11/13/19 Michael Botticelli

Century of Lies
Michael Botticelli
Drug War Facts

The Massachusetts Legislature's Joint Committee on Mental Health, Substance Use and Recovery held a hearing recently on harm reduction sites and supervised consumption facilities, so on this edition of Century of Lies we hear from MA State Sen. Cindy Friedman, Fenway Health's Carl Sciortino, and former US "Drug Czar" Michael Botticelli.

Audio file



NOVEMBER 13, 2019

DEAN BECKER: The failure of the Drug War is glaringly obvious to judges, cops, wardens, prosecutors, and millions more now calling for decriminalization, legalization – the end of prohibition. Let us investigate the Century of Lies.

DOUG MCVAY: Hello and welcome to Century of Lies. I am your host, Doug McVay, Editor of www.DrugWarFacts.org.

The Massachusetts Joint Committee on Mental Health, Substance Use, and Recovery held a hearing on harm reduction sites. They were considering two bills, H1712 an act relative to preventing overdose deaths and increasing access to treatment which was introduced by Representative Dylan Fernandez, and S1134 an act relative to supervised injection facilities introduced by Senator Joseph A. Boncore. We are going to hear some of the testimony from that hearing. The first person we are going to hear from is State Senator Cindy Friedman.

SEN. CINDY FRIEDMAN: Thank you to the Chairs and members of the committee. I am here today to testify in support of S1134, an act relative to supervised injection facilities sponsored by my colleague, Senator Boncore.

As you know, S1134 is now being discussed by its sponsor and several of my colleagues as a bill that could be redrafted based on the Harm Reduction Commission’s recent report and recommendations – a commission I had the great opportunity to serve on. I support any state efforts at harm reduction and specifically today to support the pilot program for safe consumption sites.

As you know, the 2018 Opioid Treatment Bill signed in to law last August created the commission to study harm reduction activities including the feasibility of implementing a harm reduction site pilot program in the Commonwealth to help curb the opioid epidemic, save more lives, and get more people in to treatment. We included this important provision in the bill because despite all of our efforts to date to combat this enormous public health crisis, an average of five people die from an overdose each day in the Commonwealth, and this is just not okay.

The increasing deadliness of Fentanyl further heightens this crisis. Frankly, it has become clearer that the tools and strategies we have employed to date – while helpful – were not enough. We have a moral and public health imperative to consider any and all evidence based harm reduction strategies; we cannot simply keep doing the same over and over. The Harm Reduction Commission was chaired by Secretary Sudders, and Commission Members included Representative Roy and myself, DPH Commissioner Bharel, and the Mayors of Boston and Cambridge, along with experts in the fields of addiction medicine, psychiatry, and psychology, law, public safety, plus those with lived experience and after months of thoughtful discussion, investigation, and soul searching we developed a set of meaningful, evidence based recommendations like access to clean needles, Fentanyl testing strips, increased outreach to those on the margins of substance use disorder and co-occurring mental illness. These all have been shown to have a very clear public health benefit and should be rolled out on a large scale and more broadly across the Commonwealth. You’ve heard all of this in previous testimonies and the recommendations of the Harm Reduction Report and I am very pleased that we as a Commonwealth, have begun to take meaningful steps to implement several of those proposals. Now these are very important steps to take but these strategies are not enough; we cannot stop and claim success. All of the evidence and studies the Commission reviewed, and all of the first hand reports from safe consumption sites in Canada and Europe where there are decades of experience and data available – all point to safe consumption sites as an evidence based harm reduction strategy and we can’t afford to dismiss it.

I know this is difficult for some people, the idea of safe consumption sites is uncomfortable but if it is proven to save lives then we have a moral obligation to at least give it a try. It can’t be about our feelings, it has to be about the evidence and what tells us works.

