A bill proposed on Beacon Hill would expand statewide harm reduction services to include safe injection facilities (SIFs). The Act to Authorize Public Health Workers to Pursue New Measures to Reduce Harm and Stigma for People Affected by Substance Use Disorder is an amendment to an already existing law to provide “a space for people who use drugs to consume pre–obtained drugs under the supervision of healthcare professionals,” which opened the door for “trained staff [to] provide other related services including but not limited to needle exchange, overdose prevention, and referrals to treatment and other services.”
If the bill, sponsored by Senator William Brownsberger, is successful, Mass would be the first state in the country to open a safe consumption site. The SIFMA NOW Coalition—born last year and comprised of people in recovery plus doctors, lawyers, public health workers, medical students, addiction and recovery advocates, treatment providers, law enforcement representatives, community organizations, family members and concerned citizens—has publicly supported the proposal with the belief that opening a SIF in Mass will help prevent the loss of lives. In 2015, the Department of Public Health estimated that 1,574 people died from accidental opioid-related overdose.
“People are dying across the state,” Brownsberger told DigBoston. “We need to be open to whatever might be helpful to protect people from the worst consequences of their addictions.”
The Hub-based Boston Healthcare for the Homeless opened its Supportive Place for Observation and Treatment (SPOT) last May. It was seen as a compromise for folks who opposed SIFs: people cannot use drugs on-site, but they can enter the space while intoxicated and remain there for observation until they decide they are safe and lucid enough to leave on their own. Throughout their stay at SPOT, nurses monitor the vital signs of users and can transfer them to more intensive medical care if the person needs it. According to a post on the Health Affairs Blog written by BHCHP staff that run SPOT, in their first 15 weeks of operation they had 983 encounters with 218 unique individuals, and transferred people to emergency care less than 15 times.
There are currently eight countries that operate SIFs—Switzerland got its first site 30 years ago—and the endeavor has been successful in all of those places. According to SIFMA NOW, the safe consumption designations “have been proven to be an effective measure against the transmission of disease, specifically HIV and Hepatitis C, as well as to reduce fatal overdoses.” These sites have also led to an increase in the number of people seeking both drug treatment and medical care for other conditions, as well as decreased numbers of discarded syringes in public areas. Unlike some more controversial safety initiatives, there is significant support for SIFs in the medical community as well as with recovery-focused groups like the Drug Policy Alliance.”
North America currently has only one SIF, InSite, in Vancouver, British Columbia, Canada. InSite has high levels of community support, and staff there have overseen millions of injections and more than 2,000 overdoses since opening in 2003, with zero fatalities. In addition, InSite staff has made more than 20,000 client referrals to healthcare and other services, more than 50 percent of which have been to detox facilities. Similar results are expected in the states, with officials in Seattle as well as Ithaca, New York endorsing the idea of opening a SIF in their city.
All the data notwithstanding, SIFs will likely face some hurdles in Mass.
“I view it as a conversation starter and we’ll see how it goes,” Brownsberger said. This coming two years after the topic first gained traction among Commonwealth health officials. “I’m not sure if people are ready for it.”