People who use drugs can find a lot of helpful services at Fenway Health’s needle exchange program, known as Access — medical care for hepatitis C and other infections, links to addiction treatments, and clean syringes and other sterile supplies to prevent the spread of disease.
But when they want to take illicit substances, clients must leave the Cambridge facility. They head to the streets and public restrooms, often with drugs that are contaminated with deadly fentanyl. And often they die of overdoses as a result.
“We’ve lost seven clients in the past month,” said Carl Sciortino, executive vice president of external relations for Fenway Health, which provides care for vulnerable populations. “This has been going on for years now. We’re all fed up and impatient waiting for the political wheels to turn.”
What Sciortino and others are waiting for, and working toward, is the long-discussed establishment of centers where people can bring in drugs they’ve obtained elsewhere and use them under the watchful eyes of trained staff who can rescue anyone who overdoses.
Shifting political winds here and around the country have bolstered advocates’ optimism, even as last week’s stunning news of a surge in opioid-related overdose deaths in Massachusetts intensifies their sense of urgency.
“There’s been a lot of change regionally, locally, that I think is building momentum for it,” said state Representative Dylan A. Fernandes, sponsor of a bill that would establish a 10-year pilot program involving two or more such centers, often called safe consumption sites. “There’s no question that we need to take action on this. And the data is clear that safe consumption sites save lives and get people into treatment.”
Fernandes’s bill won committee approval earlier this month and now heads to another committee.
Meanwhile, Rhode Island has already enacted a law authorizing such sites, the first state to do so. And while officials in Somerville had pledged to open the country’s first safe consumption site, New York City beat them to it, opening two sites in November.
OnPoint NYC, the agency that runs those sites, reported on May 31 that during its first six months, the agency had averted 314 overdoses and safely discarded nearly 500,000 syringes that otherwise might have ended up in public parks.
Safe consumption sites — also called supervised injection sites, overdose prevention centers, and harm reduction centers — provide a hygienic place for people to bring in drugs obtained elsewhere and inject or inhale them within view of trained professionals ready to intervene in an overdose. Clients also have access to clean injecting equipment and employees who can steer them to health care, including addiction treatment.
Sciortino, who visited one of the New York sites, described it as a four-story building offering an array of social and medical services; the room where people use drugs is the smallest component, he said.
There are almost 200 overdose prevention centers around the world, according to the Drug Policy Alliance. But these centers have been considered illegal in the United States. The federal “crack house statute” makes it a felony to “knowingly open, lease, rent, use, or maintain any place, whether permanently or temporarily, for the purpose of manufacturing, distributing, or using any controlled substance.”
Advocates say the law does not apply to a facility with a public health purpose and the goal of saving lives. Still, the Trump administration’s Justice Department went to court to prevent a similar site from opening in Philadelphia.
In Massachusetts, the former Trump-appointed US Attorney Andrew Lelling said he would deploy “law enforcement” if any such site opened in this state.
But the Biden administration has made no moves to shut down the New York facilities. And President Biden’s choice for US attorney in Massachusetts, Rachael Rollins, publicly supported safe injection sites in her previous role as Suffolk County district attorney. She hasn’t commented on the issue since becoming US attorney in January, however, and her office did not respond to a query from the Globe last week.
The political tides are turning in state government too. Governor Charlie Baker, who has long opposed the sites, is leaving office. The leading candidate to replace him, Attorney General Maura Healey, has voiced support for safe consumption sites.
Fernandes, who represents Falmouth, Martha’s Vineyard, and Nantucket, said the opioid crisis has deeply affected his community. In a three-year period, a dozen youngsters at a single Falmouth elementary school lost a parent to overdoses, he said. ”It is immoral that we are leaving tools on the table that we know could save lives,” he said.
He hopes his bill will pass before the current legislative session ends on July 31, but if not, Fernandes said, he’ll file it again.
Rhode Island’s first-in-the-nation law authorizes safe consumption sites as part of a two-year pilot program.
The state’s Department of Health has written regulations and put out a request for proposals. So far, no one has responded, but Project Weber/RENEW, which provides a needle exchange and other services, is interested in developing a site in partnership with Victa, a treatment program.
Annajane Yolken, director of programs, said Project Weber/RENEW is scouting locations in Providence, where Mayor Jorge Elorza has been a vocal supporter.
Meanwhile, Somerville is moving ahead — and winning what appears to be widespread support among its citizens; the city’s new mayor, Katjana Ballantyne, has enthusiastically picked up the ball from her predecessor.
Somerville has already started investing in the project: The city spent $12,000 for a feasibility study by the Brown University School of Public Health and $40,000 for further study by Fenway Health, which has been engaging with residents and businesses, assessing locations, and proposing a framework for the program.
The city also kicked in $500,000 to enhance an existing fund that will pay for the site’s operation.
“We know the crisis is getting worse,” said Nikki Spencer, the mayor’s chief of staff. “The vast majority of feedback we’ve had so far has been supportive and positive.”
Some 200 people registered for an online community forum on June 1. In a survey before the forum got underway, 60 percent said they were already supportive of the idea, 18 percent were curious, and 11 percent opposed, Sciortino said.
The biggest fear that residents have expressed is that the site will become a magnet for drug users or dealers, drawing troublemakers into the community, Sciortino said.
But people already living in the community need the service, Sciortino said, mentioning three recent overdoses in Davis Square. Safe consumption sites in Canada and New York have found that their clients come from nearby and that people don’t tend to travel for such services. Studies have found no increase in crime around these sites.
The Fenway team is studying possible locations on city-owned property in Davis Square and East Somerville, where clusters of overdoses have occurred. They’re considering a range of options, from repurposing a building to parking a trailer in a lot, Sciortino said.
He envisions a phased-in approach, with the program expanding as more people take advantage of it.
“We have to start somewhere. We have to start saving lives. We have to prove the concept,” he said. Years ago, the first syringe exchanges — intended to prevent the spread of AIDS — had operated illegally. Today there are dozens across the state, accepted as vital, life-saving services.
A safe consumption site, Sciortino said, “is the next step.”