By Katie Mulvaney
Providence Journal
PROVIDENCE, R.I. — Jonathan Goyer watched family relationships fray, jobs vanish and his social network dwindle to nothing during the 10 years he injected heroin. During his darkest times, he dwelled alone in the underground world of opioid addiction.
Even so, Goyer says he would experience days, or even mere moments, when he wanted to put the drugs aside. He calls such moments “windows of willingness.”
Goyer, now eight years in recovery, is among the supporters of safe injection sites as a means to keep drug users safe, curb the spread of infectious diseases and possibly reach them during those openings, to provide them with access to drug treatment, medical care, safe supplies and support.
“We don’t know when a window of willingness is going to come to people. We don’t know,” said Goyer, an expert adviser to the Governor’s Overdose Prevention and Intervention Taskforce.
Safe consumption sites — supervised, hygienic clinics where people can safely inject illicit drugs under monitoring — would be staffed in part by people who traveled the world of addiction themselves. The aim is to build a rapport with drug users so when that window opens, trained staff can step in to put them in touch with resources.
Rhode Island could become the first state to make safe consumption sites a reality under legislation approved by state lawmakers last week that now heads to the desk of Gov. Daniel McKee. The legislation would establish a two-year pilot program to prevent drug overdoses through the establishment of so-called “harm reduction centers,” or safe injection sites, with local approval.
“This is the best in the country. States will really be looking to Rhode Island. Nationally, there’s a new shift to this,” Goyer said.
A spokeswoman for McKee would not comment on whether the governor plans to sign the legislation into law.
New approach to opioid crisis
The harm-reduction legislation was just one of several proposals that won passage this session that signal a sea change in the state’s approach to the opioid crisis. State lawmakers also voted to reclassify possession of small amounts of some drugs from felonies to misdemeanors and legalize possession of buprenorphine, a prescription drug used to treat opioid-use disorder that is sometimes sold illegally on the streets. Rhode Island joined Vermont as the second state to legalize buprenorphine, with McKee’s signature Thursday.
“It’s a political shift and it’s a personal shift,” as more and more Rhode Islanders are directly touched by the opioid crisis, said Sen. Joshua Miller, long a champion for the creation of harm-reduction centers.
The shift comes, too, as Rhode Island experienced a record 384 accidental drug overdose deaths in 2020 during the pandemic after years of gradual declines. This year, it appears, could be on a similarly devastating track with the final overdose numbers from the start of the year up from a year ago.
While the state has taken crucial steps to keep opioid prescribers in check and expanded access to naloxone, more needs to be done to address the active users, particularly as the potent and potentially deadly fentanyl is so widespread, advocates say. The harm-reduction centers would be supervised and provide clean syringes and drug testing, as well as referrals for medical and substance-use treatment. Narcan would be supplied to reverse overdoses.
“I think coming out of COVID, we’ve had to look outside of what we had been doing because it wasn’t working as well as it should be,” said Steven DeToy, director of government and public affairs for the Rhode Island Medical Society.
The passage of those bills, as well as legislation that requires insurance companies to send health communications directly to patients instead of a parent or spouse, demonstrates a collective commitment to trying to save lives, DeToy said.
“This means we will have several new arrows in our quiver to keep people alive,” DeToy said.
Rethinking simple possession
To a drug user, a felony conviction can be an obstacle to getting a job, securing safe housing, and maintaining economic prosperity or even stability, Goyer says. It entangles them in the judiciary, taking time away from possible treatment or employment.
“I don’t think the average person understands what it means to have a felony on their record. It’s a lifelong sentence,” Goyer said.
It’s with that in mind that Attorney General Peter F. Neronha supported legislation to reclassify simple possession of 10 grams or less of certain controlled substances as a misdemeanor punishable as a two-year misdemeanor rather than a felony.
“I do not believe that simple drug possession is felony conduct. Those who simply possess drugs — who are addicted and cannot escape the cycle of addiction — face barriers to employment, housing, and other opportunities to turn their lives around because such conduct is presently classified as felony,” Neronha said in an email last week. “This common-sense reform will reduce those barriers, properly position possession of small amounts of drugs for personal use where it belongs on the spectrum of criminal threats we face and allow us to focus our law enforcement resources on the drug traffickers who warrant it.”
