What
are supervised consumption sites (supervised injection facilities, SIFs)?
A supervised injection facility is a safe, clean space where persons who inject drugs (PWID) can inject themselves with drugs that they already possess under the supervision of trained medical staff who can intervene in case of an emergency.
Does the facility provide the drugs?
No. The supervised injection facility does not supply heroin or any illegal drugs; persons who inject drugs may bring their own injectable drugs into the SIF. The facility will have life-saving, FDA-approved, legal naloxone on hand in order to counteract
overdoses, as necessary.
How
did supervised consumption site advocacy work at MMS begin?
The Massachusetts Medical Society (MMS) advocacy for supervised consumption sites (or supervised injection facilities, SIFs) has reached the most important political arenas in the Commonwealth and the country. The medical society now serves as a go-to
resource for legislators and policymakers who wonder what the state’s medical community’s position is on supervised consumption sites — spaces where people can inject drugs under clinical supervision and receive referrals to treatment and other services. Several key elected
officials, including Boston
Mayor Marty Walsh and Massachusetts
State Sen. Cindy Friedman, have moved from skepticism to openness to exploring the establishment of a facility in Massachusetts. How did we get here?
The Origin of MMS Involvement
The MMS’s work on SIFs began at the intersection of Albany Street and Massachusetts Avenue in Boston’s South End. It was the fall of 2015 and Nicholas Chiu’s first week at the Boston University School of Medicine (BUSM). Chiu had moved into a residence
hall near the stretch of Mass. Ave. commonly called “methadone mile” for its abundance of methadone clinics and the prevalence of opioid use disorder (OUD) among the neighborhood’s denizens.
Nicholas Chiu at the 2015 AMA Interim Meeting where he got his first taste of health care activism. Photo by Sang Myung Han.
Read
more on Nicholas Chiu here.
MMS support timeline
At the Massachusetts Medical Society’s Annual Meeting in 2016, the Society’s policy-making body, the House of Delegates (HOD), adopted as amended Resolution A-16 A-104, Establishment of a Pilot Medically Supervised Injection Facility in Massachusetts,
pending the conclusions of an internal, evidence-based study of the ethical, legal, and liability considerations and feasibility of a medically supervised consumption facility.
MMS Task Force on
Opioid Therapy and Physician Communications commissions a study on the efficacy
of supervised consumption sites. Read
the report here.
The report concluded
that supervised consumption facilities would bring significant harm reduction and
save lives in the wake of the Commonwealth’s devastating opioid crisis. Then, at the 2017 Annual Meeting in April, the MMS House of Delegates, by way of majority vote, adopted an organizational policy stipulating that the MMS advocate for a pilot
supervised consumption site program in Massachusetts under the supervision of a task force convened by a state authority, such as the Department of Public Health.
From there, the new
policy and the concept of a pilot supervised consumption site was made public
and MMS advocacy efforts began in earnest.
“As a physician and president of the Massachusetts Medical Society, I was initially inclined to oppose the concept of supervised injection facilities,” he wrote. “How, I thought, could a health care professional, someone grounded in ethics and an
oath to “do no harm,” stand by and watch as individuals inject street drugs into their veins?”
- Dr. Henry Dorkin
Massachusetts Medical Society Past President Dr. Henry Dorkin penned a piece on supervised consumption
sites for Stat that gained national attention.
Read the full article here.
The Massachusetts Medical Society remains a local
and national leader in advocacy efforts to establish a pilot supervised
consumption site. In the following months, the MMS brought this topic to the attention
of the media and the public.
As
opioid epidemic rages on, Massachusetts Medical Society backs supervised injection
rooms
The society's House of Delegates approved a pilot project of
supervised injection facilities (SIFs) during the group's annual meeting
Saturday. It passed by a wide margin:. "I'm tired of losing my
patients," said Dr. Mark Eisenberg, a primary care physician at the
Massachusetts General Hospital clinic in Charlestown. Eisenberg said three of
his patients died after an opioid overdose in just the past six weeks.
Massachusetts
Medical Society recommends medically supervised drug use clinics
Dr. Dennis M. Dimitri, who chaired the
society’s opioid task force, said injection clinics also decrease drug use and
drug paraphernalia in parks and on streets. And there is no evidence, he said,
that the clinics lead to an increase in drug addiction. “In an ideal world, you would like no one to be injecting
illicit substances illegally,” said Dimitri, a past president of the society.
State
commission recommends piloting supervised injection sites for illicit drug
users
The Massachusetts Medical
Society, which issued a release in support of the commission's recommendation, issued a report in 2017 in support of a pilot safe injection facility.
‘We
have to think outside the box’: Lawmakers consider safe injection sites
Supervised
injection facilities are illegal. These cities want to open them anyway
Henry
L. Dorkin, past president of the Massachusetts Medical Society, said he was
initially skeptical about supporting a facility that enables drug use, but
changed his mind after looking at the research. “The bottom line was these
people already had these drugs and they were already going to inject them,” Dorkin
said. “The only thing that’s being facilitated is saving their lives, and at
the same time, making available to them rehabilitation facilities and people
who wouldn’t be available down that proverbial dark alley where they would
normally shoot up.”
AMA
endorses trying supervised injection facilities
Massachusetts Medical Society Past President,
Dr. Dennis Dimitri, who led the task “The AMA's decision follows a similar vote by
the Massachusetts Medical Society in late April. The group said its
consideration of SIFs was "greatly assisted" by a review of research prepared
by physicians in Massachusetts.”
AAFP
endorses supervised consumption sites
Dr. Dimitri also encouraged the
American Academy of Family Physicians to explore supporting supervised
consumption facilities.
“Legal challenges and
misinformation are the main barriers to establishing supervised injection sites
in the US despite public health research in support of these sites. Public
health agencies and officials have taken steps to introduce harm reduction
strategies to combat the opioid crisis including drug courts that screen for
health needs and place individuals on pathways to treatment and rehabilitation,
expanding syringe exchange programs, and expanding the availability of naloxone
to reverse the effects of an overdose. The effectiveness of public health
interventions, including safe injection sites, underscores the importance of
treatment and recovery of, rather than punitive action against, individuals
with substance use disorders”.
Safe
injection veto frustrates San Francisco readers
Reynolds characterized
SIFs as “evidence-based interventions that save lives, [and] prevent HIV and
HCV infections”—and though the growing body of literature is still in its early
stages, many medical researchers largely agree with Reynolds. According to a
literature review by the Massachusetts Medical Society, “the existing research is rigorous and has been endorsed by many
experts and published in peer-reviewed journals…providing evidence that SIFs
achieve positive outcomes.”
Supervised
Consumption Site Infographic
Supervised
Consumption Site FAQs
Unfortunately, many residents of the Commonwealth have been impacted by the opioid epidemic. In the first six months of 2019, according to the Massachusetts
Department of Public Health, there were 611 confirmed opioid-related overdose deaths and DPH estimates that there will be an additional 292 to 363 deaths. During an opioid overdose, medical intervention with a medicine called naloxone can help save
lives. Research showed a reduction in overdose mortality by 35 percent. Importantly, SIF utilization is also associated with an increase in referral to addiction treatment, including a 30 percent increase in the rate of detoxification use and an increase
in the use of medication-assisted treatment.
Supervised consumption sites are one of many approaches that the Massachusetts Medical Society supports to reduce the harmful effects of opioid use disorder (OUD) and the opioid crisis. Because data have shown that these sites can help to reduce overdose
mortality, the MMS believes that they may be one tool to help save lives and get patients suffering from OUD on the path to medically appropriate treatment and recovery.
