State legislators discuss controversial safe consumption site bill
Two lawmakers recently addressed issues of political will, empathy and opposition to their efforts to create a space for clinically supervised drug use
A long-stalled bill to legalize safe drug consumption sites in Massachusetts has recently made incremental progress towards passage, legislators say.
They add, though, that the finish line remains a distant goal as a complex web of competing political and personal concerns grows.
“This has been going on for years now and we’ve barely put a dent in it,” state rep. Dylan Fernandes said of the larger local drug crisis in an interview with Substantive. “We can’t continue to express outrage and disgust and loss and the rest without putting in some real action to address it.”
Safe consumption sites, indeed, are no new concept. First piloted in Europe, they allow people with addictions to use drugs in a clinical setting where they’re supervised by nurses and provided with key harm reduction supplies like clean needles and alcohol preps to sanitize injection sites.
Proponents on both sides of the Atlantic Ocean say these locations cut back on overdoses and curtail often raging epidemics of bloodborne pathogens like HIV or Hepatitis.
Those supporters cite copious scientific research showing successful efforts abroad. Likewise, local backers have increasingly turned to a recent study from the Institute for Clinical and Economic Review focused further on Boston. That work found that the city could save lives, decrease overall overdose rates, take burdens off emergency rooms and ambulance services, and save thousands of dollars by creating a safe consumption site.
Opponents, however, say safe consumption sites concentrate drug use in certain neighborhoods, spilling dirty needles onto sidewalks and saturating spaces with more people than they can support.
They point to situations like the one in a troubled portion of Vancouver, Canada, where a safe consumption site has increased complaints of crime, discarded needles and public intoxication in its neighborhood.
Regardless, Massachusetts elected officials have long pushed to bring sites into this state.
“We spend about two billion dollars a year...to address the opioid epidemic and we’ve barely made progress in the number of deaths,” Fernandes said. “We need to think a lot more intelligently and creatively about our approach.”
A former Dorchester resident, Fernandes now represents a portion of Falmouth, Mass. in the legislature.
He’s the latest in a line of several lawmakers to introduce legislation to create a safe consumption site pilot program, likely in Boston.
A long running process, Fernandes says he and other co-sponsors have brought in outside speakers to try to build political capital for their effort within the state house.
Back in 2019, for one, Fernandes told Substantive, a prominent member of the Quebec Ministry of Health visited Beacon Hill to talk specifically about safe consumption site experience in Canada.
Efforts like that have paid off.
Just this year, the Joint Committee on Mental Health, Substance Use and Recovery reported favorably on a study order for Fernandes’ latest safe consumption site bill. This was a first, making progress where other bills had failed.
“That’s positive traction,” Fernandes said.
‘This needs to be near people with addiction’
Still, as Fernandes is optimistic, Senate President Pro Tempore William Brownsberger emphasized in his own interview with Substantive that he sees a long road ahead.
Massachusetts’ addiction epicenter almost certainly sits along a one mile strip of road through the South End and Roxbury, known as the Mass and Cass region. This space would be the most likely candidate for a safe consumption site, especially through a pilot program like the one Fernandes’ legislation proposes.
Residents of the area, however, are frustrated, saying they’ve seen past harm reduction efforts fail. They point to existing harm reduction “comfort stations” that already see widespread drug use within their walls even though that’s technically banned.
“We need to disrupt that,” city council candidate and community advocate Leon Rivera recently told Substantive. “There’s nothing comforting about that area.”
Brownsberger said he hears those concerns, noting, “All of those things are very real problems for the community.”
People like Rivera, in turn, ask whether any possible safe consumption site could relocate from the city to more suburban communities. They hypothesize that such a move would reduce the strain on places like the Mass and Cass region, which already hosts a cluster of homeless shelters and medically-assisted opioid withdrawal clinics.
Brownserger, however, has pushed back.
“People are not going to get in a car and drive a half an hour to go get a hit,” he said. “This needs to be near a lot of people with addiction.”
“There’s a belief that the cause of [problems at] Melnea and Cass is the presence of services,” he elaborated. “I don’t know the extent to which that is true.”
‘You can’t pass legislation into a vacuum’
Beyond hyper-local concerns about Mass and Cass residents’ opinions, though, Brownsberger says municipal and institutional anxieties are also removing a sense of urgency from this legislative process.
“The challenge is that you can’t really pass legislation on this into a vacuum,” he said. “You need a municipality prepared to support zoning and permitting. And you need an organization that is willing to run this.”
Even as communities like Somerville have expressed interest in opening a safe consumption site, Brownsberger and Fernandes agree that a combination of stigma and federal opposition to these facilities is holding many more back.
“You still see stigma even about needle exchanges,” Fernandes said. “That’s just insane to me...Stigma is not a reason to perpetuate a system that is killing — at least in Massachusetts — thousands of people.”
‘A little outside the box’
The current debate about safe consumption sites rages in a complex political climate.
Twenty two senators and representatives have signed onto Fernandes’ latest legislation.
Some, like Fernandes, hail from suburban districts hit hard by addiction.
Others represent more affluent districts that observers on the streets of Boston say effectively exile their residents battling addiction to more urban areas.
Jon Santiago, Elizabeth Malia, and Brownsburger, though, then join the bill as co-sponsors. They represent portions of Suffolk County, which includes Boston.
Outside of the legislature, harm reduction experts and emergency room workers alike are loudly calling for change, with at least one addressing state officials with impassioned comments, last month, as new data revealed a surge in overdoses amid the COVID-19 pandemic.
This bill has support. But it hasn’t taken any steps forward since coming out of committee analysis.
Organizers like Rivera and the larger South End Roxbury Community Partnership, meanwhile, are gathering and speaking out.
Opinions vary. Some, even, are not directly opposed to safe consumption sites. Regardless, there is almost universal frustration.
Beacon Hill feels out of touch, many have said in an online Facebook group. Legislators are not answering questions. And efforts feel short-sighted, failing to provide infrastructure around a proposed safe consumption site to steer people with addictions towards treatment.
“We need a comprehensive network to connect people in crisis to the services they need most urgently, starting with emergency shelter space,” one commenter wrote in that Facebook group.
“I would love to see a very thorough plan of action on this,” another chimed in. “This needs to come from the providers who serve this population.”
Back on Beacon Hill, Dylan Fernandes says he remains optimistic, nonetheless, that this bill will eventually pass.
Hearing concerns and aware of issues particularly in Boston, he’s simply calling for compassion.
Safe consumption sites, he says, are but a manifestation of that compassion.
“I hope that any moral and empathetic person would be more in favor of people keeping their lives…and gaining access to a treatment pathway rather than using deadly drugs alone and dying,” he said. “It’s time to start thinking about policies that might be a little outside the box for some people.”
Please subscribe to Substantive if you have not done so already to get a weekly email detailing the latest from Boston’s addiction community. It’s free. And you can cancel at any time…
And share this page if you know anyone who would benefit from reading this reporting…
Lastly, this conversation on safe consumption sites is an ongoing one with many stakeholders. Likewise, this is not necessarily a binary question of who is for any certain legislation and who is against it. Reach out to me with any comments or concerns you have about my reporting. And feel free to drop a line if you have personal perspective or opinion you would like to share!