"When people first hear about this, their gut instinct is to say, 'No way.' "

Jennifer Michaels, medical director of the Brien Center for drug abuse said about a new possibility for Massachusetts' opioid epidemic: supervised drug injection facilities.

"But when we dig a little deeper, it becomes clear that supporting [this] is the right thing to do," she said.

Jennifer Michaels and her husband, Basil Michaels — both doctors and Berkshire County delegates to the Massachusetts Medical Society — voted in favor of a resolution advocating for a pilot supervised injection facility program in Massachusetts at the society's annual meeting on April 29.

Michaels has been working in addiction medicine for over 25 years.

HOW IT WORKS

Drug users would bring their own substances to injection facilities — medical staff would not be providing drugs, Michaels said.

Drug users would be provided with safe, unused syringes. They would experience the effects in the facility under the supervision of medical staff, she said.

"They're not injecting alone in a bathroom and perhaps overdosing," she said.

Michaels added that supervised injection facilities could prevent the use of unclean needles, as addicted users direct their money and energy toward purchasing drugs to avoid painful withdrawal symptoms — not to securing clean needles.

"Their money is being spent to get the drug, and there's little money left for anything else," she said. "By the time people are so desperate ... they're not so much using to get high, they're using to avoid withdrawal."

This effort would save money along with saving lives, she said.

"Even if you're just looking at the bottom line, [this] makes sense," Michaels said. "Think of it this way. Treating one person for Hepatitis C — one person — can cost about $100,000."

Injections in a safe, private facility reduces drug use in public areas, she said.

If adverse reactions occurred, users would receive medical help, enabling them to live another day to hopefully seek treatment, she said.

"When they're there, they may be kindly made aware that treatment works, and asked, 'Do you want any help to access care?' " she said. "If they say no, that's fine. There would be a whole menu of treatment options available. What people often don't realize is that having a supervised injection [facility] also offers the opportunity for people to enter treatment."

Medical providers could talk to users about options like detox, methadone treatment or Narcotics Anonymous meetings, she said.

These options are especially relevant in a state like Massachusetts, which has more treatment options than other states, Michaels said.

Other places have very few detox beds and no or limited methadone clinics where transportation is a greater issue for drug users.

"We have very robust treatment options," she said. "Is it perfect? Absolutely not. Are there waiting lists at times? Yes. But it's better than the vast majority of states [in] the country."

CLOSER TO TREATMENT

An estimated 1,979 people in Massachusetts suffered unintentional or undetermined opioid-related deaths in 2016, up from an estimated 1,751 in 2015, according to recently released data from the Massachusetts Department of Public Health.

Nationwide, opioids killed more than 33,000 people in the United States in 2015 — more than any other year on record. 91 Americans die every day of an opioid overdose, according to the Centers for Disease Control and Prevention.

These facilities would help users to continue on the path to hopefully recovering from their addiction.

"The hope is, people will live another day, and those accumulated days will bring them closer to a desire to enter treatment," Michaels said. "There's concerns that [these facilities are] encouraging people to use. That hasn't been shown to be the case."

Supervised injection facilities have been implemented in Canada, Australia, Spain, Germany and other countries. The first North American clinic opened in Vancouver in 2003. Washington state officials approved the United States' first safe injection sites in January, one to be located in Seattle and one in the surrounding county.

The initial pilot clinics in Massachusetts would likely be located in the Eastern part of the state, not Berkshire County, Michaels said.

But the program would likely would make its way out to the Berkshires if it was considered successful, said State Rep. William "Smitty" Pignatelli , D-Lenox.

"If one pilot is successful, you know they're going to want to replicate it," he said. "I just think that should be far down the road. I think we should exhaust every other opportunity."

The Massachusetts Medical Society's vote to advocate for these facilities is not a policy document.

Legislation would have to be crafted to actually create these facilities, Pignatelli said.

Those addicted to drugs face treatment challenges in Berkshire County, including a lack of transportation and availability of treatment beds. Insurance companies have also been slow to pay for ongoing recovery treatment, he said.

Pignatelli said he's reluctant to support any potential pilot injection facility. He said he'd much rather see the money spent on a facility go to increasing the number of beds in treatment locations.

"I just think it says the wrong message, I really do," he said. "When I first saw this, I said, 'You've got to be kidding me.' Are we getting that desperate with this problem in Massachusetts that we think that's the solution? I think it's sad."

HARM REDUCTION

Services like syringe access, naloxone and supervised injection facilities reduce the harms associated with drug use, said Jennifer Kimball, program coordinator of the Berkshire Opioid Abuse Prevention Collaborative.

Harm-reduction practices save lives and make it more likely drug users will seek other treatment, she said.

"The more people start engaging ... they are more likely, down the road, to do other self-care, including seek treatment," she said. "I think that's where the value is to a community."

These measures support drug users as individuals with the right to exist, she said.

Although it's very unlikely a supervised injection facility would be implemented in Berkshire County in the near future, Kimball said she's looking forward to seeing how the pilot program may be implemented elsewhere in the state.

"I have a wait-and-see attitude," she said. "I don't know how they're going to create the program ... For us, it's all so new."

Reach staff writer Patricia LeBoeuf at 413-496-6247 or @BE_pleboeuf.