“Nuisance Health Establishment”

Last night, government was happening in the form of a ban on something already illegal. Specifically, the City Council held a public hearing on an ordinance to ban supervised injection sites (“SIS”) within city limits. A SIS is a “harm-reduction” intervention that allows people who inject drugs to use previously obtained substances under the supervision of health professionals. Of note, these sites are currently illegal under both state and federal law.

So, how did we get here?

If we hop back in time a bit, Rep. Tara Hong signed on as a petitioner to House Bill H.2196, An Act Relative to Preventing Overdose Deaths and Increasing Access to Treatment. The bill seeks to shield from criminal liability individuals running and using “harm reduction programs.”

The bill reads, in relevant part:

“Programming or services provided by a harm reduction program may include, but shall not be limited to: needle exchange; primary care, including disease prevention and health screenings; access or referral to evidence-based treatment options; drug testing services; overdose reversal care; supervision of persons who use pre-obtained substances; and other social support services deemed permissible by the department.”

If you read the full bill, it essentially decriminalizes narcotic possession for those “accessing” the SIS.

(^ If you know, you know. If you don’t, now would be a good time to quit your job and watch every second of every episode of The Wire. You can thank me (and David Simon) later. But mostly me.)

The language regarding “supervision of persons who use pre-obtained substances” caught the eye of Councilor Robinson, who took to social media to voice his concerns.

Days later, Councilors Robinson and Gitschier filed a motion requesting that the City Manager “have the proper department draft an ordinance banning safe injection sites within city limits.” At the September 23 meeting, the Council voted 9–1 in favor of the motion (Councilor Nuon opposed; Mayor Rourke was in Toronto).

Soon after, on September 25, Rep. Hong released a statement defending his support of the bill. He emphasized that H.2196 encompasses a broad range of harm-reduction measures—not just supervised injection sites.

Last Friday, we got our first look at the ordinance.

Last night, the Council voted 8–2 in favor of adopting it (Councilors Jenness and Nuon opposed; Councilor Scott absent).

Speaking in opposition, Councilor Jenness stressed that he was not, per se, in favor of SIS, but rather objected to a lawmaking process that (a) banned something already illegal and (b) failed to obtain input from public-health professionals. Councilor Nuon echoed this sentiment.

However, I do not believe that a longer or more measured process would have made much difference. The concept of a SIS is easy to understand. I don’t think councilors (or the public) struggle to grasp what these sites are or what they seek to accomplish. Instead, I sense that most people generally understand the idea—and reject it.

That said, I was surprised that only one speaker showed up last night to oppose the ordinance, especially given that several speakers weighed in at the September 23 meeting and that the issue has generated significant online attention. In those forums, proponents repeatedly suggested that rejecting SIS is equivalent to rejecting expert opinion and “evidence-based” conclusions.

However, much of the pro-SIS evidence commonly cited comes from outside the United States—Vancouver, Sydney, Oslo, Spain. These are world-class cities that, I assume (I don’t really go anywhere), have greater resources and more robust social-service infrastructures. Meanwhile, the few SIS-type operations that have appeared in the U.S. have faced legal challenges and lack long-term, comprehensive study. For a novel and controversial intervention like SIS, the burden of proof for implementation in a city like Lowell should be quite high. I do not believe proponents met that burden.

Lowell is already poor as dirt—our schools, fire department, and pretty much everything else are underfunded—and we already serve as a regional hub for addiction services. Expanding that role has community consequences that proponents seem to ignore (in fairness, I think those opposed to SIS are glossing over some potential benefits). For example, where would we put it? The entire SIS model depends on an illegal drug purchase followed by the illegal transport of narcotics into the site. Where, in relation to the SIS, do we expect those acts to occur? Once someone safely injects, will they leave the area or simply hang around until it’s time to repeat the process?

Certainly, there was some political theater baked into last night’s ordinance. Councilor Jenness was correct to note that it didn’t really accomplish anything. Legally, he’s right. But I suspect the eight “yes” votes understood that perfectly well. The true purpose was the messaging. First, that once again, the council takes exception to state measures that impact local operations. Second, Lowell can reasonably reject certain items on the social-service buffet menu.

Last night’s ordinance opposing SIS is neither an attack on expert opinion nor a callous response to the opioid crisis. Rather, I see it as an expression of frustration with both top-down measures (in general) and a perceived “enablement” approach to addiction that may not be yielding positive outcomes.