BOSTON – Thousands of opioid-related deaths have substance abuse experts, lawmakers and even doctors weighing the merits of allowing addicts to use their drugs under the supervision of health care workers, but the threat of a federal crackdown looms over the debate.
Last week, a state commission recommended that Massachusetts explore a pilot program creating supervised sites for drug use, to help prevent deaths from opioid overdoses.
"These sites keep people who use drugs alive and help reduce the public health risks of disease transmission," the 15-member commission concluded in a written report, which recommended a pilot project with one or two sites.
"These sites can also provide a safe space where people may receive harm reduction materials and linkages to other services," commissioners wrote.
If it happens, Massachusetts would be the first state to take the controversial step. Canada, the Netherlands and Australia have had injection sites for heroin addicts for years.
Lawmakers in New York and California – along with city officials in Seattle and San Francisco – are also debating injection sites modeled on those programs.
But the controversial strategy remains illegal under federal law, and U.S. Attorney for Massachusetts Andrew Lelling says anyone who uses or works at such a facility would face federal charges, "regardless of any state law or study.”
"These sites normalize intravenous drug use, and they're not nearly as effective as people think they are," Lelling said in an interview. "It's not a guaranteed defense against people overdosing."
Lelling said the policy debate on Beacon Hill is skewed by misinformation, misleading studies and arguments from supporters that the sites are a panacea.
He points to the death of an addict last year from a fentanyl overdose at an injection site in Ottawa, Canada, which has four such facilities.
"I've see it reported again and again that nobody has ever died at an injection site. That is false," he said. "As fentanyl becomes more common, injection sites are less effective."
Despite the threat of federal intervention, Sen. Cindy Friedman, D-Arlington, a commission member, said she believes the state should press ahead with the idea.
"I know the feds have come out strong in their opinion, but there are other legal opinions out there," she said Tuesday. "We need to start thinking outside the box."
Gov. Charlie Baker, who has made addressing opioid addiction a key part of his agenda, cites threats of a federal crackdown as part of the reason not to pursue the idea.
"I'd much rather focus on stuff that we can do and are doing rather than on something the feds have made clear they're not going to permit us to do," Baker told reporters last week.
Similar proposals have been debated on Beacon Hill but failed to win support. The Senate approved an injection site proposal as part an opioid bill last year, but the measure didn't make it into the final version.
Physicians who support the move say state-sanctioned injection sites, albeit controversial, would save lives.
"You're trying to reduce the harm in the short term so that people can live another day to potentially benefit from addiction treatments," said Richard Saitz, a physician and professor at Boston University's School of Public Health. "With all the arguments for and against it, someone who is dead can't get into treatment."
Despite arguments to the contrary, he said research suggests that supervised injection sites don't increase drug use.
"Seatbelts don't increase motor vehicle fatalities, they reduce them. Condoms don't increase sexual activity or the spread of sexually transmitted diseases, they decrease them," he said.
A group representing physicians supports researching the idea.
"Addiction is a chronic illness," said Dr. Alain Chaoui, president Massachusetts Medical Society, whose governing board voted last year to study whether such sites can reduce overdose deaths. "If a physician does not explore and consider all medically appropriate measures by which to treat a chronic illness, it flies counter to our obligation to our patients."
Lawmakers are divided over the issue, and not just along party lines.
"If it came down to a vote today, I'd be opposed to it," said Rep. Paul Tucker, D-Salem. "I understand what people are trying to do, but it's not the right approach."
Allowing addicts to inject drugs under medical supervision amounts to surrendering the war against opioid addiction, said Rep. Linda Campbell, D-Methuen.
She wants the state to continue focusing on approaches such getting more people to undergo medically assisted treatment.
"We're seeing progress but we need to continue expanding treatment options for those who are struggling with addiction," she said. "We shouldn't be raising the white flag yet."
Others, like Rep. Ted Speliotis, D-Danvers, say they're "open to the idea" of exploring injection sites if it reduces opioid fatalities.
"It's certainly not the best solution, and I wish we didn't have to do it, but we're talking about a life or death situation," Speliotis said.
Rep. Lenny Mirra, R-West Newbury, said he believes supervised injection sites should be explored to "help reduce the scourge of fatal opioid overdoses.”
"We're burying an average of four people a day from overdoses," he said. "If something like this gives us a chance to reduce the number of deaths, we absolutely should explore it."
Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group’s newspapers and websites. Email him at email@example.com.