What does the evidence in harm reduction sites tell us? It tells us that a harm reduction site where one can use and consume substances in the presence of healthcare workers who can immediately intervene to prevent overdose. This absolutely, positively saves lives and reduces health issues associated with intravenous drug use. At the first harm reduction site in North America, which opened in Vancouver in 2003, there was immediately a 35% reduction in overdose deaths in the immediate vicinity compared with 9% reduction in the rest of the city when they applied other harm reduction strategies. The evidence tells us that the availability of clean needles at safe consumption sites reduced the transmission of diseases like Hepatitis C, and HIV and the evidence tells us that these harm reduction sites can be so much more than a safe place to use substances. Instead they can and should be a place where health care workers can develop a trusting relationship with those they seek to treat by offering a wide variety of additional services including drug checking, blood born virus testing, injection site wound care, initiation of medication assisted treatment for Substance Use Disorder, and referrals to health and social services. Let’s be clear, we must keep people alive first before we can help them and providing Narcan – which is critical, is not enough to keep everybody alive. This epidemic is far from over. People are still dying and we need to consider all of the evidence based and informed interventions that have proven track record of saving lives. There must be multiple doors to treatment, all with a very low threshold of entry. For this reason, the Commission made clear in its published recommendations that the Commonwealth should take the steps necessary to create a pilot test to impact the safe consumption sites here in Massachusetts. As I mentioned earlier, we must continue to evaluate all of these programs and the recommendations in the context of the ongoing public health crisis that we find ourselves in and while the deaths from overdoses are down in some areas; this crisis is far from over. In several of your communities the death toll rises. We still had 938 confirmed and estimated opioid related deaths in the first six months of that year so that doesn’t include July, August, and September. We continue to be in the midst of a public health crisis, plain and simple. We need to use every tool in the toolbox in order to address it and it would be irresponsible if we did not explore every opportunity as a means of tackling this epidemic and that includes establishing safe consumption sites. Lives are at stake! I ask every member of this committee to both recognize the magnitude of this epidemic and very seriously consider this very important bill. We cannot hold back in addressing this crisis. This epidemic is not only affecting those with Substance Use Disorder, but their children who are flooding our foster care systems and creating huge challenges for grandparents and family members. It is ravaging families and causing untold heartache – no one has not been affected. I strongly urge, plead, and beg the committee to report the bill out favorably. Thank you very much.

DOUG MCVAY: That was Massachusetts State Senator Cindy Friedman. She was testifying before the Joint Committee on Mental Health, Substance Use, and Recovery in October at a hearing on harm reduction sites. She was testifying in support of two bills, H1712 introduced by Representative Dylan Fernandez, and S1134 introduced by State Senator Joseph Boncore. Both of them regard supervised injection facilities.

You of course, are listening to Century of Lies. I am your host, Doug McVay. I am the Editor of Drug War Facts at www.drugwarfacts.org.

Now let’s get back to that hearing shall we? There is a lot to listen to. Let’s hear from Gary Langris.

GARY LANGRIS: Hi. I am Gary Langris. I am a resident of Gloucester, Massachusetts and just a citizen. Thank you Sir and Madam Chair and the Committee for hearing us today. I am here today as a witness. I have witnessed the heroin world – my first overdose I witnessed was 53 years ago. I have lived through it and am still living through it today. I have seen a lot of people pass on including family members – the list is just too long and you have heard it here today, you have heard the science, you have heard the numbers about the stigma and it is about time we need to really care about all of us here and not just a few. Where did this stigma come from? Did it come from us? No. I think a lot of the drug related stigma stated back in the 1800s – 1870s, passing the first opioid laws in San Francisco and it has progressively gotten worse. The last 70 years the people who use drugs have been treated like sub human beings, called every name in the book. There is not junky. That is something that somebody came up with – somebody that lays a stigma on us. When harm reduction came to this country and it started happening with small needle exchange people. It wasn’t like legislators. It wasn’t medical professionals, or public health professionals that stood up and said we are losing our friends from AIDs, what are we going to do? Do you think there were laws passed to protect those folks? No. We had to go out there and be people that do things illegal for years and years to get them done. That was in the mid-80s and my wife was HIV positive. I remember I put pot in a lot of the stuff back then. Have we gotten better? Sure. The stigma remains. The stigma is going to be there. When I get laid out there is going to be somebody there talking about the “junkie” hanging down on Shirley Ave. I know that! But there are other folks out there including our sons, daughters, grandchildren that are experiencing this right now. We can undo a lot of that stigma that started with legislation back in the 1870s in to the Harrison Act and all of that good stuff. The only option for a drug user back in the 50s was like Kentucky and Texas. There were two places. We have come so far but we still treat people who use drugs like criminals. Guess what? We are not all criminals! We are not all criminals. That is a label that has been put on us through legislation and its time now to legislate our way out of some of this stuff. We are not going to arrest our way out of it, we are not going to legislate our way out of it, but we can work on providing services for a group of folks that have been neglected for a hundred years. Thank you.

