►
Description
Docket #0819- Hearing regarding medically supervised infection facilities.
A
Boston
City
Hall
in
Boston
city,
council
chambers.
This
is
here
a
hearing
on
docket
number,
zero,
eight
one,
nine,
the
impacts
of
medically
supervised
injection
facilities,
I
am
Boston
city,
councillor
at-large
and
Easter.
Si
B
Jorge,
chair
of
this
committee,
the
Committee
on
homelessness,
mental
health
and
recovery,
I'd
like
to
remind
everyone
that
this
hearing
is
being
recorded
in
broadcast,
live
on
Comcast
8r,
CN
82,
as
well
as
streamed
online
and
replay
for
further
viewing
I.
Ask
that
you
please
turn
off
your
cell
phones
or
any
other
devices
that
make
noises.
A
Also,
if
you
haven't
already,
please
sign
up
for
public
testimony
there,
a
sign-in
sheets
by
the
entrance,
if
you'd
like
to
testify,
please
check
the
box
and
we'll
have
you
after
public
testimony
later
in
the
hearing.
Today,
we
are
going
to
be
discussing
a
very
controversial
topic:
medically
supervised
injection
facilities,
I'd
like
to
remind
everyone
that
this
is
a
chamber
that
this
in
this
chamber,
the
point
of
the
hearing
is
to
learn
as
much
as
we
can,
and
that
means
we
need
to
hear
from
all
sides
out
of
respect
for
everyone
here.
A
I
expect
that
there
will
be
no
applause,
no
signs
and
absolutely
no
use
of
stigmatizing
or
derogatory
language.
We
will
hear
from
every
from
everyone,
and
we
will
also
hear
first
from
an
esteemed
two
esteemed
panels.
Each
panelist
will
present
to
the
counselors
and
have
an
opportunity
to
ask
follow-up
questions.
We
will
then
start
with
public
testimony.
If
you
have
tracked,
you
will
be
called
up
in
the
order
of
arrival.
Please
keep
your
remarks
to
no
more
than
two
minutes.
If
you
can,
you
may
also
submit
written
testimony
which
we've
received
quite
a
bit
of.
A
We
are
facing
an
opioid
crisis.
Opioid
overdose
is
the
number
one
cause
of
accidental
death
in
Massachusetts,
claiming
nearly
six
lives
every
day
as
our
region's
capital,
not
just
for
the
state
but
for
the
region.
Boston
is
on
the
front
lines
of
this
battle.
We
have
to
be
proactive
and
to
make
sure
that
we
are
part
of
this
conversation.
There
is
one
happening
at
the
Statehouse
regarding
medically
supervised
injection
facilities,
and
this
conversation
should
not
be
happening
without
the
city
at
the
table.
We
are
the
key
stakeholders
and
that's
why
we
are
here
today.
A
I
look
forward
to
a
very
productive
and
respectful
hearing
and
want
to
thank
my
colleague,
councillor
Frank
Baker,
for
his
co-sponsorship
of
this
legislation.
After
this
hearing
order
on
this
on
this
issue,
I'd
also
like
to
recognize
in
order
of
their
appearance,
councillor
Tim
McCarthy,
who
is
the
vice
chair
of
this
committee,
Michael
Flaherty
at-large
councillor
district
council,
Josh,
Zakim
district
district
councillor
mark
co-moh
district
councillor,
Tito
Jackson
I
have
also
received
a
letter
from
councillor
for
district
for
Andre
Campbell,
who
is
regrettably
unable
to
attend
today's
hearing.
A
A
We're
going
to
go
right
to
the
panel
because
we
do
have
a
large
crowd
today
and
lots
of
public
testimony.
Do
you
want
to
be
as
efficient
as
possible
with
our
time
and
I
do
remind
everyone
that
this
is
the
initial
conversation.
This
is
the
first
conversation,
so
there'll
be
there'll,
be
many
more
opportunities
to
discuss
so
with
that
we
have
and
if
we
could
just
go
through
and
introduce
ourselves,
but
I
have
first
on
my
list,
dr.
Henry,
Lawrence
Dworkin,
if
you'd
like
to
introduce
yourself
for
the
record
right.
Thank
you.
A
C
You
very
much
my
name
is
Hank
Dorkin
I'm,
a
pediatric
lung
specialist
practicing
in
Boston
and
I'm
president
of
the
Massachusetts
Medical
Society
and
I
first
want
to
thank
the
chair
and
the
counselors
for
having
this
hearing
I.
Think
it's
very
important
with
the
Medical
Society
are
concerned
about
the
opioid
crisis,
as
is
everyone,
and
so
on
the
first
slide.
This
shows
a
three
different
blocks
of
the
crisis.
As
average
annual
opioid-related
death
rate
400,000
in
the
Commonwealth.
C
The
first
to
the
left
is
2001
to
2005,
oh
6,
to
10
in
the
final
from
11
to
2015
and
unfortunately,
as
you
can
see,
the
areas
around
the
state
in
blue
and
dark
blue
signify,
where
we
are
having
a
problem,
and
it
is
pretty
much
everywhere
that
we're
having
this
issue
in
order
to
help
mitigate
this
epidemic.
The
Medical
Society
has
worked
for
the
past
few
years
to
address
prescribing
habits
as
well
as
education
of
physicians
and
patients.
C
For
example,
we
offer
free
continuing
medical
education
modules
that
have
been
used
by
10,000
physicians,
nurse
practitioners
and
other
prescribers.
We've
worked
hard
towards
partial
fill
legislation,
education
of
our
medical
students
and
dental
students
and
reduced
prescribing.
Our
focus
has
been
to
prevent
dependency
where
possible
and
to
some
extent
the
efforts
are
working
between
the
beginning
of
2015
and
2016.
We
saw
more
than
20%
drop
in
the
number
of
opioid
prescriptions,
but
the
epidemic
unfortunately
continues
while
the
fractional
increase
in
deaths
has
been
slowing.
C
The
total
number
of
deaths
has
been
increasing
each
year
to
the
point
where
we
lost
2,000
citizens
from
the
Commonwealth
in
2016.
This
is
what
a
supervised
injection
facility
looks
like,
and
basically
these
are
considered
harm
reduction
facilities
to
try
to
reduce
overdoses
and
other
harms
associated
with
legal
drug
use.
It's
a
legally
approved
public
health
facility
that
offers
a
hygienic
environment
where
people
can
inject
previously
acquired
illicit
drugs
under
the
supervision
of
training
staff.
Who
will
intervene
if
these
people
get
into
trouble?
C
C
In
2016,
the
Medical
Society
House
of
Delegates
felt
that
the
MMS
should
perform
an
internal,
evidence-based
study
of
the
ethical,
legal
and
liability
considerations
and
feasibility
of
a
medically
supervised
injection
facility
in
Massachusetts,
with
a
report
back
to
the
Board
of
Trustees
in
the
House
of
Delegates
no
later
than
a
17
which
occurred
at
recently
in
April,
and
we
tried
to
spare
no
no
opportunity.
We
were
in
communication
with
people
in
other
parts
of
the
world
who
are
doing
sips
and
other
parts
of
the
United
States
that
are
also
considering
it.
C
Although
currently,
there
is
no
approved
sis
anywhere,
but
we
felt
that
the
data
were
somewhat
compelling.
If
we
look
at
the
Vancouver
data,
the
overdose
mortality
decreased
by
35%,
if
that
were
comparable
in
Massachusetts
of
the
2000
that
we
lost
in
2016
700.
People
who
died
would
not
have
died,
and
these
are
mothers
and
fathers,
sons
and
daughters,
sisters
and
brothers
spouses,
all
of
whom
would
be
alive
and
in
fact
there
was
a
30%
increase
in
the
rate
of
people
entering
detoxification
increase
in
methadone
maintenance
initiation.
C
There
were
no
reports
of
negative
consequences
to
the
communities
and,
in
fact,
several
of
the
groups
that
at
first
were
reluctant
to
see
this
go
through
in
Canada,
namely
people
in
the
local
communities
and
the
Constabulary.
When
it
came
up
for
renewal,
they
were
among
the
strongest
supporters,
because
deaths
were
down,
the
distribution
of
paraphernalia
and
drug
litter
was
decreased
significantly
and
there
was
less
crime
and
in
fact,
a
recent
study
at
Johns
Hopkins
found
that
there
would
be
a
significant
decrease
in
medical
care
costs.
