Rhode Island introduces harm reduction centers

By Eileen Weber
October 3rd, 2021
Rhode Island State Senator Joshua Miller (D-28th District)
Rhode Island State Senator Joshua Miller (D-28th District)

Rhode Island is the first state in the U.S. to enact a law designated for harm reduction centers. Effective March 2022, these centers, also known as overdose prevention sites or supervised injection facilities, will integrate people suffering from substance abuse disorder with the physical and behavioral healthcare they need.

The legislation was introduced by Majority Floor Manager John G. Edwards (D-Portsmouth/Tiverton) and Senator Joshua Miller (D-28th District), authorizing a two-year pilot program launching the community-based centers to prevent drug overdoses. These facilities will provide health screening, disease prevention, and recovery assistance in which pre-obtained substances can be safely consumed.

In a written statement, Miller addressed the reasons behind setting up such a program:

“People who are addicted need help and protection from the most dangerous possibilities of addiction,” he said. “Having a place where someone can save them from an overdose and where there are people offering them the resources they need for treatment is a much better alternative to people dying alone in their homes or their cars.”

Miller clarified that statement when speaking to New England Psychologist. There’s a high incidence of overdose in most communities and fentanyl is the biggest problem.

“There’s a component of it in other substances. It was in heroin and now it’s being found in cocaine, meth,” he said. “More overdoses are fatal because people are unaware of what they’re consuming. That was the driving force behind this legislation.”

Monica McMyne-Smith is CEO and executive director of RI Community for Addiction Recovery Efforts (RICARES).

Monica McMyne-Smith is CEO and executive director of RI Community for Addiction Recovery Efforts (RICARES).

Monica McMyne-Smith, CEO and executive director of RI Community for Addiction Recovery Efforts (RICARES), a recovery and advocacy organization focused on substance abuse based in Providence, couldn’t agree more. She said because of cuts into the drug supply, people are consuming drugs laced with fentanyl when they were not seeking out fentanyl in the first place.

“We are facing an overdose crisis,” she explained, “and the U.S. is immeasurably behind on that fight. There are about 120 prevention sites throughout the globe and we have nothing of the sort. This kind of program moves us toward a more evidence-based response that’s internationally recognized.”

Miller said other regions are also proposing similar services—California and the city of Philadelphia are just two examples.

McMyne-Smith added that Massachusetts also has similar programs. But while the services they offer are effectively harm reduction centers, that’s not how they refer to them.

But whatever the name, these facilities are important to their surrounding communities, according to Miller. He said, “Harm reduction centers are 40 percent more effective in transitioning to getting treatment rather than the ER, police, or other clinical settings.”

Miller noted the state’s Department of Health is setting up a group to regulate the program and offering it to communities that may be interested in having a center. At this time, it’s uncertain how many centers there will be and where they will be located.

However, he said they anticipate harm reduction centers to be a permanent fixture within their respective communities. But it will be based on funding and how the communities respond. As he put it, “As long as there is a need for it, there will indefinitely be one or more in Rhode Island.”

According to Prevent Overdose RI (PORI), the need for harm reduction centers is obvious. PORI is a data dashboard that provides the latest addiction and overdose information in the state. Based on their findings, more than 70 percent of overdose deaths in 2020 involved fentanyl. All age groups were affected, mostly adults with a majority of men. In fact, three out of four males died from overdose.

RICARES provides a simple walk-through on their website of what a harm reduction center would look like. Individuals first meet a staff member at the registration desk at which their personal information and the substances they wish to use are confidentially recorded.

They then sit in the waiting room for an open booth in the consumption room. In the consumption room, visitors will have the option to test their substances using a mass spectrometer, which details the molecular break down of each substance, or fentanyl strips to determine drug safety. Sterile needles and smoking supplies are available.

The next step involves moving into an observation area to make sure they are well before leaving the facility.

Critics argue that the centers will enable drug use. Proponents believe the facilities will reduce the number of overdose deaths as well as significantly reduce the risk of infectious diseases. While the staff members are there to support users, they do not interfere or directly assist in drug usage.

Miller said the American Medical Association (AMA) was initially unsupportive of the centers but recently reversed its position. In a released statement from the AMA in early July, the organization lauded Rhode Island for taking the first steps to implement such a program.

AMA Opioid Task Force Chair Bobby Mukkamala, M.D., noted:

“By enacting the nation’s first law in support of a pilot harm reduction center, Rhode Island is taking an important step to save lives from drug-related overdose and death,” he said. “The AMA strongly supports the development and implementation of harm reduction centers in the United States. These facilities are designed, monitored, and evaluated to generate data to inform policymakers on the feasibility, effectiveness, and legal aspects of reducing harms and healthcare costs related to injection drug use.”

Harm reduction centers won’t be a magic wand and it will take some time for communities to buy into the idea no matter where in the state they end up, said McMyne-Smith.

She said it’s very likely Providence will see harm reduction centers because there is a greater need there. What she hopes, however, is that these centers will destigmatize drug use. That will be the measure of their success.

“Reducing the stigma and saving lives is the pinnacle to a program like this,” said Smith, “because dead people can’t recover.”

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