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Massachusetts Medical Society recommends medically supervised drug use clinics

Shaun watched as his friend Chris shot heroin behind a house in Boston in May 2016.

Keith Bedford/Globe Staff/File

Shaun watched as his friend Chris shot heroin behind a house in Boston in May 2016.

Massachusetts, devastated by thousands of opioid-related deaths in recent years, should take the unusual step of opening clinics where drug users could inject under medical supervision, according to the Massachusetts Medical Society.

The society’s governing body voted overwhelmingly Saturday to adopt a resolution urging Massachusetts to set up a pilot program that would allow up to two such clinics in the state.

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“It’s counterintuitive that you would let people do something that is illegal and dangerous in a setting that is safer,” said Dr. Barbara Herbert, president of the Massachusetts Chapter of the American Society of Addiction Medicine. “But in fact, there’s good scientific and epidemiologic evidence that it saves lives, and we’re in such a terrible epidemic that anything that saves lives, we want to embrace.”

Such clinics, which are illegal under state and federal law, would inevitably face opposition from members of the public and law enforcement concerned that the facilities would encourage illegal drug use.

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“The harm is that people wouldn’t be looking to stop using drugs,” said William G. Brooks III, chief of police in Norwood and past president of the Massachusetts Chiefs of Police Association. “They think, ‘Well, it’s OK, it’s safe, there’s medical people overseeing it.’ ”

The society, which represents 25,000 doctors and medical students, says there is strong evidence that medically supervised injection facilities in Canada and Australia have led to fewer cases of overdose deaths and communicable diseases such as HIV.

Dr. Dennis M. Dimitri, who chairs the society’s opioid task force, said injection clinics also decrease drug use and drug paraphernalia in parks and on streets. And there is no evidence, he said, that the clinics lead to an increase in drug addiction.

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“In an ideal world, you would like no one to be injecting illicit substances illegally,” said Dimitri, a past president of the society.

“But since we know these kinds of activities are going on, we can reduce the harm of those behaviors.”

Nearly 2,000 people are believed to have died from opioid overdoses last year in Massachusetts, according to state officials, a record tally that defied widespread education campaigns designed to stanch the crisis as well as efforts to increase the availability of naloxone, the overdose-reversing drug commonly known by the trademark name Narcan.

Michael O’Keefe, district attorney for the Cape and Islands, said injection clinics deserve closer study, given the heavy death toll.

“I certainly would want to look at this carefully and not condemn it as something that’s enabling drug use,” he said. “We have to do more in this area, to be sure.”

At supervised injection sites — which opened in Switzerland in 1988 and in Canada in 2003 — doctors do not inject drugs, but oversee the process to ensure it is done as safely as possible.

In the event of an overdose, they administer naloxone. They also encourage drug users to enter treatment and prevent them from sharing needles, which can lead to the spread of HIV, hepatitis B and C, and other blood-borne infections.

“We would simultaneously keep you alive long enough to get you into treatment — that’s the dream,” Herbert said.

In Vancouver, Canada, researchers found a 35 percent drop in the number of lethal overdoses after an injection clinic opened in that area, according to a report by the Massachusetts Medical Society. In Sydney, ambulance calls related to overdoses dropped by 68 percent in the area where a clinic opened, according to the report.

Dr. Richard Pieters, a radiation oncologist and past president of the society, spoke against the resolution before it was approved by a vote of 193 to 21.

“My principal point was that we have two legal options, which have not been adequately promoted and funded, which need to be promoted: needle exchanges and mass distribution of naloxone, preferably by peer-delivery system,” he said. “These two systems have the power to prevent disease, save lives, and bring people into treatment.”

Michelle Hillman, a spokeswoman for the state Executive Office of Health and Human Services, released a statement that touted the Baker administration’s commitment to fighting opioids, but did not directly address where the administration stands on injection clinics.

“The administration’s evidence-based efforts to build a strong foundation of prevention, intervention, treatment and recovery will continue and expand to fight this epidemic,” the statement said. “Safe injection sites are not legal in the United States.”

Herbert said the next step is to persuade the Legislature and the Baker administration to back a pilot program and protect doctors from professional liability if they work at the clinics. The Trump administration would also have to sign off on the clinics, the society said.

“This is only step one,” Herbert said. “But it’s a huge step to say this could be a viable option.”

Michael Levenson can be reached at michael.levenson@globe.com. Follow him on Twitter @mlevenson.
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