C
C
There
is
little
change
in
drug
deals,
there's
no
increase
in
crime,
and
our
staff
has
spoken
to
the
medical
officers
in
Vancouver.
They
said
in
the
area
around
the
sift
is
not
only
better.
There
has
not
been
one
death
related
to
people
who
are
using
the
sips
and
the
data
and
support
continued
at
the
annual
meeting
of
the
Medical
Society.
C
But
clearly
this
is
something
where
we
still
need
to
generate
more
data
and
more
information
as
best
we
can
and
that
this
would
be
a
collaborative
effort.
So
where
do
we
go
from
here?
I
think
that,
as
you
save
it
earlier,
this
is
fact-finding
and
there's
a
lot
more
information
to
get,
but
we
hope
that
people
will
use
the
69
page
report
that
our
task
force
under
Denis
Demetri
and
Jim
Gesner,
put
together
as
a
basis
for
further
investigation.
Thank
you
thank.
A
You
dr.
Dworkin
I,
do
I
probably
should
have
started
I'm
sorry
with
our
executive
director
for
the
Boston
Public
Health
Commissioner
Monica
Valdes
Lupi
enough
you've
got
presentation
to
share
Devin
Larkins
the
director
of
beer.
The
bureau
of
recovery
services
would
like
to
go
next.
D
Thank
you
good
afternoon
councillors,
asabi
George
and
Baker,
and
members
of
the
committee.
My
name
is
Monica
Valdes
Lupi
and
I'm.
The
executive
director
of
the
Boston
Public
Health
Commission
and,
as
you
mentioned
council
arm,
joined
today
by
Devon
Larkin,
who
serves
as
our
Bureau
director
for
recovery
services,
thanks
very
much
for
the
opportunity
this
afternoon
to
provide
testimony
for
today's
hearing.
D
As
you
know,
and
as
you've
already
highlighted,
the
crisis
of
substance
use
disorders
is
one
that
many
cities
and
towns
in
the
Commonwealth
and
across
the
country
are
grappling
with
and
trying
to
look
at.
A
whole
range
of
different
interventions.
Strategies
need
to
look
across
the
continuum
from
prevention
to
treatment,
arm
reduction
and,
ultimately,
recovery
services.
The
crisis
of
substance
use
disorders
in
our
city
is
a
challenge
that
has
required
creative
thinking
and
strong
partnerships
and
I
share
Mayor
Walsh's.
Deep
commitment
to
addressing
this
challenge.
D
I
wanted
to
share
some
some
data
that
we
gather
at
the
health
department
to
just
provide
some
additional
context
to
what
we're
seeing
in
the
city.
Cancer
was
the
leading
cause
of
premature
mortality
for
Boston
residents
from
2011
through
2015
heart
disease
was
the
second
leading
cause
of
death
between
2011
and
2013,
but
was
replaced
by
accidents
in
2014.
D
Accidents
include
unintentional
drug
overdoses
in
2015,
unintentional
opioid
overdoses
accounted
for
71
percent
of
the
deaths
due
to
accidents
for
residents
under
the
age
of
65
and
would
rank
third,
if
explicitly
specified
within
our
ranking
scheme.
In
terms
of
these
health
conditions,
my
colleague,
Devin
Larkin
will
go
into
more
detail
around
the
existing
services
offered
for
people
seeking
recovery,
as
well
as
the
significant
prevention
efforts.
D
The
city
is
engaging
in,
but
I
wanted
to
touch
on
some
of
the
achievements
we've
made
to
date,
the
FY
17
investment
from
the
city
to
expand
the
paths
program
through
integration
with
3-1-1
doubled
the
number
of
weekly
pass
contacts
and
consequently
increase
our
capacity
to
make
connections
to
vital
recovery
services.
We
now
see
between
130
and
150
visits
each
week
and
are
still
averaging
four
to
five
new
clients.
Each
day,
mayor
Walsh
and
the
administration
also
invested
in
a
new
neighborhood
engagement
team
of
four
staff
who
conduct
street
outreach.
D
Overdose
prevention,
education
and
connecting
individuals
with
street
outreach
and
recovery
services
and
shelter
in
the
new
Market
Square
area,
the
team
works
seven
days
a
week
from
8
a.m.
to
4
p.m.
including
holidays
and
during
bad
weather.
Since
the
program
began
last
summer
in
August
of
2016,
the
team
has
completed
over
12,000
engagement
activities,
which
includes
the
number
of
hours
spent
on
street
outreach
number
of
people
that
they've
engaged
with
a
number
of
people
actually
offered
services,
including
over
800
referrals,
to
shelters
and
treatment
programs.
D
In
addition
to
our
past
program
and
street
engagement,
there
were
many
other
accomplishments.
We
delivered
over
600
opioid
overdose
prevention,
trainings
and
collected
13,000
syringes
from
public
spaces.
Lastly,
on
behalf
of
the
Health
Department
I'm
really
pleased
at
mayor,
Walsh
has
provided
strong
support
for
our
FY
18
initiatives.
We
have
two
new
initiative
that
I
wanted
to
highlight
in
terms
of
pass,
which
will
now
extend
our
hours
of
operation
to
7:00
p.m.
on
weeknights
and
9:00
a.m.
through
4:00
p.m.
on
weekends.
D
Increasing
our
hours
of
operation
will
strengthen
our
work
to
ensure
that
the
system
is
as
easy
to
navigate
as
possible
for
those
who
need
it
in
Boston
were
committed
to
fighting
the
opioid
epidemic
and
providing
critical
addiction
and
recovery
services.
I'd
now
like
to
turn
it
over
to
Devin,
to
share
some
more
details
about
our
different
programs
and
services.
Again,
thank
you
for
the
opportunity
to
bring
us
all
together
to
speak
about
this
important
issue.
Thank.
E
Good
afternoon
councillors
and
members
of
the
committee,
thank
you
for
the
opportunity
to
provide
testimony
for
today's
hearing.
A
core
function
of
the
Boston
Public
Health
Commission
is
to
provide
critical
addiction
and
recovery
services.
As
we
know,
a
weird
addiction
is
a
national
epidemic
and
Boston
is
at
the
forefront
of
its
treatment
efforts.
The
city
of
Boston
has
a
robust
system
of
care
for
individuals,
families
and
communities
affected
by
substance.
Use
disorders.
E
We
work
to
make
sure
the
system
is
easy,
is
as
easy
to
navigate
as
possible
for
those
who
need
our
support
in
partnership
with
an
excellent
network
of
community-based
providers
throughout
the
city,
we
offer
programs
and
resources
aimed
at
supporting
the
treatment
and
recovery
of
those
impacted
by
addiction.
We've
found
the
best
way
to
tackle
the
issue
in
Boston
is
to
work
collaboratively
with
neighborhood
associations,
nonprofit
groups,
treatment
providers
and
partners
across
multiple
city
and
state
departments
to
ensure
that
we
can
best
provide
a
comprehensive
continuum
of
services.
E
The
mayor's
office
of
recovery
services
and
the
bureau
of
recovery
services
has
partnered,
with
Boston
EMS
Boston
Police
and
Boston
Fire
to
engagement
residents
post
overdose
and
to
provide
harm
reduction
and
access
to
care
services
to
them
in
their
homes.
As
Monica
mentioned
for
the
last
nine
months
for
outreach,
workers
have
been
walking
the
main
roads
and
side
streets
around
mill,
media,
Katz,
Boulevard,
seven
days
a
week,
engaging
with
vulnerable
individuals
and
helping
them
access
the
services
they
may
need
on
a
given
week.
They
may
have
500
client
contacts.
E
The
city
has
also
integrated
existing
recovery
services,
support
the
mayor's
3-1-1
hotline,
creating
a
24-hour
hotline
where
people
can
access
information
and
seek
treatment
and
recovery
support.
The
301
hotline
integration
has
led
to
a
50%,
uptick
and
client
interactions.
We
remain
committed
to
providing
a
full
scope
of
services
to
active
users,
including
referrals
to
treatment,
naloxone
and
overdose
prevention,
HIV
and
HCV
testing
needle
exchange
and
our
goal.
The
goal
of
our
work
and
survive
these
services
in
a
way
that
is
safe,
reduces
harm
and
engages
individuals
and
comprehensive
services
and
support.
