Pubdate: Sun, 27 Dec 2015
Source: Boston Globe (MA)
Copyright: 2015 Globe Newspaper Company
Contact: http://services.bostonglobe.com/news/opeds/letter.aspx?id=6340
Website: http://bostonglobe.com/
Details: http://www.mapinc.org/media/52

MASSACHUSETTS NEEDS SAFE INJECTION SITES

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.

Fatal opioid overdoses are preventable. In 2016, that should be the 
goal for Massachusetts' political leadership. Anything else 
needlessly risks lives.
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MAP posted-by: Jay Bergstrom