After taking a trip last week to Montreal and Toronto to see multiple safe injection sites (SIF) and taking a ride-along with Canadian police, Mayor Martin Walsh said this week he was impressed with the safe injection operations he saw in those two major Canadian cities.
The trip was largely unannounced, but came as part of Walsh’s membership on the state’s new Harm Reduction Commission – which was created by the State Legislature last summer to study safe injection sites when it passed sweeping opioid legislation.
In the South End and Fenway – in particular – residents have been wary of any type of SIF in their neighborhood due to the large volume of services that already exist there. Putting any new services there so close to the epicenter of the opioid epidemic, many believe, could create a congregation of more people with drug problems – a type of “clubhouse” effect. That battle has been waged with elected officials for more than a year, as neighbors prod electeds for their positions – which seem to morph and change.
That is the case for Mayor Walsh, who told the Sun he was impressed with what he saw there, and said he wasn’t afraid to say his position is evolving on the matter. He was once adamantly against such SIFs in Boston, particularly locating any in the South End.
“In recovery, I’m not afraid to say I took a wrong position on something or I’m in the wrong place,” he said. “I’m open to it. That’s what people should do; they should evolve. When you’re talking about harm reduction it’s very complicated and very challenging. It’s not a simple fix and not like we’re building a building that’s going to be controversial for being too big or too dense. Here, we’re talking about human beings’ lives… I’m impressed with them. Anything that can be used to reduce deaths, I think, is important. It’s an option we’re looking at.”
Walsh wasn’t as strongly against siting a SIF in the South End, however, as just last September he said that would never be an option. However, he also said he wanted to meet people where they are at.
“I think we have to think about where do we put them,” he said. “I think what they do in Montreal and Toronto is they meet people where they live and what happens at Mass and Cass is people who don’t live there come there for services. I think there is an opportunity there to think about where are people coming from and is there an opportunity for a lot of people to get treatment around where they live. That’s where I’m evolving to.”
The Canadian visit was also attended by Jen Tracey of the Mayor’s Office of Recovery Services and Jess Gaeta of Boston Healthcare for the Homeless (and also a member of the Harm Reduction Commission). Both detailed their observations with the mayor at Tuesday’s meeting of the South End Forum Opiate Working Group.
Tracey said they spent two days on the trip, visiting three safe consumption sites (as they’re known in Canada) and a mobile service van in Toronto. In Montreal, they did a police ride along, visited four sites and looked in on a mobile safe consumption site van.
“We saw quite a few different models,” she said. “We saw sites integrated into a health center. We saw large sites run by the Public Health, and smaller ones as well. We saw some where they have hundreds of visits a day and some that have 30 or fewer a day. The changes in Montreal and Toronto came in the 1990s with the AIDS epidemic as they embraced harm reduction as a strategy. The culture of harm reduction is part of the culture of the communities in the cities. I don’t think it’s something we quite have here in the U.S.”
Gaeta said the typical site model includes a check-in area, a consumption area, and then a “chill out” room – which is supervised by a qualified nurse. She said a typical visit will last between one and two hours.
Both said they didn’t see an open drug market outside of any of the sites, or homeless encampments that are typical on the Mass/Cass corridor.
Some neighbors, however, have been disturbed by the increased wading into the waters of SIFs by City officials.
At the Worcester Square Area Neighborhood Association (WSANA) on Jan. 22, the matter came up and many were wary about where the City and its leaders were headed with the investigation.
That sentiment was also shared at the Working Group on Tuesday, with many residents from the South End quite riled by the fact that the Harm Reduction Commission is made up of providers and politicians – with no neighbors.
“This whole idea is being shoved down the South End’s throat by the Harm Reduction Commission that has no representation from the neighborhoods,” said Bob Minnocci, vice president of WSANA.
“If they are spread out regionally, I think we’re a lot more sympathetic,” said WSANA President George Stergios. “Our fear is something like Vancouver…If you put a SIF in Mass/Cass, it will be a huge one because there are a lot of addicts there. It will look like Vancouver. If you have one in Beacon Hill, the Back Bay, Central Square (Cambridge) and in other places spread out across the state it is a better approach. Having five, 10 or 12 across the state is more palatable…But starting out and piloting a massive one here in the South End is not palatable.”
South End Forum Moderator Steve Fox said there is quite a worry that those using in the Mass/Cass area would shoot up an average of five or six times a day – leaving no time to leave. That, he said, could create a culture of “hanging around.”
“There is a sustained concern in the South End about the fact that this giving a single person the opportunity to use it several times,” he said. “Is there a clubhouse effect to SIFs? If you put one of these in a certain, specific geography and then you could create a clubhouse effect because people stay near the facility.”
Tracey said no one is trying to shove anything down anyone’s throat, but rather they are trying look at all options.
“I don’t think anything is being shoved down anyone’s throat,” she said. “In Boston, we are looking at every initiative and service. I think it would be egregious not to…We want to save lives and at the same time create a better quality of life for neighbors.”
One major hurdle is the fact that SIFs are illegal in American, and the U.S. Attorney for Boston has routinely said they would prosecute anyone opening an unauthorized SIF in Boston.
Gaeta said there is a pathway, though, by changing state laws and deeming it part of the opiate crisis emergency declaration.
“There is a pathway in Massachusetts, but it won’t happen quickly and it’s not without risk,” she said. “There has to be political will and there has to be public buy-in. It won’t be easy, but it is possible.”
Meanwhile, Gaeta also stated that BHCH would not get involved in any potential siting discussions – even though they advocate for the concept.
“We are not going to be discussing location,” she said. “Location is something we have no interest in weighing in on.”