F
Hi
there
thank
you
for
inviting
me
my
name's
Aubree
Esther's
I'm,
a
member
of
sip
I,
mean
now
it's
a
community
organization
devoted
to
opening
supervised
injection
facilities
in
Massachusetts
now
I'm.
Also,
a
person
who
uses
drugs
I'm
also
resident
in
Boston
I
support,
Boston,
City,
Council
and
Iker
encourage
you
to
support
SIF
for
a
number
of
reasons
and
I'll.
Give
you
two
right
now
I'm
wondering
if
this
slideshow
that
I
had
prepared
is
playing.
G
F
A
H
F
A
A
H
You
Aubrey
for
yielding
your
time,
not
not
your
time
good
hi,
my
name
is
Gabriel
wick
and
I'm.
A
primary
care,
physician
and
addiction
specialist
at
Boston
healthcare
with
homeless
program,
which
for
over
30
years,
has
been
caring
for
the
homeless,
in
shelters
and
on
the
streets
here
in
Boston.
Drug
overdose
is
now
the
leading
cause
of
death
among
our
population,
and,
as
such,
we
have
come
to
believe
that
we
need
to
strongly
support
the
development
of
medically
supervised
injection
facilities
or
sips
as
a
vital
tool
to
help
us
combat
that
epidemic.
H
On
extend
our
really
our
heartfelt
gratitude
to
committee
chair,
asabi,
George
and
councillor
Baker,
for
co-sponsoring
this
hearing
and
for
the
opportunity
to
provide
testimony.
We're
also
deeply
grateful
to
the
city
for
his
leadership
in
confronting
this
devastating
epidemic.
Boston
is
so
fortunate
to
have
a
terrific
needle
exchange
program,
unprecedented
access
to
naloxone
and
a
wide
range
of
high
quality
drug
treatment
services.
As
some
of
my
fellow
panelists
have
mentioned,
this
epidemic
is
really
increasing
in
Boston
as
well
as
elsewhere.
H
Fatalities
in
Boston
were
three
times
the
size
of
any
other
city
in
the
Commonwealth
last
year,
and
part
of
that
is
due
to
the
mixing
of
synthetic
opioids
into
the
heroin
supply
and
despite
our
best
efforts,
this
is
a
changing
epidemic.
Our
current
established
strategies
simply
have
not
been
enough
to
address
this
crisis
and
reduce
deaths
so
far.
In
this
context,
our
organization
has
expanded
our
outreach
to
active
drug
users,
who
are
at
high
risk
of
overdose.
H
For
the
past
year,
we've
operated
a
recovery
room
that
we
call
the
supportive
place
for
observation
and
treatment
or
spot
where
people
who
are
already
over
sedated
can
come
to
be
medically
monitored
and
connected
to
further
treatment.
We
open
spot
out
of
desperation
to
save
lives
and
to
engage
the
people
who
are
actively
using
in
the
first
year
at
spot.
We
saw
about
500
high-risk
users
in
nearly
4,000
encounters.
Our
efforts
have
avoided.
We
estimate
around
a
thousand
emergency
room
visits
and
have
likely
saved
lives.
H
We're
also
proud
to
report
that
one
in
10
of
the
very
high-risk
people
that
have
used
spot
have
been
directly
connected
to
treatment
from
that
encounter.
Yet
what
we're
learning
is
this
spot
is
not
enough.
People
are
dying
before
they
can
get
to
medical
care.
We've
come
to
supported
strategies
at
11.
H
Other
countries
around
the
world
have
pursued
since
as
early
as
1984
in
the
decades
since
over
about
a
hundred
peer-reviewed
studies
on
safes
have
been
conducted,
I
want
to
share
with
you
what
the
evidence
tells
us
in
answer
to
about
five
questions
drawn
from
our
local
research
from
the
literature
on
the
subject,
four
of
the
landmark
studies
on
supervised
injection
are
included
as
part
of
our
written.
Testimony.
Number
one
consist
impact
overdose
deaths.
Yes,
as
dr.
H
Also,
yes,
in
fact,
they
can
increase
users
entry
to
treatment
in
a
study
published
in
the
New
England
Journal
of
Medicine
people
who
use
their
sips
most
often
also
got
into
detox
most
often
those
SIF
clients
who
had
any
contact
with
the
addiction
counselor
at
their
sip
got
into
treatment
much
faster
than
those
who
did
not.
In
fact,
yes,
sis
can
increase
referrals
treatment.
H
Initiation
I
think
this
really
addresses
some
of
the
fears
that
we
have
among
us
about
Sif's
and
shows
that
they
do
not
actually
encourage
people
to
start
using
or
to
relapse.
Number
five
number.
Four.
Sorry.
What
impact
does
this
have
on
their
surrounding
community
I?
Think
the
research
suggests
that
they
have
either
neutral
a
positive
effect
on
public
order
and
again
in
Vancouver.
They
found
that
when
the
SIF
began
afterwards,
they
found
less
public,
injecting
and
less
publicly
discarded,
both
syringes
and
other
drug
use
equipment.
H
We
recently
conducted
a
survey
in
the
South
End
and
showed
that
there's
a
high
burden
of
this
type
of
blight
in
our
neighborhood.
We
think
that
a
SIF
could
really
lead
to
improvements
in
public
disorder
at
number
five
do
people
want
a
stiff?
Our
preliminary
data
shows
that
Bostonians
who
use
drugs
really
would
use
a
sip.
H
I
can
elaborate
that
on
that
in
questions,
if
you
like,
we
also
have
a
local
survey
that
shows
that
about
one
half
of
South
End
residents
thought
that
a
stiff
was
a
good
idea,
and
this
was
done
over
a
year
ago.
Prior
to
this,
this
issue
really
making
the
headlines
I
think
the
research
is
actually
quite
clear,
sifts
save
lives
and
they
benefit
both
individuals
and
communities.
H
Now,
more
than
ever,
we
cannot
wait
for
people
suffering
from
addiction
to
reach
out
to
us.
We
have
to
go
to
them
at
the
point
of
injection,
even
if
it's
difficult
the
time
between
Injection
in
his
deadly
effects
has
shortened
so
much
that
people
are
dying
in
seconds
and
minutes
before
help
can
arrive.
H
This
is
a
clear
treatment
gap
and
one
that
we
cannot
close
if
we
only
focus
on
recovery
services,
sifts
really
play
a
key
piece
in
the
continuum
of
care
for
this
chronic
and
relapsing
disease,
and
they
exist
to
keep
people
alive,
so
they
can
make
it
to
further
treatment.
I
think
we
desperately
need
that
option
here
in
Boston.
I
My
name
is
Joe
Wright
I
am
also
a
doctor
at
Boston
healthcare
for
the
homeless,
I'm,
the
medical
director
for
our
office
based
addiction,
treatment
program,
I'm,
an
HIV
specialist
and
I
provide
general
medical
care.
I
want
to
echo
dr.
wicks
appreciation
for
this
hearing
for
the
opportunity
to
testify
counselor,
sabe,
George
and
counselor
Baker.
Thank
you
for
sponsoring
this.
I
Many
people
in
this
room
know
how
strong
a
force
addiction
can
be,
how
people
keep
using
a
drug
like
heroin
despite
bad
things
coming
from
it.
Dr.
wick
has
given
you
some
data
in
the
second
portion
of
our
joint
testimony,
I'm
going
to
talk
about
a
story,
one
story
among
many
of
that
time
of
injection
that
dr.
Bishop
talked
about
for
one
patient
of
ours,
a
26
year
old
man
who
all
called
Mike.
He
had
come
to
spot
many
times.
He
would
come
to
us
sedated
by
breathing.
We
kept
him
safe.
We
kept
him
alive.
I
We
got
to
know
him
even
as
he
kept
using.
He
started
trusting
us
knowing
we
cared
for
the
person
he
was
and
not
just
for
who
we
wanted
him
to
be
when
he
decided
he
was
ready
to
stop
using.
He
came
to
us
at
the
same
moment.
Probably
around
the
time
Mike
told
us,
he
was
ready
to
stop
some
labs
somewhere
in
the
world
was
producing
a
particular
dose
of
fentanyl.
Fentanyl
is
much
faster
acting
than
heroin
and
it's
about
50
times
more
potent.
It
can
be
produced
anywhere.