While the Rhode Island Police Chiefs Association pushed for the drug amount to be reduced to 5 grams due to concerns about fentanyl, it stayed silent regarding the safe consumption sites and legalizing buprenorphine, according to Sid Wordell, the association’s executive director.
“We are looking to work with the community and the resources available,” Wordell said of the centers.
He acknowledged that law enforcement has come a long way.
“Law enforcement has been slow to accept it as a disease. The fact that we’re not objecting is a show that in Rhode Island we’re viewing addiction as a disease,” Wordell said.
Brandon Marshall is a professor of epidemiology at the Brown University School of Public Health who conducts research that aims to improve the health and well-being of people who use drugs. He also serves as an expert adviser to the governor’s overdose taskforce.
“Rhode Island has led the nation in mounting a robust response to the overdose crisis. But what we’ve learned is that our best efforts are hamstrung when drug use remains criminalized. When we felonize the use of certain types of drugs, we push people into the shadows and away from resources, treatment, and health care. This new suite of legislation is highly promising and will de-stigmatize substance use disorders, improve access to support and care, and address racial inequities that grew out of the war on drugs,” Marshall said in an email.
Ashley Perry, a project manager in Pawtucket for Project Weber/RENEW, works directly with people with substance-use disorders to help keep them safe and provide them with access resources.
“They couldn’t believe that people were finally taking their disease seriously,” Perry said. “The fact that we took steps to end the war on drugs, I’m really proud of that.”
Still, the harm-reduction centers received pushback from some state lawmakers.
Rep. Arthur Corvese, D- North Providence, at the State House Tuesday expressed “visceral” opposition to the notion of taxpayers potentially paying for prosecution-free, safe-zones for addicts to take illegal drugs.
“What kind of signal do we send?” Corvese asked.
According to advocates, nonprofit organizations are expected to cover many of the costs and staffing related to the centers.
Federal stance is unclear
Proponents of safe injection sites look to the successes of the more than 100 sites operating worldwide. They cite findings that crime rates dropped near the centers and that they’ve seen no overdose deaths.
Rep. John G. “Jay” Edwards, a sponsor of the harm-reduction legislation, emphasizes the need to establish just one center to pilot the program and demonstrate the success to the rest of the state.
“I want to save people’s lives. Maybe, just maybe, they will be able to get them into treatment and get them back into society,” Edwards, D- Portsmouth, Tiverton, said.
Rhode Island is not alone in exploring its options to quell the opioid crisis. Somerville, Massachusetts, is moving with its plan to open a center where people can inject drugs under the oversight of medical professionals. San Francisco, Philadelphia and New York City are among the cities that have fielded proposals. There is legislation in Massachusetts that would authorize two pilot sites.
The federal government’s stance on such centers remains unclear.
Federal prosecutors successfully blocked a so-called safehouse from being opened in Philadelphia by arguing that it would violate the U.S. Controlled Substances Act’s prohibition on “crackhouses.”
In January, a federal appeals court panel agreed, despite the American Medical Association’s brief in support.
“Safehouse admirably seeks to save lives,” the court wrote. “And many Americans think that federal drug laws should move away from law enforcement toward harm reduction. But courts are not arbiters of policy. We must apply the laws as written.”
Brown’s Marshall, who co-led the needs assessment and feasibility study for supervised consumption sites in Somerville, remains optimistic about the federal response under President Joe Biden.
“We don’t have a clear understanding of the federal response to this specific legislation yet, but the Biden administration has been much more supportive of harm reduction programs than previous presidencies,” Marshall said in an email.
He noted that Xavier Becerra, the secretary of the Department of Health and Human Services, voiced strong support for supervised consumption sites when he was California’s attorney general.
“So I don’t expect that federal interference should weigh very heavily on those here in Rhode Island who are working every day to prevent overdoses and save lives,” Marshall said.
In the meantime, even as the legislation to clear the way for centers in Rhode Island heads to McKee’s desk, state lawmakers and the task force members vow to forge ahead to find new ways to clear obstacles to treatment and recovery.
“All of these bills, it says that Rhode Island cares enough to take bold initiatives to save our people,” Edwards said. “There’s no silver bullet for this opioid crisis. We’re going to have to continue to look at other areas.”
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