe injection facility.
Drug users are more likely to enter treatment, or enter treatment more quickly, and have better access to health and social services, when these sites are available. Studies also show fewer people injecting in public and sometimes a reduction in syringe and injection litter. The facilities had no effect on crime rates.
But the report notes that many of the studies are 10 years old, and took place before deadly fentanyl became pervasive in the drug supply and methamphetamine use resurged.
The group also took testimony from 48 concerned individuals, including drug users, researchers, clinical experts, legislative experts, and a law enforcement officer.
These conversations revealed that in safe injection facilities, drug users can build relationships with other clients and staff, have on-site access to social workers and counselors, and benefit from a compassionate approach that contrasts with the “shaming and blaming” they often encounter in health care.
Drug use still sometimes occurs just outside such facilities, however, and community members complain.
The institute will hold a Dec. 3 virtual meeting of its New England Comparative Effectiveness Public Advisory Committee to discuss the policy implications of its findings.