DOUG MCVAY: That was Gary Langris. Gary was testifying before a hearing of the Massachusetts Legislature’s Joint Committee on Mental Health, Substance Use, and Recovery.

Next up, this year from Carl Sciortino. Carl is the Vice President of Government and Community Relations at Fenway Health and he is also a former member of the Massachusetts Legislature.

MALE VOICE: Next I would like to call up Carl Sciortino for the identification of members, Carl Sciortino is a former colleague.

CARL SCIORTINO: Good morning Chairmen and members of the committee. Thank you for your time and attention to this issue this morning. I am here in support of H1712 and S1134. Fenway Health is a community health center that offers a wide range of services to people struggling with Substance Use Disorder and I want to share with you a little bit about our perspective on why we are supporting this legislation. As a community health center we are able to provide a full range of services. The medical department provides primary care, support for infection control, and a whole range of medical related services. The behavioral health department can provide counseling, support, and access to treatment referrals. Between the two we have medication assisted therapy. We provide MAT to our patients and those numbers are only growing right now.

More importantly than either of those services we also provide harm reduction services. The Access Drug User Health Program provides clients with a range of harm reduction program services including HIV/STI testing, Hepatitis C testing, treatment navigation, syringe exchange, nursing care, integrated behavioral health care, and more important than any of that; a friendly face. These are staff that build trust on the front lines, on the streets of the greater Boston area with people who inject drugs to give them an access point to treatment services that we provide at Fenway.

So what is the problem? The problem is we still have (despite the services like those that we provide) 2,000 people on average per year dying in the streets of Massachusetts. That exceeds the death rate from the AIDS epidemic at the height of its crisis. Despite the really valiant efforts of this legislature, of this committee, of the governor, that death rate has barely budged. We have celebrated to some extent small decreases, but overall we still have around 2,000 people on our streets dying.

So what do we need? We need a comprehensive approach to the opioid crisis. There are four prongs to the intervention that we should be deploying. 1) Prevention, 2) Treatment, 3) Law Enforcement. Those three this legislature has taken on full throttle. The fourth pillar of an intervention for the opioid crisis is harm reduction. The budget this year with the leadership of members of this committee and others invested over five million dollars in harm reduction, an increase this year and that is excellent. Yet with the harm reduction services that we are currently able to offer we still have to tell patients and clients when they are ready to use they have to leave our doors. They have to go in to the streets, in to public bathrooms, in to homes, in to unsafe injection facilities. We urge you to use your authority. As you have heard here this morning, Massachusetts has never waited for the federal government to take action, to be a leader on a whole range of issues including in public health. I urge your support. Thank you.

MALE VOICE: Thank you, Representative. I would like to recognize Representative Dan Ryan who has joined us. Questions from the committee, Chair Decker.

CHAIR DECKER: Thank you. It’s really great to have you here. I miss you as a colleague but I am so deeply grateful for your work and the role that you have taken on since leaving. Can you tell us a little bit more about what we are also seeing, if I understand this correctly, pockets of the state where they are experiencing high rates of overdose along with higher rates of new cases of HIV and AIDS.

CARL SCIORTINO: Sure. So as was mentioned by Representative Fernandez, for many years we saw a decrease in HIV transmission among people who inject drugs. In fact that was one our Massachusetts miracles; one of our success stories we told around the country. From the late 90s when we established syringe exchange programs until 2014, we saw an almost 90% reduction of HIV transmission among this population down to a low of just about two dozen cases in 2014. Two dozen cases statewide in 2014 which is nearly zero cases of HIV transmission – a real success story! What has happened since 2014? You have heard about the outbreak in Lawrence and Lowell? Roughly 150 cases (the number has changed a couple of times going up). The number of identified cases was approximately 125 – 150 of HIV tests in those communities alone during that outbreak. That is alarming to say the least. In Boston we identified a cluster through our program (UNINTELLIGIBLE) and others in the city of over six cases and that number has grown in the last several months as well. We have seen an outbreak in Worchester. We are seeing signals of HIV upticks across the state in communities – a reversal of the trend towards getting to zero so we have a lot of alarm in that arena. As was mentioned, we are now seeing thousands of new Hepatitis C transmissions among people who inject drugs. With Hepatitis C we saw Baby Boomer (UNINTELLIGIBLE) that was going to age out over time or be cured once the cures came online. The number of young people and people who inject drugs that are getting Hepatitis C today far exceeds the Baby Boomer generation of Hepatitis C from 20 – 30 years ago.

