5 minute read
The Importance of Using OPCs as a Harm Reduction Tool in Massachusetts
I have been closely following overdose prevention centers (OPCs), also known as safe injection sites, for many years. I have dedicated a significant portion of my life and work to supporting Latino men with substance use disorder through the opening of Hector Reyes House, two sober houses, and Café Reyes, where some of these men are employed. What I have found is that we need culturally competent and focused recovery programs, and places that keep our patients alive while in the throes of addiction.
OPCs are facilities where people who use drugs may go to consume previously obtained substances in an environment that is hygienic, monitored, without the fear of arrest. OPCs often offer an array of programs such as drug checking, medical care, case management, along with mental health care, housing services, food and nutrition, and hazardous waste management. On Point NYC even has laundry services and showers, and is working towards opening a pharmacy and barber shop in their facility (1). Staff at these centers are specifically trained to work with people who use drugs, and many have lived experience themselves. This creates a supportive and safe environment, safe from judgment and stigma, increasing the pathways to treatment and other resources (2). We need places where people who use drugs can feel safe, be monitored, and be able to connect to services when they wish for them to be initiated. In the 147 OPCs located in sixteen different countries, there has never been a fatal overdose.
As a community physician, I have lost so many patients to overdoses, many of whom used alone. Many of these patients feel like there is not a safe, nonjudgmental space for them to seek support. This leads them to continue using in hidden spaces such as bathrooms, hallways, and other places where they can manage their illness, which unfortunately, often results in death. These deaths are preventable, and I think that people too often forget that using drugs is a symptom of a medical condition. We need to start treating it as such.
I believe OPCs are a step in that direction. If my patients had access to an OPC, many of them would perhaps still be here, parenting their children, improving our communities, and living a life they feel is worth living.
The opioid mortality numbers in the country are the highest they have ever been. The Massachusetts Department of Public Health indicates that in 2022 there were 2,359 overdose deaths - a 3% increase from 2021 and a 9% increase from 2016 (3). Over 93% of fatal opioidrelated overdoses in the Commonwealth from January to April 2023 tested positive for fentanyl (3), which is 50 times stronger than heroin.
In our own community, the numbers are concerning as well. In the City of Worcester, we are seeing overdose incidents decrease, however, the fatalities continue to increase. Comparing preliminary data from January to September of 2023 to 2022, we are seeing a 19.3%3 decrease in opioid-related incidents but a 15.6% increase in opioid-related fatalities (4)*. As Figure A shows, these fatalities have steadily increased over the last decade. The city and county currently have the highest mortality rates in the state (5) .
As the drug supply becomes more toxic, we have been losing and continue to lose too many people from substances like fentanyl, xylazine, and other synthetic substances that are poisoning the drug supply. Furthermore, people of color continue experiencing higher numbers of overdoses and overdose-related deaths. Even though addiction affects all ethnicities, genders, and social classes, the war on drugs and its policies have targeted communities of color through segregation, poverty, racism, and intergenerational trauma. Due to stigma and a lack of trusting environments, there are many missed opportunities to engage people who use drugs and meet their needs. OPCs are a model to expand harm reduction services and we need that now more than ever.
Support for OPCs in Massachusetts has been present for over a decade. In 2013, the coalition “SIFMA Now!” began advocating for the legalization of such sites. The Massachusetts Harm Reduction Commission, which I was a part of, called to have an OPC pilot program in the state in 2019. Other public supporters include the Massachusetts Medical Society (MMS), American Association of Addiction Medicine (ASAM), American Medical Association (AMA), ACLU Massachusetts, Boston Medical Center, Fenway Health, amongst others. In December 2023, the Massachusetts Department of Public Health released a feasibility study on OPCs, recommending the establishment of OPCs “pending legislative action to extend legal protections7”. If legal protection were to be passed, Massachusetts would be the second state in the nation to pass such legislation.
On March 4, 2024, the Worcester Board of Health unanimously voted in favor of a pilot program for an OPC, making Worcester the first city in Massachusetts to approve a safe injection site.
Matilde Castiel, MD, Commissioner of Worcester Department of Health & Human ServicesEmail: castielm@worcesterma.gov
