>>> THE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH IS LOOKING TO
OPEN SAFE MONITORING SITES WHERE PEOPLE WHO USE ILLICIT DRUGS CAN
BE WATCHED BY A MEDICAL PROFESSIONAL AFTER TAKING THE
SUBSTANCE.
PROPONENTS SAY THIS IS PART OF AN OVERALL STRATEGY OF HARM
REDUCTION.
CAROLEE McGRATH SAT DOWN WITH TWO MERCY MEDICAL CENTER
EMPLOYEES, DR.
ROBERT ROOSE, THE CHIEF MEDICAL OFFICER AND DR.
ARI KRIEGSMAN, THE MEDICAL DIRECTOR OF ADDICTION CONSULT
SERVICE, TO LEARN MORE ABOUT WHAT THIS WOULD LOOK LIKE.
>> RIGHT NOW, THE STATE IS ENGAGED IN A PROCESS TO MOVE
FORWARD AN IDEA THAT HAS TO DO WITH HARM REDUCTION THAT REALLY
IS FOCUSED ON SAVING PEOPLE'S LIVES STRUGGLING WITH OPIOID
ADDICTION.
WE ARE IN A CRISIS AND IN THIS AREA IS PARTICULARLY TROUBLED
AND CHALLENGED BY HIGH RATES OF OVERDOSE DEATHS.
SO THE STATE HAS LOOKED AT SOME NEW NOVEL AND INNOVATIVE IDEAS
TO HELP PREVENT PEOPLE FROM DIES FROM OPIOID OVERDOSE.
SAFE MONITORING CENTERS OR MEDICAL OBSERVATION POST
OVERDOSE IS ONE OF THOSE WAYS.
THEY ARE SPECIFICALLY ORIENTED AROUND ENSURING PEOPLE DON'T DIE
FROM OVERDOSE, GET EDUCATION, AND GET CONNECTED TO TREATMENT
AFTERWARD AFTERWARDS.
>> HOW WOULD IT BE SET UP?
>> THE STATE IS LOOK FOR INTERESTED COMMUNITY AGENCIES OR
PROVIDERS TO DEVELOP THESE IN PROBABLY ABOUT FIVE AREAS AROUND
THE COMMONWEALTH HARD HIT BY OVERDOSE.
IT IS MODELLED AFTER A SUCCESSFUL PROGRAM IN BOSTON
THAT IS HOWESED IN THE HEALTH CARE FOR THE HOMELESS LOCATION
THAT IS CALLED S.P.O.T.
THE CHIEF MEDICAL OFFICER THERE HAS DEVELOPED A WONDERFUL
PROGRAM THAT HAS SOME REMARKABLE OUTCOME CONSIDERING THE
POPULATION THAT THIS IS REACHING.
AND THE WAY IT IS SET UP IS THERE IS AN AREA WHERE
INDIVIDUALS WHO MAY BE UNDER THE INFLUENCE FROM A SUBSTANCE, ARE
ABLE TO GO IN SAFELY, BE MONITORED BY REGISTERED NURSES
OR NURSE PRACTITIONERS, RECEIVE ANY TREATMENT OR SUPPORT THEY
MIGHT NEED, AND THEN BE ENGAGED BY PEERS, OFTENTIMES RECOVERY
COACHES OR OTHER COMMUNITY HEALTH TYPE WORKERS.
ALL UNDER THE SUPERVISION OF A PHYSICIAN OR SOMEBODY WITH A
MEDICAL LICENSE AND ADDICTION EXPERTISE THAT COULD HELP ENSURE
PATIENTS ARE TAKEN CARE OF APPROPRIATELY.
>> THIS IS SORT OF A FIRST CONTACT MAYBE FOR MANY PEOPLE.
THEY WOULD GO IN THERE, OBVIOUSLY, YOU ARE TAKING CARE
OF THEIR IMMEDIATE NEEDS, BUT THERE WOULD BE THAT AFTER
CONTACT OF SAYING WE HAVE COUNSELING SERVICES, RECOVERY
COACHES.
IS THIS EFFECTIVE?
>> YEAH.
WHAT WE KNOW FROM THE S.P.O.T., THEY ENGAGE 20% TO 25% PEOPLE
THEY ARE SEEING INTO ADDICTION CARE AFTERWARDS.
HAVING A PLACE PEOPLE FEEL COMFORTABLE AND SAFE AND BILL
THAT RAPPORT, THAT IS A VALUABLE RESOURCE.
PEOPLE KNOW WHERE TO GO WHEN THEY ARE READY FOR HELP.
HAVING THAT PLACE AND A TOUCH POINT WHERE THEY ARE SAFE AND
THERE IS EVIDENCE IT COULD BE A GOOD STARTING POINT TO GET INTO
TREATMENT.
>> SOME PEOPLE MIGHT BE CYNICAL ABOUT IT BECAUSE THERE WAS
CONTROVERSY WHEN WE TALKED A YEAR AGO ABOUT SAFE INJECTION
SITES.
SOME PEOPLE SAY THIS IS A STEP DOWN.
SOMEBODY GETS HIGH OUTSIDE OF THE CLINIC AND WALKS INTO THE
MONITORING SITE.
DOES THIS ENCOURAGE BEHAVIOR AS SOME MIGHT SAY?
>> YEAH.
I THINK PROBABLY THE BEST EVIDENCE WE HAVE IS THE SAFE
INJECTION SITES THAT HAVE DONE SOME RIGOROUS RESEARCH ON AND
SHOWN IT DOESN'T ENCOURAGE ONGOING USE OR INITIATION OF
USE, IT ENCOURAGES PEOPLE TO BEGIN THE PROCESS OF RECOVERY.
