In the years since Somerville officials began pushing to open the first supervised drug consumption site in Massachusetts, City Council President Matthew McLaughlin says he has heard an increasingly common refrain from opponents: "We don't want another Mass. and Cass."
But to McLaughlin, the snowballing crisis of addiction and homelessness at the intersection of Massachusetts Avenue and Melnea Cass Boulevard in Boston makes the exact opposite case.
"Mass. and Cass exists right now, and it's exactly why we need new thinking on how to address this problem," McLaughlin told legislators at a hearing Monday. "The problems that people fear with safe consumption sites exist right now with no supervision at all. There are unsafe consumption sites all over the commonwealth, all over the state and the nation where people are openly using drugs with no medical assistance, no resources, nothing to prevent overdoses or help people get off drugs."
Doctors, addiction experts and community advocates have been arguing for years that Massachusetts needs dedicated facilities where people can use drugs — acquired on their own — under the watch of medical professionals, who would revive them after possible overdoses, prevent disease transmission and try to connect those caught in the throes of addiction with treatment.
The idea has earned support from President Joe Biden's nominee to serve as U.S. attorney in Massachusetts and from a panel chaired by Gov. Charlie Baker's top health and human services deputy, but it has yet to gain momentum among legislative leaders or Baker himself amid concerns that embracing supervised consumption sites would violate federal law.
"They're obviously extremely controversial within the addiction community," Baker when asked about the issue on Monday afternoon. "I would much rather put people into treatment, and I think that should be our primary focus."
While neither House Speaker Ronald Mariano nor Senate President Karen Spilka endorsed supervised consumption sites, they both signaled Monday in the wake of a lengthy committee hearing that they might be open to the proposal.
"It's my belief that we're still in the middle of a crisis situation, an opioid crisis, so right now, I'm willing to take a look at just about anything that will help improve the situation," Mariano said. "I'm anxious to hear the pluses and the minuses around the debate about a site."
"The hearing just occurred on it, so I also am looking forward to hearing from the chairs and the members as to what they hear for the most recent, up-to-date statistics and information about it," Spilka added. "I know it's been successful in some countries. There are many members that want to go forward with it, so I'm looking forward to hearing the information that was gleaned at the hearing today."
In February 2019, after then-U.S. Attorney Andrew Lelling indicated he would pursue "federal enforcement" against any such site, Baker said he would rather "focus on the stuff that we can do now."
"Chasing something that's not legal under federal law just doesn't make a lot of sense," Baker said.
Lelling, a Trump appointee, stepped down at the end of February, and his departure could portend a major shift on the issue. Biden's pick for the next U.S. attorney, Suffolk County District Attorney Rachael Rollins, has been willing to try new approaches in law enforcement and on record for years as a supporter of safe consumption sites.
"Investing resources in evidence-based solutions, such as Safe Consumption Sites, isn't just the right thing to do; it's the smart thing to do," Rollins wrote to lawmakers in October 2019 voicing support for a pilot program.
Rollins will need to secure confirmation from the U.S. Senate to take the reins as the Bay State's top federal prosecutor. On Thursday, the Senate Judiciary Committee postponed for one week its scheduled vote on Rollins's nomination.
She is not alone among Massachusetts district attorneys supporting supervised consumption sites. Berkshire County District Attorney Andrea Harrington on Monday said the facilities are "empirically proven to save lives."
The most recent annual overdose death numbers increased 44 percent in Berkshire County, compared to 5 percent in the rest of the state, Harrington said.
"My community's community-based prevention services and our EMS providers and our police are asked to pick up the pieces reactively," Harrington said. "We are asking the Legislature to be proactive, to help our communities implement strategies that save people and protect public health."
Legislation before the Mental Health, Substance Use and Recovery Committee (H 2088 / S 1272) would launch a 10-year pilot program establishing at least two supervised consumption sites in Massachusetts, regulated and licensed by the Department of Public Health.
Sterile injection supplies would be provided at the facilities, where personnel would be available to administer first aid in overdose cases and help users access addiction treatment services.
