Safe Injection Facilities — the Time is Now

Last weekend, the Massachusetts Medical Society endorsed the legalization of safe injection facilities.

I am the sponsor of a bill to create a framework for legal operation of these facilities. The bill is a conversation starter — it needs a lot of refinement as piece of legislation. But the bill speaks to a crying need, now that fentanyl is on the market being sold as heroin.

Safe injection facilities bear no resemblance to the chaotic shooting galleries where people die in the dark, slouched against bare brick. They are quasi-medical clinics where people check-in and then enter an adequately lit individual alcove and, while visible to trained professionals, self-administer the chemicals they have purchased elsewhere. Once it appears that they are not dying of an overdose, they can leave or go to a quiet place.

The facilities offer a unique opportunity to offer drug treatment and AIDS counseling. Properly run, safe injection facilities can be a tool, not only for reducing the harms of addiction, but also for fighting addiction itself.

Injecting a chemical one bought on a street corner into one’s blood – there are few more terrifying thoughts for most of us.

Yet thousands of people in Massachusetts do exactly that everyday – many of them with enough education to know that they are taking wild risks every single time that they do it: Risks of infection, risks of poisoning, risks of deaths from overdose. Even as obvious signs of harm emerge – ugly infected abscesses at the spot of injection, friends dying around them — they continue.

That is the essence of the disease: seeking pleasure or relief from compulsive need with denial of – absolute emotional blindness to — emerging harms. Safe injection facilities are a harm reduction strategy.

Harm reduction strategies are sickening to consider, because they mean accepting the reality of substance use disorder as a chronic relapsing disease – something that people don’t recover from because we tell them to, something that people don’t recover from despite their firmest personal resolutions, something that people don’t recover from even if we punish them for it.  Most people with opiate substance use disorders need medically-assisted treatment and huge ongoing support to have a shot at recovery.

Over the past five years, the death rate from overdose has tripled in Massachusetts. While opiate addiction has been spreading and is now tragically endemic among people of all ages, the death rate appears to be growing much faster than addiction.

Fentanyl is one of a family of highly potent chemicals which, in microscopic doses, feel like heroin and are now widely available on the blackmarket, often sold as heroin. Because they are so potent, they are heavily mixed with inert substances before sale. Mixes prepared by amateurs will inevitably be uneven – some doses from the mixture will be much more potent than others.

As reckless as they are, many addicts use some caution in the injection process and have a sense of their own tolerance and limits. With fentanyl though, they have no idea of what they are doing to themselves and that is why fentanyl is now the most frequently identified chemical in overdose deaths. With fentanyl rampant, we need safe injection facilities more than ever.

The real political challenge for creation of a safe injection facility is finding the private and municipal leadership to create one. In Vancouver, where they have a very well studied SIF, the political conditions may have been rather unique – there is a neighborhood with a very high concentration of drug users who organized themselves politically. In Massachusetts, it remains to be seen whether we have a neighborhood that is willing to host such a facility.

Until we have a concrete, professional proposal for a facility and the support of local officials, it will be hard for the legislature to focus on my proposed legislation.

Published by Will Brownsberger

Will Brownsberger is State Senator from the Second Suffolk and Middlesex District.

102 replies on “Safe Injection Facilities — the Time is Now”

  1. A couple facts:

    Fact 1: this WILL NOT lead to an increase in illicit drug use. Period. That’s just not debatable (see Portugal).
    Fact 2: everything you think you know about substance addiction is wrong.

    Here’s a 15 min TED talk anyone who thinks they know anything about addiction should watch; and if you’re just making assumptions and have never studied anything about addiction but you’re commenting here and you vote on these issues NEEDS to watch.

    https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong

  2. It’s good to see so many people excited (pro & con) about your proposal. Such conversation almost always helps a good cause, which a safe injection site certainly is.

  3. Where will people get the drugs to inject at these “SAFE”injection sites?
    Maybe we should have safe rehab facilities where addicts can go to get clean

    1. >Where will people get the drugs to inject at these “SAFE”injection sites?

      Where do people get the drugs to inject now?

      >Maybe we should have safe rehab facilities where addicts can go to get clean

      It’s not either/or.

  4. I am pleased with your proposed initiative and forward thinking. State injection facilities would be an excellent initiative to begin the process of providing a safe environment for those addicted and the first step in initiating a process of recovery.

  5. Looks like you have given this a lot of thought. This need has been neglected for too long.

  6. Sen. Brownsberger,

    Have you spoken with the leadership of our hospitals and clinics about their role in providing similar resources? If places like MGH, BWH, and local health centers can be properly trained and set aside some space for safe injection, this could greatly help with infrastructure costs. Further, health care facilities are equipped to deal with the more serious sequelae of overdoses.