FROM THE RESEARCH THAT HAS BEEN DONE SO FAR IS ROBUST IT DOESN'T
ENCOURAGE NEW USE AND THERE IS A TREND TOWARD PEOPLE GETTING INTO
TREATMENT AND REDUCING THEIR USE.
>> IS THAT ONE OF THE CHALLENGES YOU BOTH FACE, I ASSUME,
CHALLENGING THE OPINIONS THAT PEOPLE HAVE ALWAYS HAD ABOUT
SUBSTANCE ABUSE AND PERHAPS THEY WOULD COME AT IT FROM A
DIFFERENT POINT OF VIEW, WHERE YOU ARE SAYING, LISTEN, THIS IS
OUR INITIAL CONTACT TO GET THIS PERSON INTO RECOVERY.
IS THAT A CHALLENGE AS YOU TRY TO HELP PEOPLE?
>> YEAH.
I THINK THE CULTURE IS CHANGING AROUND THIS, PUBLIC OPINION IS
CHANGING.
THE CRISIS IS SUCH THAT IT IS HARD TO MEET SOMEBODY WHO HASN'T
HAD A FRIEND OR FAMILY MEMBER OR COLLEAGUE THAT HAS BEEN AFFECTED
BY IT.
I THINK THE MORE PEOPLE WHO ARE, UNFORTUNATELY, AFFECTED BY THIS,
I FIND THE CONVERSATION IS OPENING MORE AND MORE TO HELP,
LIKE, IF THIS WAS YOUR FAMILY MEMBER OR YOUR FRIEND, WHERE
WOULD YOU WANT THEM TO BE?
WOULD YOU RATHER THEY WERE IN A PUBLIC RESTROOM, IN A PARK
NOBODY ELSE AROUND OR SUPERVISED SOMEWHERE?
I FIND THE CONVERSATION STILL HAS A LONG WAY TO GO, BUT I
THINK THERE ARE SOME BIG STEPS FORWARD.
>> WHEN YOU TALK A LITTLE ABOUT THE OPIOID RELATED DEATHS
STATEWIDE, THEY ARE TRENDED DOWN.
YOU TALKED ABOUT WESTERN MASS BEING PARTICULARLY HIT HARD IN
THIS AREA.
TELL US ABOUT SPRINGFIELD AND HOLYOKE?
>> THAT'S RIGHT.
STATEWIDE, LARGELY THE WORK THAT CAME OUT OF THE WORKING GROUP,
SETTING A FRAMEWORK OF HOW DO WE PREVENT AND INTERVENE WITH
PATIENTS.
WE HAVE SEEN A DECREASE IN OVERALL OVERDOSE FATALITIES
ACROSS THE STATE.
THAT HAS NOT BEEN THE EXPERIENCE IN THE CITY OF SPRINGFIELD AND
SURROUNDING TOWNS LIKE HOLYOKE H. IN SPRINGFIELD THERE WAS AN
INCREASE IN OVERDOS RATES BETWEEN 2017 AND 2018.
IN HOLYOKE THEY STAYED ABOUT THE SAME.
WHY THAT IS, I THINK IS POTENTIALLY A COUPLE OF
DIFFERENT FACTORS.
ONE IS WE ARE IN AN AREA HERE THAT IS VERY SORT OF RIFE WITH
POTENT FENTANYL SYNTHETICS THAT CAN CAUSE AN OVERDOSE DEATH IN
SECONDS.
IN COMMUNITIES WHERE FENTANYL RATES ARE HIGH THAT PRESENTS A
CHALLENGE TO PREVENT DEATH.
SECONDLY, WE ARE IN COMMUNITIES WHERE WE NEED TO ENSURE ALL THE
INTERVENTIONS WE HAVE DEVELOPED ARE REACHING THOSE POPULATIONS.
WHAT WE HAVE SEEN IS COMMUNITIES OF COLOR, HISPANIC AND BLACK
COMMUNITIES, HAVE SUFFERED DRAMATIC INCREASES IN OVERDOSE
DEATH RATES WHEN THOSE IN WHITE COMMUNITIES HAVE ACTUALLY
DECREASED.
THAT PEEKS -- SPEAKS TO, I THINK, TO ENSURE THE
INTERVENTIONS WE ARE EMPLOYING TO REACH ALL THE COMMUNITY AND
TO RECOGNIZE THERE MAY BE ADDITIONALLY MARGINALIZED OR
SPECIAL COMMUNITIES THAT WE NEED TO DO SOME NEW AND INNOVATIVE
THINGS.
WHEN WE LOOK AT HARM REDUCTION THAT IS WHERE WE CAN SEE, LIKE
THE SAFE MONITORING CENTERS, TO REACH PEOPLE THAT MAYBE
OTHERWISE HADN'T BEEN REACHED AND LOOK TO PREVENT DEATH
INCLUDING RIGHT HERE.
>> HARM REDUCTION WOULD INCLUDE NARCAN.
THAT WAS CONTROVERSIAL A FEW YEARS AGO AS WELL, YES?
>> HARM REDUCTION IS A STRATEGY.
TO REDUCE HARM IS TO HONOR THE DIGNITY OF PEOPLE, THE AUTONOMY
OF PEOPLE CAN BE DEFINED BY A SET OF STRATEGIES TO REDUCE THE
CONSEQUENCES IN THIS CASE PARTICULARLY SUBSTANCE ABUSE.
THAT COULD INCLUDE NALOXONE, SAFE CENTERS, ENGAGEMENT WITH
INDIVIDUALS USING SUBSTANCES.
IT IS ALL ABOUT MEETING PEOPLE WHERE THEY'RE AT, PROVIDING
SERVICES THAT ATTEND TO AND REDUCE THOSE RISKS AND HELPING
THEM LEAD HEALTHIER LIVES.