CHAIR DECKER: I want to thank you and I want to also thank you for bringing this to my attention early on in this session. I guess I continue to struggle with tying this to rates of usage to the issues of safe consumptions and finding it alarming that while we are acting quickly to address the vaping crisis – and I do think it is a public health crisis – but I you look at the numbers compared to overdoses or the alarming numbers of new individuals who have contracted HIV and AIDS. The fact that this isn’t public, this isn’t front page news; that I find alarming. If you could just talk a little bit more about tying the story in to why you are here today.

CARL SCIORTINO: Absolutely. So when I think about the history of Massachusetts public health interventions, the AIDS crisis has always been our success story. We took a leading role in showing the country how to respond, removing stigma, and doing services in a whole range of ways including ways, as was mentioned, that were considered illegal under federal law because we had people dying in our streets of AIDS. We now have more people dying of opioid related overdoses than the AIDS epidemic at its height. Take a look at what the harm reduction programs we currently offer: syringe exchange provides sterile equipment, testing provides intervention if someone has an HIV diagnosis to get them in to treatment. If someone is treated on HIV and they are undetectable, they are also not transmittable to other people which is also part of prevention. When you look at what is happening now with Fentanyl in the system there is no heroin on the streets of Boston or Massachusetts. Every bag, every supply is laced with Fentanyl. We know that from the testing that we do – that our clients do themselves I should say. When you have Fentanyl in the system it is actually a harder high that causes more overdoses, but it also crashes sooner. So what does that mean for someone that injects drugs? It means they are injecting more frequently, they need more access to clean syringes on a more regular basis. We cannot keep up with that demand sending people off in to their communities with a supply of syringes for how much they need to be injecting today with Fentanyl in the system. This legislature has done really great work expanding harm reduction programs. We have invested in syringe exchange programs and went from only five programs statewide three years ago to over 30 communities today that have approved syringe exchange. That is a remarkable improvement yet most of the people that have Substance Use Disorder, most of the people that inject drugs in this state do not have access to one of these programs readily available. Even when they do geographically have access it is not necessarily a place they can go with the frequency that they might need, especially when dealing with barriers of homelessness, housing, and mental health issues that are all in the mix of what these individuals are facing. The last thing I will say on that point is that I speak with humility about these issues because the people that have the real expertise as I know you know, are the people with lived experience and for this committee I urge you to give them the respect that I know you will because their experiences today on the streets of this community tell me as an individual why this issue is so important for us to move forward.

DOUG MCVAY: That was Car Sciortino, he is the Vice President of Government and Community Relations at Fenway Health and a former member of the Massachusetts Legislature as a State Representative. He was testifying at a hearing on harm reduction sites before the Joint Committee on Mental Health, Substance Use, and Recovery. He was testifying in support of two measures which relate to supervised consumption sites.

You are listening to Century of Lies. I am your host, Doug McVay. We are talking about harm reduction, supervised consumption sites, and we are also talking about the progress that drug policy has made. Here is Michael Botticelli.

MICHAEL BOTTICELLI: Chair Decker, Chair Seer, Members of the Committee. Thank you for the opportunity to testify today in support of harm reduction sites. My name is Michael Botticelli, I am the Executive Director of the Grayken Center for Addiction Medicine at Boston Medical Center and the former Director of Drug Policy for President Obama.

