Editorial: Safe injection sites worth considering

Syringes left by drug users amid the heroin crisis are turning up everywhere.

Northwestern District Attorney David E. Sullivan is right to call for “outside-the-box thinking” — including supervised injection facilities — to combat the scourge of opioid deaths plaguing communities in the Valley and across the country.

Sullivan also is correct when he describes as radical the concept of sanctioned places where people can inject illegal drugs such as heroin in medically supervised settings. Those facilities should be established only after careful study addressing issues including locating them in places that are easily accessible to people who are addicted and ensuring that those drug users are educated about treatment programs.

“Supervised injection facilities are not suitable for all communities — they may not be cost effective except in large cities,” Sullivan wrote in a column published in January by the Daily Hampshire Gazette. “But I think they, and the approach they take in treating drug users with care, are an option worthy of consideration as we suffer the toll this epidemic takes in lost lives and shattered families and communities.”

Sullivan joins an increasing number of health officials and politicians who are advocating for supervised sites that provide sterile injection equipment, access to medical staff, information about reducing the harm of drug use and referrals to addiction treatment. No such safe sites currently operate legally in the United States, and, in fact, they are illegal under federal law.

However, there are about 100 such facilities in nine other countries, mostly in Europe as well as Australia and Canada. The first in North America, Insite, opened in 2003 in Vancouver, British Columbia. Nurses at Insite have supervised drug injections by some 3.6 million people in 15 years, and while there have been more than 6,000 overdoses, no one has died there, according to the Associated Press.

In 2016, there were 2,069 unintentional deaths in Massachusetts related to opioids, including heroin, fentanyl and prescription pain pills such as OxyContin.

State Sen. William Brownsberger, D-Belmont, has filed legislation that would allow state health officials to permit safe injection sites. He said the intent of the bill, which awaits action, is to save lives and get addicts into treatment.

The Massachusetts Medical Society and Massachusetts Hospital Association support consideration of supervised injection facilities. The medical society issued a report last year citing research at the sites in Canada and Australia that suggests they reduce overdose deaths and increase access to drug treatment. The medical society recommended establishing a pilot supervised injection facility program in Massachusetts, and to seek an exemption from federal drug laws.

However, there are skeptics, including Republican Gov. Charlie Baker. He testified at a Statehouse hearing in January on legislation he filed addressing the opioid crisis that, among other things, would permit police and medical professionals to bring high-risk drug users to substance abuse treatment centers for up to 72 hours, even if they do not agree. The bill does not call for supervised injection sites.

“As far as the data I’ve seen is concerned, it has not demonstrated any legitimate success in creating a pathway to treatment,” Baker said. “The harm reduction argument I think is a much better one, but I’m kind of a hard sell on that one.”

Also last month, Philadelphia officials announced that the city is seeking private organizations to set up medically supervised drug injection facilities that also would offer access to sterile needles, the overdose-reversing drug naloxone (known by its brand name Narcan) and referral to treatment and social services.

Philadelphia officials visited Insite in Vancouver, as well as Seattle, where the City Council has included $1.3 million in the 2018 budget for a safe injection site. Philadelphia officials also released a scientific review of studies concluding that such facilities reduce deaths from drug overdoses; prevent HIV, Hepatitis C and other infections; and help drug users get into treatment.

Sullivan wrote in his column, “For people who think this idea is too radical, I would say this: In order to save lives, we need to look in a clear-eyed, rational way at what works and what doesn’t work.”

We hope the state approves legislation clearing the way for a pilot safe injections site. We encourage its placement in Hampshire or Franklin county where the top law enforcement official has a progressive view about using all possible tools to combat addiction.