The Massachusetts Medical Society, representing 25,000 physicians and medical students, says it's time to try a new tool to stop overdose deaths: rooms where drug users would inject heroin or other drugs under medical supervision. 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: 193 to 21.
"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.
"My patients are overdosing in alleyways, in parked cars, in abandoned buildings, in their own bedroom," Eisenberg said. "I know that if they were able to go to safe injection facilities under supervision, these drug overdoses wouldn’t happen."
Many doctors who voted in favor of starting one or two SIFs in Massachusetts say they were persuaded by studies conducted at a safe injection clinic in Vancouver, the only such facility in North America. Research included in the medical society's report on SIFs says overdose deaths are down 35 percent in Vancouver, and 30 percent more patients who use the clinic seek treatment as compared to drug users in the area who do not.
"Everything we can do to keep people alive long enough to find that spark that makes it possible for them to be better, for them not to be controlled by drugs, I support," said Dr. Barbara Herbert, president of the Massachusetts chapter of the American Society of Addiction Medicine.
Some doctors who support the SIF plan call it a gut-wrenching option.
"It doesn’t make sense for us as physicians to watch someone do something we know is dangerous and illegal," said Dr. Glenn Markenson, the director of maternal and fetal medicine at Boston Medical Center. "On the other side, does it make sense for us to have these people overdose on the street and not get care? They’re both terrible, but you have to do something."
Medical society staff expected a lengthy debate, but only one physician rose to speak against the idea of opening a SIF in Massachusetts. Dr. Richard Pieters, a radiation oncologist and past MMS president, said it would be difficult to open a SIF because of concern from nearby communities. Pieters instead urged his colleagues to press for wider use of naloxone, the drug that can reverse an opioid overdose.
Another doctor who voted against the SIF pilot said the project is noble but misguided.
"The argument is that if they [the drug user] crash in front of you, you might be able to do something rather than have them crash outside in a doorway. That's the argument that was used to promote this," said Dr. Robert Baratz, a primary care physician in Braintree. "That's the wrong solution to the wrong problem."
Baratz says the actual problem these days is that users don't know what they're injecting. He says it's up to law enforcement to stop the flow of illicit and increasing dangerous opioids such as fentanyl; asking physicians, nurses or physician assistants to supervise the injection of unknown drugs puts the medical staff at risk, Baratz says.
"What happens if that person leaves the facility, gets in a car and causes an accident?" Baratz asked. "This doesn't pass the smell test."
The medical society's resolution suggests the creation of a task force that would review state and federal legal concerns as professional liability for doctors or nurses. Supporters say the next step is to begin lobbying on Beacon Hill. Massachusetts state Sen. Will Brownsberger has filed legislation that would let the state Department of Public Health license supervised injection rooms. The bill is before the Joint Committee on Mental Health, Substance Use and Recovery but has not been scheduled for a hearing.
"I’m not convinced this is going to help Massachusetts yet," said state Sen. Jennifer Flanagan, who co-chairs the committee.
"I know docs are trying to help us in the fight, but I want to see data that proves this is going to help," Flanagan said. "We need to look at where Massachusetts is going and if this is part of our landscape. Do we want to see this in different cities across the state?"
Brownsberger says the idea won't go far until a city or town that is willing to host a SIF steps forward. That hasn't happened yet. A grassroots group known as SIF-MA Now is holding meetings in churches and community centers in Boston, Cambridge and other cities to try to build support for the idea.
It's not clear if Gov. Charlie Baker would remain neutral on the opening of a SIF or fight the plan. His office of Health and Human Services released a statement in response to the MMS vote:
Fighting the opioid epidemic is a top public health priority of the Baker-Polito Administration, as more is being done now to systemically address substance use disorders than at any point during the Commonwealth's history. The administration's evidence-based efforts to build a strong foundation of prevention, intervention, treatment and recovery will continue and expand to fight this epidemic. Safe injection sites are not legal in the United States.
Attorneys say it would be difficult to open a SIF without authorizing legislation and the project may need an exemption from sections of the Federal Controlled Substances Act.
If Massachusetts decides to allow one or more safe injection facilities, there's no telling when one might open.
"It’s going to be a while," said Dr. Alan Woodward, a past president of the medical society and member of the state's Public Health Council. "Trying to predict a time frame is unrealistic."
Massachusetts is not the only state taking a look at this way to curb the rising death toll from opioid overdoses. Elected leaders in San Francisco, Seattle, Vermont and Ithaca are all studying the idea of a safe injection facility or taking steps to open one. And a resolution asking the American Medical Association to launch a review of safe injection facilities may get a vote at the group's annual meeting in June.
This segment aired on May 1, 2017.