Four people will die today from an opioid overdose in Massachusetts. Tomorrow, if the average from 2015 remains unchanged, another four souls — who may at this very moment be reading this article — will also lose their lives with the push of a plunger.
For the new year to look any different from the last, it has become clear that uncomfortable measures will need to be taken in order to end the overdose crisis. Gloucester Police Chief Leonard Campanello has shown a willingness to do just that by taking on Big Pharma and offering treatment instead of jail time, as has Governor Charlie Baker in his willingness to go up against the medical establishment to curb the overprescription of opioids.
The governor’s opioid bill, however, concentrates on prevention and treatment of drug addiction. Much more pragmatic tools are needed immediately. A good start would be a dramatic increase in spending for the harm-reduction approaches that are shown to work but can be politically polarizing: making the anti-overdose drug Narcan more widely available; improving access to substitution treatments such as methadone and buprenorphine; and bolstering needle exchange programs. In fact, the Legislature should go one step further and be the first in the nation to legalize safe injection sites.
Many overdoses happen because people are taking drugs alone, out of stigma or fear of law enforcement. Public health officials in eight other countries have addressed this by establishing nearly 100 facilities worldwide where users can shoot drugs under the watch of health care providers. Doctors or nurses are available to intervene in the event of medical emergency, but staff also distribute clean syringes and other supplies and direct addicts to drug treatment.
Right now Vancouver, British Columbia, operates the only supervised injection facility in North America. That program, called Insite, opened in 2003. More than 30 peer-reviewed studies have found that Insite saves lives every day, thousands of lives altogether. It also saves millions of dollars in both health care and public safety costs, reduces transmission of diseases such as HIV and hepatitis C, and promotes entry into treatment. There is no evidence it promotes drug use or drug-related crime.
The legal hurdles for Massachusetts to follow in Insite’s footsteps are daunting. Organizations that want to open a supervised injection site would risk federal prosecution and 20 years in prison under what are known as “crack house statutes,” which make it a crime to “knowingly open, lease, rent, use, or maintain any place . . . for the purpose of manufacturing, distributing, or using any controlled substances.” State lawmakers would have to craft a carve-out, similar to Good Samaritan laws already enacted for Narcan distribution, to shield safe injection site operators from scrutiny by local and state law enforcement — and hope the feds choose not to interfere, which seems possible, considering the precedent set by the Obama administration’s hands-off stance on state marijuana laws. Given the current public health emergency, legal experts suggest the timing for such a gamble has never been better.
Two obvious locations for the Commonwealth’s first safe injection site would be Cambridge’s Central Square or the intersection of Massachusetts Avenue and Albany Street in Boston. Both are, in different ways, ground zero of the opioid crisis, but the latter, sometimes referred to as “Methadone Mile,” is already home to the venerable Boston Health Care for the Homeless Program. One doctor there reports now often being unable to walk from the parking lot to the clinic’s front door without encountering someone in the early stages of overdose.
In November, Dr. Jessie Gaeta, the program’s chief medical officer, suggested that it may open a “safe space” where people could come when they’re high on heroin. No actual drug use would take place, Gaeta told WBUR, but the program would instead offer “a safe place to be that’s not a street corner.”
Mayor Marty Walsh reacted positively to the idea. “I’m up for trying anything when it comes to addiction and active using,” he said at the time. “If we can help some folks, homeless folks in particular, we should try anything.”
If we take the mayor at his word, empowering Gaeta and her colleagues to open a true supervised injection site would have exponentially greater impact.
Experience teaches that breaking past stigma and fear on public health matters has wide-reaching consequences. In the 1980s, clean-syringe programs were also seen as political nonstarters, but HIV contraction among drug users has fallen by more than 90 percent in the state since exchanges were introduced. In 2001, there were only two official Narcan-distribution programs nationwide. Last year, first responders administered 11,000 doses of Narcan to people overdosing in Massachusetts alone. A safe injection site is today’s equivalent to those initiatives, a life-saving public health service to all those in the Commonwealth who need it.