In 2020 there were at least 2,104 opioid-involved overdose deaths in Massachusetts, the highest ever recorded and nearly four times the rate from 10 years ago. The overdose crisis continues to evolve, with opioid-involved deaths among Black men increasing by nearly 70 percent in Massachusetts over the past year. Compounding the crisis are a rapidly spreading HIV cluster among people who inject drugs in Boston; a drug supply overrun with fentanyl and other unregulated synthetics; and increasing prevalence of stimulants and opioids being used together, both intentionally and not.
One of the most urgent actions we can take is to authorize safe consumption sites (SCS). They exist legally in 11 countries, and have finally been sanctioned in the United States in the form of a two-year pilot program being implemented in Rhode Island. It remains to be seen where a site would be located in Rhode Island, and the Biden Administration has not commented on the federal legality of such a site.
In Massachusetts, we’ve been forced to watch as thousands of people have died of preventable overdose while legislation that would authorize the creation of our own SCS has languished. But now, we may finally be on the cusp of change.
In 2020, comprehensive legislation authorizing SCS was filed in the Massachusetts State House of Representatives and Senate. It is set to be heard on September 27. The bill would enable a local town or city’s board of health to approve a pilot SCS for 10 years, set minimum health and safety requirements for an SCS, and provide legal protections for participants, staff, property owners and the entity operating the site.
While the bill does not provide funding, new opportunities for funding streams independent of federal restrictions or oversight will become possible as money begins to stream into Massachusetts from the settlement of various opioid litigations.
“We can’t discount out any option that has the potential to save lives from the opioid epidemic,” State Senator Julian Cyr (D-Truro), chair of the Joint Committee on Mental Health, Substance Use and Recovery and sponsor of the legislation, told Filter. “As opioid use disorder continues to ravage too many lives in the Bay State, the legislation we filed would pilot supervised consumption sites in the Commonwealth and offer public health workers a crucial new tool to save lives.”
Unlike other US attempts to site an SCS pilot, Massachusetts may not face a high level of opposition.
Unlike other US attempts to site an SCS pilot, Massachusetts may not face a high level of opposition from either policymakers or residents. One city has indicated its willingness to host an SCS, and is engaging in a collaborative process to ensure community members are involved in the process moving forward. Somerville, located a few miles outside of Boston, has already produced a needs assessment and feasibility report and continues to build local support for a site with the backing of municipal officials.
“About three and a half years ago I became homeless and had more time to talk to people who use drugs and read the data about SCS.” Tj Thompson, an organizer with SIFMA Now! told Filter. SIFMA Now! (Supervised Injection Facilities in Massachusetts Now!), a statewide grassroots advocacy organization with which I am also affiliated, has been fighting for SCS since 2016.
“As soon as I started doing this, I realized that when you read any of the data, there’s really nothing bad about these sites,” Thompson said. “It’s better for the communities they’re situated in, better for people who use and don’t use drugs and better for people who are unhoused.”
Not a single fatal overdose has ever occurred at any of the 120 sanctioned SCS around the world. They save lives and improve public health outcomes. Research has also demonstrated how SCS would save an average of $4 million each year in US cities that implemented them, including Boston. In 2017, the Massachusetts Medical Society became the first state medical society in the country to endorse SCS. Legislation to authorize the sites was proposed in the Massachusetts State Senate that same year—but the bill never appeared on the floor for debate.
By the following session, in 2019, the SCS proposal was replaced by the more politically feasible creation of a Harm Reduction Commission. The commission—a mix of state and local officials, legislators, law enforcement and harm reduction experts—was tasked with exploring which of the various possible interventions could be implemented in Massachusetts. Their official report, released in March of 2019, recommended what we already knew: that the state should pilot one or more SCS.
Massachusetts Governor Charlie Baker, however, remained hostile to SCS, emphasizing their illegality under federal law. Similarly to the legalization of cannabis dispensaries in Massachusetts, policymakers can move forward if they want to, so long as they’re not being federally prosecuted. Baker’s stance was backed by the then-US attorney of Massachusetts, Trump-appointee Andrew Lelling. Though Lelling chose not to prosecute the state’s cannabis dispensaries, when it came to SCS he chose to argue that the issue was not one to be dealt with on the state level, calling it a “philosophical contest” best left to Congress.
Advocates are hopeful Rollins will continue to show support for an SCS pilot, and not prosecute any sites that open.
But soon, Biden-appointee and former Suffolk County District Attorney Rachael Rollins will become the new Massachusetts US attorney (once she is confirmed by the Senate). Rollins has been vocally supportive of SCS and their legality. Some advocates for SCS are hopeful that she’ll continue to show public support for an SCS pilot and release guidance that her office will not prosecute any sites that open. Others worry she’ll simply maintain the status quo.
But the tide in Massachusetts is shifting. A growing crisis has been met with growing demands to address the policy failures that are costing us so many lives. A new administration, new US attorney of Massachusetts and an increase in support among local officials and community activists mean we may finally be achieving the political landscape we need to authorize SCS.
“We really want to be ready for that [the passage of SCS legislation on the state-level] and have our shovel-ready program and projects ready to go,” said Doug Kress, director of Health and Human Services in Somerville, at a recent local town hall. “If that were to happen that would certainly ease much of the challenges that we might face.”
State legislation would put a host community on stronger legal and regulatory footing. The currently proposed bill would require a site, such as the one that Somerville hopes to open, to have the support of the state Department of Public Health for regulatory matters, and would hand down clear protections from licensure revocation and criminal and civil charges.
“It’s not going to be much longer that Massachusetts will be able to sit back and ignore that supervised consumption sites have saved hundreds, if not thousands, of lives around the world over the past 30 years,” Thompson told Filter. “Overdose death is a public health issue, and this is an evidence-driven public health solution.”
Photograph courtesy of SIFMA Now!
Abby Kim, former legislative director for Massachusetts State Senator John Keenan, provided legislative expertise on the forthcoming bill and its previous iterations.