    1. The time is now for such facilities. Waiting for a facility to be constructed means more lives lost while waiting. We have hospitals available now that could and should provide such services so that these services are presented throughout the Commonwealth as this opiod epidemic rages, it knows no limits to geography, it doesn’t discriminate in any one neighborhood – it is rampant in every city/town throughout Massachusetts. I support this measure!

  7. Drug Injection Clinics: Why We Need Them Now
    By Marc D. Goldfinger

    There are some people who are I.V. drug users who are not ready to stop using. Others are. But abstinence aside, a medically monitored, safe place to shoot up is a great idea that can save lives. Opiates are difficult to quit and there is more than one way that people get clean. I know because I was a heroin addict for over 30 years. Even when I wanted to stop, I did not have the wherewithal to make such a major life change. I would stay abstinent for a few years, and then relapse again. This happened a number of times between my first recovery and 2004, when I started on a Suboxone regimen that enabled me to stay clean and sober for 13 years now.

    There are many ways shooting drugs can kill you; many of my friends have died of overdose or because of improper injection techniques. Getting high seems simple, but there are many complex factors to consider, all of them of a medical nature. This is why Injection Sites monitored by health workers are a necessity in today’s world.

    I remember once when I was at a poetry reading in a church, and I went into the bathroom and injected my heroin. Suddenly, darkness closed in all around me and I dropped to the floor.

    I was lucky because I realized I had overdosed and struggled to maintain consciousness. I stumbled out of the bathroom, unlocked my bicycle, but I was too twisted to ride. I staggered down the street with my bicycle, fell over, got up, and staggered some more.

    I knew that if I stopped moving and just lay on the ground, I would die. I was one of the lucky ones who made it through the crisis. If I had had an access to a Monitored Injection Site, I could have gone there to shoot up safely.

    It sounds like an oxymoron —“shoot up safely”—but that is what I used to teach people when I worked at the Cambridge Needle Exchange. Shooting up is dangerous. Never shoot alone. Always use a clean needle. Use alcohol where you shoot. Whenever possible, know your dealer and ask how the dope is.

    Of course, most dealers will say “this stuff is a smoker”, which means that it is powerful dope because they are selling a product and nine times out of ten, they are addicts themselves and want to keep their customers because their customers keep them in dope too.

    Then there’s the other side of the picture. Because we’ve made heroin illegal, people who have never had any medical training put the bags together in dingy apartment buildings. What this means is that when you dump the bag in the cooker, you have no idea what you’ve got. You mix it with water and assume there is something there that will get you high.

    Maybe you’ve used that cotton in the spoon to filter the dope and water mixture more than once, and so bacteria that are not supposed be there get into your body. Alternatively, when you stick a needle in without swabbing your skin with an alcohol pad, skin bacteria can enter your body.

    When you push the needle into your vein, you may push the bacteria into your bloodstream, which is your lifeline. That’s why people who shoot dope without proper sterilization techniques can get a heart disease called endocarditis. This is why Injection Sites monitored by health workers is a necessity in today’s world.

    People are not going to just stop shooting dope folks, regardless of how many wars we start. But they are going to need to be taught the proper way to do it, if we want them to live. This is called Harm Reduction. Harm Reduction keeps people from dying. If you die, you can never recover from the illness of addiction.

    I’m not saying that everyone who goes to an Injection Site will stop shooting dope eventually. But, at an Injection Site, people can be exposed to the principles of recovery. And they will live long enough to consider all their options.

    Recovery is the disease of addiction going into remission. If you die, your chance of going into remission is over. We can save the people who use dope by injection if we want to. Every user is someone’s son or daughter; maybe someone’s wife, husband, mother or father. Do we have the courage to keep them alive?

    We don’t want these people to die. That is why the time for safe medically monitored Injection Sites has come. Recovery won’t happen the first or second time. It takes a while. I’ve been in recovery full time since 2004 with the help of support groups, Suboxone, my wife Mary Esther, and a therapist. But the first time I entered recovery was in March of 1994.

    A safe, medically modeled Injection Site could save many lives—maybe your son or daughter, or your own. People who really understand the illness of addiction support Harm Reduction. The time is now.

  8. Asking for clarification, I may have missed this in the different articles, so if I did please forgive me and point me in the right direction and I’ll take a look! Are there any studies on the utilization rates for SIF’s? How will these center’s be identified in the community to be able to be utilized? Are there specific communities in Massachusetts that are being focused on for a pilot program?

  9. If you are skeptical about “safe injection sites” you are in good company. And you should read what Wikipedia has to say about Insite, the safe injection site in Vancouver BC in operation since 2000. The research citations about the work done there, accomplishments, and success will blow you away. Just read it, and be a skeptic.
    https://en.wikipedia.org/wiki/Insite

    NOW: Insite is not the kind of place you would want to hang around too long, it is depressing, and it is in a sketchy neighborhood like where drugs are sold on the street in Boston. BUT, Insite is definitely the kind of play you would want a family to be who was using and wanted to be safe. That is the word … S A F E … , not just secure from threats, but with medical supervision. Worth giving a try, don’t you think,?

