Doctors, city councilors debate idea of center where addicts could shoot up under medical supervision

Giving addicts a place where they could shoot up under medical supervision would save lives and clean up neighborhoods, several doctors - and one heroin addict - told several Boston city councilors at a hearing today.

But a potential "supervised injection facility" would face a tough battle on the council: Councilors Michael Flaherty (at large), Tim McCarthy (Hyde Park, Mattapan, Roslindale) and Frank Baker (Dorchester) said they heard nothing at a hearing today to convince them the idea is anything other than what Flaherty called "absolutely asinine."

Councilor Tito Jackson (Roxbury), flat out said he doesn't trust the state because of the way it approved "methadone clinic after methadone clinic" in one small part of Boston and said the blood of at least some dead addicts is on the hands of the city officials who shut Long Island, so he's not much inclined to trust any proposal that doesn't involve treatment.

"Nothing you've said today makes me go 'Oh jeez, I'm going to change my mind,' " McCarthy said.

Councilors said they're tired of Boston, in particular Methadone Mile corridor along Melnea Cass Boulevard and Mass. Ave. being a dumping ground for out-of-town addicts, and said maybe it's time for them to join the battle. When the president of the Massachusetts Medical Society, who testified in support of pilot supervised injection site somewhere in the state, acknowledged he lived in Newton, Flaherty said he would gladly accompany him to visit with the mayor of Newton and the Newton City Council to lobby to put one of the facilities in that city.

Boston Medical Center currently has a room where addicts who have shot up in the street can go to be watched.

Setting up a room where addicts could bring their drugs in and shoot up under medical supervision would require a change in state, and possibly federal, law. But with six people a day in Massachusetts now dying from opioid overdoses, traditional treatment programs are no longer enough, Medical Society President Dr. Hank Dorkin told the council. The society voted last year to promote the pilot testing of the supervised-injection idea in Massachusetts, although it did not recommend a specific site.

Dorkin and Dr. Gabriel Wishik, a doctor at Boston Healthcare for the Homeless, argued that with heroin increasingly being replaced on the street by the far stronger fentanyl, traditional treatment programs are often too late to save lives.

"People are dying before they can get to medical care," Wishik, who lives in the South End, said.

Dorkin said that a facility in Vancouver has led to a decrease in overdose death, an increase in the number of addicts seeking treatment and a significant decrease in the number of needles and related trash on city streets. Doctors and nurses in the center do not supply drugs, but they stand ready to intervene medically should an addict overdose.

Aubri Esters, who has used opioids for 12 years now, said she is tired of seeing "blue and purple faces gasping for breath in alleyways and bedrooms." She said she ODed herself a week ago, and "got lucky that I survived" after disregarding her own personal method of repeatedly texting a friend who could come help her if the text messages stopped because she didn't want to bother her friends.

"Personal morals don't belong in public health policy," she said, adding that Methadone Mile "is already an injection facility, it's just not supervised."

But councilors said a shoot-up center would promote drug use and scare off nearby residents and businesses, that they'd rather spend time figuring out ways to increase the amount of money for treatment programs and that they figured the state would try to site the place in Methadone Mile.

McCarthy said he's spent time watching documentaries about the Vancouver neighborhood in question and said it's a hellhole, where the street over from the center is called "Bloody Alley," and said there's no way he'd want one across the street from his house.

Plus, he asked, "Why does Boston always have to shoulder the burden for the entire state?"

Flaherty prefaced his remarks by saying he has probably done more than any other councilor to help addicts and that he doubted any member has lost more family members and friends to addiction than he has. And then he called the idea of an injection site "absolutely asinine."

Flaherty said he would rather be discussing ways to guarantee treatment on demand - and court-ordered treatment - for addicts. And Flaherty, who drafted a change in the city zoning code to keep marijuana facilities far apart from each other, said he now thinks he will draft an amendment to the zoning code to outright bar any supervised injection facilities.

Flaherty, a one-time assistant district attorney, questioned the "legal and ethical issues" of having licensed medical professionals oversee an illegal act.

Pro/con
Mass. Medical Society SIF fact sheet.
Safe' drug sites no Recovery Road.

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Comments

Um ...

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Have you taken a look at Tito Jackson recently?

There are two issues going on here: One is the basic idea of an injection site. The other is everybody's assumption that it would go on Methadone Mile. They're not necessarily related issues.

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Doctors

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I had relatively minor Day surgery and was prescribed 100 OxyContin by the hospital. I reported them. I would've most likely gotten addicted and transitioned into something stronger and cheaper. City and state officials need to sue Pharma and docs.

Proof? Studies? Evidence? Facts?

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But councilors said a shoot-up center would promote drug use and scare off nearby residents and businesses

If they are all-knowing and all-seeing, why don't they just use their God powers to end the epidemic?

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Like I said below

There's two options:

1) The junkie shoots up in front of your storefront or residence.

2) The junkie shoots up inside a building near a person who isn't mean to them and will give them medicine.

Again, there's no 3. What part of "addict" is not understood by these people we're paying $90,000 a year to talk about this?

