Massachusetts has a drug problem. Somerville's bold plan should be part of the solution

Mar 07, 2024

Advertisement

In June, Somerville took an important step to help curb the overdose crisis in Greater Boston by approving significant funding to set up the area’s first safe consumption site (or SCS).

This announcement could not have arrived at a more critical time: That month, the Massachusetts Department of Public Health released new data indicating a record high in overdose deaths related to opioids — 2,357 confirmed and estimated lives lost in 2022. That’s more than six people every day, with Black Bay Staters hit the hardest. This is unacceptable, and with the budget to move forward with Somerville’s first SCS, the city has taken the reins to steer a change.

Safe consumption sites help prevent overdose deaths. I know firsthand how valuable these services are to a city overwhelmed with a preventable epidemic. I managed Vancouver’s Insite, North America’s first public, legally sanctioned SCS, for its first eight years. Also known as overdose prevention centers, SCSs are places where people can use illicit substances such as heroin, cocaine or methamphetamine under the supervision of trained staff and without fear of arrest. Staff at these sites provide overdose assistance, including administering oxygen or naloxone, which can reverse opiate overdose.

Safe consumption is not a new idea. These sites have existed for more than 35 years, and there are currently nearly 200 in 14 countries around the world. In the U.S., there are two in New York City, another slated to open early next year in Rhode Island, and many others in the planning stage.

The data are very clear: SCSs offer medical intervention that works. After Insite’s doors opened in 2003, overdose deaths in the surrounding community decreased by 35% overall and by nearly 50% among minorities, Indigenous people and women. In the 20 years that have passed since that time, there has not been a single fatality at Insite, which sometimes has as many as 900 visits a day. In fact, despite the variety in their geographical and operational circumstances, these sites all have one thing in common: There has never been a single overdose fatality at any of them.

[T]hese sites all have one thing in common: There has never been a single overdose fatality at any of them.

SCSs have been endorsed by prominent medical and public health associations, including the American Medical Association, the American Public Health Association and the John Hopkins Institute for Health and Social Policy, as well as the Law Enforcement Action Partnership. The reason for these powerful endorsements is simple: These facilities work.

Why are SCSs so successful at harm reduction?

The criminalization of drugs pushes the people who use them into social and emotional isolation, which creates more health and safety risks. That’s what has unfolded along Mass and Cass, the area of Massachusetts Avenue and Melnea Cass Boulevard in Boston where individuals use drugs on the street and engage in risky behaviors such as sharing needles.

SCSs help to move drug use indoors, away from street corners and public areas. SCSs reduce both mortality (death) and morbidity (injury and disease) from overdose or unsafe drug use. They also connect people to substance use treatment with methadone and buprenorphine and to other forms of health care and social support, including housing. SCSs also offer an environment of acceptance and compassion, which are the cornerstones of healing for everyone, but perhaps especially for people who use illegal drugs. By embracing safe consumption, Somerville is showing people who struggle with addiction that their lives matter.

In essence, SCSs create a platform for people to make their own decisions about their health — and they do. For example, in Vancouver, participants said the environment at Insite encouraged them to adopt safer practices and to make a habit of using them. Further research confirmed that people who use Insite even one time are 70% less likely to share drug use equipment, both on and off the premises.

Significantly, in the 18 months after Insite opened, there was a 33% increase in the use of detoxification services in the area. What’s more, clients referred to these services by Insite were almost twice as likely to begin methadone treatment and almost four times as likely to enroll in other forms of addiction treatment compared to people who were not associated with Insite.

In fact, demand for detoxification services was so high that we opened a treatment center in our building to meet it. We offered people access to safe consumption downstairs and treatment upstairs, meeting people where they were at in their own cycles of addiction and recovery. That’s when I truly understood how safe consumption fits within a continuum of care.

But not everyone gets it. Fears about how the Somerville facility might encourage drug use and crime have been raised by the program’s critics. In Vancouver, a study showed that the SCS there did not increase the rate of relapse into drug use, nor did it promote initiation into injection drug use. Another study found no increase in drug-related crimes, including drug trafficking, assaults, robbery, vehicle break-ins or vehicle theft in the area around the site after it opened. In fact, according to other research, the site was associated with improved public order.

My hope is that what happened in Vancouver will happen here: The longer the SCS was open, the more people saw its impact and supported it. In the meantime, I applaud the city of Somerville for embracing this proven harm-reduction solution and leading the way in Massachusetts.