I drove to a nearby gas station for my annual vehicle inspection and while there used the bathroom. On the wall was a poster that read: “You might be high. You might be afraid. If you see an overdose, call 911.” The station’s owner knew that people inject drugs in the bathroom and wanted them to call 911 in an overdose situation. They were trying to save lives. Serendipitous, for that afternoon I was driving to Montreal to visit supervised consumption sites.
With overdose numbers at record highs in Massachusetts, there is growing interest in allowing supervised consumption sites, also known as safe injection sites or overdose prevention centers. Research shows nobody has died from an overdose at these sites, that they help limit the spread of sexually transmitted and blood-borne infections, and that they save money by reducing associated health care and emergency response costs, and serve as paths to treatment. However, the concern is always, “They’ll ruin whatever neighborhoods they’re in.” To find out if they do, I went to neighborhoods where sites are already located to see for myself.
In Montreal, Vancouver, Toronto, Quebec City, and New York, and in Philadelphia where sites are proposed, I spent hours walking the neighborhood streets and alleyways, sitting at bus stops, talking with people, and lingering in parks and doorways.
In Montreal, at dusk on a Saturday night, I sat on a bench across from a storefront site. Clients of all ages arrived by foot, car, and bike, mostly indistinguishable from the patrons standing in line at a restaurant just down the block. A few waiting restaurant patrons walked by, some with children, seemingly unaware of what was behind the door to the site. Those who stopped and read the information displayed in the window casually meandered back to the restaurant line.
A site in downtown Montreal was different. On a side street, it was marked by a nondescript door. People quietly came and went until after midnight. The neighborhood featured a busy commercial road at the end of the street and newer, higher-end housing throughout.
In contrast, the Downtown Eastside neighborhood of Vancouver can only be described as jarring. Hundreds of people were wandering the streets and alleys, with many encamped at the time in a nearby park. Old and worn apartment buildings, rooming houses, and hotels fill the area. There are several nondescript supervised consumption sites in the neighborhood, practically invisible among the busy street life.
In New York, I went to scope out the East Harlem site the day before I was to formally visit, but on my first pass, even with the address, I couldn’t find it. A pastor at a local church told me the site was helping those in need with minimal — if any — negative neighborhood impacts.
In Toronto, people loitering outside a community health center hinted that a site was located inside, but it wasn’t entirely obvious within the context of the whole neighborhood. A staff member said they were looking at alternatives to sharing the health center entrance. A police officer working a detail for a movie filming next door was not sure how he felt about such sites but felt location was key in terms of access and limiting neighborhood impacts. In Quebec City, the new site looked like nothing other than a storefront.
Indistinguishable. Nondescript. Practically invisible. Supervised consumption sites blend with their neighborhoods.
How they look from the street contrasts with how they look inside. In Canada, the rooms appear clinical, almost sterile; in New York, a little less so. All have cubicles with a chair, clean counter, mirror, disinfecting wipes, and a disposal container. Some have rooms for people who inhale drugs, and all have rooms in which clients can relax. They offer clean needles, pipes, and other supplies. Each is staffed with qualified and caring staff, paid and volunteer, ready to respond to an overdose with oxygen or naloxone, a medication used to reverse an opioid overdose.
From what I observed, they treat clients with dignity and respect and develop easy rapports with them, determined by the comfort level of each client. Friendships form, making it easier for clients to access health care and to ask for treatment, something I witnessed in East Harlem.
Viewing the sites and what they do must be put in context. I had heard that some who visited the Vancouver sites on official trips, for instance, were shocked by the neighborhood, concluding that the supervised consumption sites attracted drug users and dealers and were responsible for the jarring conditions.
A police officer with whom I walked the neighborhood after spending a full day there myself said it looked this way long before the sites opened. For years, the officer explained, it was a place where people with untreated mental health conditions ended up after losing jobs and housing. He said he believes untreated mental illness is at the root of the neighborhood’s problems and that while supervised consumption sites are not the full answer, they do save lives.
By walking the streets and visiting the sites, I also learned how these facilities can lessen the strain that drug use puts on local first responders and hospitals. Just off Kensington Street in Philadelphia, within moments of arriving to view an area proposed for a site, I saw fire apparatus and police cars pulling out of a side street. Two firefighters remained to try and help a woman, while the man with her said, “You OD’d girl. You’re purple.”
In contrast, at a Vancouver site a couple of weeks before I visited, 14 overdoses occurred in a single day at one injection site due to a bad batch of drugs in the neighborhood. Nobody died. Some of those 14 people might have died on the streets if not for the site. There might have been several 911 calls, several police, fire, and ambulance responses, and several transports and emergency room stays. Instead, having trained personnel on hand meant each case could be handled swiftly and appropriately, while simultaneously sparing health care and emergency response resources.
Massachusetts has successful needle exchange programs. At a Montreal site, the director referenced how it originally had been a safe materials site, i.e., a needle exchange program. They knew when they provided a client with clean needles and supplies that the client was walking out the door and to a nearby alley or park to inject. Or, as I thought, to the bathroom of a gas station. Instead, she said, why not let them walk through the door into a supervised setting, eliminating the risks of overdose, needle litter, and infection.
The number of overdose deaths in Massachusetts suggests that, however well-intentioned, signs in gas station bathrooms are not enough. Supervised consumption sites can help bring drug use out of bathrooms, alleyways, and parks, and into safe places.
What I saw and learned in Montreal, Vancouver, Toronto, Quebec City, Philadelphia, and New York leads me to believe that Massachusetts should allow any community that chooses to host a supervised consumption site to do so as a pilot program, using the experience and data to better inform Massachusetts policy makers and residents of the role such facilities can play in efforts to combat the drug epidemic. They can save money, and they will save lives.
Senator John F. Keenan represents Norfolk and Plymouth counties in the Massachusetts Legislature.