Supervised consumption sites are a promising solution to the Commonwealth’s drug overdose crisis
“Drug use is a very, very solitary sport and it’s fraught with despair, isolationism, and desolation, and real darkness. And when you’re using a safe injection site, you’re using…in the social context, so it breaks all that.”
These compelling reflections describe the benefits an overdose prevention center (OPC) in Canada, one of the 100+ sites operating worldwide. OPCs, also referred to as supervised consumption sites, are professionally-staffed facilities which offer people who use drugs a safe place to do so, aiming to reduce overdose deaths and prevent the transmission of HIV and other diseases.
Health care providers staffing OPCs monitor injection of pre-obtained substances, respond to potential overdoses, provide education about safer drug use, and refer individuals to community resources. On the frontlines of the nation’s overdose epidemic, health care professionals and advocacy organizations are calling for the development of interventions to differently address this ongoing public health emergency, including the expansion of OPCs to the United States.
Massachusetts may soon follow in the footsteps of Rhode Island, which is developing an OPC, and New York, where recently-opened OPCs are already achieving favorable outcomes. Earlier this year, state Reps. Dylan Fernandes and Marjorie Decker and Sen. Julian Cyr introduced H.1981/ S.1242, “An act relative to preventing overdose deaths and increasing access to treatment,” proposing funding for a 10-year pilot program to establish and evaluate OPCs in the Commonwealth.
In late October, the Joint Committee on Mental Health, Substance Use and Recovery conducted a public hearing to elicit feedback on this measure. While 70 percent of Bay Staters are in favor of OPCs, some event participants, including elected officials, expressed stigmatizing, moralistic, and inaccurate views of people who use drugs, stating that OPCs legitimize drug use and increase violence.
These misperceptions underscore the importance of continued community dialogue and information-sharing, as convincing evidence from numerous scientific studies indicate that OPCs substantially decrease fatal overdoses, reduce transmission of HIV and other diseases, facilitate engagement in medical and behavioral health treatment, and substantially lessen financial and social burdens associated with drug use, without causing additional crime. Recognizing the life-saving benefits of OPCs, a coalition of local organizations and activists supports this legislation, and cities and towns including Somerville may be poised to develop OPCs should the state grant approval.
The values and practices embodied by OPCs represent a sharp break from the Nixon-era war on drugs, the nation’s decades-long and abysmally unsuccessful attempt to address substance-related matters, advancing policies which criminalize a health issue and disproportionately target communities of color, unhoused people, and other marginalized groups. Billions of dollars are expended per year, but the results are catastrophic: mass incarceration, rampant community violence, and an opioid epidemic which has ravaged the nation.
Nationwide, fatal overdoses are a leading cause of injury-related deaths, a crisis which has become even more profound since the onset of COVID. In fact, in 2022, over 2,300 people in Massachusetts died of opioid-related overdoses, the highest figure ever recorded. With the proliferation of fentanyl and xylazine, it is unlikely that these numbers will diminish without prompt action.
Given this extraordinary loss of lives, there is tremendous urgency for bold responses to the state’s drug-related emergency. We need to think differently about drugs and addiction treatment and forge creative solutions which invite compassion and advance social justice. Years of research demonstrate effectiveness of harm reduction strategies adopting collaborative rather than coercive approaches, including syringe exchange services, naloxone distribution, housing first programs, and medication-assisted treatment.
Massachusetts is at the forefront in its response to substance use disorders, offering integrated, evidence-based approaches throughout a continuum of care, including prevention, engagement, treatment, and ongoing recovery support. Comprehensive strategies addressing the complex biopsychosocial-spiritual factors that influence substance misuse and involve peers, self-help groups, families, and community members in the recovery process help individuals understand their substance use, connect with community, and enact positive change.
If the proposed bill is enacted, OPCs can become a novel option in the state’s larger network of services, a small but significant step toward viewing substance use from a public health perspective rather than as a criminal justice issue. This is an unprecedented opportunity to listen more closely to voices of people who use drugs, develop evidence-informed programs that are guided by science, honor the expertise of local health providers, and support innovative legislation which has the potential to save the lives of our loved ones.