Time for action on safe consumption facilities

Evidence is clear on benefits of supervised injection sites

WITH FIVE MASSACHUSETTS residents dying from overdose every day, our Legislature must move quickly to implement additional lifesaving tools to address the overdose crisis. The recent decision by a federal judge in favor of a Philadelphia non-profit seeking to open a supervised consumption facility (SCF) (United States v. Safehouse) should catalyze such action.

Safe consumption facilities (SCFs) are designed to provide safe places for people who use drugs to do so under medical supervision and with access to sterile equipment. Such facilities are highly effective in reducing drug-related harms and are cost-effective.

Since the first supervised drug consumption facility opened in 1986, more than 120 such sites have proliferated throughout Europe, Canada, Australia, and Mexico. Communities with SCFs experience decreases in HIV incidence, HIV prevalence, injection-related injuries, injection-related litter and disorder, and HIV risk behaviors related to injection drug use. Use of SCFs is associated with uptake of drug treatment services; moreover, there have been no documented increases in crime or public disorder in the areas surrounding SCFs.

Our Commonwealth struggles to contain the precise types of drug-related harms that SCFs are proven to address. Although drug overdose rates in Massachusetts may be stabilizing, they remain at unacceptably high levels. The spread of infectious disease attributable to injection drug use is an acute public health crisis, most tragically illustrated in the recent outbreak in HIV and hepatitis cases in the northern part of our state. Access to evidence-based treatment and harm reduction services remains uneven.

In a number of urban areas, pervasive levels of street drug consumption and litter have prompted conflict and reactive actions like the recent Operation Clean Sweep in Boston. Such actions are not rooted in evidence of sustained positive impact, and instead aggravate the very problems they purport to address by destabilizing and criminalizing vulnerable individuals, while wasting taxpayer resources. To address public injection and disorder that serves as the motivation for Operation Clean Sweep and similar actions, we must instead turn to the extensive evidence base of SCF effectiveness and cost-effectiveness.

Legislation now on Beacon Hill is intended to do exactly that. Reps. Dylan Fernandes and Tami Gouveia introduced H.1712, which that directs the Department of Public Health (DPH) to promulgate regulations authorizing a pilot program for SCFs. The Senate version, S.1134, filed by Sen. Joseph Boncore instead directs DPH to merely evaluate the feasibility of SCFs in the Commonwealth. The Joint Committee on Mental Health, Substance Use, and Recovery heard public testimony on both bills on October 1.

These legislative proposals are a step in the right direction, but they may not go far enough. Most importantly, further study and small-scale pilots on this issue would cause unnecessary delay and cost lives. The overdose crisis requires immediate action on the part of state and local government, while proposed legislation does not reflect the urgency with which government must respond.

Just this past spring, the Commonwealth’s Harm Reduction Commission conducted a comprehensive review of the evidence base, legal issues, and other considerations related to implementing SCFs in our state, at the behest of the Legislature.

In conducting numerous hearings, consultations, and deliberations, the interdisciplinary body concluded that “supervised consumption sites are an effective harm reduction tool in the countries where they have been implemented… A pilot program of one or more supervised consumption sites should be part of the Commonwealth’s efforts to combat the opioid crisis.” These findings echo those of similar reviews at various levels of government and well-respected academic and policy institutions throughout the United States.

Numerous Massachussets policymakers, Gov. Charlie Baker among them, have stated their opposition to SCFs in the Commonwealth based on the belief that they violate federal law. Some of this hesitation may stem from statements made by US Attorney Andrew Lelling and other federal law enforcement officials.

The Safehouse decision challenges this view. In his recent decision, Judge Gerald McHugh strongly rejected the government’s argument that the Controlled Substances Act’s “Crackhouse Statute” bars the operation of SCFs. As the judge correctly noted, Safehouse (the proposed SCF in Philadelphia) is a legitimate public health measure and “no credible argument can be made that facilities such as safe injection sites were within the contemplation of Congress either when it adopted [the Crackhouse Statute] in 1986, or when it amended the statute in 2003.” Notably, Pennsylvania has not promulgated a state law authorizing SCFs; state authorization, such as that pending on Beacon Hill, would put such a facility on even stronger footing.

The Safehouse decision is by no means final; indeed, the US attorney who brought the action against Safehouse stated: “Today’s opinion is merely the first step in a much longer legal process that will play out. This case is obviously far from over.” But even if the Safehouse decision is not upheld or if other jurisdictions come to conflicting conclusions on this point, Massachusetts should still choose to pursue its own policy path. This is precisely what our Commonwealth has done on cannabis. Absurdly, under federal law, cannabis appears in Schedule I alongside heroin, potentiating the very same levels of criminal liability for its unauthorized possession and any other activities; and yet, sale of adult-use cannabis is now a standard feature of life in Massachusetts.

To distinguish SCFs from the advent of the cannabis industry, many policymakers have pointed to threatening statements by federal law enforcement regarding SCFs, both locally and on the national level. But the fact of the matter is that officials from the Trump administration’s Department of Justice have made almost identical statements threatening federal enforcement actions in regards to cannabis. Little discernible action followed.

Additionally, officials who led federal policy regarding SCFs, including former attorney general Jeff Sessions and his deputy, Rod Rosenstein, have since left the administration. It would be an abrogation of our duty to the residents of Massachusetts to base state public health response on what any federal official has said—especially in the context of this particularly chaotic administration. Although opposition to SCFs may remain federal policy for the moment, we must do what is right by the people of Massachusetts and be prepared to defend it in court, if necessary.

From vaccination mandates to universal health insurance coverage, Massachusetts has led the way in crafting evidence-informed public policy to protect its residents, even in the face of controversy; this issue should be no exception.

Meet the Author
Meet the Author

Leo Beletsky

Assoc. Prof. of Law & Hlth Sci, Northeastern University
As the overdose crisis continues to ravage our state, SCFs are a vital tool we cannot continue to ignore.

 Jessica Bresler is a third-year student at Northeastern University School of Law and chair of its Drug Law and Policy Society. Leo Beletsky is a professor of law and health sciences at Northeastern and director of the Health in Justice Action Lab.