I
Someone
can
set
up
a
lab
with
no
poppy
fields
required
fentanyl
and
even
more
potent
fentanyl
derivatives
are
out
competing
heroin
in
the
drug
economy
either
getting
mixed
in
with
or
simply
replacing
heroin
heroin
has
always
been
dangerous,
but
heroin
mixed
with
fentanyl
or
replaced
by
fentanyl
is
much
more
dangerous
and
in
this
story,
as
Mike
started
thinking
about
next
steps,
a
small
amount
of
fentanyl
powder
was
moving
towards
its
eventual
destination.
Our
staff
got
Mike
into
detox
and
a
transitional
program.
I
He
put
together
six
weeks
with
sobriety,
but
then
he
was
discharged
to
the
street
and
it
was
too
early.
Mike
started
feeling
that
pull
he
came
back
to
spot.
He
said
he
was
about
to
use,
he
knew
his
tolerance
was
low,
so
his
overdose
risk
was
higher.
He
looked
for
people,
he
knew,
but
he
couldn't
find
a
friend
to
come
with
him
to
administer
naloxone
if
he
needed
it.
One
of
our
nurses
warned
him
how
much
danger
he
faced.
She
talked
to
him
about
treatment
to
give
him
naloxone
to
carry
with
him.
I
He
left
she
worried,
meanwhile,
that
fentanyl
had
traveled
to
multiple
middlemen,
who
probably
diluted
it
a
bit
mixed
it
with
heroin
or
didn't
and
moved
it
to
a
street
dealer
in
Boston
who
may
have
or
may
have
not
diluted
it
more.
No
one
was
using
the
kind
of
precise
pharmaceutical
manufacturing
techniques
that
allow
hospitals
to
use
IV
fentanyl
for
rapid
sedation.
I
When
Mike
died,
it
was
likely
just
a
few
minutes
later
he
was
found
dead
an
hour
and
a
half
after
he
left
our
building,
just
a
couple
of
blocks
away
in
the
shadow
of
a
world-class
Medical
Center
and
a
large
needle
exchange
program
with
a
narcan
kit
at
arm's
length
if
Boston
has
been
especially
hard
hit
by
this
epidemic.
Boston
also
has
a
unique
opportunity
to
lead
in
its
creativity
and
its
compassion.
We
hope
for
a
city
without
the
private,
shame
and
danger
of
people
suffering
and
dying
alone.
I
We
believe
in
bringing
people
out
of
the
shadows
and
into
our
collective
embrace
in
our
vision
we
don't
have
to
watch
mic,
walk
away
and
die
in
our
vision.
We
say
no
matter
what
we'll
be
here
with
you
counselors.
Thank
you
on
behalf
of
dr.
wick
and
I
for
the
opportunity
to
speak
today
and
for
the
opportunity
to
contribute
this
important
conversation.
Thank.
F
G
F
I'm
long
speaking,
I'm
going
to
show
some
faces
of
people
who
live
in
Boston
who
support
supervised
injection
facilities
on
the
screen
in
the
background,
while
I
speak
and
a
lot
of
them
are
people
who
use
drugs.
My
name
is
Aubrey
esters,
I'm,
a
Boston
resident
and
I'm
a
person
uses
drugs.
I
encourage
the
Boston
City
Council
to
support
supervised
injection
facilities
for
a
number
of
reasons.
Here
are
two
I'm,
a
person
who
uses
drugs
who
would
use
a
SIF
if
it
was
available.
F
My
safety
net
right
now
consists
of
doing
a
slow
shot
testing
for
fentanyl
presence
with
a
strip
and
immediately
after
injection,
and
immediately
continuing
to
text
back
and
forth
for
a
few
minutes
to
ensure
that
someone
would
know
if
I
overdosed
and
may
hopefully
get
to
me
in
time
to
save
my
life
if
something
went
wrong.
I
overdosed
a
week
ago,
while
alone
and
since
I
didn't
want
to
bother
my
friends
I
didn't
use
that
safety
net.
F
The
result
was
a
near
fatal
overdose,
where
I
lost
hearing
in
both
my
ears
for
12
hours,
I
still
haven't
fully
recovered
from
I
got
lucky
that
I
survived,
but
this
doesn't
need
to
happen,
especially
not
in
a
city
like
Boston,
that's
so
committed
to
public
health.
A
second
thing
I'd
like
to
say,
and
my
second
reason,
I
like
to
bring
up
today,
is
because
I've
lost
far
too
many
friends,
loved
ones
and
peers
to
accidental
overdose
in
the
past
12
years.
Their
names
are
etched
in
my
mind
and
their
faces
are
ones
I'll.
F
Never
forget,
especially
the
faces
of
my
my
people.
Those
blue
and
purple,
faces
gasping
for
breath
and
alleyways
and
bathrooms,
because
no
one
cared
enough
to
make
sure
they
survived,
and
people
perhaps
didn't
think
they
matter
to
excuse
my
language,
I'm,
sorry
I,
remember
one
day,
a
group
of
folks
injected
together
in
the
bathroom
apartment
in
Boston
and
one
man
in
a
wheelchair
overdosed
and
the
only
person
he
was
capable
of
responding,
simply
rolled
him
out
the
back
door
into
the
alleyway
to
die
alone.
F
A
B
You
Thank
You,
counselor,
asabi,
George,
I,
guess
I'm
for,
in
my
opinion,
on
sips
now.
My
concern
is:
is
more
I
think
that,
through
the
through
the
reports
and
and
through
talk
that
you're
here
and
it's
always
unofficial
talk,
it
is?
Is
the
talk
of
the
Southampton
corridor
being
a
great
site
for
a
sieve?
I'm,
not
counting
City
Council
down
there
and
and
I
just
I
have
a
hard
time
thinking
that
that
it
will
be
helpful
to
us
down
there
and
I'm
still
not
convinced
by
it.
B
You
test
them
like
not
even
close
that
that
it
will
be
helpful.
Some
of
the
issues
that
I
have
is
it
doesn't
seem
to
be
any
any
endpoint
for
to
use
it
for
using
these
sites,
like
you
have
in
Vancouver,
I
have
some
some
data
from
the
Vancouver
Coastal
Health
263,000
visits
a
year
by
6500
individuals,
and
it
has
only
464
referrals
to
one
site
detox
that
doesn't
seem
like
great
numbers
that
were
say:
okay,
you're
going
to
use
this
and
that
for
X
amount
of
days,
I
just
think.
B
I
Think
is
it
time
for
us
to
respond.
Yeah,
yeah,
I.
Think
there's
two
questions
to
tease
apart
in
your
remarks.
Counselor
one
is
the
issue
of
is
a
sip,
a
good
idea
and
that's
an
important
question
to
answer
one
that
you
know
you're
not
sure
about
the
other.
Is
the
question
of
citing
I
I
think
the
question
of
citing
it
is
a
tough
one
for
the
reasons
you
use
state
I
think
many
people
are
going
to
have
concerns
about
citing
but
I.
Don't
think.
I
I
think
there
are
possibly
you
know,
creative
ways
that
we
can
deal
with
the
possible
urban
impacts,
but
I
would
also
say
that
The
Vancouver,
Downtown
Eastside
neighborhood
was
a
neighborhood
is
a
neighborhood
that
was
impacted
in
that
very
concentrated
way
that
the
South
Hampton
corridor
has
been
and
I
think
that
neighborhood
went
through
the
same
process
of
you
know
a
people
outside
this
community
saying
you've
got
to
be
kidding
me
to
be
well.
This
neighborhood
is,
you
know,
a
lot
calmer,
cleaner,
more
orderly,
fewer
people
dying.
B
F
Guys
do
something
to
as
a
person
who
who's
down
there
every
day,
your
hours,
it's
already
an
injection
facility,
it's
just
not
supervised.
There's
no
people
making
sure
folks
aren't
dying.
People
are
already
injecting
publicly
all
over
the
place.
We
all
know
that
so
I
think
getting
over
this.
This
fact
that,
oh,
my
goodness,
people
are
going
to
be
starting
to
inject
in
a
safe
place
where
they
make
sure
we
don't
die.
I
really
don't
understand
what
the
objection
is.
F
B
Limit
on
certain
people
alive,
my
point
my
point
from
from
the
first,
and
that
represents
the
neighborhood
down
there.
