Cheryl Juaire lost two of her sons to the opioid epidemic — Corey died from an overdose in 2011, as did Sean 10 years later in 2021.

Juaire, founder and president of the nonprofit Team Sharing Inc., now advocates for overdose prevention centers in Massachusetts.

The centers, also known as supervised consumption sites or safe injection sites, are a harm reduction approach where participants can consume pre-obtained drugs under supervision.

The evidence-based approach is designed to minimize the negative health effects of drug use, such as overdose death and disease transmission. The centers typically include sterile equipment, drug testing and referrals to treatment, according to the Drug Policy Alliance.

“I would have driven my kids there if I could have one more day with them,” Juaire said.

As opioid-related overdose deaths climb in Massachusetts, the support for overdose prevention centers has grown. However, advocates said the stigma around drug use impedes it from becoming a reality.

“The whole goal is to keep them alive one more day,” Juaire said. “To me, it’s really a no-brainer.”

The Department of Public Health recommended the establishment of overdose prevention centers in a feasibility report released in December.

“DPH is committed to reducing overdose deaths and ensuring that individuals in the state have access to the harm reduction, treatment and recovery services they need, when they need it,” a DPH spokesperson wrote in a statement.

Three decades of success

For more than 30 years, overdose prevention centers have operated in Canada, Australia and parts of Europe. There has never been an overdose death reported at a center, according to the National Institute on Drug Abuse.

Brandon Marshall, professor of epidemiology at the Brown University School of Public Health, said he supports overdose prevention centers because of the evidence.

“They are not a new intervention,” Marshall said. “Although this is a new model of addressing the overdose crisis in the U.S., we can look to scientific studies from other countries and have high confidence that they will reduce overdose deaths.”

The DPH reported approximately 2,359 opioid-related overdose deaths in 2022, according to the most recent data. This represents a 3% increase from 2021 and a 16% increase from 2019.

Opioid-related overdose deaths spiked as a result of an increased presence of fentanyl in the illegal drug market. Fentanyl was present in 93% of toxicology reports of opioid-related overdose deaths in 2022, according to DPH data.

The synthetic opioid is 50 times stronger than heroin and 100 times stronger than morphine, and it is often used to adulterate other drugs, according to the Centers for Disease Control and Prevention.

Massachusetts invested $1.2 billion in substance use and harm reduction programs from 2015-2022, according to the DPH feasibility report.

The state operates 60 state-funded Syringe Service Programs, also known as needle exchanges, providing access to sterile needles and syringes to reduce the risk of disease transmission.

The Healey-Driscoll administration has funded several existing harm reduction measures, such as the increase in fentanyl test strips, expansion of the 24/7 overdose prevention hotline and an increase in the distribution of naloxone — an overdose-reversal medication commonly known by the brand name Narcan.

Dr. Jessie Gaeta, an addiction medicine specialist with the Boston Health Care for the Homeless Program, said overdose prevention centers are needed as another part of the addiction service continuum.

“This is only one part of the strategy for a community. There is not a single answer to this issue,” Gaeta said. “There are lots of things that are needed. This is definitely one of them.”

Arguments against prevention centers

Not in my backyard, or “NIMBYism,” is a common response to overdose prevention centers, Marshall said. Residents often fear that the existence of these centers will attract people who use drugs, drug dealers, drug-related crime and drug-related waste to their community.

“Hopefully, by pointing to the evidence and educating neighbors and the public, you can start to see a shift in those perceptions,” Marshall said.

But state Rep. Lindsay Sabadosa, D-Northampton, said the opioid epidemic is so widespread in Massachusetts that it has already reached everyone’s backyard.

“Drug use is happening all the time. It is happening as we are speaking right now, somewhere in our community,” she said. “There’s no such thing as ‘not in my backyard’ because you can turn a blind eye but it is already there.”

Since the opening of OnPoint NYC — two overdose prevention centers in Manhattan — there were no “significant changes in measures of crime or disorder” where the centers were located, according to a 2023 study.

OnPoint NYC also found a reduction in syringe litter and hazardous waste in the community in its annual report. NYC Parks collected around 12,000 fewer syringes in the park across the street from the Washington Heights location in the first month after the facility opened.

