The Governor is Missing a Great Opportunity
(with Mark Eisenberg and Jim Stewart)
When the current opioid crisis burst forth, some politicians called for the addicted to be involuntary quarantined, echoing how the AIDS crisis initially brought out the worst in some leaders. Recall, Indiana's Rep. Dan Burton carried his own scissors to the House barbershop to avoid "catching" AIDS from someone else's hair.
We dismiss such puritanically inspired, hysterical responses and seek enlightened leadership. And, as with AIDS, today brings optimism regarding leadership about opioid addiction. Many politicians and police departments are moving from punitive, zero tolerance policies towards a more supportive harm reduction approach, including needle exchanges, Narcan and other acknowledgments that neither the drugs nor those using them are going away.
These changes are part of a welcome move towards effective treatment, which is labor intensive, hands on, and non-punitive. It features connection, caring, and respect. And it works.
But while Massachusetts residents can be assured that public officials will not plumb the depths, Gov. Baker's ineffectual Opioid 2.0 proposal reveals a politician cowering behind the bland instead of rising to the challenge.
No one can object to creating clearer guidelines and regulations on treatment programs, credentialing recovery coaches, and clarifying medical evaluations. But reducing and eliminating overdose deaths requires expanding the availability of proven and effective interventions to those struggling with substance use disorder. There is near universal recognition in the medical and public health fields that Supervised Injection Facilities (SIFs) are a proven, effective way to confront the devastation of lives lost among the severely addicted and under treated. Yet, Baker's Opioid 2.0 is silent on this approach as well as Medically Assisted Treatment, a parallel path away from the ravages of addiction.
SIFs are proven
At SIFs, people bring in and ingest street-bought drugs under the supervision of supportive medical professional who can test for potency and contamination. There are roughly 100 SIFs, confronting death, disease and addiction in over half a dozen countries. And after literally millions of such injections, there has yet to be a fatality. Overdoses are routinely and safely reversed. Supported by the AMA and the Massachusetts Medical Society, this medical intervention has been shown to work in hundreds of peer reviewed studies without negative side effects.
SIFs bring people to treatment, which is readily offered but not forced. They are a portal to hope proven to reduce public disorder, not an additional burden on burdened neighborhoods. This approach acknowledges that the drugs are dangerous and that drug misusers are multiply challenged, but SIFs provide the same second chances and unconditional support that help more privileged addicts. SIFs buy them needed safety, support, and time to confront their demons.
There are obvious technical legal hurdles, as well as the inevitable initial opposition from tepid leadership. Every meaningful harm reduction move (before enjoying retrospective support) was initially opposed by claims that it "condoned" drug use or was too controversial. But strong grassroots and political leadership have overcome such objections in six counties. The time to support SIFs is before they are created, not after; when they are predictably shown to save lives that were being needlessly lost.
The Joint Committee on Mental Health, Substance Use and Recovery should use the occasion presented by the governor's proposal to bring forward and enact legislation like Sen. William Brownsberger's S1081, which would make it legal for public health workers to make use of the proven and effective methods that the governor is unwilling to recognize and use. It is deeply disappointing that a governor with a clean slate and bipartisan support is failing to protect his most vulnerable constituents. Failure to support SIFS in general and S1081 in particular will be a quarantine by other means. And every bit as hysterical, puritanical, and deadly.
The Jan. 16 public hearing at Gardner Auditorium is a perfect opportunity to remind him of this.