The impact of insite, North America's first supervised injection facitity, and possible implementation in Massachusetts
Perera, Ryan Timothy
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The impact of the opioid crisis has been worsening in recent years. Opioid-related overdose deaths in the United States have reached 9.0 per 100,000 people and in Massachusetts the number is even worse at 17.3 per 100,000. People who inject drugs (PWID) are at high risk of overdose death, of superficial and deep tissue bacterial infections, and of chronic viral infections such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV), which can be transmitted through shared injection equipment. Although abstinence from substances is the best way to avoid these outcomes, the complicated nature of substance use disorder (SUD) means that not everyone will be able to stop substance use at any given time. The concept of harm reduction is based on engaging PWID who are not ready or able to stop substance use, to reduce the frequency of adverse outcomes. One intervention supported by harm reductionists is medically supervised infection facilities (SIFs), which are locations where PWID may inject substances under medical supervision. People are provided with clean equipment and are monitored post-injection so that medical intervention can be provided in case of an overdose. Furthermore, people are able to access a variety of health services, including wound care, condom access, and referrals to SUD treatment. In 2003, Insite in Vancouver, Canada became North America’s first legally sanctioned SIF. Research conducted since its opening has shown many positive benefits. Insite has been credited with the prevention of overdose deaths and the encouragement of safer injection practices both inside and outside of the facility. In addition, the facility has been shown to be an effective bridge to addiction treatment, particularly among higher risk PWID. The presence of Insite has also been associated with a reduction in public injections. Furthermore, Insite does not appear to increase the number of people who are actively injecting, nor does it serve as a location for people who are injecting drugs for the first time. Because of these benefits, there has been growing interest in establishing an SIF within the United States. Advocacy groups, including the Massachusetts Medical Society, have begun to press for one within Massachusetts. Moreover, the PWID community in Boston has expressed interest in taking advantage of the harm reduction benefits that an SIF can offer. Efforts to establish an SIF, however, face several barriers including state and federal drug laws and political opposition to such a facility. The stigma associated with SUD and the very idea of an SIF is an issue that must be addressed in order to bring this life saving tool to Massachusetts.