    My sister and I visited Insite after a family member who had been an addict, and we thought recovering, died just 4 years ago. If he had access to a place like Insite he’d still be with us.
    Insite opened and, at first, treated addicts who had been unresponsive to methadone treatement. Insite does NOT provide heroin, the clients arrived at the door with what they planned to use. Bad drugs were rate in the city because now attention is being paid, and the police watch too.
    Insite is located two blocks from police HQ in downtown East Vancouver, and it had their full support at the beginning because it solved a problem the police could not solve!!
    Addicts were not dying, stealing, or causing their usual social mess. Some of them are working, smiling, have jobs.

    There is a treatment center on the second floor of the building, and a short-term residential center on the third floor upstairs. Everyone on the staff we met had been an addict.
    You need to give credit for success.

    Be informed before deciding.
    Cheers!

  10. Gabor Mater is the Medical Resident at the Insite Supervised Injection Facility in Vancouver BC.
    Listen to his TED talk, what he says … about the power of addiction.
    He admits he is an addict ~ to classical music, collects CDs, he spent $8,000 on them in one week and … , well listen and find out for yourself!!

    https://singjupost.com/power-addiction-addiction-power-gabor-mate-transcript/

    If you want to read more … get his book ~
    https://www.amazon.com/Realm-Hungry-Ghosts-Encounters-Addiction/dp/155643880X/ref=sr_1_1?s=books&ie=UTF8&qid=1494004965&sr=1-1&keywords=gabor+mate

  11. Provide a safe environment for people affected (voluntarily or involuntarily ) to use drugs seems to be a good idea. It provides a better chance of saving lives. But I strongly dis-agree on being soft on drug dealers. Those people who sell drugs for a profit should be considered the worst criminals to our society and they should be jailed and severely punished.

  12. The Criminal Justice Policy Coalition’s position on safe injection sites

    The Criminal Justice Policy Coalition is in favor of establishing safe injection sites across the state. Safe injection sites save lives. According to the Massachusetts Department of Public Health’s latest overdose numbers, the projected deaths from opioid overdoses are on average six users a day. Six unnecessary deaths every day.

    A safe injection site with a trained medical professional, equipped with Narcan and Fentanyl test strips, is our best hands-on defense against these unnecessary deaths. For definitive measurements, more research is underway in Canada, Europe, and Australia and the Commonwealth should study the results. In the meantime, it follows that the return on investment for these sites pays in lives saved.

    For more information, see the following sources:
    http://www.mass.gov/eohhs/docs/dph/stop-addiction/current-statistics/data-brief-overdose-deaths-may-2017.pdf
    http://www.mass.gov/eohhs/docs/dph/stop-addiction/current-statistics/town-by-town-listings-may-2017.pdf
    http://www.wbur.org/commonhealth/2017/05/11/fentanyl-test-strips

  13. Has anyone suggested providing fentanyl test kits to SIF users? Could be a way to further reduce overdose onsite.

  14. The time is now for such facilities. Waiting for a facility to be constructed means more lives lost while waiting. We have hospitals available now that could and should provide such services so that these services are presented throughout the Commonwealth as this opiod epidemic rages, it knows no limits to geography, it doesn’t discriminate in any one neighborhood – it is rampant in every city/town throughout Massachusetts. I support this measure!

  15. Is there any evidence that these facilities ever result in a cure? Otherwise, we are spending more resources on normalizing criminal behavior.

    Also, what is the success rate in rescuing someone who has injected fentanyl?

    How many people have been “saved” by these facilities who would not have been saved by the EMT’s?

    Will you start giving them bus passes so they can get there? Why not just set them up in massive housing facilities so they aren’t in the street at all?

    Where does it end?

    1. The thing is that they really are a way to get people into treatment. They create an opportunity for positive engagement.

      But you make a good point when you ask whether people will go there. The evidence as I understand suggests that people will not travel far for this, so you have to locate them where there is already a large population of active users. That limits the options substantially.

  16. Wouldn’t a better solution be to assist drug users in testing the drug they plan to administer first…instead of having a team or facility created to encourage the actual administration of the poison and THEN save them after they inject it? Forgive me but this bill seems counterintuitive to me. While there would be opportunity to educate and potentially capture a few lost souls if we were to provide a safe place to inject…a more prudent solution would be to offer a safe way to test the drug…give them some encouragement and immediate solution for prompt initiation of a withdrawal free and comfortable detox process with a plan to graduate to a recovery program instead? Wouldn’t a drug testing system be more efficient and far less costly?

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