Wednesday, July 24, 2024

The organization Supervised Injection Facility in MA has set up pop-up tents where people can get access to clean supplies for drug use. (Photo: Sifma Now)

The city of Somerville was set to make history in Massachusetts with plans to open an overdose prevention center – five years ago, in 2019.

Often referred to as safe consumption sites, overdose prevention centers offer a safe environment for people to bring drugs and use them with sterile supplies in the presence of others, sometimes medical professionals. Supervised use is considered a valuable harm reduction tool because it allows for intervention in the event of an overdose.

Somerville seemed to have all the tools to make the site a reality, including support from then-mayor Joe Curtatone and others in city government, as well as among the community. Beacon Research reported last year that 7 out of 10 voters statewide were in favor of passing a bill to allow cities to establish overdose prevention centers. New York has since opened two, with promising results.

Why hasn’t Somerville acted?

Questions clog process

Until last year, Jennifer Korn, an employee of the Somerville Police Department’s unit for Community Outreach, Help and Recovery, attended regular Health Department meetings about how the site would be funded; its consultants provided insights on staffing and location as well as community needs, interests and concerns.

Location seemed to pose the biggest challenge in group discussions; an outside 2021 study recommending Davis Square and East Somerville “based on data including where overdose calls and discarded needles are spatially distributed, access to transportation and community need.”

The group deliberated whether the site would go in a city-owned or private building. The owner would need to be prepared for the legal ramifications, as the injection sites are not legal federally.

Staffing was another question. Medical professionals who participated risked losing their license. Matthew Mitchell, director of prevention services for the city of Somerville, says one of the biggest obstacles with opening an OPC is the legal liability risks for those using and operating the site. If the site were not approved by the state, licensed medical professionals could lose their licenses.

“There was a shift, probably nine months or a year ago, in our thinking, and the guidance that there was just a lot of liability for the city and also potential users of the site, potential practitioners and staff,” said Karin Carroll, Somerville’s director of health and human Services. As a result, “some of our work shifted to advocacy at the state level.”

Since the state licenses all medical professionals, state officials can offer protections for clinicians working in an OPC. “Until Massachusetts finds ways to offer these legal protections there can’t be a whole lot of movement here,” Carroll said.

In December, the state’s Department of Public Health released its own OPC feasibility report that Carroll said reached most of the same conclusions as Somerville’s, carried out by Fenway Health. 

Checking in

Current Somerville Mayor Katjana Ballantyne is in favor of opening an overdose prevention center, but told WBUR nearly a year ago that given the high stakes, there is a “demand that we move thoughtfully, deliberately and in collaboration with key stakeholders.”

In reporting this story, we checked in with our sources and found no changes from the situation several months ago.

The lack of progress has frustrated activists and those who use drugs who believe the time to act is now: The state Department of Health recorded 2,359 overdose deaths in 2022, and that number is climbing.

Cambridge also on pause

There are similar concerns in Cambridge, where on May 13 the City Council called for an expert look at potential legal issues for hosting a center. Legalization seems to be moving toward rapid approval on Beacon Hill with a bill co-sponsored by Cambridge state Rep. Marjorie Decker.

That legislation, Bill 1981, creates a 10-year pilot program and establishes an overdose prevention center to offer harm-reduction tools and prevent overdose deaths. The Massachusetts House of Representatives referred it in February 2023 to a Joint Committee on Mental Health, Substance Use and Recovery, which passed it with a favorable recommendation. This March, the bill made it to the House Ways and Means Committee. Time will tell if the bill is successful; similar bills have been stuck in limbo or forgotten altogether.

“This is going to happen at the state level, and I want Cambridge to be ready,” vice mayor Marc McGovern said.

Filling in the gaps

While work on an overdose prevention center is stalled, local programs and activist organizations fill in the gaps in Somerville and offer harm reduction tools for drug users.

Brian Sink is the program manager for the access drug user health program at the Fenway Health Aids Action Committee in Somerville. This program, funded as a public health service but challenged recently by financial problems, offers syringe exchange services and is an Overdose Education and Narcan Distribution site. Those who visit can pick up sterile supplies, sharps containers, fentanyl test strips and Narcan, which delivers an antidote for overdoses.

A majority of needle exchange programs use a one-for-one model, meaning the program will only trade someone a new, sterile needle for a used one. The AAC doesn’t require people to bring in used supplies, but they do encourage it.

Sink said he’s happy to provide sterile supplies from 100 to 200 needles.

Safety, not recovery

Needle exchange programs not only lessen the risk of transmission of infectious diseases for those who use drugs, but decrease the number of needles that can litter sidewalks or parks – and the risk that someone may pick up the needle and become infected.

Sink emphasized that the committee is not recovery oriented, but meets people where they are. While it can help users find detox centers and other treatment options, the committee is there to offer support in a safe environment regardless.

“We exist as a place where folks can be their authentic selves and talk openly about their drug use, in a way that if they’re not ready to quit, if they’re not ready to scale down their use, or even if they just started, that they have access to unused, sterile equipment and safer-use strategies and they’re able to do what they like, but in the safest way possible,” Sink said.

Sifma Now also waits

A volunteer coalition called Sifma Now – for “Supervised Injection Facility in MA” – has been offering support and advocating for the opening of overdose prevention centers since 2016.

Jim Stewart, an original member of the group, attends weekly meetings to assess what the organization can do for the community. Sifma Now has set up several pop-up tents where people can get access to clean supplies, and pop-up educational experiences to educate the community on the positive effects overdose prevention centers would have.

Stewart acknowledges upon first hearing, a safe consumption site can sound like just a place where people use drugs.

Evidence is good

The Massachusetts Medical Society Task Force on Opioid Therapy did an analysis in 2017 to assess the feasibility of opening a safe injection site. The analysis focused on overdose prevention centers in Vancouver, Canada.

The analysis found that there were no overdose deaths reported and there was a 35 percent decrease in the number of lethal overdoses in areas that had the centers.

Stewart says the evidence eliminates “any doubt that overdose prevention centers are a critical component to getting the opioid and other overdose deaths under control.” He believes these sites will meet people at their “most vulnerable point” and address the root causes of addiction.

If the invitation for a safe environment isn’t extended, people will continue to use drugs alone and in unsafe places, Stewart said.

“People don’t change their life from six feet under,” Stewart said. “If you don’t save a life, you’d never have a chance to change that life.”