A Boston nonprofit plans to soon test a new way of addressing the city鈥檚 heroin epidemic. The idea is simple: Starting in March, along a stretch of road that has come to be called Boston鈥檚 鈥淢ethadone Mile,鈥 the program will open a room with a nurse, some soft chairs and basic life-saving equipment 鈥 a place where heroin users can ride out their high, under medical supervision.
Dr. Jessie Gaeta, chief medical officer at the聽, which initiated the project, walks the avenue several times a day on her way to and from work. The path takes her past the city鈥檚 needle exchange program and a methadone clinic, as well as past one of the city鈥檚 busiest emergency rooms, at Boston Medical Center.
鈥淭here are people 鈥 just in the few blocks around our building and hospital 鈥 that we鈥檙e watching overdose on our way from the parking lot,鈥 Gaeta said.
Addiction treatment providers in the area have had conversations for many months about creating a safe place where heroin users could get high. At least eight countries around the world have some sort of聽, monitored by nurses, where patients can both use drugs and rest or sleep off the effects.
There are people 鈥 just in the few blocks around our building and hospital 鈥 that we鈥檙e watching overdose on our way from the parking lot.
With state statistics indicating that roughly four Massachusetts residents die every day from an overdose, the need for some sort of new approach seems more urgent than ever, Gaeta said. Still, her organization plans only a limited version of the 鈥渟afe place鈥 other countries offer. In Boston, patients will not be allowed to take drugs in the room.
鈥淚t鈥檚 not a place where people would be injecting,鈥 Gaeta said. 鈥淏ut it鈥檚 a place where people would come if they鈥檙e high and they need a safe place to be that鈥檚 not a street corner, and not a bathroom by themselves, where they鈥檙e at high risk of dying if they do overdose.鈥
All the funding isn鈥檛 yet secured, she said, but the plan is to convert a conference room for this purpose. A nurse and outreach worker would move among 10 or so users to check breathing, other vitals and general health. If patients in the room need more than nursing care, there鈥檚 a hospital across the street.
Gaeta says staff in the room will 鈥渢ry like heck鈥 to get patients coming off a high into treatment.
, the CEO at聽, an addiction treatment network on Cape Cod, says his staff tried a similar approach with alcohol addiction about 15 years ago.
It was marginally successful, Tamasi said, 鈥渂ut it was taxing, very labor intensive and difficult. You have to have the resources to be able to do it.鈥
The Boston organizers say they are desperate to try something new. Overdoses have become the leading cause of death among Boston鈥檚 homeless men and women. But will users who inject drugs or take a cocktail of pills find their way to this room?
鈥淚 could say, for myself, I would use it just to be safe,鈥 said Nicole, who currently is getting treatment with methadone for her heroin addiction. She asked to be identified by only her first name because some family members don鈥檛 know about her heroin use.
鈥淎 lot of addicts are homeless or by themselves,鈥 Nicole said. 鈥淪o, to have somebody 鈥 especially a nurse 鈥 keep an eye on you, and have a place to go when you鈥檙e under the influence or high 鈥 and somebody monitors you 鈥 that鈥檚 an awesome idea.鈥
础听聽in 2014 of 75 research articles found that supervised injection facilities 鈥 the type of 鈥渟afe room鈥 offered outside the United States 鈥 reduced the rate of overdose. And a聽聽found that patients in Vancouver, British Columbia, and Sydney, Australia, who were monitored by a nurse while they used heroin were more likely to end up in treatment than patients who were not monitored.
The use 鈥 or lack of use 鈥 of these safe rooms in various countries highlights a divide in addiction treatment, said聽Dr. Barbara Herbert, president of the Massachusetts chapter of the American Society of Addiction Medicine.
鈥淭he controversy,鈥 Herbert said, 鈥渋s, does it encourage people to keep using if we make their lives less dangerous and less miserable, or can we scare people into care?鈥
Herbert said many health care providers in the field of addiction medicine have moved away from the 鈥渢ough love/abstinence-or-nothing鈥 approach and instead now favor options like the 鈥渟afe-use room.鈥
鈥淚t鈥檚 not that we don鈥檛 want people to be drug free,鈥 Herbert said. 鈥淏ut dead people don鈥檛 recover.鈥
The safe-use room is part of what鈥檚 known in the world of addiction treatment as 鈥渉arm reduction.鈥 The approach includes needle exchange programs so that users don鈥檛 spread infections, training in the use of naloxone, the opioid reversal drug, and more education about the dangers of opioid prescriptions and use. Some addiction experts say Massachusetts must focus more on reducing the dangers of drug use and stop expecting users to just stop.
鈥淲e鈥檙e having problems reducing people鈥檚 involvement with drugs,鈥 said Vaughan Rees, an addiction expert at the Harvard School of Public Health. 鈥淪hort of being able to implement treatment, we need to think about how we can reduce the risk of drug use.鈥
The idea is still widely controversial among both elected leaders and those in public health. But聽Charlie Baker, the state鈥檚 Republican governor, says he鈥檚 open to hearing what Boston Health Care for the Homeless has planned.
鈥淚 have tremendous faith in them,鈥 Baker said, 鈥渁nd think because they are on the ground and because they are closer, most of the time, than practically anybody else who鈥檚 working with the homeless population, they tend to be a pretty good bellwether about good ideas.鈥
And Boston聽Mayor Marty Walsh, who speaks openly about his own past alcohol addiction and his recovery, says creating a space that鈥檚 supervised in this way could be an effective method of bringing heroin users into short-term care.
鈥淚鈥檓 up for trying anything when it comes to addiction and active using,鈥 Walsh said. 鈥淚f we can help some folks 鈥 homeless folks in particular 鈥 we should try anything.鈥
Boston police say they have no concerns about the program鈥檚 鈥渟afe room鈥 as planned. They would not support allowing injections inside.
鈥淲e can鈥檛 allow the illicit distribution or sale or transfer of narcotics to be happening and not take action against that,鈥 said Lt. Detective Michael McCarthy, a spokesman for Boston鈥檚 police department.
Some in the addiction community say a room where heroin users who are high would get care, not criticism, is another sign that attitudes about addiction are shifting.
鈥淚 think we鈥檝e come a long way,鈥 said聽, who started a parent support network in Massachusetts called聽. 鈥淭here鈥檚 a lot more talk and a lot more compassion and understanding because there鈥檚 been so many deaths. This is an enormous epidemic.鈥
In just the past month, EMTs revived six people after overdoses in the neighborhood where Boston Health Care for the Homeless plans to open its safe-use space for heroin users.
This story is part of a partnership that includes , and Kaiser Health News.