The committee advanced a similar bill last session, but it died without a vote in the Joint Committee on Health Care Financing. The Senate also included pilot program language in an opioid response bill three years ago, but House negotiators did not agree to the measure and it did not feature in the final law.
Over more than five hours of testimony on Monday, supporters and a handful of opponents aired their cases to lawmakers, warning that the state is foregoing a chance to save lives through its inaction.
Dr. James Recht, a psychiatrist specializing in addiction treatment, said many cities that open supervised drug consumption sites saw a decrease in overdose death rates and public drug use while the facilities helped connect a higher share of individuals using drugs to supportive services.
"It takes time for people with substance use problems to get into treatment. It takes time to gain insight. It takes time to overcome shame, and time is being cut short by opioid overdoses," Recht said, videoconferencing into the hearing while doing outreach on the streets of Boston. "This is true more than ever now with the prominence of synthetic, high-potency opioids like fentanyl. They cut time short. To state the horribly obvious: my patients cannot access treatment after they have died from opioid overdose."
In May, state officials reported a record high 2,104 confirmed and estimated opioid deaths in 2020.
Boston City Councilor Frank Baker, whose district includes the Mass. and Cass area, criticized the push for supervised consumption sites, warning they will not serve as "the silver bullet people think they are."
Piloting such a location near the "living hell" at Mass. and Cass, Councilor Baker said, would be "totally turning a blind eye and ear to the residents of that part of town."
"I don't question the fact that safe injection sites save lives. Of course they do, but I don't think that this is what we should be focused on," he said. "We are trying to decentralize, and I believe by adding this, we would be adding to our problem."
Instead, Councilor Baker urged lawmakers to direct additional state funding to Boston to stand up a treatment facility for women near the intersection.
Sen. Julian Cyr, who co-chairs the Mental Health Committee and co-filed the bill, replied that a supervised consumption site could serve as a tool in the area at some future point, but would take too long to launch to address the problems today.
"It's shocking and it's unacceptable in a state with the amount of resources like Massachusetts that we can allow people to live in those conditions," Cyr said. "A number of things need to be done around Mass. and Cass immediately."
Several cities in Canada have supervised consumption sites, sometimes referred to as safe injection sites. In July, Rhode Island became the first state in the U.S. to approve a supervised consumption site pilot program, and a nonprofit in Philadelphia is also fighting in court to open a facility there.
Amid the ongoing debate, Somerville officials continue to take steps toward launching their own supervised consumption site in the city. Somerville Health and Human Services Director Doug Kress told lawmakers a needs assessment pinpointed Davis Square or Sullivan Square as the best location options.
And Hannah Pappenheim, Somerville's assistant city solicitor, told the legislative committee that city leaders do not believe a section of federal law sometimes known as the "crack house statute" — at play in the Philadelphia case — would bar operation of a supervised consumption site at the municipal level.
"The city is willing to litigate this issue, but willingness aside, one cannot ignore the legal risks incurred in opening such a site," Pappenheim said. "As it stands today, there are no easy answers to these legal questions. However, state legislation wielding its constitutionally granted powers to enact laws for public health and safety has the ability to greatly minimize these risks through legislation authorizing a pilot of safe consumption sites."
Doctors aligned with the Massachusetts Medical Society say the sites authorized under the bills (H 2088 and S 1272) before the Public Health Committee would deliver "an evidence-based intervention that fill a dangerous gap in our state's capabilities to address the opioid overdose crisis."
The trade group urged legislators to act now so the state can be ready in case there's a shift in the federal government's view of consumption sites.
"State legislation is necessary now so that potential sites can turn their legal focus to monitoring the fluid local and federal issues and can be prepared to open when there is a broader legal path forward," the society said. "In other words, we strongly encourage the state to pass enabling legislation so that sites can open when they feel confident that other legal issues have been resolved. State legislation is a logical first step in the sequence of 'legalizing' SCSs given the fluid dynamics of federal prosecutorial discretion, which can be offered in a moment's notice, and given the speed at which local, municipal barriers such as community buy-in and zoning can move."
