Somerville looks to combat opioid epidemic through supervised injection sites

Somerville Mayor Joseph Curtatone is not ignoring the public health issue of opioid use, with plans to open a supervised injection site in the city by next year. However, public stigma of opioid use is slowing down the process.

According to the Massachusetts Department of Public Health, over 2,000 individuals died of opioid-related overdoses in 2018, which makes Massachusetts one of the leading states in the country for opioid-related deaths. New tools to combat the epidemic include the supervised injection sites and an extension of clean needle exchanges. These sites would offer a safe location for people to recover after using opioids. The location would be sterile, and there would be access to healthcare professionals in case of misuse.

Zachary Siegel, journalism fellow at Northeastern University's Health in Justice Action Lab, discussed the success of supervised injection sites in other locations.

“There’s currently underground unsanctioned supervised injection sites in America, and those have been studied and surveyed. The outcomes are similar to the outcomes we would see around the world... The rate of infection from Hepatitis-C or HIV ... [goes] down," Siegel said. "People get linked up to other services they need that help stabilize their lives. People do not die of overdoses in these locations.”

Although supervised injection sites and other initiatives exist with limitations, Siegel believes that the government can do more to combat the opioid epidemic.

“Rhetorically yes, people are saying that addiction isn’t a moral failing and that addiction is a brain disease, and that we must have a public health approach ...Public safety and law enforcement [are saying] that we cannot arrest our way out of this,” Siegel said. “[However, the] law and order approach of cracking down on dealers and in effect cracking down on users is still happening.”

A May WBUR poll found that although 50% of Massachusetts residents are in favor of opening supervised consumption sites, 43% oppose the initiative. In light of such concerns from state residents, former Massachusetts representative and Fenway Health’s Vice President of Government Relations Carl Sciortino said that he believed the sites would improve communities rather than harm them.

“What we learn from the experiences of the many sites around the world where they currently operate, is that ... not only [do these sites] save lives and connect people to resources ... but they also improve neighborhoods and communities,” Sciortino said.

He discussed how injection sites are already around but unsupervised. They could be in Davis Square, Cambridge and Boston.

“We have public bathrooms that are injection sites, private homes that are injection sites, alleys that are injection sites, and these are very dangerous places for the people that are injecting drugs without access to services,” Sciortino said.

Sciortino spoke to the public's worries of having supervised injection sites, stating that he believes these sites reduce public injections and disposal of syringes, which are two of the most prominent fears for these communities.

In order to familiarize the public with the idea of supervised injection sites, last week the MGH Charlestown HealthCare Center created mock supervised injection sites for public viewing. Dr. Mark Eisenberg, an addiction specialist and primary care physician who was the lead on these sites, explained the goals of the project to the Daily.

“It’s to demonstrate to the public that is this is a viable medical procedure to ensure that patients who use drugs can use them safely without the risk of acquiring HIV, Hepatitis C or other bacteria complications,” Eisenberg said.

Similarly to the United States, Canada has also struggled with opioid use in its communities. One of the first steps the Canadian government took in combating the issue was creating supervised injection sites.

Eisenberg explained that two decades ago, the first site was opened in Vancouver. While he said that there was initially pushback, after the site was formed, there was a noticeable decrease of overdosing in public areas, such as in bathrooms and restaurants.

"There’s studies that have shown that there’s a decrease of public injection and decrease [in] discarding of syringes in the alleyways and sidewalks and gardens and decrease in public disorder," Eisenberg said. "The Business Association of Vancouver is now behind it and the police of Vancouver."

Additionally, he said that law enforcement began to change the way they acted when they found an individual injecting themselves, as they had better resources to turn towards. Although Eisenberg hopes that Massachusetts sites could have the same results as Canada's, he said there is still a long way to go.

“Last year, Governor [Charlie] Baker authorized a harm reduction commission to study ... [supervised injection sites]," Eisenberg said. "They released a report earlier in the year that endorsed the concept of opening one or more sites.”

Despite Baker’s endorsement, members of the public continue to find issue with these injection sites. Another argument against these sites is that they aren’t in cooperation with federal law, because they’re distributing these illegal drugs. Eisenberg believes the tides of this are changing though.

“We just had a recent ruling by the judge in Philadelphia saying safe houses were legal. We believe that public health is behind us and the law is behind us and that states have a right to do this. The federal government can choose not to intervene, just like how they have chosen not to intervene with marijuana, for instance, or syringe exchanges,” Eisenberg said.

Many in the public health field have a lot of faith in government support for these sites. The best chance they have in getting more protection is if the U.S. House of Representatives and U.S. Senate pass the bill that Baker just signed. In either case, they are going to try to continue opening supervised injection sites.

Ian Wong, director of the Department of Health Promotion and Prevention at Tufts University, said that although opioid use is not the most prevalent form of drug use on campus, small rates of usage do exist. He noted that there can be an even larger stigma on people that use opioid drugs versus other drugs which makes this problem harder to tackle.

“There’s this very bad thinking, where good people do good drugs and bad people do bad drugs,” Wong said.

He discussed how overusing alcohol is more socially acceptable on a college campus than opioids, which increases the stigmas on the conversation of opioid drug use. Wong also explained that while working in the Department of Public Health, he often found that parents of children who were looking for opioid treatment centers didn’t want the centers to be in their own neighborhoods.

"First, it was hard to find treatment centers, but even [parents] said they didn’t want treatment centers in their neighborhoods. It was a really kind of sad thing that they said 'yeah I need it, but put it somewhere [else],'" Wong said. "You wouldn’t imagine the fights that towns get into over — ‘we don’t want a treatment center in our town.’"

He said that this debate is very similar to the problems encountered with the implementation of supervised injection sites. However, Somerville is taking a different approach by deciding to implement one.

“You can’t just stop using opioids. You go through horrible terrible withdrawals,” Wong said. “People who get stuck on opioids and heroin are just trying to feel normal. They’re not trying to get high all the time.”

According to Eisenberg, this is why programs such as supervised injection sites exist. Eisenberg said that he sees these sites as a proactive next step by Somerville to decrease overdoses.

“We don’t think this is the answer to the overdose epidemic but one tool in the toolbox. We need more treatment; we need more providers willing to see patients with addiction; we need to decrease stigma; we need to expand health insurance so that everyone has health insurance; we need to make sure everyone in the country has access to treatment. There’s a lot more to be done — this is just one little piece,” Eisenberg said.