Rep Ryan, Mayor Walsh Not Sold on Hosting Safe Injection Facility

September 8, 2017
By

By Seth Daniel

A major showdown over safe injection facilities (SIFs) for opiate users took place on Beacon Hill this week, with a hearing on a proposed bill that would potentially allow such facilities in Massachusetts.

However, though many in the medical community are in favor – including prominent physicians in Charlestown like Dr. Mark Eisenberg, local leaders still aren’t exactly convinced.

The State House hearing took place on Wednesday, Sept. 6, too late for Patriot-Bridge deadline.

On Tuesday night, a public meeting in Boston, Mayor Martin Walsh officially announced he would oppose the bill – which is put forth by Sen. William Brownsberger, who lives in Belmont but represents areas of Boston like the Back Bay.

“I had a couple firefighters who went to Vancouver to look at the facility there, actually both of them in long-term recovery, and they both said to me there’s no way on Earth we want to bring that kind of facility to Boston,” he said. “I’m not a heroin addict, I’m an alcoholic that’s sober, but having a safe place to inject heroin is not a good move. People may disagree with me and say psychologically it’s a good move. I don’t think it’s a good move. I think we need to find better ways to get people treatment – ways to get people off heroin and not encouraging them to go to a safe space to shoot heroin… That’s my concern. The bill at the Legislature I will be opposing along with some other city councilors over the course of the next couple of weeks.”

Others standing against the bill include Councilors Michael Flaherty, Frank Baker, and Tim McCarthy.

Brownsberger’s bill came following a vote of the Massachusetts Medical Society (MMS) last year that called for a task force to begin looking at how to site a Safe Injection Facility (SIF) in the state.

State Rep. Dan Ryan, whose committee hosted this week’s SIF hearing on Brownsberger’s bill, said he wasn’t convinced that giving people the tools to use heroin was a good idea.

He said his opinion came out of many years of doing harm reduction in Charlestown with the Charlestown Coalition. He said some years ago, he agreed to the controversial needle exchange program to prevent dirty needle usage, but he said he always has hesitations.

“Our committee is in the very early stages of looking at safe injections sites as a harm reduction tool for fighting the heroin epidemic,” he said. “There are far more questions than answers as to the validity to this program. I think we all want to save the lives of people in the throes of addiction. But giving an addict the means in which to inject needs to be a last resort not an issue of convenience.”

On Tuesday, Walsh said he thinks a SIF might encourage people who are on the bubble of using heroin.

“What that means is people who might be on the bubble of shooting heroin, and may not be shooting heroin today, might think they’re going to a safe space to shoot heroin and it’s okay to shoot it there,” he said. “I think we need to try other ways. The epidemic we have in the city now is not new. We’ve had this epidemic for 15 years, but they just started calling it an epidemic a couple of years ago. It was an epidemic 15 or 20 years ago. I think there are better ways of dealing with the issue of addiction than having safe sites.”

He said he joked with Sen. Brownsberger about his bill, saying that maybe they should put the first SIF in Belmont.

“Sen. Brownsberger is a friend, but what I said to him was the first facility, why not propose it for Belmont and if they like it there, we’ll take it in Boston,” he said jokingly.

  • DonHonda

    Portugal is held up as the gold standard for “decriminalizing” drugs and not “judging” the addict. Their programs has some success due to wrap-around services and is mandatory. Drug dealing is still illegal and dealt with harshly. Other EU countries tried to emulate the program. With the 2008 recession, their budgets were slashed for the addicts in program and caused overdoses, increased crime, and increased disease transmission, increased homelessness. Can you see us having an Injections Site AND wrap-around services? I don’t believe there will be funding for both. Why not use any proposed funding and increase needed detox/rehab facilities and sober living environments along with all the needed physical/mental health and social services. The way I see it, Injections Sites are prolonging the suffering and misery of the addict with the usual end result of death. Which would be more compassionate?

    http://www.globaldrugpolicy.org/Issues/Vol%201%20Issue%203/A%20Critical%20Evaluation.pdf

    THE JOURNAL OF GLOBAL DRUG Policy AND PRACTICE
    A Critical Evaluation of the Effects of Safe Injection Facilities
    Garth Davies, Simon Fraser University

    Conclusion: Taking Causality Seriously
    On the subject of the effects of SIFs, the available research is overwhelmingly positive. Evidence can be found in support of SIFs achieving each of the goals listed at the beginning of the evaluation. In terms of our level of confidence in these studies,the assessment offered here is far less sanguine. In truth,none of the impacts attributed to SIFs can be unambiguously verified. As a result of the methodological and analytical problems identified above, all claims remain open to question.

    http://www.hc-sc.gc.ca/ahc-asc/pubs/_sites-lieux/insite/index-eng.php

    Vancouver’s INSITE service and other Supervised injection sites: What has been learned from research?