The
people
that
it's,
the
people
that
are,
that
they're
not
injecting
drugs
and
that
live
there
and
pay
property
taxes
in-
and
this
is
their
neighborhoods
like
I-
think
there
should
be
real
thought
into
how
how
some
of
those
how
some
of
those
services
are
being
spread
out
across
the
state.
Oh
you.
J
H
But
I
chime
in
so
I
have
two
thoughts.
First
about
that
issue
of
the
endpoint,
the
arrays
I
think
you're
asking
good
questions
which
can
help
to
talk
about
the
path
of
addiction.
For
folks
we
know
addiction
as
a
chronic
disease
similar
to
diabetes
or
other
things
that
don't
go
away,
and
so
you
know
when
I
think
about
an
endpoint.
I
think
that
this
is
it's
not
that
this
goes
away
ever
for
somebody.
H
B
Us
your
story:
he
went
up
when
I'm
talking
about
endpoint,
so
now
I've
taken
people
to
to
detox
before
and
in
in
heroin
in
that
sort
of
the
endpoint.
For
me
to
bring
that
person
was
okay
you're
going
to
get
high
now,
okay,
you're
in
the
backseat
of
the
car
you're
going
to
get
high
in
the
backseat
of
the
car.
That's
hopefully
the
last
time
you
got
to
do
that.
You're
going
to
be
with
me,
then
you're
going
to
detox
that
sort
of
endpoint
I,
just
wrapping
my
mind
my
mind
around
okay.
B
H
I
think
the
the
way
that
their
current
situation
is
and
I'm
going
to
put
on
different
hat
as
a
resident
here,
I
believe
unconquered
in
the
south
and
I
also
work
in
the
south
end,
but
I'm
a
resident
there
and
I
have
been
for
many
years
and
I.
Take
my
laundry
to
the
laundromat
and
I
walk
through
an
alleyway.
You
know
and
I
see
people
injecting
in
my
alleyway
I
find
needles.
There
I
call
the
mayor's
hotline
little
plug
for
the
mayor's
hotline.
H
You
know,
but
it's
really,
it's
frustrating
to
see
that
where
I
live,
not
just
because
I
care
about
these
people,
but
also
for
me,
I
mean
I,
don't
want
to
step
on
something.
You
know
this
is
a
base
like
this
is
a
problem
in
our
community
now
and
people
are
using
so
I
think
that
the
difference
that
a
SIF
offers
us
in
the
South,
End
or
anywhere
where
this
is
an
intense
issue,
is
really
to
take
that
use
off
Street
and
and
engage
people
when
they're
not
we're
not
engaging
them
now.
You're.
B
Not
like
that
I
think
that
might
be
the
one
the
one
positive
that
I
could
take
from
this.
Is
you
definitely
going
to
see
less
paraphernalia
and
less
you'll
happening
in
that
area,
but
the
chances
of
someone
not
copping
right
outside
the
door
of
the
place,
coughing
say:
they're
coughing
in
my
neighborhood
in
Dorchester
they're,
not
going
from
from
my
neighborhood
down
to
wherever.
If
it's,
if
it,
you
know
they're
going
as
soon
as
you
can
you,
you
can
get
that
needle
in
your
arm.
So
I
again,
how
is
this
not?
B
H
Thought
on
that
I
think
heroin
is
sort
of
everywhere.
You
don't
have
to
go
very
far
to
get
it
right,
and
so,
at
least
in
other
cities
that
have
done
this
like
Vancouver,
but
also
Sydney
and
other
folks
across
the
world.
The
areas
that
are
affected
are
really
the
500
meters
around
the
sift,
and
you
know
people
aren't
really
travelling
long
distances
to
use
one
of
these
things.
Yeah,
it's
really
it.
You
know
immediately
surrounding
community
benefits
the
most
from
a
chef
being
there
and
so
I
think.
C
You
number
one:
it
is
a
chronic
disease
and
there
are
many
people,
for
instance,
with
alcoholism,
and
we
don't
really
cure
it,
but
they
come
off
of
it
and
they
stay
off
of
it.
But
they
know
that
if
they
take
another
drink,
there's
a
very
good
chance.
They
may
get
into
trouble
again.
So
we
can't
expect
that
we're
going
to
cure
this,
perhaps
any
better
than
we
can
cure
alcoholism.
What
we
can
do
is
help
people
get
off
of
it
and
stay
off
of
it
and
be
aware
of
their
tendency
to
it
number
two.
C
If
we
look
at
the
slide
that
I
showed
about
the
Commonwealth
of
Massachusetts,
it
clearly
is
not
just
in
the
city
of
Boston.
There
are
other
areas
and
in
the
Commonwealth
that
have
just
as
big
a
problem
and
where
the
pilot
project
should
be.
We
wouldn't
presume
to
suggest
where
that
should
be,
and
would
defer
that
to
publicly
elected
officials
and
departments
of
Public
Health
to
figure
out
where
this
would
best
be
used.
C
First
and
I
think
that
the
third
thing
is
that
the
people
in
Vancouver
around
the
area
where
the
sips
are
we're
very
vocal
in
their
feeling,
initially
that
they
didn't
like
the
idea
and
then
after
they
saw
the
results
they
came
out
in
favor
of
it
and
not
just
passively,
but
we're
actively
saying
yes,
this
should
be
refunded,
because
it's
made
a
tremendous
difference
and
I
think
that
those
people
probably
have
similar
concerns
to
those
that
you've
expressed
and
I
would
expect
that
I
would
hope,
certainly
that
the
responses
would
be
the
same.
Thank.
K
You
very
much
I,
madam
chair,
and
thank
you
for
the
entire
panel
I
feel
an
awful
lot
like
council
Baker
here.
You
know.
The
human
stories
are
very
compelling
the
data
regarding
saving
lives.
You
know
fantastic
data
leading
into
recovery
tremendous,
but
if
somebody
spent
his
entire
career
trying
to
make
Boston
neighborhoods
better
I
really
have
a
question,
because
you're
painting
downtown
east
side
of
Vancouver,
as
if
it's
like,
Beacon,
Hill
or
Wellesley,
a
Duxbury
now
maybe
I'm,
watching
the
wrong
documentaries.
K
But
that's
not
the
neighborhood
that
I'm
seeing
I've
seen
a
lot
of
documentaries
that
I've
been
watching
them.
I've
been
doing
a
lot
of
reading.
You
gave
me
more.
You
killed
a
lot
of
paper
today,
a
lot
of
trees
dead
today,
I'm,
you
know
I'm
very
concerned
with
what
I
see
in
Downtown
Eastside
Vancouver,
not
the
painting
of
the
picture
that
you're
painting
of
this
neighborhood
everybody
saying.
Oh,
this
is
the
most
wonderful
town
in
the
world.
It's
not
and
from
the
comments
that
I've
seen
on
some
of
the
documentaries.
K
People
are
happy
that
it's
there
not
for
the
reason
why
you're
saying
they're
happy
that
it's
there,
because
it's
contained
within
a
500
meters
around
just
like
you
said
dr.
people
in
other
neighborhoods
are
happy
that
it's
there,
so
everybody
who
is
an
addict
or
who
needs
help,
but
they
go
to
one
section
of
the
city
and
they
leave
this
city
alone.
So
this
is
very
concerning
to
me
and
I.
It's
not
even
my
district
but
I
used
to
work
in
Public
Works
and
we
were
down
in
frontage
road.
K
You
know
we
were
right
next
to
the
clinic,
I
know
what
goes
on
down
there
and
it's
not
a
pain.
It's
not
a
pretty
picture
so
I'm
going
to
continue
to
do
my
research
I
have
a
lot
of
reading
to
do,
but
I
encourage
people
and
I
said
at
the
last
hearing
when
we
announced
this
hearing
is
that
there
are
documentaries
out
there
specifically
about
insight
and
that
area
in
that
neighborhood
and
that
neighborhood
is
a
disaster.
K
It's
not
this
beautiful
painting
that
you're
that
you're
there
drawings
for
us,
it's
not
the
street
next
to
is
called
blood
alley.
I
mean
you
know,
this
is
not
a
nice
place.
So,
let's
not
paint
this
picture
of
Oh
everybody's,
wonderful
and
everybody.
You
know
it.
This
is
the
greatest
neighborhood
ever.
