Wednesday, June 12, 2024

A “sharps” box for disposal of opioid syringes on Carl Barron Plaza in Cambridge’s Central Square. (Photo: Marc Levy)

An order asking to explore opening an overdose prevention site in Cambridge has been promised for the final City Council meeting of June by councillor Marc McGovern.

Though Central Square is “sort of the logical place, if you will, or the place that people think of first,” McGovern said Tuesday as chair of a Human Services and Veterans Committee hearing, “I have no predetermined position on where something like this would go.”

Overdose prevention sites let people bring in potentially dangerous drugs to take under the supervision of medical personnel or peer staff, with sterile needles and other equipment. The sites might provide support services and medical care – keeping people who use drugs alive until they are prepared to seek help, McGovern said.

“I hate to be so crass, but you can’t get into treatment if you’re dead,” McGovern said.

Potential pluses and minuses were brought up for placement in Central Square, a hub of social services that draws drug users and the unhoused that has seen recent high-profile incidents involving both.

“Central Square is inundated,” councillor E. Denise Simmons said, calling it a “hot spot” for its homeless shelters, needle exchange and winter warming center. “People are going to come where the services are. We want to be fair to the population we want to serve, as well as to the community or neighborhood that’s going to host that program.” Councillor Paul Toner also said he was “concerned that all things fall on Central Square” and wondered if the appropriate place might be in a health clinic or hospital.

All agreed there would be need to be a robust conversation, as a Central Square site could also be helpful in preventing overdoses and deaths that take place mostly in the square. “It’ll be very tricky for us to figure out how we can ensure that we’re balancing that and not having Central Square become a magnet,” councillor Patty Nolan said.

Easy access could be crucial, McGovern said, but he also had in mind a lesson he learned from a research trip in Montreal. That city has a site for safe drug injection down a side street “in a neighborhood that reminded me very much of Harvard Square or Central Square – lots of nightlife and restaurants and activity. Lots of people walking around with their kids.”

“I went to all the different restaurants and asked their managers, how has having this site in your neighborhood impacted your business? It was amazing. Half of them didn’t even know it was there,” McGovern said. “The others were saying ‘People were overdosing in my bathroom or in front of my business’” and now are not, and “there’s even less needles on the ground.”

What Cambridge can expect

Alexandra Collins, an assistant professor of epidemiology at Brown University, presented on the benefits of the sites. Neighborhoods that host an OPS experienced a 35 percent decrease in overdoses within 500 meters from the site. Outside that, communities saw on average a 9 percent decrease. They also recorded less crime, less drug-related litter and fewer instances of public injection.

Based on her research, people who use one are much more likely to pursue treatment than those who do not. They were also less likely to require emergency medical attention or to contract HIV or hepatitis C.

Although the sites are better established in Canada, Australia and some European countries, the United States is starting to catch up. In November 2021, New York City opened two, both embedded in existing syringe service programs. Since their openings, the sites have seen more than 70,000 visits, and their staffs have reversed about 850 overdoses. Thanks to the sites, the burden on New York’s emergency medical responders has decreased, Collins said.

A regional approach

Leo Beletsky, a professor of law and health sciences at Northeastern University, elaborated on the public safety benefits. “To the extent that our public safety systems are overburdened and folks are burned out and stressed, the OPSs do help to reduce that and allow public safety to focus on matters that are more urgent,” he said.

Neighboring Somerville is working with Collins and other experts toward its own OPS since learning in a survey of people who use drugs that, if the city had one, 94 percent of respondents would use it. Somerville contracted with Fenway Health to plan for an eventual opening.

Boston, Worcester and Springfield are also looking into opening sites.

Police commissioner Christine Elow said she would be hesitant to support an OPS if Cambridge were the only city to open one; because of the plans in other cities in Massachusetts, she was in favor of opening one in Cambridge. “I absolutely see the benefit in these sites,” Elow said. “I love that councillor McGovern said we’re looking at a regional approach.”

Concerns about an OPS

Some councillors, including Toner, were concerned that an OPS would be illegal under federal law.

The federal government had prevented one from opening in the Philadelphia area, but is not expected to do it again, Beletsky said.

“All signs from the federal government point to the fact that they’re going to take a hands-off approach. They’re not jumping at the bit to fund and support them, but they’re also not going after them,” Beletsky said, offering marijuana dispensaries as a helpful comparison: Although these dispensaries violate more serious statutes than an OPS, the federal government has chosen to ignore them.

The Massachusetts General Court has considered legalizing the sites on the state level, but has made little progress, and McGovern said Cambridge does not have time to wait.

“Sometimes, you have to challenge the law, right, for things that are important enough?’” he said.

Date and next steps

Danielle McPeak, who leads the Cambridge Public Health Department’s substance use prevention unit, said the city saw 216 nonfatal overdoses in 2022 and so far this year has seen 68 – around 3.1 overdoses per week.

There were 38 overdose deaths within the borders of Cambridge in 2021, the most recent year for which there is data, and 21 deaths were Cambridge residents. The victims were, on average, in their early to mid-40s. Most of them were white men, McPeak said.

McGovern said he intends to write a policy order before the council’s summer break directing the city manager to create an OPS task force and to accelerate the process of opening a site in Cambridge.

“We’ve got to go faster, and we need to do more,” he said.