Even as arguments rage over the idea of providing safe places for people to inject illegal drugs, a little-noticed effort is underway in Massachusetts to establish a different type of center with many of the same goals.
The state Department of Public Health is looking for organizations to set up “medical observation and monitoring services” for people who have overdosed on an illicit drug.
People will not be permitted to use street drugs inside, but they will be welcome to come in for help after using, making the centers a little like the controversial “safe consumption sites,” minus the consumption.
Staffed by nurses and other clinicians, the centers will monitor clients’ vital signs and will administer oxygen, intravenous fluids, and the overdose-reversing drug naloxone as needed. Clients, who can remain anonymous, will also receive counseling, treatment for infections and wounds, and connections to primary care and addiction treatment.
The effort is apparently unique in the nation, modeled after a first-of-its-kind service at the Boston Health Care for the Homeless Program. But while such centers may save lives, advocates say they are no substitute for safe consumption sites, because the monitoring centers won’t help people who die quickly on the street after injecting potent fentanyl.
The public health department is soliciting bids to establish three to five monitoring sites, each able to accommodate five to 10 people who have taken too much of a sedative, such as heroin or fentanyl, or a stimulant, such as cocaine or methamphetamine. The locations of the sites have not been determined.
The plans are part of a $5 million budget item passed without fanfare last year. The appropriation puts the health department in charge of a comprehensive statewide strategy to promote “harm reduction” — services that reduce the bad consequences of drug use.
As part of the strategy, the state is also planning to expand its needle exchange program; provide naloxone to emergency departments to give to overdose survivors for future use; and test drugs for the presence of fentanyl and other contaminants, said Deirdre Calvert, director of the health department’s Bureau of Substance Addiction Services.
The “medical observation and monitoring services” plan was inspired by the Supportive Place for Observation and Treatment, or SPOT, at the Boston Health Care for the Homeless Program, according to the state’s request for proposals.
Since 2016, the SPOT program has provided a room where people intoxicated with heroin or other substances can get medical attention. Typically these are people who have injected heroin and then “layered on” other sedating drugs taken by mouth, causing their heart rate and blood pressure to plummet. Sometimes they are carried in by friends.
The room has eight recliners for people to rest in while their vital signs are continuously monitored and treatment offered as needed. SPOT recently added a couch to accommodate two additional people, but still often doesn’t have room for everyone needing help.
A study examining three months before and after SPOT’s opening found no harms to the neighborhood and a reduction in the number of oversedated people seen on the streets.
In its first three years, SPOT saw about 850 unique individuals, said Dr. Jessie M. Gaeta, chief medical officer at the Boston homeless health program. Most came multiple times, for a total of 11,000 encounters. About one in 10 received oxygen to counteract an opioid overdose; fewer than 1 percent were administered naloxone.
Nearly a quarter of participants went from SPOT directly into addiction treatment, a rate Gaeta considers “miraculous” for a such a high-risk population. That move into treatment, though, occurs only after numerous visits to SPOT, where clients gradually develop trust in the welcoming and nonjudgmental staff.
But Gaeta, who has written passionately about the need for safe consumption sites, says the monitoring centers cannot play the same role. Fentanyl overdoses happen within minutes. Often victims are found with the needle still in their arm.
“I know SPOT has saved lives but it’s not really a substitute for supervised consumption sites, because of fentanyl,” Gaeta said.
Daniel Raymond, the deputy director of policy and planning at the Harm Reduction Coalition, a New York-based advocacy group, agrees. Raymond said a SPOT-like program would be “less of a substitute than a steppingstone” to safe consumption sites. Programs monitoring people after use cannot address the hazards they face injecting in dirty places, isolated from others, Raymond said.
He called the SPOT concept “fairly novel” and said he could not think of anyone who had tried to replicate it. Some syringe exchange programs have drop-in centers where they’ll informally keep an eye on people who have taken drugs, but they don’t offer medical care like SPOT does or as the state’s planned new program contemplates.
The state will award up to five $150,000 planning grants in 2020 to organizations that will establish the new monitoring centers, and provide $500,000 a year after that to each one. The new facilities could be located in an existing health care facility or needle exchange, or they could be stand-alone facilities. The state is requiring applicants to engage with the local community in developing their plans.
Health officials expect to select the providers by the end of January, with priority given to those who can get started within three months.
Also as part of its harm reduction strategy, the health department awarded $150,000 to PAARI — the Police Assisted Addiction and Recovery Initiative, a Massachusetts-based nonprofit that helps law enforcement agencies find ways to cope with addiction in their communities other than arresting people.
PAARI is in the early stages of developing a program to test the components of street drugs. The testing would help drug users know what they’re taking and enable public health officials to monitor what’s happening in the drug supply.
Many police departments visit the homes of people who survive overdoses to offer information about treatment and often provide naloxone. Under this program, some will also provide test strips that detect the presence of fentanyl.
Additionally, PAARI will partner with Traci Green, the incoming director of the new Opioid Policy Research Collaborative at Brandeis University, to work with police departments on deploying more sophisticated testing technology.
Green’s team will use newly purchased infrared spectrometer devices to test the content of drugs picked up and destined for destruction. The information can be used to alert the public about new or more potent contaminants.
“Right now, people have to suffer, they have to overdose or to die to really see into this,” Green said. With the testing program, she said, “we can be more proactive by looking into stuff we already have.”
Correction: An earlier version of this story misstated who would be responsible for the testing of drugs picked up by police. The drugs will be tested by the Brandeis team.
Felice J. Freyer can be reached at firstname.lastname@example.org.