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Stop overthinking this

There are two options:

1) Heroin users use heroin in front of nobody who can help them and don't get treatment.

2) Heroin users use heroin in front of somebody who can help them and get treatment.

There's no 3. It boils down to whether or not you (can afford to) care about whether or not people on heroin need treatment. Now when's the (expletive) bridge getting built?

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So if I understand you

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So if I understand you correctly drug users should be allowed and essentially encouraged-by providing a safe environment-to continue using drugs for no determined amount of time? By making the assumption there are only two options where is the room for considering treatment, or a cure as it were?

Your options operate under

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Your options operate under the assumption that ALL users will use a facility each and every time. That's just impossible and improbable.

Moral obligation

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Americans and our government have a moral obligation to Mexico and other nations to the south to legalize drugs and put a final end to the cartels and their profiting off of human misery. PERIOD. END OF STORY.

What sanity prevails here,,,,,that's another matter.....

Opposition

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Adam you missed the very polished arguments refuting the Vancouver data by Allison Burns and BTW the 4 docs and 2 others for the concept left before hearing opposing arguments. Arrogant

You're mistaken

Two of the MDs (Joe Wright and Gabriel Wishik) from BHCHP were there until the very end. I'm not sure that your assessment of Allison's presentation is accurate either, she cited inaccurately and took up substantial time while circling the same points. The second panel was not terribly considerate of all of the community members who came out to speak, nor did any of them stay until the end.

Correction

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Dr Wishik sat in the back row till after you left Brianne. Ms Burn's personal arguments should not be put on par with the recommendations of the MA Medical Society.

Brianne,

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Brianne,

I did not find your argument polished, although you have referenced it here as such. It was so far out of the realm of medical opinion, and so moralistically swayed that I found myself sad for you.

After researching all the panelists who presented yesterday, I read an article quoting you about SPOT after it opened, saying support like this for patients is "enabling" and "ridiculous." If that is your ONLY contribution to this conversation, please examine why you feel morally obligated to perpetuate the stigma. You are shaming people.

People thinking they know what is best for addicts is what has been killing them for years.

Quincy

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we need one of these in Quincy Center. Seriously.

Go after the dealers.

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Go after the dealers. Support the detectives and police. Give them more resources and equipment to get these pushers off the street.

Square footage

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Lots of buildings going up down the Seaport area and Fort Point. The developments were pushing for first floor retail space and residential above. Let's find someplace there and put it to good use.

sure

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That's your definition of "good use"? Not mine.

Incredibly disheartening

This was difficult to sit through. There was very good evidence presented by folks who are working in this field on a daily basis, and it was dismissed with rhetorical grandstanding which failed to offer anything constructive to the conversation.

City council members seemed motivated more to make brash statements which were harsh, uninformed, and not constructive, than to offer compelling discourse. Flaherty and Baker were outright despicable and I look forward to doing everything I can to support opposition to any future political aspirations you two have. You should be ashamed of yourselves. Flaherty, people who like to talk about how much they've done for an issue are people who have nothing to actually show for their work.

Tito Jackson, I met you not long ago in JP, and I was really hoping for a lot more out of you today. Your points about the failure by the state to support those in need was well taken, but you seemed more interested in attacking historic injustices while failing to recognize that we are perpetuating those same inhumane policies by failing to act.

Ayanna Pressley was the only person who seemed genuinely interested in actually contributing to a solution.

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How are the race

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and gender of people discussing this issue relevant?

Flaherty

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Why is Mike Flaherty still a city councilor? He had his shot, served a while, then came up short for mayor. All he does is complain about Menino even after death and perceived lack of parking in Southie. Time to move aside and let some new blood have a shot.

The City Council hearing yesterday was a good start

I have a far more optimistic take on yesterday's hearing. I think it was the right first step in creating a thoughtful dialogue about the issue of SIFs knowing that there are strongly held views on pros, cons, research study scope and reliability, multi-dimensional neighborhood and harm reduction impact, de facto public policy direction, politics, and on and on. We also know that there is a huge void in the public education space on this issue with advocates on both sides in the past frequently resorting to slogans, accusations, and suggesting that the other side lacks either humanity or common sense. Devolving to this level doesn't help us at all, but yesterday's two panels did all of us a service by starting a dialogue.
And for those who were concerned about the initial comments of our City Councilors, we need to recognize that most of them are pretty skeptical about initiatives that don't embrace recovery, and so their reactions were not surprising. I'm sorry this is lengthy, but this is not an issue that lends itself to quips and sound bites. It's complicated.

Folks should especially understand that Councilor Essaibi-George and Baker asked for this hearing primarily because the MMS was having discussions solely with the state (after being quoted as saying when their recommendatiopn were first released that "Methadone Mile" looked like the perfect location for one of the pilot SIFs--without ever talking to anyone in Boston). Yesterday, the MMS President repeatedly backed off that initial recommendation, but in my view the MMS was decidedly clumsy in rolling out this recommendation in the way they did. And so a lot of what we saw yesterday in terms of the City Council reaction was born of pent up frustration that yet another proposal (as Tito Jackson reminded us repeatedly in the case of multiple methadone clinic placements opposed by the city being made by the state in an already overburdened area) was being crafted behind state house doors and then suddenly foisted on Boston to manage in all of its complicated dimensions.