Boston Medical Center (BMC) has been a long standing national leader in Substance Use Disorder research, education, and treatment. In 2017, BMC established the Grayken Center for Addiction to accelerate innovation and care delivery and maximize the impact of addiction services. While Massachusetts has seen a decline in overdose deaths they remain tragically high with close to 2,000 deaths. Alarmingly, non-fatal overdoses continue to rise. Overdose deaths in Massachusetts have been increasingly related to the presence of illicit Fentanyl analogs accounting for the vast majority of overdose deaths. Since Fentanyl is much more powerful than heroin and prescription opioids it precipitates a quick onset of overdose death. Coupled with data that shows an increase of deaths occurring in isolation our current overdose prevention strategies are insufficient to meet this challenging landscape. This has also affected our campus in a very dramatic way as we have seen a significant increase in overdoses in our own bathrooms and have taken the unprecedented step of installing motion detectors to make sure that we are preventing overdose deaths. In addition to drug overdose deaths, the epidemic has caused a significant increase in cases of viral Hepatitis and increased incidents of HIV associated with needle sharing which is threatening to erase years of decline in HIV incidents. While the causes and drivers of this epidemic are complex and require a comprehensive response that expands prevention, intervention, treatment, and recovery support services; additional approaches that reduce the harms associated with this epidemic must be a critical and necessary part of our efforts. The establishment of medically supervised harm reduction sites would fill a critical gap in our current efforts, especially given the scientific consensus on their effectiveness. I know you already heard from the Massachusetts Medical Society, but the existing research is rigorous and has been endorsed by many experts in published and peer reviewed journals including (UNINTELLIGIBLE) The New England Journal of Medicine providing solid scientific evidence that states consumption facilities achieve positive outcomes. For example, we just heard out of Vancouver, British Columbia utilization of sites reduced opioid overdose mortality by 35%, and significantly increased access to treatment. Given the magnitude and scope of the epidemic and the devastating toll it continues to take on families and communities across the Commonwealth, Boston Medical Center supports the establishment of such facilities. On behalf of our clinicians who focus on addiction and treating our patients with kindness and compassion, we support the establishment of such facilities consistent with the findings of the Harm Reduction Committee. Thank you for your time today to testify. Thank you very much.

MALE VOICE: Questions from the committee?

CHAIR DECKER: First I want to say thank you for your service to our country and thank you for what you continue to do today here in Massachusetts. What would you say, given your experience both at the federal level and now at the state level and on the ground to those who raise legal issues at the federal level as being an obstacle or being a red flag to put a pause on moving forward on recommendations that are being made by the medical establishment as a way of dealing with a medical crisis?

MICHAEL BOTTICELLI: By full admission I am not a legal expert as it relates to federal law and there many people who I am sure are familiar with this committee who can navigate the tricky legal landscape. I will say this and I am probably a little bit out of my element here; at the federal level they have a tremendous amount of prosecutorial discretion as it relates to how they enforce federal law. I think that this could be an instance where they could also exercise that jurisprudence. I will also say (again, not being a legal expert) having a state sponsored, legally sanctioned site could provide some level of legal protection as it relates a state sponsored facility. I go back to our area of clinical and scientific expertise and it I think most people on this committee agree that the scientific evidence is pretty clear in terms of the effectiveness of it. I think Massachusetts has been a leader in this epidemic as it relates to its state services and I think this is another example where Massachusetts can demonstrate federal leadership in continuing to respond to the epidemic.

CHAIR DECKER: Thank you. So if I am correct in what I hear you saying -- because we have various opinions on what the legal implications would be or won’t be – but what I hear you saying is that the interpretation of legal implications should not be the barrier to medical recommendations on how to best address an epidemic.

MICHAEL BOTTICELLI: That is coming from a clinical background that I think we would recommend.

CHAIR DECKER: Thank you.

DOUG MCVAY: That was former Drug Czar Michael Botticelli, testifying before the Massachusetts Legislature’s Joint Committee on Mental Health, Substance Use, and Recovery. The hearing was on harm reduction sites. Michael Botticelli was testifying in support of H1712 an Act relative to preventing overdose deaths and increasing access to treatment, and S1134 an Act relative to supervised injection facilities. For now, that is it.

You have been listening to Century of Lies we are a production of the Drug Truth Network for the Pacifica Foundation Radio Network. On the web at www.drugtruth.net. I have been your host, Doug McVay, editor of www.drugwarfacts.org. The Executive Producer of the Drug Truth Network is Dean Becker. Drug Truth Network programs are available by podcast, the URL’s to subscribe are on the network homepage at www.drugtruth.net

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