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Opinion | Cindy F. Friedman and Jeffrey N. Roy

Safe injection sites are another tool on the path to recovery

A visitor to the Harvard School of Public Health's mock safe injection site checks out the items on the demonstration table set up underneath a tent on the quad near the medical school in Boston. Jessica Rinaldi/Globe Staff/Globe Staff

When we were first introduced to the idea of safe injection facilities, we were not immediately on board. In fact, we felt uneasy about it, but vowed to keep an open mind.

After serving on the state’s harm-reduction commission, listening to testimony, studying the effectiveness of safe injection facilities in other countries, visiting clinics in the Boston area, and learning from experts, our perspective changed. The idea of such sites is uncomfortable to many, but it’s not about our comfort level. It’s about keeping people alive long enough to get them into treatment.

People are dying at an alarming rate. The state passed landmark legislation to address this opioid crisis through increased education and prevention efforts, cracking down on the over-prescription of opioids, improving access to medication-assisted treatment and counseling, and expanding access to the lifesaving drug Narcan. Despite these efforts, an average of five people per day die of overdoses in Massachusetts.

We must consider all evidence-based and evidence-informed interventions that have a proven track record of saving lives and directing people toward treatment. The data supporting safe injection facilities as an effective tool to combat the opioid crisis could not be clearer.

Study after study analyzing more than 90 facilities in Europe and Canada found that safe injection facilities not only save lives, but they also provide additional public health benefits through services that include clean-syringe exchange programs, drug checking, blood-borne virus testing, injection-site wound care, initiation of Medication-Assisted Treatment for substance-use disorder, and referrals for health and social services. Furthermore, there is no evidence to suggest that more people use drugs because of access to these facilities.

At the first supervised site in North America, which opened in Vancouver in 2003, there was a 35 percent reduction in overdose deaths in the immediate vicinity, compared with a 9 percent reduction in the rest of the city. Despite millions of injections that have occurred at more than 90 facilities internationally over the past three decades, not a single on-site overdose death has been recorded.


On June 12, 2017, the American Medical Association, in considering promising strategies to reduce the health and societal problems created by the opioid crisis, publicly voted to “support the development of pilot facilities where people who use intravenous drugs can inject self-provided drugs under medical supervision.”

Researchers from the Massachusetts Medical Society assisted with an AMA study and issued an April 2017 report recommending that the state pursue a pilot program for safe injection facilities, create an advisory board to design an evaluation protocol for the pilot, and build on programs with expertise in providing high-quality harm-reduction services to populations that would be served by the facilities. They also urged us to consider harm-reduction strategies as a component of the pilot beyond the facilities, to ensure that comprehensive health care is available to marginalized individuals who inject drugs and need treatment.


In this instance, like many others, we agree with the medical experts. Harm-reduction strategies, including safe injection facilities, are about keeping people alive and as healthy as possible until they can arrive at a place in their life where treatment works for them.

We are not suggesting that the facilities open on every street corner across the Commonwealth. Rather, we are urging the state to implement pilot programs in willing communities to determine for ourselves if the facilities could truly have an impact on reducing opioid-related overdose deaths and allow more people to get the treatment they need and deserve.

We need to be creative and offer a panoply of options to give people more opportunities to receive treatment and recover from a horrific disease that continues to plague our communities, destroy countless lives, and tear families apart. Otherwise, we are essentially sentencing people to death.

State Senator Cindy F. Friedman represents the Fourth Middlesex District. State Representative Jeffrey N. Roy represents the 10th Norfolk District.