Massachusetts Medical Society: MMS becomes first state medical society to endorse pilot supervised consumption site

MMS becomes first state medical society to endorse pilot supervised consumption site

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
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.

efficacy of supervised consumption sites


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.


    logos


      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.

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