By State Sen. William Brownsberger
Recently, the Massachusetts Medical Society endorsed the creation of safe injection facilities for people with opiate substance use disorders.
I am the sponsor of a bill to create a framework for legal operation of these facilities. The bill is a conversation starter — it needs a lot of refinement as piece of legislation. But the bill speaks to a crying need, now that fentanyl is on the market being sold as heroin.
Safe injection facilities bear no resemblance to the chaotic shooting galleries where people die in the dark, slouched against bare brick. They are quasi-medical clinics where people check-in and then enter an adequately lit individual al cove and, while visible to trained professionals, self-administer the chemicals they have purchased elsewhere. Once it appears that they are not dying of an overdose, they can leave or go to a quiet place.
The facilities offer a unique opportunity to offer drug treatment and AIDS counseling. Properly run, safe injection facilities can be a tool, not only for reducing the harms of addiction, but also for fighting addiction itself.
Every day in Massachusetts, thousands of people inject street chemicals into their blood – many of them with enough education to know that they are taking wild risks: risks of infection, risks of poisoning, risks of deaths from overdose. Even as obvious signs of harm emerge – ugly infected abscesses at the spot of injection, friends dying around them — they continue.
That is the essence of the disease: seeking pleasure or relief from compulsive need with denial of – absolute emotional blindness to — emerging harms.
Making drug use safer does not enable or encourage drug use.
People with addictions are already blind to the harm and very bad at making rational choices. Safe injection facilities simply protect them from the worst consequences of their irrationality.
Over the past five years, the death rate from overdose has tripled in Massachusetts. While opiate addiction has been spreading and is now tragically endemic among people of all ages, the death rate appears to be growing much faster than addiction.
Fentanyl is one of a family of highly potent chemicals which, in microscopic doses, feel like heroin and are now widely available on the black market, often sold as heroin. Because they are so potent, they are heavily mixed with inert substances before sale. Mixes prepared by amateurs will inevitably be uneven – some doses from the mixture will be much more potent than others.
As reckless as they are, many addicts use some caution in the injection process and have a sense of their own tolerance and limits. With fentanyl though, they have no idea of what they are doing to themselves and that is why fentanyl is now the most frequently identified chemical in overdose deaths. With fentanyl rampant, we need safe injection facilities more than ever.
The real political challenge for creation of a safe injection facility is finding the private and municipal leadership to create one. In Vancouver, where they have a very well-studied SIF, the political conditions may have been rather unique – there is a neighborhood with a very high concentration of drug users who organized themselves politically. In Massachusetts, it remains to be seen whether we have a neighborhood that is willing to host such a facility.
Until we have a concrete, professional proposal for a facility and the support of local officials, it will be hard for the legislature to focus on my proposed legislation.
The version of this post at willbrownsberger.com includes links to additional resources. As always, I appreciate hearing from folks on the web or at [email protected] or 617-771-8274.