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Overdose Prevention Sites – Authentically Pro-life

As part of the Franciscan formation process, men training to be friars spend time at ministry sites learning and serving. Recently, a student friar reflected on his experiences working with people who are addicted to drugs, describing the importance of caring for all humanity.

During a hot and humid July day in Boston, my friend Bobby and I made our rounds along Recovery Road — also known as Methadone Mile — talking to, checking on, and assisting with harm reduction in the community of active addicts along a strip of about 10 blocks in South Boston. It runs along Massachusetts Ave., Tremont St. and Southampton St. toward Route 93 — splitting Columbus and Lower Roxbury. Part of our route took us down a side road of Southampton St., where we came across a young man who wasn’t moving. We walked over and tried to wake him. In doing so, we noticed his lips and fingers were blue, and realized that this young man had overdosed.

While I called 911, Bobby began administering sternum rubs and rescue breathing. But seeing that he wasn’t responding, we administered Narcan. It was as if the young man was raised from the dead; he came to and sat up just as the Boston Police Department and first responders arrived to take over his care. I would like to say this was an exception. Unfortunately, it was a recurring experience this past summer.

While at St. Anthony Shrine last year, a part of my ministry was volunteering with a harm reduction and needle exchange program called AHOPE, which provides a range of services to people who are in active addiction and intravenously inject drugs. A service of the Boston Health Commission, the program is located near Boston Medical Center and operates at the hospital and through a mobile van.

My invaluable experience at AHOPE gave me practical knowledge of what is happening on the frontlines of our country’s drug epidemic and what is being done on a daily basis to keep our sisters and brothers safe, alive, and ultimately get them the long-term help they need — which is out of active addiction and into recovery.

The statistics are earth-shattering. According to the 2016 National Study on Drug Use and Health, an estimated 28.6 million Americans, ages 12 and over, had used illicit drugs in the month prior to the study. That number is expected to rise to at least 30 million in the next study.

Much like Boston, Philadelphia is also experiencing this epidemic at an alarming rate. In 2017, Philadelphia experienced 1,212 deaths due to overdoses. Having spent the previous summer in Philadelphia at St. Francis Inn, I experienced first-hand how this epidemic is ravishing the lives of men and women, black and white, rich and poor, young and old. The disease of addiction does not discriminate.

As our country continues to learn how to confront this epidemic, one life-saving and controversial proposal is overdose prevention sites, more commonly known as safe injection sites. The Boston Globe reported on Jan. 17, that Boston Mayor Marty Walsh, previously a staunch critic of these sites, is beginning to contemplate their value. Mayor Walsh has said, “I went from a hard ‘no’ on safe injection sites to, ‘Am I in the right place on that?’ We have to look at it all.” The mayors of Boston and Cambridge, along with a special commission, have just returned from Canada, where they visited — and witnessed the impact of — overdose prevention sites. The group has also been reviewing more than 100 studies about the sites, most of which have had positive results.

Upon their return from Canada, Mayor Walsh told the Boston Herald, “You can’t speak against them. There’s something there. It’s something that I am going to talk more about as I get a chance to debrief with the team that went with me, and then we’ll start having conversations.”

The city of Philadelphia announced last January that while it will not fund the project, it will allow the opening of Safehouse, a proposed injection site. Safehouse’s board of directors consists of former Gov. Ed Rendell and some of the city’s top leaders in medicine, behavioral health, and social/human services.

In an Oct. 8, 2018 article in the Inquirer, author Aubrey Whelan reports that Safehouse is currently searching for a location, but it is very likely that it will find its home in the Kensington neighborhood — which is the epicenter of Philadelphia’s heroin epidemic, and the neighborhood of our beloved, and hard-working St Francis Inn.

Jay speaking last year in Chicago about injustice (photo courtesy of Octavio Duran, OFM)

Benefits of an Overdose Prevention Site
An overdose prevention site is a safe, clean and monitored place where someone in active addiction can consume drugs, as opposed to being in an unsafe, dirt- and bacteria-ridden, secluded alley or building. When the addict arrives, he or she is registered (not by name, in Boston we used a specific series of letters and numbers based on personal information) into the system collecting demographic data to help in further studies.

Next, they are made aware of services that include STI testing, medical treatment for wounds, shelter and food assistance. They are then brought to a private area where they are provided with new, sterile items such as a needle, tourniquet, alcohol swabs, and most importantly — fentanyl testing strips.

The individual will have to inject themselves without the help of an employee or friend. In addition, the individual has to supply their own drugs. The sale of drugs, or passing them to others, is prohibited at these sites (and strictly enforced). Once the person has injected himself and cleaned up the area, he is brought to a holding area where he will be monitored for the possibility of overdosing.

Overdose prevention sites have four main goals: preventing overdoses, decreasing the spread of sexually transmitted infections, offering medical attention, and being there when individuals decide to enter treatment for their addiction.

Unlike the young man that Bobby and I happened upon, thousands of addicts die alone from overdoses each year because no one was there to call 911, administer Narcan, or offer some other kind of assistance.

