An opioid epidemic doesn’t stop at the city line, and neither can the fight to help the people caught up in it, say Cambridge officials moving increasingly toward drug initiatives that cross borders. Those include a medical outreach van soon to hit the streets and plans for safe-injection sites for drug users called overdose prevention centers.
The centers could finally open their doors after years of delay caused by federal legal threats if Cambridge, Somerville and Boston work together, officials said at a July 16 meeting of Cambridge’s Human Services and Veterans Committee.
The city of Somerville was set to make history in Massachusetts with plans to open one of the centers in 2019. Cambridge began turning conversation about OPCs into reality a year ago – but ran into the same problem as Somerville, Boston, Worcester and Springfield: federal liabilities such as prosecution and loss of licensing facing landlords, clinicians and patrons. Since the centers aren’t legal under federal law, the state would need to approve legislative protections; a bill co-sponsored by Cambridge state Rep. Marjorie Decker is on Beacon Hill.
“One of the things that we are really thinking through as we prepare for legislation that would permit the opening of an OPC is how we actually come together as a region and say we’re not going to open the only OPC – but if Cambridge, Somerville, Boston are all moving together, we would all feel more comfortable,” said Yi-An Huang, Cambridge’s city manager, at the meeting.
If the cities work together, they stand to offer a higher level of legal protections while saving more lives, the officials said.
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One step short of that would be engagement centers, where people wouldn’t inject drugs but could “at least go to experience their high and be monitored in the event of an overdose,” said Danielle McPeak of the Cambridge Public Health Department. It’s a possible interim step “until there is full support from the state to shield communities from any potential ramifications at the federal level for maintaining an OPC.”
In addition, $500,000 from Cambridge’s opioid abatement funds are being allocated to support the purchase and outfitting of a medical outreach van that health officials say should be rolled out by mid-August to begin meeting drug users where they are. The idea of public health vending machines has also been explored through which people could get things such as hygiene supplies and wound care kits.
Settlement with drug makers
The state is expected to get at least $1 billion in a settlement with opioid manufacturers – the total may grow as more distributors and manufacturers settle – with 40 percent of that being divided for direct payments among cities and towns. Cambridge’s share: $16 million in incremental payments that began in 2022 and will continue until 2038, with about $2.6 million in pocket.
Robert Goldstein, commissioner of the Massachusetts Department of Public Health, attended the Cambridge meeting and urged city officials to think bigger – about “ways that we can not just bring service to the streets where people are living, but to get people off the streets and get them into housing.” (Not all unhoused people use drugs and not all drug users are unhoused, officials noted.)
“There’s no way that we can accomplish everything that we want to with just the opioid abatement funds, as much as it is a very substantial amount of money,” said Liz Mengers, planning and development manager of Cambridge’s Department of Human Service Programs. “So we hope that the Cambridge governance can really advocate for more of a regional approach.”
Street medicine at work
Acknowledging that “the population of Cambridge and Somerville that engage in substance use tends to move a lot between those two cities, as well as the general Boston area,” Cambridge’s team collaborated recently with Somerville’s Health and Human Services Department in assessing a syringe service program and talking with drug users in homeless encampments, Mengers said. “It felt like it would be remiss to focus solely on one community or the other when trying to get this information.”
There’s already a street medicine team working, though “with one van and a supplemental Subaru when it’s available,” Mengers said, while the new van is being outfitted to the specifications of a medical team. The team is out on the street three shifts a week: a medical doctor who was joined a few years ago with a nurse practitioner, community health worker, phlebotomist and other services.
Originally it was federal Covid aid money going toward this mobile outreach; now $300,000 of the opioid funds annually will replace the Covid money for a van that would serve people beyond Cambridge borders.
“The distance between Central Square and Boston or Somerville is a very short walk,” Huang said. “We do really see a lot of this work as regional. The people we’re serving don’t stop at the border between Somerville and Cambridge.”
Centers get users off the street
OPCs, the safe spaces where people can use drugs with sterile supplies and medical personnel present, have been a valuable tool in reducing the number of overdose deaths, reducing infection rates and keeping used needles out of public spaces. Location can be important but controversial, said committee members and visiting experts.
Places experiencing visible drug problems such as Central Square are also where people push back on the idea of OPCs, but are “where the maximal benefit will be had,” specifically within 500 meters of a center, Goldstein said. “It’s not going to bring people there. People are already there.” The benefits of centers shown by research provide “a reasonable way to push back” on people’s concerns, he said.
Vice mayor Marc McGovern articulated that response: “If you don’t want people using drugs in public, then you need to give them something else.”
In the past five years Cambridge has seen 105 overdose deaths. In 2023, there was a slight decline to 25 deaths from 32, McGovern said.
The need for an OPC has never been greater, according to people who use drugs and favor harm reduction solutions. Cassie Heard, a member of the Material Aid and Advocacy Program, read anonymous letters to the officials written by the community members she serves.
One letter read, “Survival is where the majority of our energy goes. It’s exhausting. I’m so tired. In this heat. All I want to do is survive. And OPC would give us some space and safety to take the time to deal with the trauma I haven’t been able to think about for decades.”
This post was updated July 29, 2024, to correct the source of a quote and name of an organization.
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