Monday, May 20, 2024

A May 25 vigil on Central Square’s Carl Barron Plaza raises awareness of an addiction crisis and opioid-related deaths. (Photo: Nicholas Miller)

Next to a pile of yellow flowers and a sign that read “We Love & Support People Who Use Drugs,” Gary Martin, a self-proclaimed heroin addict, grasped a microphone.

He was speaking at a May 25 vigil in Central Square’s Carl Barron Plaza hosted by Access: Drug User Health Program to commemorate the lives lost recently to the opioid epidemic.

After a pause, he began, “We lost a lot of good people this week.”

According to one of the vigil’s organizers, Brian Sink, Access, which is on Green Street in Cambridge but provides services for people struggling with addiction across Greater Boston, had lost between eight to 10 clients just in the previous two weeks – people Martin referred to as dear friends and “fixtures in the community.”

Sink attributed the spike to an especially dangerous batch of drugs laced with high concentrations of fentanyl – a synthetic opioid 50 to 100 times stronger than morphine – and possibly tranquilizers against which Narcan, the drug used to reverse an opioid overdose, is ineffective.

Not far from the site of the vigil on Carl Barron Plaza is a “sharps” box for disposal of opioid syringes. (Photo: Marc Levy)

In line with statewide trends, the opioid crisis in Cambridge has shown few signs of retreat even amid greater efforts to make Narcan available and accessible, provide treatment to people experiencing addiction, and reverse the stigma associated with substance use.

In 2021, there were 19 opioid-related deaths among Cambridge residents, an increase from the 11 to 14 every year from 2017 to 2020, according to state Department of Public Health data released Wednesday. Thirty-seven people, regardless of their residency, died in opioid-related incidents last year while in Cambridge, nearly tripling the 13 in 2020.

Opioid overdoses in general have increased. So far in 2022, the city has averaged 3.6 opioid overdose incidents weekly, an improvement from last year’s 4.6 but still a significant increase from the 2.5 weekly average in 2019. The Cambridge Department of Public Health data was based on cases reported to emergency responders.

Progress since 2019

An opioid working group appointed by the city manager published an extensive report in 2019 about the crisis and recommendations for combating it. The report called for the creation of a Cambridge Substance Use Advisory Committee to lead and coordinate a response, and it began meeting in October 2019, said Suzy Feinberg, public information officer for the Cambridge Department of Public Health.

The committee’s first initiative was to install in city buildings 37 “Naloxoboxes” with Narcan and overdose response instructions, and to train more than 300 city employees in how to use Narcan, Feinberg wrote in an email.

City councillor Marc McGovern, flanked by former Cambridge police and health officials, marks the installation of publicly accessible first aid kits in 28 city buildings in November 2019. (Photo: City of Cambridge)

Other progress has been made in enforcement, where the Cambridge Police Department has prioritized providing resources to drug users instead of increasing arrests, said Jeremy Warnick, the department’s director of communications. The department employs two social workers who follow up with drug users and their families to help them access resources and get treatment, whether in the form of in-patient detox, medication or other outpatient services, said one of the social workers, Sabrina Voegelin. 

Martin lauded the focus on services over punishment. “They’ve been educated on what addiction is,” he said after the vigil. “They treat you with kid gloves.”

Narcan training

There has also been progress in destigmatizing drug addiction among the public, a focus of the 2019 report, Sink said.

As one of the city’s trainers for its Overdose Education Narcan Distribution Program, which trains people in how to spot an overdose and administer Narcan, Sink said he has been “flooded with requests for trainings from staffs of libraries, bars, restaurants, museums, churches.” He said he sees that as proof of the growing sympathy the public feels toward those experiencing addiction.

More people have begun to believe “that it’s okay to carry Narcan and we can all do our part to look after one another,” he said.

“Wouldn’t wish this on my worst enemy”

Still, as speakers at the vigil made clear, the opioid crisis continues to claim victims at astonishing rates and wreak havoc on the lives of others experiencing addiction.

“I wouldn’t wish this on my worst enemy,” Martin said of his addiction afterward. “It’s horrible. You can’t wake up in the morning and go ‘What a beautiful day, what am I going to do today?’… You have to get up and go [get drugs].”

City councillor Marc McGovern, who attended and spoke at the vigil, said the city needs to do more. “The problem has not gone away, it’s not gotten better,” he said.

Engagement service center

Boston Health Care for the Homeless Program opened a sobering center in April 2016, filling what had been a conference room. (Photo: BHCHP)

Despite its success in Narcan distribution, the city has yet to implement one of the key recommendations of the city manager’s report: the creation of a 24/7 engagement service center where people can come for medical attention, support for addiction recovery and services such as housing assistance. Boston Health Care for the Homeless Program opened a similar  “sobering center” in April 2016.

The opioid committee is “exploring the feasibility” of such an engagement center, Feinberg wrote.

At an update on the opioid crisis held Thursday by the City Council’s Human Services & Veterans Committee, councillors and Cambridge Health Alliance staff expressed earnest support for the engagement center but were unsure where it would be.

A more regional approach is needed too, McGovern said at the hearing. Now, residents sent to inpatient detox facilities elsewhere in Massachusetts don’t get continued support when they return to Cambridge. 

But what some call the most necessary tool is also one that’s illegal under federal law: safe-injection sites.

Safe-injection site

At such facilities, which are open in Europe, Australia and Canada, users can consume drugs under the supervision of medical personnel who can provide clean needles and tests for contaminants, reverse overdoses if something goes wrong and offer addiction and mental health resources.

New York City established the first two safe consumption sites in the United States in November; Somerville is planning to open the first facility in Massachusetts.

Critics say the facilities only encourage drug use, but proponents argue they provide life-saving resources to people who would otherwise be using in more dangerous circumstances.

“Really what it’s about is keeping people alive,” McGovern said. “You can’t get into recovery if you’re dead.” 

Little progress has been made in creating such a facility in Cambridge.

Little progress on a site

Another “sharps” disposal box is at City Hall near Central Square. (Photo: Marc Levy)

Even amid some success in destigmatization, McGovern said the idea of safe consumption sites has received significant public backlash, which he sees as evidence of continued misunderstanding of addiction.

As mayor in 2019, McGovern led a delegation of city officials to Montreal to observe its supervised injection facilities. He said the support of such sites taught him how far behind Cambridge is in its “understanding of addiction as an illness and not as a crime.”

There are also significant legal obstacles, Feinberg said. A federal “crack house” statute prohibits the willful operation of facilities where people are using illegal drugs, although under the Biden administration, the Justice Department has taken a softer stance on safe-consumption facilities and has not yet intervened in the New York sites.

Given the legal complications, “opening a safe consumption facility is not currently one of the city’s frontline strategies for responding to the opioid crisis,” Feinberg wrote.

Covid cost opioid progress

The rise of Covid less than a year after the city manager’s report drew resources and attention away from the opioid crisis. For a long period in 2020 and 2021, the Substance Use Advisory Committee was diverted “by the demands of the pandemic,” before it reconvened in September, Feinberg said. It’s expected to make additional recommendations to the city manager at the end of June.

The pandemic also disrupted planned Narcan education and trainings, said Assaad Sayah, Cambridge Health Alliance’s chief executive, during Thursday’s hearing.

And 2021 saw the city’s highest level of overdose incidents in at least six years. 

“Covid took such a focus of everyone’s attention, especially our health department, and on other things the focus was lost,” McGovern said. “It’s time to recommit ourselves.”