A slow, cautious slog toward opening a safe injection site

In April 2017, the Massachusetts Medical Society voted overwhelmingly to support a concept that it acknowledged was “counterintuitive”: opening a center where people can inject illegal drugs under medical supervision.

Doctors in the society, which had conducted a study of safe injection sites, reasoned that drug users who are now dying in public bathrooms and on public streets should have the chance to come inside — and survive.

Nearly three years later, no safe injection site has come close to opening in Massachusetts, or anywhere in the United States, despite the endorsement of public health experts.

But the gears are turning, if slowly.

In the Massachusetts Legislature, bills have been filed, meetings held, and studies conducted. Significantly, Mayor Joseph A. Curtatone of Somerville has pledged to establish a safe injection site in his city and has formed a working group to pursue the ambitious goal of opening it by the end of next year.

Last year, state lawmakers killed a bill to establish a safe injection site after Governor Charlie Baker and US Attorney Andrew E. Lelling strongly opposed it, with Lelling threatening “law enforcement” if such a facility opened.

Instead, legislators created a commission to study the issue. That commission recommended that Massachusetts test the idea in one or two pilots, and new legislation was filed. That bill is before the Joint Committee on Mental Health, Substance Use, and Recovery, sponsored by the committee’s cochairs. A hearing earlier this year drew no opposition, but the bill has not been brought to a vote.

Asked why the legislation had stalled, Representative Jeffrey N. Roy said he didn’t think it had.

“The committee chairs are taking a good hard look at it and trying to determine the best way to report something out,” said Roy, a Franklin Democrat who supports opening a safe injection site. “They’re really trying to put something together that makes sense.”

Senator Julian Cyr, the Cape Cod Democrat who serves as committee cochair, said he was optimistic that the committee would act on the bill. But he explained that it first needs to address some thorny issues. For example, clinicians who want to work at the site fear action against their licenses by federal authorities who consider such sites illegal.

But above all, the bill’s sponsors have to persuade colleagues to support an idea that, at first blush, might seem crazy.

“What we’ve been trying to do is move deliberatively to make sure we have buy-in and that our colleagues understand the issue,” Cyr said. “You’ve got to educate people. It takes a little time to get people’s attention and have them understand the issue.”

That pace is frustrating for Jim Stewart, the firebrand leader of SIFMA-Now (Safe Injection Facility Massachusetts), who wants Cyr and the cochair, Representative Marjorie C. Decker, to publicly promise to move the bill forward.

“They’ve made no specific commitment. Are we going to have a bill that comes out?” Stewart asked.

Seven SIFMA-Now members met with a top aide to House Speaker Robert A. DeLeo on Wednesday, but were unable to wrest a promise to move the legislation, according to Stewart.

The debate has come up in the race for US Senator Edward Markey’s seat. On Tuesday , US Representative Joseph P. Kennedy III announced his support for the state legislation and urged Lelling to let Massachusetts pilot a safe injection site without federal interference. Markey and the other candidates for his seat had already voiced their support for piloting a safe injection site.

Canada and other countries have long operated what are variously called “supervised injection facilities,” “supervised consumption sites,” and “overdose prevention sites.” They have documented reductions in overdose deaths and infections, and no increase in crime.

Such sites provide a clean, safe space where people can use illicit drugs they have obtained elsewhere. Nurses or other clinicians are on hand to revive anyone who overdoses, as well as to teach safe injection practices and refer people to treatment if they want it.

But no such site operates in the United States, although New York, Seattle, and other cities have talked about it.

Philadelphia is considered the furthest along: The city government supports safe consumption sites and a nonprofit named Safehouse has formed to run it. Safehouse won a huge victory when a federal court ruled in October that the site would not violate federal law.

Now, Safehouse is waiting for a final order from the judge, said Safehouse vice president Ronda B. Goldfein. Then it plans to move forward with multiple sites in parts of the city known to have high rates of overdose deaths, she said.

In Boston, Mayor Martin J. Walsh has said he supports safe injection sites and the proposed state legislation, but does not believe a site can open as long as federal authorities consider it illegal.

Boston City Councilor Annissa Essaibi George, chairwoman of the council’s Committee on Homelessness, Mental Health, and Recovery, said she opposes safe injection sites because they have not been shown to connect many participants with long-term recovery. But she said she is “open to learning” and plans a visit to Philadelphia this week to meet with Safehouse officials.

Meanwhile, Baker remains steadfast in his opposition, preferring to increase access to treatment and address the problem in other ways that are unambiguously legal.

Lelling, the US attorney, said he doesn’t agree with the Philadelphia judge, who does not have jurisdiction in Massachusetts. In a statement after the ruling, he said safe injection sites exist “for the purpose of making it easier to take heroin and fentanyl” and “attract high concentrations of drug users, followed by drug dealers, and so an increase in crime.”

But regardless, Somerville is plowing forward. Doug Kress, Somerville’s director of health and human services, said the city is not waiting for the Legislature to act. A working group of about 30 community members, first responders, and city officials has been examining the ins and outs of federal, state, and local ordinances and contemplating the best location for a site.

“We realize that there are multiple eyes that are watching us,” Kress said. “We want to make sure we do it right, that it’s done in a way that’s going to be successful.”

Kress said the group hopes to present its recommendations to the mayor and City Council by late spring, and then begin the process of obtaining zoning and planning approvals.

“The commitment is there, and we’re continuing to move this forward,” Kress said.

Felice J. Freyer can be reached at felice.freyer@globe.com. Follow her on Twitter @felicejfreyer.