On November 6, 2018, Charlie Baker was re-elected to a second term as governor of Massachusetts. Throughout the campaign, Governor Baker highlighted his legislative accomplishments in addressing the state’s opioid crisis while urging for further action to be taken.
In his speech at the 2018 Massachusetts Republican State Convention, for example, he stated: “…our work on the opioid crisis is far from over. With the passage of two major laws over the past four years, we now have the ability to turn long-term treatment and recovery into a viable option for everyone dealing with an opioid addiction. When it comes to opioids, we need to do more than bend the trend in Massachusetts – we need to end the trend.”
The two laws Baker is referring to are the Step Act, a 2017 law which mandated participation in the state’s Prescription Drug Monitoring Program and expanded access to opioid substitution treatments, and a 2016 law which limits first-time opioid prescriptions to seven days. Preliminary data from the Center For Disease Control show that overdose deaths in Massachusetts decreased 8 percent last year, suggesting that at least some of these policy initiatives contributed to the lowering of overdose deaths.
In light of the recent success in curbing the skyrocketing trend in overdose deaths, it is sensible to think that in his second term, Governor Baker will continue to pursue this two-tiered policy of prescription restrictions coupled with expanded access to opioid treatments. This approach is rather cautious and indicative of Baker’s signature political style; it essentially reduces the prescribing of some opioids while expanding access to others. As such, it is unlikely that the Baker Administration will pursue the more radical policy option of creating safe injection sites to address the opioid crisis given both the administration’s opposition to them and their illegality under federal law.
Safe injection sites are “centers where drug users can go to consume or inject their drugs in a medically supervised environment.” In this environment, many of the risks of illicit drug use, including the sharing of contaminated needles and use in an unfamiliar setting, can be mitigated by a dedicated staff of medical professionals on hand who provides safer supplies or intervenes in the case of an overdose.
Creating safe injection sites in Massachusetts was a major tenet in the opioid strategy of Jay Gonzalez, Governor Baker’s challenger in the 2018 election. In one speech on the subject at a political fundraiser in Lexington, Gonzalez affirmed that “[s]afe-injection sites…have been proven to work in other parts of the world, not only to help keep people alive, but also to help get them into the treatment they need.”
Governor Baker, however, does not share this view. In an interview with The Boston Globe, he stated, “[t]he evidence is clear that sanctioning heroin injection facilities does not reduce overdose deaths and these facilities are not a responsible tool to combat the opioid epidemic.”
The academic evidence, however, does not appear to be as ambiguous as this debate would suggest. While there are currently no operating safe injection sites in the United States, researchers have examined their effects on the local communities they serve in Europe and Canada. According to the European Monitoring Center for Drugs and Drug Addiction, there is no evidence supporting the claim “that safer injecting facilities increases drug use or frequency of injecting.” Additionally, safe injection sites have been shown to reduce overdose mortality by 88 deaths per 100,000 each year, and are associated with “67% fewer ambulance calls for treating overdoses, and a decrease in HIV infections,” due to the decreased sharing of contaminated drug paraphernalia.
The real obstacle standing in the way of the widespread adoption of safe injection sites in the United States is therefore not a lack of evidence, but rather, the federal Department of Justice. In August of 2018, the Justice Department threatened legal action against city officials in Philadelphia and San Francisco for pursuing the creation of a safe injection site due to its violation of federal drug laws. The city government in Philadelphia nonetheless plans to move forward with this proposal, despite federal warnings. Thus, even if Governor Baker did favor further action on safe-injection sites, it would be difficult to pursue this without engendering a constitutional conflict between the laws of the state and federal government, the latter of which is supposed to be supreme.
The next four years will be a crucial time for the Baker Administration to continue to take action in addressing the opioid crisis. However, given Governor Baker’s public disapproval of them and aversion to making political enemies, we should not expect that safe injection sites will become a part of his policy toolkit. Still, without more radical policy changes such as this, it is unlikely that Massachusetts will make dramatic progress in reducing overdose deaths until more resolute action is taken.
Image Credit: Flickr/Executive Office of Health and Human Services
