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RI HEALTH

Here’s what a safe injection site would look like

Rhode Island is the first state to authorize supervised drug consumption sites to help prevent overdoses. Officials created an exhibit so residents can better understand what’s involved

Rhode Island Community for Addiction Recovery Efforts (RICARES) has created a model of an overdose prevention site, aiming to debunk myths about these spaces and show how they save lives. The exhibition was created in partnership with the People, Place, and Health Collective at the School of Public Health at Brown University. The Boston Globe was given a tour of the exhibition site.
Rhode Island Community for Addiction Recovery Efforts (RICARES) has created a model of an overdose prevention site, aiming to debunk myths about these spaces and show how they save lives. The exhibition was created in partnership with the People, Place, and Health Collective at the School of Public Health at Brown University. The Boston Globe was given a tour of the exhibition site.Jonathan Wiggs/Globe Staff

PROVIDENCE — The storefront, across from a church and next to a hotel in downtown Providence, has potted plants and posters in the front window, plus office partitions and comfortable chairs inside.

“Boring,” Selene Means said of the site, “but friendly.”

“It’s like the DMV,” Haley McKee said.

“It’s like a reception area for a medical office or a nonprofit,” Monica McMyne-Smith said.

In other words, the model for Rhode Island’s newly authorized “harm reduction centers,” where people would use illicit drugs while supervised in order to prevent overdoses, bears no resemblance to the grim images often portrayed of drug use, advocates said this week during a tour of the exhibit.

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“People picture things they see on TV — dark alleyways, flop houses, crack houses,” said McMyne-Smith, CEO of Rhode Island Community for Addiction Recovery Efforts (RICARES). “But this is a friendly, inviting space.”

“Because drug use is so stigmatized, people think it’s dirty or weird,” said Means, RICARES’ visual designer. “But these facilities remind you of a doctor’s office.”

Monica McMyne-Smith, CEO of the group RICARES, gave a tour of an exhibition showing what an overdose prevention site would look like in Rhode Island.
Monica McMyne-Smith, CEO of the group RICARES, gave a tour of an exhibition showing what an overdose prevention site would look like in Rhode Island. Jonathan Wiggs/Globe Staff

In the final days of this year’s legislative session, the General Assembly passed legislation to create a two-year pilot program for centers where people “may safely consume pre-obtained controlled substances under the supervision of health care professionals.” Governor Daniel J. McKee signed the legislation into law on July 7.

While cities such as Philadelphia, New York, and Somerville, Mass., have moved toward opening such sites, Rhode Island is the first state to authorize overdose prevention sites statewide, McMyne-Smith said.

Canada and other countries have long operated overdose prevention sites, but they remain illegal under federal law in the United States, and Rhode Island is expecting to face a legal challenge, she said.

Haley McKee, co-chair of the Substance Use Policy Education and Recovery Political Action Committee (SUPERPAC), said, “I would fully expect that 20 years from now, 50 years from now, people are going to reflect and say, ‘Wow, Rhode Island did this right, they did it first, and they paved the way for other states.’ I really and firmly believe that.”

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Rhode Island enacted the law after setting a new record for accidental drug overdose deaths: In 2020, 384 Rhode Islanders died of accidental overdoses, surpassing the previous record of 336 set in 2016, according to the latest state Department of Health data.

RICARES, a nonprofit run by people in recovery and their allies, is not planning to open an overdose prevention site at its offices at 133 Mathewson St., but it opened the exhibition there in May, basing it on overdose prevention sites found in other countries, including Canada, Australia, and Switzerland.

RICARES created the exhibition in partnership with the People, Places, and Health Collective at Brown University’s School of Public Health. The exhibit will be open each Friday, from noon to 6 p.m., through Sept. 17.

The exhibit includes a map of the more than 120 overdose prevention sites found around the world. “That is one of the most surprising things for people — learning that there are so many but none in the United States,” Means said.

