Marc McGovern is tired of attending annual vigils where grieving community members read off the names of people killed by opioid overdoses. More than 50 people have perished that way in his home city of Cambridge in the past two years.
“How many more people need to die before we take action?” said McGovern, a city councilor and former mayor. “Every one of those people was a 10-year-old kid once, who dreamed of playing second base for the Red Sox or becoming a doctor or a lawyer.”
Frustrated by the opioid crisis, McGovern is among a growing number of public officials in Massachusetts embracing the creation of supervised consumption sites, which a multitude of studies have shown to save lives, reduce the spread of infectious diseases, and improve access to treatment.
The concept is straightforward: Allow people who are struggling with addiction to bring illicit drugs into special centers where they can use them under the watchful eye of trained professionals, who can step in and rescue anyone who overdoses.
In recent months, a coalition of 16 mayors from the Greater Boston area, the city councils of Somerville and Cambridge, and the top county prosecutor in northwest Massachusetts have endorsed the concept. Many of those officials, as well as a growing number of addiction treatment specialists and state lawmakers, have also spoken in favor of legislation that would create a 10-year pilot program in Massachusetts allowing cities and towns to operate the centers.
A similar version of the bill passed a key committee last year before failing to come to a House vote, but proponents say it has a greater chance of advancing this year. “It’s immoral and unconscionable that we’re leaving tools on the table to keep people alive,” said Representative Dylan Fernandes, a Falmouth Democrat and the bill’s sponsor.
The growing support is being driven by the prolonged surge in overdose deaths caused by increasingly potent street drugs such as fentanyl. In Massachusetts, fatal opioid overdoses last year reached their highest level on record, with 2,357 lives lost. The rate of deadly overdoses, measured as a percentage of the population, is now nearly one-third higher than the national average.
“The vast majority of the folks who die [from overdoses] in Massachusetts and around the nation have one thing in common: They die alone,” said Northwest District Attorney David Sullivan, whose office serves Hampshire and Franklin counties. “These [sites] would address that and save hundreds of lives.”
Yet significant legal and political obstacles remain. Critics argue that the sites can become magnets for drug dealers soliciting customers and encourage a relaxed attitude around the use of illegal drugs. Also, a 1986 federal law often referred to as the “crack house statute” makes it illegal to operate and maintain a site for the purpose of using illegal substances.
Advocates say the federal law does not apply to a facility with a public health purpose and the goal of saving lives. Still, the Donald Trump administration’s Justice Department went to court to prevent a similar site from opening in Philadelphia, and President Biden’s administration has not explicitly endorsed the strategy. Without legal clarity, some municipalities in Massachusetts have been reluctant to move forward, advocates say. The proposed legislation would shield supervised consumption providers and their staff from criminal and civil liability.
Meanwhile, some health researchers have questioned the sites’ effectiveness in getting large numbers of people to stop using drugs.
Studies of safe consumption sites in Canada and Europe have found that people will not travel far for the services. Therefore, to have a broad impact, there would have to be thousands of such centers across the country. Yet local opposition to the sites makes that unlikely: In the four decades since the first site opened, there are fewer than 200 of them worldwide and just two in the United States.
“It’s a very neighborhood-focused intervention,” Keith Humphreys, a professor of psychiatry and behavioral science at the Stanford School of Medicine, said at a legislative hearing last month. “They’re not going to move population indicators of overdoses in Massachusetts. You would need an enormous number of them and . . . that would be economically difficult, and it’s very hard to site them.”
Yet many public health officials and others working on the front lines of the opioid crisis see the strategy as essential to saving lives.
Safe consumption sites — also called overdose prevention centers or safe injection sites — provide a hygienic place for people to bring in drugs obtained elsewhere and inject or inhale them within view of staffers trained to use naloxone, the overdose reversal medication. Clients also have access to sterile needles, receive care for injection wounds, get tested for HIV or hepatitis C, and get linked to outside medical or addiction services.
OnPoint NYC, the operator of two supervised consumption sites in northern Manhattan, estimates that, as of two weeks ago, it has averted 1,131 drug overdoses since opening its program in November 2021. The centers have also safely discarded more than 2 million units of hazardous waste material, including syringes, cook trays, and other drug items, that otherwise would have ended up in parks and on city streets, the nonprofit said.
In April, 16 mayors from Greater Boston — including the mayors of Boston, Newton, Quincy, Revere, and Somerville — as well as city managers and other officials urged Governor Maura Healey to explore the use of overdose prevention centers. The centers “have demonstrated success in other countries and regions in protecting people who use drugs, reducing the amount of discarded biohazardous materials in the public way, preventing unsafe and open-air drug use, and decreasing opioid overdose deaths,” the Metropolitan Mayors Coalition wrote in a letter to Healey.
“There are cities all over the state that are interested in doing this, but no one wants to be first, and no one wants to be alone,” said McGovern of Cambridge, where the City Council recently voted in favor of hiring a consultant to start a community conversation about a supervised consumption site.
Yet Somerville is the only city in the state pressing forward with specific plans and funding for a safe consumption site. In June, the City Council approved $170,000 for the development of a site, on top of $827,000 previously appropriated. Somerville has not settled on a location or a precise design, though a report commissioned by the city recommended a large trailer stationed at a city-owned parking lot. The annual cost of operating the site would range from $1.4 million to $2.9 million, depending on staffing and hours of operation, the report said.
In January, Somerville Mayor Katjana Ballantyne and a group of city workers toured one of OnPoint’s sites in New York — an experience that reinforced her enthusiasm for the concept, she said. Among her discoveries, she said, is that area businesses supported the site because it kept drug users off the street and gave them a safe place to go during the day. There was also a dramatic reduction in the number of discarded needles at a park nearby where children played, she said.
“Because people in my community are dying,” said Ballantyne, when asked why she supported the concept. “At the end of the day, we know we can do something about it, that there’s evidence-based research. So why wouldn’t we?”