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The first step to treatment is staying alive

Used needles littered the ground at an open air drug market along train tracks in Philadelphia’s Kensington section.Michael Bryant/The Philadelphia Inquirer/AP

DRUG TREATMENT can’t help dead people.

That’s why San Francisco is scheduled to open two safe injection sites later this year, where drug users will be allowed to shoot up under medical supervision. If an addict overdoses, trained staff will be available to revive them with an overdose antidote like naloxone, commonly known as Narcan. Staffers can also recommend treatment options to those interested.

In an effort to stem fatal overdoses, safe injection sites are now under discussion in such cities as Philadelphia, Seattle, and Ithaca, N.Y.

There are no similar discussions in Boston, however, or anywhere else in Massachusetts, where Governor Baker, Boston Mayor Marty Walsh, and Mayor Domenic Sarno of Springfield have all expressed either doubt or outright opposition.


Despite Governor Charlie Baker’s commitment to fighting the opioid crisis, he remains unconvinced that this state would be well served by safe injection sites which, he says, are not “a path to treatment.” During a State House hearing last month on the epidemic, he also said he was “kind of a hard sell” on the idea that such sites could curb fatal overdoses.

Since becoming governor, Baker has stressed the need for treatment for addicts. During his State of the Commonwealth address, he touted the addition of 1,110 treatment beds, a 60 percent increase in state spending on addiction services, improvements to the prescription monitoring program, and greater access to Narcan. He also touted a 10 percent drop in opioid deaths during the first nine months of 2017, compared to the same period in the previous year.

Yet according to Boston EMS, overdose deaths rose 54 percent in Boston. That’s largely due to the prevalence of fentanyl, a synthetic drug about fifty times more powerful than heroin.

Statistics from other cities with safe injection sites hint that such locations can save lives. In Sydney, Australia, about 5,900 people have overdosed in medically monitored sites since 2001 — and none have died. Safe injection sites are a measure this page has urged before in Massachusetts, and continues to endorse.


Without question, there are already illegal safe injection sites operating behind the backs of law enforcement nationwide. But formally recognized and publicized sites would reach more people, and creative jurisdictions are eyeing ways to overcome legal obstacles. In San Francisco, public health officials say its sites will be privately funded, allowing the city to avoid any liability. According to the Justice Department, it’s against the law to “manage and maintain sites on which such drugs are used and distributed.” But safe injections sites do not distribute illegal drugs.

Baker has already shown his willingness to push provocative ideas, such as a controversial 72-hour involuntary hold for drug users posing a danger to themselves or others. A bill with that emergency treatment provision, one the ACLU called “medically dangerous,” was already rejected by lawmakers in 2016.

This extraordinary epidemic demands an extraordinary response, and safe injection sites are a measure both Baker and the Legislature should embrace. A bill sponsored by state Senator William Brownsberger that would let state officials permit injection sites deserves support.

The greatest struggle with drug addicts isn’t getting them into treatment. It’s keeping them alive long enough to get them help. Being alive, after all, is itself a path to treatment. Despite the governor’s objections, safe injection sites belong in the state’s toolbox amid a raging opioid crisis that still claims far too many lives.