Selene Means, visual designer for the group RICARES, led a tour of the exhibition of an overdose prevention site in Providence.
Selene Means, visual designer for the group RICARES, led a tour of the exhibition of an overdose prevention site in Providence.Jonathan Wiggs/Globe Staff

The first step in the exhibit is a registration desk, where people sign in using just their initials or a client ID number. They also list the drug they are using and the method of use, such as “methamphetamine/smoking.”

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The registration area includes educational information about safer drug use practices, naloxone nasal spray, syringe disposal canisters, and fentanyl test strips.

The waiting area contains pictures and quotes from people in long-time recovery, including McMyne-Smith. “People who drink have a safe place to consume their drug of choice,” she is quoted as saying. “I deserve the same safety, regardless of my drug of choice.”

The consumption room includes a variety of supplies for injecting and smoking, including sterile syringes, alcohol swabs, and tourniquets. Once people get those supplies, they can take a seat in an open booth or inhalation stall.

A range of sterile injecting and smoking supplies displayed at the exhibition showing what an overdose prevention site would look like in Rhode Island.
A range of sterile injecting and smoking supplies displayed at the exhibition showing what an overdose prevention site would look like in Rhode Island.Jonathan Wiggs/Globe Staff

After using their drugs, people can head to an observation area where they are monitored for signs of overdose.

“This is where somebody can chill, relax,” McMyne-Smith said. “Different substances would need different chill-out spaces because of the different ways the body reacts to specific substances.”

In the observation area, people can help themselves to juice and snacks, and they can talk with nurses, peer recovery coaches, and case workers, getting connected to help with housing, employment, and basic health care, she said.

“That is what is great about these facilities,” McMyne-Smith said. “If they are well run, they can provide wraparound services.”

She said the most common concern about overdose prevention sites is the impact on the neighborhood. But she said studies show the sites do not increase crime or drug dealing in the area, and while there have been overdoses at these sites, there has never been an overdose death. Nurses are on site to supervise the drug use and provide medical assistance if needed, she said.

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“A safe space for people to come use their preferred substances will ensure that they live through the day,” McMyne-Smith said, “and that it’s not as cold as a dumpster in an alleyway.”

When the Rhode Island legislation came before the House, Representative Arthur J. Corvese, a North Providence Democrat, was among those who objected.

“What kind of a society do we want to live in?” he asked. “We set laws and rules and parameters for our people to conduct themselves. But yet we say, ‘You want to chase the dragon or shoot up? There is the place to do it — we are going to protect you.’”

The drug consumption room at a Providence exhibition showing what an overdose prevention site would look like.
The drug consumption room at a Providence exhibition showing what an overdose prevention site would look like.Jonathan Wiggs/Globe Staff

Corvese said taxpayers should not be asked to fund centers where people can violate drug laws.

But Haley McKee said the proposed overdose prevention sites would be funded only with private money, not public funds. “Fortunately, we have had interest from private donors, people interested in doing research, and volunteers,” she said.

Rhode Island could very well see more than 400 accidental drug overdose deaths in 2021, McKee said. The increase in overdose deaths stems in part from the isolation brought on by the pandemic and poor economic conditions, she said. But mostly, the trend reflects a drug supply that contains lethal doses of fentanyl and carfentanil, an elephant tranquilizer, she said.

No decision has been made yet about where the overdose prevention sites would be located, McKee said, noting that the legislation calls for creation of a committee to advise the Department of Health on the harm reduction center program. Also, she noted that city or town councils would have to approve any overdose prevention sites in their communities.

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Historically, the highest concentration of public overdoses have occurred in downtown Providence areas such as Kennedy Plaza and the Providence Place mall restrooms, McKee said. “Ideally, the centers would be located where people are experiencing the highest prevalence of overdoses,” she said.

RICARES program director Ian Knowles, who is in long-term recovery, said Rhode Island needs overdose prevention centers to address an escalating public health crisis.

“The people who are dying of overdoses are family members, friends, human beings who deserve to live,” he said. “Why wouldn’t we do whatever we can to keep them alive while they’re going through their struggles so that hopefully they can find recovery? We don’t recover if we’re dead.”


Edward Fitzpatrick can be reached at edward.fitzpatrick@globe.com. Follow him on Twitter @FitzProv.