NORTHAMPTON — The first time Cara Moser considered the idea of a safe, legal place for her daughter Eliza Harper to use opioids was in 2018 after seeing Eliza dead. Her family discovered her following an overdose at age 26.
“I saw my daughter in rigor mortis,” Moser said, sitting in her office at the nonprofit Tapestry Health, which also runs needle exchange programs in Northampton and Holyoke. “Nobody should ever have to see their baby like that. I remember getting back to the house and saying, ‘Why don’t we have safe consumption sites?’ … Just someone with her would have saved her. It just ate at me. ‘Why not?’”
It’s a question that many local proponents of the “harm reduction” approach to public health have been asking for years, together with a growing coalition of people who use drugs, their loved ones, lawmakers and those like Moser who deal with the unending pain of losing a child to addiction.
In the four counties of western Massachusetts, 325 people died of opioid-related overdoses in 2020, according to the most recent data available from the state Department of Public Health. That’s up from 294 such deaths in 2019 — a 10.5% increase. Across the first nine months of 2021, opioid-related overdose deaths increased statewide by 1% during what is already a deadly epidemic.
For those in the harm reduction world, those are deaths that could be prevented by interventions that “meet people where they’re at.” And increasingly, advocates in the state and across the country are calling for places where people using opioids can safely use them in the presence of medical experts and have access to medical care, information about treatment and other social services.
“One of the reasons why people pass away from an overdose is from using alone,” said Liz Whynott, the director of harm reduction at Tapestry. “Having a site where people are able to go and don’t have to use alone is a life saver.”
People refer to such sites by different names — “safer consumption sites,” “supervised injection sites,” “overdose prevention centers” and more. But the idea is the same: a place where drug users can bring already purchased drugs, test them for other substances like the powerful opioid fentanyl, get clean needles or other equipment like pipes, and use them in the presence of a trained professional with the overdose-reversing medication naloxone, which is often known by the brand name Narcan.
The sites, which have opened in New York City and elsewhere across the world, also provide drug users with medical care for abscesses, for example, or other ailments, referrals to medical providers, details about medication-assisted treatment with methadone or buprenorphine, vaccines, testing for diseases like HIV or hepatitis, information about treatment and more.
“People can go into these places and feel like they’re human,” Moser said. “Build relationships with people who are caring for them.”
And there is growing support for the idea, which is seen as controversial in some circles but which supporters point out is backed by data that show the sites decrease deaths and communicable diseases, helping people into treatment in many cases.
And people are already creating their own versions of such sites, though in less effective and sporadic settings. In some cases, they’re in basements with friends. In other cases, people are finding individual ways to try to save their own lives.
That’s what University of Massachusetts Amherst public health master’s degree student Sam Tarplin did before he got into recovery from heroin since 2013. Back when he was using, he said that harm reduction “saved me on numerous occasions, from Narcan to being able to access clean needles.”
But Tarplin didn’t have a safe consumption site to access back then, so he said he would get high in his car in the parking lot of a hospital, his foot on the brake and the car in drive.
“If I went out, hopefully I’d roll into somebody and get help,” he said.
As part of their master’s program, Tarplin and fellow master’s students Parker Sweet and Erin Maggiulli have been working with Whynott, putting together a detailed report on what it would take to open and operate a safe consumption site in western Massachusetts. That includes a detailed breakdown of the staff needed to run the site, how many people it could help and how to build stakeholder and community support.
“It’s important and beneficial,” Whynott said of the report. “It does a lot of the leg work for an overtaxed organization like a lot of nonprofits are … it’s important to have a plan laid out.”
The researchers found that Springfield has the highest number of fatal overdoses in the area and a larger portion of residents experiencing poverty, making it a prime location for a safe consumption site.
However, those sites have experienced pushback from some. Abstinence-only attitudes, drug war-era legislation and legal challenges have prevented sites from opening in other places. Locally, when Tapestry opened a needle-exchange program in Holyoke a decade ago — only the second such program west of Boston — members of the City Council sued in an attempt to prevent it from doing its harm-reduction work, arguing that it encouraged drug use.
The UMass Amherst researchers acknowledged that political realities may ultimately dictate where the first safe consumption site opens in western Massachusetts, arguing that Northampton might be the place where it is the most politically feasible.
“The politics in places like Springfield and Holyoke, where there’s the most need, the politics aren’t very conducive to that at all,” Maggiulli said.
Whynott said that it’s an unfortunate reality. But she noted that the first needle exchange program in the state west of Boston opened in Northampton in 1995 due to “a lot of political will and courage” in the area. She said it shouldn’t take courage to open a safe consumption site, given the evidence of their positive impacts, but that it inevitably will.
Northampton Mayor Gina-Louise Sciarra declined to comment on the issue of safe consumption sites in general. Court Cline, a mayoral assistant in Sciarra’s office, said that the mayor “hasn’t really given it a lot of thought” and didn’t have time to offer a comment during budget season.
Currently, there are several bills pending before the state Legislature related to safe consumption sites, including one that would create a “10-year pilot program establishing two or more supervised consumption sites that utilize harm reduction tools.” Those bills face a May 9 deadline to be reported favorably out of the Legislature’s Joint Committee on Mental Health, Substance Use and Recovery, after which they’d then have to pass through other committees before securing a vote on the floor. Last session, a similar bill made it out of committee but leadership in the Legislature did not bring it to a vote.
For some of those who have lost a loved one to an overdose, the time is now to act on the issue.
Jackson Harper, 18, remembers his sister Eliza as the person who introduced him to fishing, was always there to encourage him to pursue his hobbies and taught him “the value of being happy with what you’re doing in the moment.” When she died of an overdose, he said the pain was “paralyzing,” and that he wishes people understood the devastation an overdose death causes.
“I want them to understand that a lot of the pain comes from the feeling that their loved one was unaccepted in society because of their illness,” he said. “There needs to be an understanding in our communities that this pain that’s indescribable is preventable.”