In August, Somerville Mayor Joe Curtatone announced his plan to open a supervised consumption space for drug users within the next year, even though such a space would violate state and federal laws, according to the Somerville Journal. He is the first mayor in the state to commit to opening such a site, though other politicians like state Rep. Christine Barber and U.S. Rep. Ayanna Pressley have voiced support.
A supervised consumption drug site—often called a safe injection site when referring specifically to opiods—is a facility staffed with medical professionals where people struggling with addiction can use drugs. There are two primary goals of a supervised site: to reduce infections and the risk of death by overdose, and to teach people strategies for recovery. Supervised consumption sites do not provide users with drugs.
These facilities follow a harm-reduction model, “which means they strive to decrease the adverse health, social, and economic consequences of drug use without requiring abstinence from drug use,” says Tiffany Atkins of Vancouver Coastal Health, which has run such a site for 16 years.
“Harm reduction is a philosophy with a primary goal of any positive change. Any way to reduce harm to an individual or community, even in the smallest ways, is something that should be celebrated,” Aubri Esters, commissioner of the Massachusetts Harm Reduction Commission, tells the Journal.
Currently, 12 countries worldwide use supervised consumption sites. Vancouver Coastal Health opened the first North American location, called Insite, in 2003. According to Insite’s user statistics, the staff have intervened in over 6,400 overdoses and there have been zero deaths at the site. In addition to stepping in during emergencies, clients at Insite can also be treated for wound infections and tuberculosis, and be vaccinated against pneumonia and the flu. Insite employees also connect clients with mental health professionals and addiction counselors.
“Once clients become more engaged with the health care system, and develop relationships and build trust with health care staff, people are more likely to pursue detox, addiction counseling, and addiction treatment services,” Atkins says.
Atkins also argues that supervised consumption services “can bring stability to the community by improving public order and reducing the number of injections taking place on the street.” In Vancouver, the police department supports Insite. There have been fewer discarded needles found in the streets and petty crimes have not increased in the neighborhood since Insite was founded, she says.
Opponents of supervised consumption sites, like Massachusetts U.S. Attorney Andrew Lelling, claim the harm-reduction model is not preventative enough and actually encourages drug use.
“If you’re a drug dealer looking for customers, an injection site is where you’ll find them. If your neighborhood hosts an injection site, drug addicts will go to your neighborhood,” Lelling writes in an opinion piece for the Boston Globe in January.
If a supervised consumption site were to open in Massachusetts, Lelling would take legal action to close it down, he says in an interview with WBUR.
“Heroin and fentanyl are not pot brownies,” Lelling writes. “Promoters of supervised injection sites need to understand that, short of legislative reform, any effort to open an injection site in Massachusetts will be met with federal enforcement.”
U.S. Attorney William M. McSwain took a similar stance toward Safehouse in Philadelphia, which would be the nation’s first supervised consumption site if allowed to operate. McSwain sued the operation before it planned to open its doors back in February, and the case reached federal court in August. The case is still being considered, and U.S. v. Safehouse is expected to set a legal precedent for supervised consumption sites across the country, according to the Philadelphia Inquirer.
There have been recent efforts to open up supervised consumption sites in San Francisco, New York City, and Seattle, but the plans were shot down in the cities before they could come to fruition because of similar legal concerns.
An informal working group in Somerville is currently meeting to further research the legality of supervised consumption sites by reaching out to advocates in Philadelphia and looking into the success of Canadian models, the Journal reported.
Democratic presidential candidates Sens. Bernie Sanders and Elizabeth Warren have both endorsed supervised consumption sites in their criminal justice reform plans.
“I’ll support evidence-based safe injection sites and needle exchanges, and expand the availability of buprenorphine to prevent overdoses,” Warren wrote in a post on the website Medium.
Legislators expressed support for a site in Sanders’s home state of Vermont in 2018, but a report released as part of Gov. Phil Scott’s Opioid Coordination Council questioned the legality of the project and ultimately prevented its opening, according to the Vermont Digger, a local news site.
“Safe injection facilities are presently not a viable option for Vermont,” the report said. “They are illegal under federal law and highly controversial. Cost-effectiveness and neighborhood impacts are unknown. Most importantly, they have an unproven track record of harm reduction and for providing a pathway to treatment.”
The report also noted that syringe service programs—which provide sterile needles and dispose of used needles in order to prevent HIV and other bloodborne infections—can achieve similar results to safe injection sites. There are also no legal roadblocks to syringe service programs, and they are already present across the United States—including in Boston, one of the first cities to adopt the program.
While the future of supervised consumption sites in Massachusetts is unclear, the support in the greater Boston area is evident. Boston Mayor Marty Walsh and Cambridge Mayor Marc McGovern toured facilities in Canada, and McGovern told Boston.com that they are “absolutely” worth looking into, even though “there’s a long way to go” before one can be opened in Cambridge.
“Not only the legal hurdles that have to be figured out, but then even if Cambridge were to open one of these sites … there’s a community process that has to happen, there’s an education process that has to happen. There’s a lot of steps. So nothing’s happening tomorrow,” he says in an interview on the website.
Curtatone told the Journal that he understands the legal issues regarding the site, but that he is devoted to facing the opioid crisis in the city head-on.
“My role, my greatest responsibility as a public official, is to continue to advance and improve the health of the public,” Curtatone says. “I have an opportunity, with a simple and practical policy decision, to have an impact. This epidemic has no signs of slowing. We need to rethink our approach.”