As the opioid epidemic rages on, two mayors from Massachusetts decided to get a firsthand view of a life-saving but controversial tool: supervised injection facilities (SIF).
Boston Mayor Marty Walsh toured clinics in Montreal and Toronto where people who use drugs are given clean needles, monitored while they consume, and revived if they overdose. Cambridge Mayor Marc McGovern was also in Montreal, meeting with the city's mayor and chief of police.
Both explained their surprising findings to WBUR's Bob Oakes. The interview below is lightly edited.
Your main impressions?
McGovern: These facilities were well-staffed. They were clean. They had a very medical feel to them. We visited three brick-and-mortar sites and one mobile site. I was really surprised, pleasantly surprised, at not just the level of professionalism but the way in which the sites were organized and run. We didn't see a lot of chaos or activity that was worrisome, at least not on my visits.
Walsh: I was expecting chaos. I was just expecting a lot of people hanging around these facilities outside. [We] didn't witness that. These sites really started in the '90s doing harm reduction for needles in the HIV and AIDS epidemic and the drug epidemic back in the '90s. The natural next step was to look at safe consumption sites. If we bring these back to the United States of America, some work really has to be done on the harm reduction piece of it before we start looking into the next natural step, which is the safe consumption sites.
On harm reduction, what do you mean?
Walsh: We have a needle exchange program in Boston, one of the oldest in the state. But we have one exchange program. In Toronto, there's needle exchange programs within the health centers and within social services. It's something that we in Boston, possibly with Cambridge as well, can look at because basically with these safe consumption sites, it is harm reduction. I know people have different views and different opinions on what they are. But it is about harm reduction. It's about not having overdoses on the streets. You don't have that chaotic feel outside. It's really eye-opening.
McGovern: If we're really going to address our substance abuse crisis, you have to fight this on multiple fronts. Of course we need to invest more money in treatment [and] more money in prevention. But harm reduction is a piece of that puzzle as well. You can't get someone into treatment if they die on the street. No one has died in a safe injection site, and that is extremely important.
Do these clinics connect drug users to treatment?
Walsh: That's one thing that I asked time and time again, and the number wasn’t high. Basically, these clinics build trust with people, don't judge them, allow them to get to a point where they might want to ask for help.
In Toronto, one of the clinics was in a neighborhood. A lot of folks in the community would come in so they weren’t using alone in their home.
Somebody listening to this conversation is going to be scratching their heads saying, “What are these two talking about?” But I think you have to witness it. We have to do a really thorough job of getting the information out to the public, so people feel more comfortable with what Marc and myself are talking about.
Which was reasonably run, calm, so to speak, organized facilities. You didn't see any drug dealers?
Walsh: The drug dealers are there. They do it very smooth and quick. But again, it's about — Mayor [John] Tory from Toronto was talking to me about the decision he has in front of him: Do I work to save lives, or do I work to just kind of move the problem along?
McGovern: Mayor Walsh and I went out with the police commander for Montreal on Thursday. It was very quiet. I went back at 8, 9, and 11 p.m. on Friday night. There was no activity in front of the building. People weren't congregating. It was very calm.
No needles littering the streets?
McGovern: No needles. This section of Montreal reminded me of Central Square in Cambridge: a lot of restaurants, a lot of bars, different stores. I asked the managers: “How is this impacting your business?” Half of them didn't even know it was there, and the other half said, they're not using in front of my business anymore. We're not seeing needles around. Those are all benefits to the community in addition to the benefits of saving the person's life.
Did you see anything that surprised you in a negative way?
Walsh: No, although I did not go to Vancouver. In Vancouver, there are people on the streets using. The difference is that in Vancouver, these started in 2003 when they were responding to an overdose epidemic. They didn't have the necessary foundation that I witnessed in Montreal or in Toronto. And that's why we shouldn't just say, “Let's start this tomorrow.”
McGovern: Although there is a great deal of consistency amongst the sites, the way in which they are implemented are different depending on the city. I don't think a Vancouver model of saying, “Let's just contain it to this area” — I don't think that would work for Cambridge or Boston. But one in this neighborhood and another in this neighborhood — a Montreal model is much closer, at least for Cambridge.
Are either one of you ready to bring a program like this to your city?
Walsh: Again, this didn't just happen in Montreal or Toronto overnight. This is a process that started with harm reduction and evolved into a program for safe consumption sites. I think people need to be educated on this. We would need a change or an exemption in federal law to even consider this. We need a consistent funding mechanism. We are not anywhere near where we need to be. Even if the Legislature approved this tomorrow in Massachusetts, we cannot do it.
McGovern: This isn't something that's going to happen tomorrow, if it happens at all. The first site in Vancouver opened a couple of decades ago, and it had to go through a court battle. Philadelphia is doing it right now. The federal government might come in and say you've got to shut down, and then you battle it out in the courts. But I think we're on the right path investigating this, and again, I come back to saving people's lives.
Do you both see the possible potential?
Walsh: I would agree with that.
McGovern: Yes I would. But there’s a great deal of education that has to happen. There's all kinds of drugs, right? Alcohol is a drug. You can go into a bar and get drunk and ruin your liver and die from that. People look at heroin and they react very differently. But again, how do you make sure that people can survive so that they can get help when they're ready to get help.
Both Walsh and McGovern are members of a special Harm Reduction Commission whose work includes reviewing supervised injection sites. A report from the commission is expected on March 1. The city of Cambridge is preparing its own report that will consider whether to recommend opening a SIF. And legislation that would allow a pilot SIF is once again before the state Legislature.
This segment aired on January 23, 2019.
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