By: Henry L. Dorkin, M.D., FAAP
President, Massachusetts Medical Society
BOSTON CITY COUNCIL HEARING #0819
Committee on Homelessness, Mental Health and Recovery
Monday, June 19, 2017 – 2:00 PM – Boston City Hall
Committee Chair: Councilor At-Large Annissa Essaibi-George
With
the opioid epidemic continuing to grow as a public health crisis, physicians of
the Massachusetts Medical Society have expanded their advocacy and education
efforts in response. To
some extent, our efforts have worked. We have had 10,000 unique users of our
free online CME programs on opioid prescribing, and between the beginning of
2015 and the beginning of 2016, we saw a more than 20% drop in prescriptions. But
the epidemic rages on, especially among those it had already touched. Last
year, the state saw 2,000 opioid-related overdose deaths. We need to save
lives.
In response to the epidemic, at
our 2016 Annual Meeting last spring, the House of Delegates, the Society’s
policymaking body, passed a resolution stipulating that we study the concept of
medically supervised injection facilities and that our Board of Trustees report
back with recommendations.
- That the MMS perform an internal
evidence-based study of the ethical, legal, and liability considerations
and feasibility of a medically supervised injection facility in
Massachusetts
- That at the
conclusion of an internal study of medically supervised injection
facilities, the Board of Trustees will report back to the House of
Delegates, no later than A-17, with recommendations for an MMS advocacy
position on SIF.
Medically
supervised injection facilities, also known as supervised or safe injection
facilities (SIFs) or supervised consumption facilities, are a harm-reduction
strategy designed to reduce overdose fatalities and other harms associated with
illegal drug use. Specifically, a SIF is a legally approved public health
facility that offers a hygienic environment where people can self-inject
previously acquired illicit drugs under the supervision of trained staff. Some
facilities also allow people to smoke illicit drugs. Staff are medical
professionals who are prepared to provide emergency care, including naloxone,
when needed. Importantly, SIFs do NOT supply illicit drugs to the patients. The
patients themselves must bring their own. SIFs also facilitate referrals to
recovery programs upon patient request.
Many MMS members were
skeptical about this approach when this resolution was first proposed, but kept
an open mind as the task force worked to prepare its report and review the
evidence. While conducting the research, we continued our advocacy on
other life-saving efforts, such as improved access to naloxone and access to
comprehensive treatment for those in recovery.
When the report on SIFs
was completed, we reviewed the data and discovered there is a clear,
evidence-based argument in support of SIFs as a harm reduction approach.
Specifically, SIFs reduce harms associated with drug use by reducing overdose
deaths by 35%; provide an alternative to unsafe injection practices that lead
to HIV, HCV, and other diseases; and facilitate entry into drug treatment,
including a 30% increase in detoxification and an increase in methadone
maintenance initiation. SIFs can also protect persons who inject drugs,
especially women, from street violence associated with public injectable drug
use.
Before SIFs opened in
other countries across the globe decades ago, there were concerns of negative
consequences within the communities they served, but the reality has not borne
these out. There has been a reduction in public injection and related litter,
crime has not increased, and zero deaths have been reported despite the recent increase
in the potency of drugs being used, including fentanyl and carfentanil. In
fact, after initial reticence, both business leaders and law enforcement in
Vancouver have expressed support for that city’s SIF, and police and Vancouver
SIF staff maintain a productive and positive relationship as they continue to
combat the disease of addiction and improve public order in their community.
SIFs
not only save lives and improve health, they save money. Johns Hopkins
University estimates demonstrate that “at an annual cost of $1.8 million, a
single SIF would generate $7.8 million in savings, preventing 3.7 HIV
infections, 21 Hepatitis C infections, 374 days in the hospital for skin
and soft-tissue infection, 5.9 overdose deaths, 108 overdose-related ambulance
calls, 78 emergency room visits, and 27 hospitalizations, while bringing 121
additional people into treatment.” Recently, San Francisco researchers published findings indicating
that a 13-booth SIF could save $3.5 million annually in that city.
With
the research complete, at our recent Annual Meeting, our House of Delegates overwhelmingly
passed a resolution that we advocate for a pilot SIF program to be run by a
state-led task force. Our message is that it is appropriate for the state to
consider a pilot program to see if the success that other countries have
reported would be reflected in the Commonwealth of Massachusetts. We believe
that any decisions to be made about the logistics of such a program – including
location(s) – be made by a collaborative task force that represents a variety
of stakeholders engaged in public service and public health.
National
interest in this issue is growing as other states confront the same epidemic. Just
last week, the American Medical Association voted to support the development of pilot facilities in the U.S. where
people who use intravenous drugs can inject self-provided drugs under medical
supervision.
In closing, it is important to remember that
SIFs are not experimental. Research from decades of operation in countries
across the world show that SIFs are a proven strategy, one piece of a larger, comprehensive
continuum of healthcare to aid those struggling with addiction. Therefore, we
urge Massachusetts, as a world leader in pioneering, compassionate healthcare,
to establish a state-led task force to consider piloting SIFs in the
Commonwealth. The current opioid epidemic
represents the greatest public health crisis our state has faced in recent
memory. Therefore, it will take a variety of brave and innovative strategies to
change its course. SIFs should be one of those strategies.
We thank the Boston City Council for bringing
together a variety of voices to evaluate whether SIFs may be an effective tool
at saving lives in our communities.