“There have been many studies that have looked at the neighborhood-level impacts,” Marshall said. “They demonstrate, time and time again, improvements in neighborhood conditions.”

To mitigate the fear of one site becoming a “magnet,” Marc McGovern, a Cambridge city councilor and former mayor, said there needs to be overdose prevention centers open in every community.

“Let’s do some regional planning for once in Massachusetts,” McGovern said. “We’re going to do this together so that no one community is going to carry the responsibility.”

Dr. Bertha Madras, a professor of psychobiology at McLean Hospital and Harvard Medical School, explained taxpayers do not want to “facilitate addiction” by making drug use easier.

“These people obviously have an influence on the politicians who vote for appropriations for these facilities,” Madras said.

Marshall said there is a “pervasive myth” that overdose prevention centers enable drug use, which is “simply not true.”

“Implementing harm reduction measures doesn’t enable, it prevents people from dying,” Sabadosa added. “It enables life.”

Another point of concern among people opposed to overdose prevention centers is their “hard-earned” tax dollars funding it, Madras said.

However, there are ways to fund overdose prevention centers outside of state dollars.

Foundations and philanthropy fund the observation of drug use at OnPoint NYC. Meanwhile, opioid settlement dollars, private foundations, grants and individual donors fund a center set to open in Providence later this year.

Pending Massachusetts bill barred by stigma

A bill presented in February 2023 would establish a 10-year pilot program for overdose prevention centers in Massachusetts.

Under the legislation, a local board of health must approve its establishment. The center must also include sterile equipment, referrals to treatment and data collection.

The bill was voted favorably out of the Legislature’s Committee on Mental Health, Substance Use and Recovery, and referred to the House Ways and Means Committee.

It has 17 co-sponsors in the Senate and 58 representatives in the House. Lawmakers have until July 31 to act or the measure will need to be refiled next year.

Sabadosa, a co-sponsor, said support for the legislation has “grown exponentially” throughout her time in office, but there is still “fear of the unknown.”

“Many people still have a lot of stigma related to drugs and drug usage,” she said. “That can impede progress on legislation like this.”

A Beacon Research survey found that 70% of Massachusetts voters support the bill. However, advocates said stigma around drug use is a roadblock to the bill’s passage.

“We believe, generally speaking as a society, that addiction is a moral failing, that it is something to be punished,” Gaeta said. “The biggest barrier is us.”

Gaeta said overdose prevention centers run “so counter” to this common view of addiction that people may have a hard time understanding why they will be helpful.

The ‘crack house’ statute

Overdose prevention centers in Massachusetts face a potential legal battle. They could be deemed illegal on both federal and state levels.

The Massachusetts Controlled Substances Act makes it illegal to possess certain controlled substances without authorization.

Meanwhile, the federal “crack house” statute makes it illegal to own or operate a property for the purpose of “manufacturing, distributing, or using any controlled substance.” The statute — enacted in 1986 — is intended to ban houses and buildings where drugs were manufactured and used.

McGovern said there is an unclear legal standing of overdose prevention centers because it is not the intention of the statute.

“There’s certainly a lot of attorneys out there who I think would argue pretty convincingly that this isn’t illegal,” McGovern said.

However, without authorization, Marshall said there are “real risks” to people who work at the centers.

The pending Massachusetts bill includes language protecting participants, staff, property owners and operating entities from legal action, including professional licensure.

Sabadosa added that grassroots overdose prevention centers are popping up all over the place.

“This bill really just takes a big step forward in allowing people to step out of the shadows,” Sabadosa said.

Advocates urge Massachusetts to take the risk and join other states at the forefront of the movement.

“Many things have changed in our society because someone challenged them legally,” McGovern said. “Maybe that’s what we have to do here.”

Marshall said so many people are affected by the opioid crisis that it creates an understanding of the need for “new approaches.”

“Everybody’s been affected somehow. Somebody knows somebody,” Juaire added. “It’s not till that happens that movement happens, change happens.”

Sabadosa said she doesn’t know if the bill will pass this session, but legislators are realizing “it is the morally right thing to do.”

Brendan Nordstrom writes for the Greenfield Recorder through the Boston University Statehouse Program.