Narcan, the name brand of Naloxone, is an opioid antagonist used to reverse an opioid overdose. Along with Narcan, the immediate administration of life-saving practices also decreases the time the brain is without oxygen, thus decreasing the possibility of brain damage. According to the Boston Public Health Commission, from October 2016 to May 2017, Narcan is credited with reversing nearly 1,123 overdoses just in Boston.

Another leading cause of death among addicts is from sexually transmitted infections (STIs). People who inject drugs are at high risk for transmitting STIs through the sharing of needles and other drug paraphernalia, such as cotton swabs and the cookers used to dissolve drugs.

While HIV continues to be an STI that is transmitted among those who inject drugs, it is Hepatitis C that is most affecting the community. In 2015, among the cases of newly infected people with Hepatitis C, 64 percent of those in the study were drug abusers that used injections.

There is certainly no question that the accessibility of new needles and paraphernalia reduces the spread of STIs. But another important benefit of an overdose prevention site is that nurses and doctors are readily available to administer medical treatment for those who need it.

For an addict in active addiction, health is not high on the priority list. When a person is deep into addiction, they are so concerned with getting the next fix that they are not aware of the abscesses or open wounds that have formed because of poor injections or flesh wounds. An overdose prevention site will have nurses and doctors on staff who will be able to care for wounds. To confront the systemic problem of abscesses, proper injection training will be available by nurses and social workers to those who visit the sites.

The ultimate goal and hope of the site, is that staff is available at the very moment an addict decides to surrender to the disease of addiction and enter treatment. An overdose prevention site has access to local treatment facilities and the wherewithal to help individuals gain access to treatment.

Knowledge from Professionals in Field
As with all ethical debates, there is another view to this discussion a view that struggles to understand the positive value of overdose prevention sites.

In an Oct. 15, 2018 article from the Philadelphia Inquirer, U.S. Attorney William M. McSwain pledged to do all he can to block Safehouse. McSwain calls Safehouse “fundamentally illegal,” while citing a 1986 federal law – “known colloquially as the ‘crack-house statute,’ making it a felony punishable by up to 20 years in prison to knowingly open or maintain any place for the purpose of manufacturing, distributing, or using controlled substances.”

However, I would agree with Ronda Goldfein, the vice president of Safehouse and the executive director of the AIDS Law Project of Pennsylvania, who is quoted as saying that “the intent of the crack-house law was to prohibit one type of conduct. We believe that our conduct is different from that – namely, that Safehouse is working to prevent overdoses, not promote drug use.”

As with all hot-button issues, this story is ever changing — and on Feb. 6, 2019, federal prosecutors in Philadelphia launched a legal challenge against Safehouse, continuing to cite the 1986 Controlled Substance Act. Goldfein, in an interview with NPR, stated, “We have a disagreement on the analysis and intention of the law. We don’t think it was intended to prevent activities such as this, and perhaps it will take a court’s ruling to move the issue forward.”

I would like to propose two ways that we can bravely and prophetically be a part of this movement. The first is to join the discussion. If your area is considering an overdose prevention site, participate in the discussions. Don’t feel that you have to have all the answers, or that you have to know definitively where you stand on the issue. Come to the discussion with an open mind and an open heart. In many of the cities where this discussion is occurring, the organizations are deeply benefitting from the ethical and spiritual guidance and support of members of different faith communities.

The second method is to seek knowledge and understanding from professionals in the field. Remember that this is uncharted territory for everyone and that although there are certainly many who are and have been on the frontlines of this debate for some time, we are all learning and growing in our understanding of harm reduction and overdose prevention sites. Also keep in mind that there are many cities around the country that are currently in this process, and it has been my experience that those clinics are enthusiastic to assist in any way they can.

I raise this issue because we Franciscans currently find ourselves either near areas where this discussion will soon begin, or we are already in the epicenter of the debate. We have the love, trust and respect of our neighbors, many of whom are in active addiction and who use our stoops and doorsteps as overdose prevention sites.

When in Philadelphia, I and others at the St. Francis Inn ministry would exit the friary each morning, cautiously picking up needles and other drug paraphernalia from the steps and sidewalks. This past summer, I was regularly disposing of drug bags or paraphernalia near the Shrine in Boston.

My only desire with this article is to present my own experience as a grateful recovering addict who was once down that cyclical dark pit of despair, and as one who currently ministers to those both in active addiction and in recovery.

Like Christ, our Father Francis didn’t stop to ask the leper how he had acquired leprosy or what he was going to do about it. He honored the dignity of the person, and having experienced the Incarnation within that leper, he grew in his own conversion and vocation toward caring for all of humanity and creation.

My sisters and brothers, in the midst of this opioid and drug epidemic, how is God calling us to prophetically answer this challenge to live the Gospel? We are called to meet our sisters and brothers with open hearts and open minds, however and wherever they are along their journey of life. May God continue to show us what is ours to do.

— Br. Jay, a native of Peabody, Mass., is in his third year of theology studies at Catholic Theological Union in Chicago. His ministry for the last three years in Chicago has been as a chaplain at Cook County Jail, working mostly with men who are in early recovery and are awaiting trial for a drug charge. He professed first vows as a Franciscan on Aug. 2, 2015.

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