The
second
piece
that
we
haven't
really
talked
about
is
the
cost
who
pays
for
this?
Who
runs
it?
K
This
is
a
very
tough
pill
to
swallow,
but
somebody
who
lives
in
that
500
meters
that
you're
talking
about
so
I'm
going
to
continue
I'll
read
all
this
I
promise.
I'll
continue
to
do
my
research,
but
you
know
I'm,
not
nothing.
That
you've
said
today
makes
me
say:
oh
geez
I'm
going
to
change
my
mind.
I.
I
Just
to
respond
briefly
to
your
comments
about
neighborhoods
I,
certainly
wouldn't
paint
the
East
Side.
As
you
know,
some
kind
of
tourist
paradise,
that's
for
sure,
I
think
the
response
of
the
folks
there
was
that
it
was
making
a
very
bad
situation
somewhat,
better
and
and
I
and
I
guess
I
would
I
would
also
you
know,
I
I
think.
I
Obviously
the
you
know
every
councilor
is
going
to
feel
a
deep
responsibility,
not
just
to
the
people
of
a
city
but
to
the
physical
fact
of
the
city
and
the
way
this
this
affects
it.
So
I
hear
that
I
do
think.
I
would
urge
you
to
consider
first
thinking.
Does
it
make
sense
to
try
to
make
the
epidemic
safer
in
this
particular
way
and
then
say?
I
Is
there
anywhere
to
do
that
and
because
and
and
the
reason
I
respectfully
suggest,
that
is,
if
you
go
right
to
citing
the
conversation
in
your
mind,
is
going
to
stop
the
the
Public
Health
value
of
it
is,
is
sort
of
over
because
you're
already
having
the
second
part
of
the
conversation
in
your
head.
I
say
that
I
completely
understand
why
you're
having
that
part
of
the
conversation
but
I
do
hope
that
you'll
consider
the
public
health
part
of
the
question
the.
I
How
do
we
get
people
to
survive
another
day
so
that
they
can
make
another
try
at
recovery?
And
this
is
why
we
tell
this
particular
young
man's
story.
It
was
just
so
heartbreaking
to
us,
and
this
has
happened
again
and
again
where
people
are
really
trying.
But
you
know,
100
percent
success
on
at
riot
at
stopping
using
is
is
pretty
tough
and
a
lot
of
folks
do
not
stop
using
and
their
deaths
their
illnesses
their
hospitalizations.
All
of
that
makes
a
big
impact
on
the
city,
so
I
would
start
there
and
then
ask.
C
Addressed
the
second
question:
yes,
the
second
one
was
about
cost
cost
effectiveness
was
was
dealt
with
in
our
report.
Just
last
week,
johns
hopkins
university
supplemented
our
data
with
new
estimates
at
an
annual
cost
of
1.8
million
dollars.
A
single
SIF
will
generate
7.8
million
dollars
in
savings,
preventing
3.7
HIV
infections,
21
hepatitis,
C
infections,
374
days
in
the
hospital
for
skin
and
soft-tissue
infections,
5.9
overdose
deaths
108
over
dose-related
ambulance
calls
78
emergency
room
visits
and
1
7
27
hospitalizations,
while
bringing
121
additional
people
into
treatment.
C
K
I
read
that
little
blurb
in
your
presentation
and
I,
and
that's
why
I
mentioned
the
cost
savings
in
my
opening
statement,
but
you
mentioned
collateral
damage.
What's
the
collateral
damage
on
a
neighborhood,
when
maybe
businesses
shut
down,
people
stopped
moving
out?
What's
that
collateral
damage,
I
mean
that
that's
what
we
have
to
and
you
know
I
understand
your
job
is
to
road
to
health
and
I.
K
K
F
Cc
facility,
they
are
I,
think
part
of
the
problem,
with
the
reason
why
there's
so
much
high
intensity
public
drug
use
is
because
that's
nowhere
near
enough
for
the
number
of
people
who
are
using
drugs
on
the
street,
Vancouver
I
think
they're
they're
out
there
are
there's
an
unsanctioned
sis.
That's
opened
up
outside.
There
are
other
ones
that
are
opening
up
the
next
year
and
I
think
that's
going
to
reduce
the
amount
of
public
injection,
that's
still
happening
in
the
area
and
the
public
drug
use.
So.
K
In
the
last
documentary
in
this,
my
last
point,
madam
chair,
is
that
there
is
now
a
program
that
they
are
providing
heroin
up.
There
is
that
our
next
step
now
is
that
what
wins,
when
is
this
is
there's
a
great
concern
with
that
right
because
I'm
pretty
sure
that
when
they
started
their
SIF,
they
never
thought
they'd.
K
Take
that
next
step,
but
there
is,
there,
is
now
I
was
watching
a
documentary
I'll,
look
it
up
if
you'd
need
to
know
for
the
record,
but
now
there
is
a
gentleman
who
runs
and
they
have
they
are
providing
heroin.
Now
that
that
scans
me
as
somebody
who
has
two
young
boys
this,
this
scares
me
this.
We
are
going
down
a
dangerous
path.
Thank
you,
madam
chair
Thank,.
L
L
You
Madame,
chair
and
I
thank
councillor.
Flower
I
have
a
meeting
that
starts
right
now,
so
I
appreciate
accommodating
me
I've
one
question
I
think
it's
probably
for
you,
director
from
the
Public
Health
Commission
one.
What
is
what's
the
Commission's
position
on
this,
and
is
this
even
allowed
I
mean
I,
know,
there's
a
bill.
The
State
House,
but
are
there
federal
permissions
that
are
acquired?
This
I
mean
strikes
me
something
that
this
body,
even
if
we
all
are
in
agreement,
couldn't
authorize
on
our
own.
Thank.
D
Department
really
is
on
the
continuum
of
services
that
Devon
and
I
have
walked
through.
I
will
say
that
I'm
in
a
learning
mode,
like
many
of
the
councillors
and
trying
to
get
up
to
speed
and
hearing
what
you
know,
some
of
our
clinicians
on
the
panel
and
shared
in
terms
of
what
they've
learned
in
their
environmental
scan
of
what's
happening
in
Vancouver
and
in
other
places.
Thank.
L
You
I
I,
just
say
I
want
to
thank
you
both
for
bringing
this
forward,
but
I
think
it's.
It
can
be
an
emotional
issue,
a
fraud
issue.
It's
obviously
complex
and
I
appreciate
all
the
experts
and
people
who
are
telling
us
about
it,
and
you
know
whether
it's
a
success
well
I'm,
certainly
very
much
someone
who
wants
to
look
at
the
numbers
and
the
data
and
do
things
that
can
make
everyone
our
community
safer,
but
I
think
before
we
are
all
spending
a
lot
of
resources
and
time
on
this.
L
We
think
we
need
to
know
what
what
is
even
feasible
I
think.
Certainly,
this
current
federal
administration
is
not
one
that
I
would
expect
to
be
giving
any
sort
of
exemptions.
I
mean
they're
talking
about
coming
after
medical
marijuana
now,
which
we've
had
in
this
state
already
for
some
time.
So
it's
that's
I!
Guess
my
quick
and
dirty
view
on
this,
but
I
appreciate
everyone's
time
and
in
your
testimony
and
I
apologized.
After
a
go
to
another
meeting,
anger.
C
Two
comments
comment
number
one.
Clearly,
any
a
task
force
that
looks
into
this
in
great
detail
would
have
to
look
at
any
legality
issues,
whether
they're,
federal
or
state,
and
you
know
we
would
assume
that
that
would
be
part
of
what
the
task
force
would
do.
The
second
I
just
want
to
make
a
comment
that
at
no
time
has
anyone
in
the
medical
society
even
hinted
at
the
concept
of
providing
illegal
drugs
ever.
M
M
Chair
I'll
preface
my
comments
in
terms
of
being
from
a
recovery
family
having
been
the
longest
serving
City
Council
here,
I
would
argue
that
of
no
one
has
done
more
on
the
City
Council
around
the
issue
of
treatment
and
recovery,
then
than
me
from
sensitive
to
recovery
and
sensitive
to
treatment.
Options
spend
a
significant
amount
of
my
time
as
a
City
Council
working
with
individuals
working
with
families
trying
to
find
them
detox
treatment,
recovery
stood
with
them,
and
the
families
and
courts
having
them.