    Final report of the Expert Advisory Committee

    http://www.kiro7.com/news/local/councilwomans-idea-for-seattle-safe-injection-site-locations-belltown-lake-city/466411868

    “At the Vancouver site, the manager said since opening in 2003, the overdose death rate in the area around the clinic has dropped 35 percent. But the clinic also estimates 15 to 20 percent of people using the site come from other parts of the country specifically for it.”

    http://www.seattletimes.com/seattle-news/health/is-vancouvers-safe-drug-use-site-a-good-model-for-seattle/
    “Although research appears to bear that out, many of the studies that attest to Insite’s success are small and limited to the years after the center opened. For instance, a 2011 study published in the journal The Lancet found a 35 percent reduction in overdose deaths in the blocks surrounding Insite, versus 9 percent in the rest of Vancouver.

    But that often-cited study looked only at the period two years before and two years after the center opened, not the ensuing decade.”

    http://www.seattletimes.com/seattle-news/health/is-vancouvers-safe-drug-use-site-a-good-model-for-seattle/

    “Although Insite is paired with a drug-treatment center, called Onsite, Berner and other critics point out that completion rates are low. Of the 6,500 people who visited Insite last year, 464 were referred to Onsite’s detox center. Of those, 252 finished treatment.”

    The Vancouver Insite was placed in a crime-ridden, drug-ridden, low-income neighborhood. It only got worse.

    http://www.seattletimes.com/seattle-news/health/is-vancouvers-safe-drug-use-site-a-good-model-for-seattle/
    “Although the Insite center is a model, the Vancouver neighborhood surrounding it is nothing to emulate, advocates acknowledged.

    “If I came from a city like Seattle and I went to that Insite place, it would scare the hell out of me,” Kral said. “I would think, ‘Are we going to create one of those?’ ””

    http://news.nationalpost.com/news/vancouvers-gulag-canadas-poorest-neighbourhood-refuses-to-get-better-despite-1m-a-day-in-social-spending
    Vancouver’s ‘gulag’: Canada’s poorest neighbourhood refuses to get better despite $1M a day in social spending

    What do you think would happen if this was placed in a middle-class neighborhood, or, ANY neighborhood?

    https://www.youtube.com/watch?v=audzsuRMWBE&t=586s
    https://www.youtube.com/watch?v=wwJkqTZ5H_s

    http://news.nationalpost.com/news/canada/brian-hutchinson-thousands-of-used-drug-needles-have-become-the-new-normal-for-vancouver
    4/27/2016
    Brian Hutchinson: Finding used drug needles in public spaces has become the new normal for Vancouver

    http://www.huffingtonpost.ca/mark-hasiuk/insite-vancouver_b_3949237.html

    “Ten years later, despite any lofty claims, for most addicts, InSite’s just another place to get high.”

    The 100% positive studies on Vancouver’s Insite (Safe Injection Facility) was done “Early last decade, Montaner and Kerr lobbied for an injection site. In 2003, the Chretien Liberals acquiesced, gave the greenlight to B.C.’s Ministry of Health, which, through Vancouver Coastal Health, gave nearly $1.5 million to the BC Centre (that’s Montaner and Kerr, you remember them) to evaluate a three-year injection site trial in Vancouver.

    I asked him about the potential conflict of interest (lobbyists conducting research) and he ended the interview with a warning. “If you took that one step further you’d be accusing me of scientific misconduct, which I would take great offense to. And any allegation of that has been generally met with a letter from my lawyer.”

    Was I being unfair? InSite is a radical experiment, new to North America and paid for by taxpayers. Kerr and company are obligated to explain their methods and defend their philosophy without issuing veiled threats of legal action.”

    In the media, Kerr frequently mentions the “peer review” status of his studies, implying that studies published in medical journals are unassailable. Rubbish. Journals often publish controversial studies to attract readers — publication does not necessarily equal endorsement. The InSite study published in the New England Journal of Medicine, a favourite reference of InSite champions, appeared as a “letter to the editor” sandwiched between a letter about “crush injuries” in earthquakes and another on celiac disease.”

    Really? What kind of “science” produces dozens of studies, within the realm of public health, a notoriously volatile research field, with positive outcomes 100 per cent of the time? Those results should raise the eyebrows of any first-year stats student.”

    And who’s more likely to be swayed by personal bias? InSite opponents, questioning government-sanctioned hard drug abuse? Or Montaner, Kerr and their handful of acolytes who’ve staked their careers on InSite’s survival? From 2003 to 2011, the BC Centre received $2,610,000 from B.C. taxpayers to “study” InSite. How much money have InSite critics received?”

