Doctors, city councilors debate idea of center where addicts could shoot up under medical supervision

There are two options:

1) Heroin users use heroin in front of nobody who can help them and don't get treatment.

2) Heroin users use heroin in front of somebody who can help them and get treatment.

There's no 3. It boils down to whether or not you (can afford to) care about whether or not people on heroin need treatment. Now when's the (expletive) bridge getting built?

This was difficult to sit through. There was very good evidence presented by folks who are working in this field on a daily basis, and it was dismissed with rhetorical grandstanding which failed to offer anything constructive to the conversation.

City council members seemed motivated more to make brash statements which were harsh, uninformed, and not constructive, than to offer compelling discourse. Flaherty and Baker were outright despicable and I look forward to doing everything I can to support opposition to any future political aspirations you two have. You should be ashamed of yourselves. Flaherty, people who like to talk about how much they've done for an issue are people who have nothing to actually show for their work.

Tito Jackson, I met you not long ago in JP, and I was really hoping for a lot more out of you today. Your points about the failure by the state to support those in need was well taken, but you seemed more interested in attacking historic injustices while failing to recognize that we are perpetuating those same inhumane policies by failing to act.

Ayanna Pressley was the only person who seemed genuinely interested in actually contributing to a solution.

I have a far more optimistic take on yesterday's hearing. I think it was the right first step in creating a thoughtful dialogue about the issue of SIFs knowing that there are strongly held views on pros, cons, research study scope and reliability, multi-dimensional neighborhood and harm reduction impact, de facto public policy direction, politics, and on and on. We also know that there is a huge void in the public education space on this issue with advocates on both sides in the past frequently resorting to slogans, accusations, and suggesting that the other side lacks either humanity or common sense. Devolving to this level doesn't help us at all, but yesterday's two panels did all of us a service by starting a dialogue.
And for those who were concerned about the initial comments of our City Councilors, we need to recognize that most of them are pretty skeptical about initiatives that don't embrace recovery, and so their reactions were not surprising. I'm sorry this is lengthy, but this is not an issue that lends itself to quips and sound bites. It's complicated.

Folks should especially understand that Councilor Essaibi-George and Baker asked for this hearing primarily because the MMS was having discussions solely with the state (after being quoted as saying when their recommendatiopn were first released that "Methadone Mile" looked like the perfect location for one of the pilot SIFs--without ever talking to anyone in Boston). Yesterday, the MMS President repeatedly backed off that initial recommendation, but in my view the MMS was decidedly clumsy in rolling out this recommendation in the way they did. And so a lot of what we saw yesterday in terms of the City Council reaction was born of pent up frustration that yet another proposal (as Tito Jackson reminded us repeatedly in the case of multiple methadone clinic placements opposed by the city being made by the state in an already overburdened area) was being crafted behind state house doors and then suddenly foisted on Boston to manage in all of its complicated dimensions.

Having spoken to councilors in advance of the hearing, I know how strongly they felt that this hearing was essential to give Boston a seat at the table on the wisdom of this initiative and to offer us an opportunity to listen to all points of view.

As a South End guy who testified at the hearing, I made 3 points that I think fairly represent the views of the South End neighborhoods most directly impacted by the Mass/Cass crisis:

1) As the hearing demonstrated yesterday, with two good panels--one pro and one con--the jury is clearly still out on the long term evidence-based impact of SIFs. For every advocating study (like the Vancouver study quoted most frequently suggesting a 30-35% reduction on OD mortality), there are lots of questions raised about the selective population studied and the funding of the study which it was noted at the hearing came from the parent company operating the SIF. But we are still left with the common sense notion that a medically supervised high is inherently safer than one that is not. Period. The question comes for many in the aggregate and in the stats that offer conflicting views of overall OD mortality stats released by the BC Coroner's Office (even taking fentanyl out of the picture. I think most Southenders are open to be convinced one way or another with evidence-based data. And yesterday, neither the pro panel nor the con panel hit a home run in my opinion.

2) the South End Forum and Newmarket Business Assn. are unified in our view that our neighborhoods can no longer sustain any additional services and facilities. We are overwhelmed and it is getting worse not better. One of the key concerns about siting an SIF within the Mass./Cass corridor is that it holds the possibility of bringing more of the addicted community to the South End. And today, in the South End, one of our biggest problems is that a) our shelters are gender exclusive, so that when couples want to be together, they have to be on the street because they can't both be at a shelter (that's why we're looking at implementing a low-barrier day location behind the Southampton shelter), and b) when a client comes to Mass/Cass for methadone or suboxone or other treatment at 9 AM, many have follow up appointments at 2, 3, or 4 in the afternoon at BHCHP or BMC or other facilities co-located in the area. Where do you think they will be between 9 and 3? Largely in the SE neighborhoods or alleys or on Mass Ave. many over-sedated, many sick, and many with no place to go. This is what we are trying to get our arms around in this neighborhood today--to try to find places, programs, alternatives that are both safe and offer an opportunity to get hooked up to treatment.

So now bring a SIF into that mix--we are told that the average facility visit is 30-40 minutes--and following medical monitoring to ensure an OD is not imminent, these souls are now back as part of the Mass/Cass sedated/oversedated rough environment that we are already wrestling with today. A SIF would be a major impact multiplier for a neighborhood that is simply overwhelmed.

3) Finally, we publicly called on the City Council and the State and the business community to expand the focus of the conversation on from a focus from only harm reduction strategies to the broader challenge faced jointly by the city and state.

We proposed to the Council what we think is a a revolutionary and transformative idea to try to address the currently decentralized "bits and pieces," and stovepipe programs of critical service providers located in scores of pockets throughout the city and now concentrated in the South End.The "band-aid" approach--doing what we can with what we have-that has characterized our efforts for years is getting overwhelmed more and more each day. It's time for us to treat this with an unprecedented commitment of resources, political will, and multi-disciplinary expertise.

We called for a major state-city public private partnership investment (organized perhaps as a Foundation) in a "Rehabilitation Campus" offering multi-modal treatment options, detox, a critical continuity of service model on site including both residential programs and in and out-patient services with direct (and site presence) linkages to all the various addiction/recovery service providers located throughout Boston. We need, for lack of a better term a "mother-ship" that not only serves as a state of the art large scale multi-modal treatment center, but offers opportunities for cutting edge research, and supportive reintegration as part of a more aggressive recovery model.

This is not a fanciful "out there" recommendation. We need only look at the publicly held Shattuck Hospital campus located between Forest Hills Cemetery and Franklin Park that could offer a supportive and self-contained campus setting without direct impact on any residential neighborhood or right in the middle of the drug trade for the city. The site requires big capital improvements that needs public dollars and major private corporate dollars--all of which seems totally feasible is we are serious. By the way, Pine Street Inn is already operating programs there.

As we continue to discuss the research and on SIFs including those that shut down as well as those still operating today, we need Boston to commit to a Rehab Campus that may offer us our best opportunity for enhanced coordination, real research, treatment on demand, and every other modality that will help us to try to get ahead of this before the next wave of new even more powerful synthetic drugs hit our streets. We have to invest now or pay later.

Again, apologies for such a long post.