We Can Do More to Treat the Opioid Crisis TODAY

Those of us living or working in the South End, Roxbury and Newmarket witness the opioid crisis’ devastating impact every day. While we are encouraged by the devotion of public health and elected officials in exploring novel treatments, even those which are currently illegal, we also note that effective treatment options, approved by the Federal Drug Administration (FDA), have not been fully exhausted either in Boston or other cities in Massachusetts.

We believe these treatments should be more broadly offered to those suffering from addiction.

Public officials, Boston residents, and the media have recently showcased Safe Injection Facilities (SIFs), which would enable people to inject heroin under the supervision of medical professionals, lessening the chances of overdosing. Supporters note that no deaths have occurred inside of a SIF worldwide and that SIFs teach safe injection techniques, provide clean needles to decrease hepatitis C and HIV transmission, and increase access to primary care for a marginalized population. They claim that SIFs can also lead to referrals to recovery programs and Vancouver’s original SIF’s proponents claim a death reduction within the neighborhood. Many of these services are already provided today by the needle exchange (A-HOPE) and overdose observation center (SPOT) on the edge of the South End, Roxbury, and Newmarket.

Opponents note that the most frequently cited study supporting SIFs only counted deaths that occurred within a third of a mile of the Vancouver SIF. Further, a 2007 New South Wales University (Australia) Report found that for 1,000 visits to a Sydney SIF, there were only 2.66 referrals for drugs used to quit heroin over a six-year period. More recently, the British Columbia coroner’s office August 2018 data shows that the opioid overdose death rate throughout British Columbia continues to increase to this day, even with the placement of more SIFs. In fact, on July 27, 2018 alone, 130 suspected opioid overdoses occurred within Vancouver.

While the legal debate and professional liability and ethics questions surrounding SIFs remain within Massachusetts, people are still dying every single day. Fortunately, we can do more today without violating state or federal laws by opening up SIFs.

It is important to focus on what we can legally do today given that the evidence for current treatment that shows an increase in people recovering from substance abuse disorders and a reduction in death over the long term. We agree with the calls to raise reimbursement for treating patients who suffer from opioid use disorders given the necessary added services like urine testing. Increased reimbursement will drive more physicians to become involved and others to increase their patient load. Additionally, we encourage the treatment of Opioid Use Disorders within primary care offices. We believe the state should cite additional Methadone and Suboxone clinics in areas where they are most needed. As the State funded Health Policy Commission notes, treatment facilities are often not located in the most opioid-burdened areas. We also encourage the Massachusetts Health and Human Services Department to review state-owned properties and explore public/private relationships to facilitate the placement of additional clinics in underserved areas.

Lastly, we call attention to the idea of a federal waiver on certain Methadone regulations. A federal waiver would allow the Massachusetts Health and Human Services Department to regulate Methadone, allowing localized solutions to the opioid crisis. For example, Australia and the United Kingdom allow Methadone to be provided in a community pharmacy setting. Portugal has utilized mobile vans to increase Methadone access. In the US, San Francisco has a program that allows enrolled doctors to provide Methadone outside of a traditional Methadone clinic. In general, state-controlled Methadone regulation will allow rapid exploration for ways to help patients. We encourage high-profile regional officials to also voice their support.

There is a tendency in times of frustration to reach out and grasp at straws for solutions. This sometimes leads to a desire to try new things without exhausting all of the ways we can increase access to legal, FDA-approved therapies today. We recognize that there is no magic bullet to solving the opioid crisis. But if our ultimate goal is to save lives based on years of evidence, we should encourage and remind the public that FDA approved medicines like methadone and suboxone do exist, have proved to be efficacious and that there is a need for increasing access throughout Massachusetts.

Annissa Essaibi George, Boston City Councilor-at-Large, Chair of the Homelessness, Mental Health and Recovery Committee

Desmond Murphy, PharmD, RPh, South End Resident

Bob Minnocci, South End Resident, Vice President, Worcester Square Area Neighborhood Association (WSANA)

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