M
Sectioned
I
happen
to
subscribe
to
treatment
on
demand
and,
and
if
that
doesn't
work,
quit
mandated
treatment.
I
think
is
also
better
options
than
what
we're
discussing
and
I
preface
that,
because
anyone
that
says
that
if
you're
against
this,
that
you're
inhumane
you're
not
sensitive
to
treatment
of
recovery,
I
but
also
probably
look
through
the
Galleria
I
would
argue
that
no
one
has
probably
lost
more
loved
ones,
more
neighbors
and
close
friends
to
addiction
than
then
and
me
and
my
family.
So
that
said,
I
think
this.
This
idea
is
asinine,
absolutely
asinine
and
dr..
M
You
had
mentioned
sort
of
from
the
from
the
public
health
side
of
things,
but
that's
not
how
it
plays
out
the
street
and
I
come
at
it.
Also
as
a
former
Assistant
District
Attorney.
How
it
plays
out
in
the
street
is
the
average
heroin
addict
does
about
a
gram
of
heroin
a
day,
that's
somewhere
in
the
vicinity.
It
could
be
24,
25
glassine
bags
a
day
and
if
we
think
for
one
minute
someone's
going
to
buy
a
school
some
heroin
and
take
a
train
or
a
bus
to
get
to
this
facility,
it's
not
the
reality.
M
It's
they're
going
to
they're
going
to
inject
or
snort
within
minutes
of
the
purchase,
and
they
do
that
because
they
need
to
keep
that
high,
going
or
they're
afraid
they're
going
to
get
rolled
robbed
or
it's
stolen
from
them.
So
that's
another
exigent,
circumstance
or
they're,
afraid
they're
going
to
be
stopped
by
the
police
and
have
it
seized.
So
this
vision
that
we
have
of
people
scouring
heroin
and
then
taking
the
taxi
ride
or
the
bus
ride
or
the
long
walk
similar
to
what
we
see
sort
of
it.
M
As
we
call
methadone
mile
where
everyone
sort
of
congregates
at
the
Dunkin
Donuts
and
Andrew
square,
and
then
they
take
the
long
pilgrimage
over
South
Hampton
Street
Bridge
to
get
their
fix,
that's
not
going
to
happen
doctor!
That's
not
going
to
happen.
So
unless
the
whole
drug
trade
is
going
to
go
to
surround
itself,
it's
going
to
be
wrapped
around
this
particular
facility.
The
reality
is:
is
that
one
so
in
school?
M
Is
heroin
they're
not
wait,
they're,
not
waiting,
they're
going
to
inject
other
going
to
snow
it,
and
it's
going
to
be
a
within
minutes
of
that
purchase.
So
unless
to
us,
the
buyers
and
the
sellers
are
going
to
be
moved
close
to
this
facility.
So
that's
just
that
dr..
You
just
mention
something
about
make.
No
mistake
that
you
know
medical
professionals
are
not
going
to
be
supplying
this,
but
they're
going
to
be
in
the
presence
of
a
category,
one
substance
and
I'm
not
quite
sure
how
that
works.
M
So
epically
from
you
know,
professional
medical
standards,
but
putting
doctors
and
nurses
and
other
medical
professionals
in
the
vicinity
with
is
a
Schedule
one.
Substance.
I,
don't
think!
That's
currently
allowed.
You
can
correct
me
if
I'm
wrong,
but
I
don't
think
it's
so
yeah
you're
not
supplying
it
but
you're
in
the
presence
of
it
and
I.
Think
that's
right.
Also
with
with
some
some
legal
and
ethical
issues,
I
think
we're
going
to
start
to
normalize
it
for
the
next
generation.
M
I
think
it
sends
the
message
that
controlled,
you
know
the
use
of
controlled
substances
or
in
this
particular
the
use
of
heroin
is,
is
acceptable
and
it
also
I
think
it's
going
to
push
the
limits
of
high
so
that
when
someone
normally
will
take
a
certain
amount,
I
don't
hope
they
come
through.
They
may
now
push
the
limits
of
their
own
boundaries,
because
they're
going
to
have,
they
think
we're
going
to
be
there
with
the
paddles
or
to
be
there
within
IKEA
and
again
I.
M
Just
think
this
is
wrought
with
many
issues,
and
I
would
rather
have
us
having
a
discussion
about
more
money
for
treatment
and
recovery
treatment
on
demand
in
the
city
of
Boston
and
again,
when
that
doesn't
work,
court
mandated
treatment,
that's
where
we
have
our
best
results
with
respect
to
that
so
and
finally,
doctor,
where
do
you
live?
What
community
do
you
do
other
than
the
11
Newton?
So
what
do
you
think
this
would
be
great
across
free
from
your
house
if.
C
C
Across
the
street
from
the
Johns
Hopkins
Hospital
did
you
like,
and
let
me
tell
you
that's
a
dangerous
neighborhood
down
there
and
I
would
have
had
no
problem
with
it
there
and
if
it
happened
in
Newton,
and
it
was
felt
that
that
was
it
I'm
still,
a
physician
and
I
want
to
see
what's
best
for
our
patients.
Right
I
would
accept
the
decision
of
the
Commonwealth
as
to
where
they
felt
it
was
best
cited.
M
In
as
referenced
earlier,
there's
no
neighborhood
is
immune
from
from
abusive
and
it's
affecting
our
whole
state.
So
will
you
join
I'll,
go
with
you
if
you
want
want
to
go
to
the
to
the
to
to
sit
with
the
mayor
of
Newton
in
the
Newton
City
Council
in
proposed,
putting
this
close
to
your
home.
Well,.
C
A
M
And
what
is
the
mechanism
by
which
we're
going
to
be
testing
say?
Someone
comes
in
with
a
glassine
bag
with
we're,
calling
it
a
Schedule
one
substance
we
test
against
event
all
week,
so
it
could
be,
it
could
be
heroin
or
it
could
be
a
lethal
dose
of
a
combination
of
different
things
and
we're
just
going
to
sit
and
watch
and
wait
to
see
what
happens
again.
M
We're
gonna
have
a
facility
that
were
not
gonna,
be
able
to
test
the
substances
that
people
are
bringing
in
through
the
front
doors
we're
going
to
watch
them
inject
snort
whatever,
and
we're
going
to
sit
by
and
wait
to
see
whether
we
get
to
jump
in
and
render
assistance.
I
think
that
is
absolutely
absent.
N
F
Fentanyl
there
is
no
heroin
left
in
Boston
there's,
none
everything
in
Boston
is
fentanyl
or
fentanyl
analogues.
There
is
no
heroin
left
in
the
city.
There,
probably
isn't
any
heroin
left
in
the
state
people
being
having
having
access
to
a
to
a
GCMs
or
an
infrared
scanner
to
be
able
to
know
what
they're
consuming
in
the
supervised
injection
facility
would
be
incredible.
So
people
know
what
they're
consuming
they
are
able
to
use
safer
and
the
people
who
are
supervising
them
are
able
to
have
a
heads
up
as
to
what
the
person
is
going
to
be.
M
You
absolutely
so
the
option
through
the
chair.
The
option
is
recovery
right
and
I'm
happy
to
help
you
I'm
happy
to
help
anyone
that
you
think
could
use
the
help
to
to
get
clean
and
sober
and
I
think
that
should
be
the
endgame
here.
It
shouldn't
be
providing
safe
houses
in
normalizing
the
activity
it
should
be
trying
to
get
folks
off
of
heroin
and
now,
in
this
instance,
away
from
deadly
fentanyl.
That
should
be
the
goal
here.
O
Madam
chair
and
thank
you,
council
Baker
for
bringing
this
to
the
body
as
someone
who
grew
up
in
Roxbury
I,
just
I
have
to
first
go
to
history
and
I
want
us
to
think
about
how
we
treated
people
who
are
on
crack
in
this
city
of
Boston
in
that
same
neighborhood
and
how
we
failed
them.
How
we
didn't
do
any
way
at
that
time.
It
was
three
three
strikes:
rules,
Rico
cases,
mandatory
sentencing,
lock
them
up
and
throw
away
the
key.
O
O
In
addition,
that
is
further
conflated
with
the
closure
of
the
city's
own
methadone
clinic
and
where
do
those
patients
go?
Interestingly,
those
patients
were
relocated
to
a
facility
closer
to
this
area.