Having spoken to councilors in advance of the hearing, I know how strongly they felt that this hearing was essential to give Boston a seat at the table on the wisdom of this initiative and to offer us an opportunity to listen to all points of view.

As a South End guy who testified at the hearing, I made 3 points that I think fairly represent the views of the South End neighborhoods most directly impacted by the Mass/Cass crisis:

1) As the hearing demonstrated yesterday, with two good panels--one pro and one con--the jury is clearly still out on the long term evidence-based impact of SIFs. For every advocating study (like the Vancouver study quoted most frequently suggesting a 30-35% reduction on OD mortality), there are lots of questions raised about the selective population studied and the funding of the study which it was noted at the hearing came from the parent company operating the SIF. But we are still left with the common sense notion that a medically supervised high is inherently safer than one that is not. Period. The question comes for many in the aggregate and in the stats that offer conflicting views of overall OD mortality stats released by the BC Coroner's Office (even taking fentanyl out of the picture. I think most Southenders are open to be convinced one way or another with evidence-based data. And yesterday, neither the pro panel nor the con panel hit a home run in my opinion.

2) the South End Forum and Newmarket Business Assn. are unified in our view that our neighborhoods can no longer sustain any additional services and facilities. We are overwhelmed and it is getting worse not better. One of the key concerns about siting an SIF within the Mass./Cass corridor is that it holds the possibility of bringing more of the addicted community to the South End. And today, in the South End, one of our biggest problems is that a) our shelters are gender exclusive, so that when couples want to be together, they have to be on the street because they can't both be at a shelter (that's why we're looking at implementing a low-barrier day location behind the Southampton shelter), and b) when a client comes to Mass/Cass for methadone or suboxone or other treatment at 9 AM, many have follow up appointments at 2, 3, or 4 in the afternoon at BHCHP or BMC or other facilities co-located in the area. Where do you think they will be between 9 and 3? Largely in the SE neighborhoods or alleys or on Mass Ave. many over-sedated, many sick, and many with no place to go. This is what we are trying to get our arms around in this neighborhood today--to try to find places, programs, alternatives that are both safe and offer an opportunity to get hooked up to treatment.

So now bring a SIF into that mix--we are told that the average facility visit is 30-40 minutes--and following medical monitoring to ensure an OD is not imminent, these souls are now back as part of the Mass/Cass sedated/oversedated rough environment that we are already wrestling with today. A SIF would be a major impact multiplier for a neighborhood that is simply overwhelmed.

3) Finally, we publicly called on the City Council and the State and the business community to expand the focus of the conversation on from a focus from only harm reduction strategies to the broader challenge faced jointly by the city and state.

We proposed to the Council what we think is a a revolutionary and transformative idea to try to address the currently decentralized "bits and pieces," and stovepipe programs of critical service providers located in scores of pockets throughout the city and now concentrated in the South End.The "band-aid" approach--doing what we can with what we have-that has characterized our efforts for years is getting overwhelmed more and more each day. It's time for us to treat this with an unprecedented commitment of resources, political will, and multi-disciplinary expertise.

We called for a major state-city public private partnership investment (organized perhaps as a Foundation) in a "Rehabilitation Campus" offering multi-modal treatment options, detox, a critical continuity of service model on site including both residential programs and in and out-patient services with direct (and site presence) linkages to all the various addiction/recovery service providers located throughout Boston. We need, for lack of a better term a "mother-ship" that not only serves as a state of the art large scale multi-modal treatment center, but offers opportunities for cutting edge research, and supportive reintegration as part of a more aggressive recovery model.

This is not a fanciful "out there" recommendation. We need only look at the publicly held Shattuck Hospital campus located between Forest Hills Cemetery and Franklin Park that could offer a supportive and self-contained campus setting without direct impact on any residential neighborhood or right in the middle of the drug trade for the city. The site requires big capital improvements that needs public dollars and major private corporate dollars--all of which seems totally feasible is we are serious. By the way, Pine Street Inn is already operating programs there.

As we continue to discuss the research and on SIFs including those that shut down as well as those still operating today, we need Boston to commit to a Rehab Campus that may offer us our best opportunity for enhanced coordination, real research, treatment on demand, and every other modality that will help us to try to get ahead of this before the next wave of new even more powerful synthetic drugs hit our streets. We have to invest now or pay later.

Again, apologies for such a long post.

recovery campus

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...and Methadone and Suboxone should be distributed by pharmacists at assigned pharmacies in a planned way as a way to dilute the masses of sick and vulnerable people that congregate daily at these clinics, prey to crime and drug and pill dealing

Recovery campus

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A great suggestion! aLemuel Shattuck Hospital is underused, and has another building not in use at all, although i think that it would need to be demolished and rebuilt. There is parkland and it is close to public transformation.