    There has never been an independent analysis of InSite, yet, if you base your knowledge on Vancouver media reports, the case is closed. InSite is a success and should be copied nationwide for the benefit of humanity. Tangential links to declining overdose rates are swallowed whole. Kerr’s claims of reduced “public disorder” in the neighbourhood go unchallenged, despite other mitigating factors such as police activity and community initiative. Journalists note Onsite, the so-called “treatment program” above the injection site, ignoring Onsite’s reputation among neighbourhood residents as a spit-shined flophouse of momentary sobriety.”

    http://www.hc-sc.gc.ca/ahc-asc/pubs/_sites-lieux/insite/index-eng.php

    Reducing the Transmission of Blood-Borne Viral Infections & Other Injection Related Infections

    “Self-reports from users of the INSITE service and from users of SIS services in other countries indicate that needle sharing decreases with increased use of SISs. Mathematical modeling, based on assumptions about baseline rates of needle sharing, the risks of HIV transmission and other variables, generated very wide ranging estimates for the number of HIV cases that might have been prevented. The EAC were not convinced that these assumptions were entirely valid.
    SISs do not typically have the capacity to accommodate all, or even most injections that might otherwise take place in public. Several limitations to existing research were identified including:
    Caution should be exercised in using mathematical modelling for assessing cost benefit/effectiveness of INSITE, given that:
    There was limited local data available regarding baseline frequency of injection, frequency of needle sharing and other key variables used in the analysis;
    While some longitudinal studies have been conducted, the results have yet to be published and may never be published given the overlapping design of the cohorts;
    No studies have compared INSITE with other methods that might be used to increase referrals to detoxification and treatment services, such as outreach, enhanced needle exchange service, or drug treatment courts.
    Some user characteristics relevant to understanding their needs and monitoring change have not been reported including details of baseline treatment histories, frequency of injection and frequency of needle sharing.
    User characteristics and reported changes in injection practices are based on self-reports and have not been validated in other ways. More objective evidence of sustained changes in risk behaviours and a comparison or control group study would be needed to confidently state that INSITE and SISs have a significant impact on needle sharing and other risk behaviours outside of the site where the vast majority of drug injections still take place.”

    “It has been estimated that injection drug users inject an average six injections a day of cocaine and four injections a day of heroin. The street costs of this use are estimated at around $100 a day or $35,000 a year. Few injection drug users have sufficient income to pay for the habit out through employment. Some, mainly females get this money through prostitution and others through theft, break-ins and auto theft. If the theft is of property rather than cash, it is estimated that they must steal close to $350,000 in property a year to get $35,000 cash. Still others get the money they need by selling drugs.”

    https://www.scientificamerican.com/article/massive-price-hike-for-lifesaving-opioid-overdose-antidote1/
    Massive Price Hike for Lifesaving Opioid Overdose Antidote

    Suddenly in demand, naloxone injector goes from $690 to $4,500

    Should we follow the money? Who would be profiting bigly from the increased use of naloxone?

    https://www.bramptonguardian.com/community-story/7520683-money-and-resources-for-drug-rehabilitation-sorely-needed-in-peel-say-advocates/

    “Setting up free injection sites to deal with the recent spate of drug overdoses does not address the root of the opioid problem, says Ted Brown, executive director of Brampton’s Regeneration Outreach Community.

    Instead, Queen’s Park and other tiers of governments should consider investing resources and dollars toward rehabilitation programs to help those dealing with addiction and mental health issues, said Brown. ”

    http://www.bcmj.org/premise/supervised-injection-sites%E2%80%94-view-law-enforcement
    Supervised injection sites—a view from law enforcement

    Jamie Graham, former chief of Vancouver Police has outlined the successful model of dealing with an epidemic: Support, mandatory treatment, abstinence, and counseling as all part of the solution. My recover(ed)(ing) addict friends say they would agree.

    https://mosaicscience.com/story/iceland-prevent-teen-substance-abuse
    Iceland knows how to stop teen substance abuse but the rest of the world isn’t listening

    In Iceland, teenage smoking, drinking and drug use have been radically cut in the past 20 years. Emma Young finds out how they did it, and why other countries won’t follow suit.

    https://www.usatoday.com/story/news/nation-now/2017/05/05/pigeon-nest-needles-highlights-vancouvers-drug-problem/101323878/

    Pigeon nest of needles highlights Vancouver’s drug problem

    Some graphs about how overdoses in Vancouver, BC have increased:

    https://uploads.disquscdn.com/images/4937e3e285c02900541696be294c99859dd986654fc2ea3b3b1f41f673618dc7.png

    One more: https://uploads.disquscdn.com/images/d2f8aa542d4033a1f198a3b0e3e802482a4becf1e45b04e77079e989e5c6460a.jpg