It’s been called the pandemic within the pandemic: Opioid-related overdose deaths soared last year across the country. In Massachusetts, they rose by 5 percent — the first increase in three years — to 2,104. The state toll was two more deaths than the previous peak year of 2016.
Rates among non-Hispanic Black males saw the largest increase in overdose deaths in the state. Before the COVID-19 pandemic, Massachusetts had seen a “steady decline,” Dr. Monica Bharel, the state public health commissioner, told the Public Health Council in May. In only 18 months, the pandemic erased years of progress in the fight against opioid addiction through prevention, treatment, and recovery efforts.
To make matters worse, Boston has an active cluster of HIV cases among individuals who use drugs and people experiencing homelessness.
This isn’t the time to be cautious. On the contrary, state and city leaders should use every tool in the proverbial arsenal to combat opioid deaths, including the most controversial: safe injection sites. The city of Somerville is leading the charge in the state and is planning to open a safe and clean facility where individuals can use previously acquired illicit drugs, so that if they overdose they can receive speedy medical attention.
That’s because Somerville’s elected officials get the urgency of the moment. Granted, opening safe injection sites is a hard sell in many communities — including in Boston. But for municipalities that want to offer this lifesaving service, the state should allow them to launch their own safe consumption sites.
“We know that what we’ve been doing so far has had some successes, but it hasn’t been enough,” said Dr. Miriam Komaromy, medical director of Boston Medical Center’s Grayken Center for Addiction. “Let’s look at [safe injection sites] as an experiment. Let’s gather and study data to look at the impact on overdoses, infections, neighborhoods.” Komaromy said the facilities are “unquestionably the right thing to do.”
The Boston HIV outbreak on top of the opioid crisis only adds to the urgency of pushing for bold policy solutions. “What’s particularly scary about [the active HIV cluster] is that there was a dramatic drop in HIV testing during the pandemic due to the isolation and social distancing measures,” said Dr. Alex Walley, a primary care physician for HIV patients at BMC who’s also an addiction specialist at the Grayken Center. “Despite that, we were seeing more cases, and when you have less testing and more cases, the concern is that there may be more transmission than you’re aware of.”
Though hampered by legal setbacks and other delays, Philadelphia and San Francisco are moving forward with their plans to launch safe consumption facilities. Rhode Island’s governor signed a law earlier this summer authorizing them, becoming the first state to do so. Meanwhile, in Massachusetts, there will be a hearing on Beacon Hill at the end of this month on bills tackling safe injection sites. One of them allows the creation of 10-year pilot programs at two or more sites across the state. The Legislature should prioritize it.
It’s been disappointing that no Boston mayoral candidate has unconditionally and fully championed a facility for the city, despite the statewide increase in overdose deaths and the rapidly deteriorating conditions in the area of Massachusetts Avenue and Melnea Cass Boulevard. “I do think that [the city’s infrastructure] is ready to support this,” said Komaromy. “There is treatment availability. Part of the job of implementing a safe injection facility is to set up the connections needed, [such as] hiring harm reduction outreach workers who will educate users of the facility of the treatment services available.”
One of the concerns about safe injection sites is that the state should be steering people to treatment, not giving them a place to take illegal drugs. But the two are not mutually exclusive, and indeed the sites can serve as a way to connect people with services while also preventing them from dying.
Tuesday was International Overdose Awareness Day and September is National Recovery Month. Both the worsening opioid crisis and the HIV outbreak in Boston are preventable. The state can make progress on both by allowing cities and towns to establish safe consumption sites.
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