Testimony on Medically Supervised Injection Facilities

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.

  1. 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
  2. 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.

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