So
I
don't
know
Vancouver
I've
never
been
to
Vancouver,
but
I,
definitely
dag
on
know
what
happens
on
Melanie
R
casts
and
on
mass
F
and
I
know.
The
city
of
Boston
is
complicit
in
exacerbating
the
situations
that
have
happened
in
that
area,
regardless
of
whether
we
have
a
sip
or
not.
O
It
happened
on
our
watch
and
people
died
and
people
are
dying
because
of
the
actions
of
the
city
of
Boston
and
a
tent
ain't.
Gonna
fix
it,
and
so,
as
we
have
this
conversation,
what
I
know
is
the
state
of
Massachusetts
has
failed
the
city
of
Boston
in
permitting
methadone
clinic
after
methadone
clinic
after
methadone
clinic
in
the
same
and
in
the
same
area,
and
so
I
don't
have
a
lot
of
trust
in
the
state
of
Massachusetts
on
these
matters
and
and
these
issues
do
I
think
that
people
need
help
and
do
I
see
it.
O
O
So
what
I
need
to
know
is
that
people
who
live
in
these
neighborhoods
and
in
these
communities,
folks
who
do
business
and
risk
their
own
capital
in
those
neighborhoods
and
communities,
are
going
to
be
on
this
board,
because
what
I
do
know
is
the
McDonald's,
the
great
gentleman
that
used
to
own
that
he
sold
it.
The
gas
station
very
nice
person
used
to
own
that
they
sold
it.
So
there
has
to
be
a
community
voice
at
the
table
on
these
issues
because,
time
after
time
after
time,
the
state
of
Massachusetts
has
failed.
O
The
city
of
Boston
on
on
these
issues,
with
a
hyper
concentration
of
of
methadone
clinics
in
that
area
and
I
guess
I,
would
also
just
note
I
hear
you
on
the
deferred
cost
every
single
time.
Somebody
oldies
in
that
area,
the
police,
ambulance
and
fire
are
all
called
and
I
would
love
to
hear
through
the
chair
on
the
numbers
relative
to
those
calls
and
a
cost
associated
from
our
Fire
Department
police
department,
as
well
as
ambulances,
I.
Think.
O
That's
a
critical
component
and
I
think
we
need
to
look
at
that
as
a
savings
in
the
future,
but
I
also
know
that
there
is
a
disproportionate
amount
of
burden
that
is
felt
by
a
specific
small
part
of
the
city
of
Boston.
Now
we
got
to
listen
to
folks
who
live
in
those
neighborhoods
who
are
having
their
their
doors
kicked
in
on
a
regular
basis
who
are
dealing
with.
Sadly,
issues
and
I
had
someone
who
had
a
door
broken
who
had
something
stolen
that
was
exponentially
less
valuable
than
that
door.
O
So
we
also
have
to
look
at
it
from
a
quality
of
life
perspective
for
those
folks,
and
there
could
be
a
compelling
case
there,
but
I
I
just
know
that
it
is
absolutely
critical
that
something
is
done,
but
I
I
know
as
a
local
elected
official
on
that
the
state
of
Massachusetts
has
not
served
us
well
and
I
would
ask,
and-
and
through
the
chair
to
the
doctor,
that
you
demand
that
there
is
local
rep
from
folks
who
live
in
that
neighborhood
live
in,
that
community
do
business
in
that
community
on
that
board,
because
that
is
the
the
highest
concentration
of
a
distribution
of
methadone,
I
believe
in
the
state.
O
O
I
would
I
would
also
know
if
we're
not
having
a
conference
conversation
about
detox
beds
on
demand,
then,
when
I
have
it
in
a
real
conversation,
if
we're
not
having
a
conversation
about
increasing
the
needle
distribution
in
the
city
of
Boston,
we're
not
having
a
real
conversation,
I
see
the
folks
back
there,
but
there's
not
enough
of
them.
They
work
their
butts
off
every
single
day
and
if
we're
not
having
a
real
conversation
and
listening
to
the
people
who
are
on
the
ground,
then
what
we
are
actually
doing
ourselves
a
disservice
and
wasting
folks
time.
O
I
want
to
thank
the
two,
the
two
co-sponsors
of
this.
This
is
the
issue
of
our
time.
In
the
United
States
of
America
post
post-world
War,
two
we're
going
up
every
single
year
in
life
expectancy
last
year's
numbers
we
saw
for
the
first
time.
In
a
long
time,
we
actually
saw
life
expectancy
in
the
United
States
go
down
and
I
deal
with
the
district
from
Back
Bay
to
Roxbury
that
has
a
33
year
difference
in
life
expectancy.
O
My
wish
and
hope
for
the
City
of
Boston
is
that
the
folks
that
we
move
towards
the
91.9
in
that
day
versus
the
50
8.9,
that
is,
a
life
expectancy
in
Roxbury.
Currently
that
is
actually
lower
than
that
of
the
life
expectancy
in
Gambia
and
lower
than
that
of
the
life
expectancy
in
Iraq,
so
I'm
all
ears
and
I'm
thinking
about
things
that
we
can
do,
but
it
has
to
be
measured,
thoughtful
and
inclusive
of
people
in
our
neighborhoods
and
communities
and
our
also
the
businesses
in
those
neighborhoods.
Thank
you
so
much
Thank.
A
You
councillor
I
would
have
just
two
quick
responses
to
your
remarks.
One
this
council
has
changed
and
it's
part
of
why
we're
here,
especially
in
regards
to
our
relationship
with
the
state.
This
is
why
we're
here-
because
it's
so
important
for
us
to
have
this
conversation,
because
it
does
so
directly
impact
impact,
the
city
of
Boston
and
both
positively
and
negatively.
So
I
have
a
couple
of
quick
questions
and
the
in
Vancouver.
A
If
any
of
you
could
speak
to
any
changes
in
the
number
of
individuals
using
heroin
for
the
first
time,
but
I
don't
know
if
any
of
the
data
has
shown
that,
because,
with
with
the
smaller
number
of
with
the
small
number
of
beds,
a
high
number
of
visits
I'm
just
wondering
if
we
stemmed
the
tide
of
new
users
or
is
enough,
does
the
number
increasing
continue
to
increase
I'm,
not
sure
if
you've
got
any
of
that
data?
I.
A
Then,
regarding
the
sibs
who
operates
them
typically,
is
it?
Is
it
a
Department
of
Health
or
equivalent?
Is
a
government
agency?
Is
it
a
private
entity
because
one
of
our
challenges,
especially
with
the
some
of
the
methadone
clinics
in
the
city
of
Boston,
is
that
they
are
privately
operated
and
that
presents
certain
challenges
for
sure
I
don't
know
if
anyone
knows
who
operates,
sibs
I
think.
A
And
then
I'd
like
to
recognize
that
we've
been
joined
by
my
at-large
colleague
from
Florida
Jana,
Presley
I,
know
that
you've
had
just
a
moment
to
come
in.
But
if
I'm
just
thank
any
opening
comment
or
that.
A
B
You
all
for
your
time,
Joe
you,
you
made
one
point
a
couple
times
you
kept
coming
back
and
I
just
I
appreciate
it
like
it.
So
we
have
that
we
have
to,
as
the
city
have
to
have
a
full
discussion.
So
we
so
when
we
move
forward
or
if
it
moves
sort
and
where
it
moves
forward
sighting
is
after
a
full
discussion,
so
I
think
what
what
council,
sabe
and
myself
are
looking
for
is
to
have
this
discussion.
B
But
my
issue
is
since
I've
I've
represented
this
area
down
there,
there's
been
a
couple
things
that
were
just
kind
of
they
happened
and
there
was
no
discussion
on
them
and
one
of
them
comes
to
Jax
and
talked
about
the
second
methadone
clinic
that
happened
on
Brad
Brad
since
trachea.
So
we
really
need
to
be
in
the
discussions
and
you
know,
let's
bring
the
whole
state
in
also.
Thank
you.
Thank
you
any
time,
Thank.
M
Director
have
found
through
the
chair,
if
in
your
circle
and
the
discussions
you're
having,
if
you
could
let
the
folks
know
that
they
should
be
looking
at
other
locations
outside
of
Boston
I'm,
preparing
to
think
well
possible
text
amendment
to
the
zoning
code
to
ban
them.
So
I
would
like
to
see
a
wide
and
broad-based
suggestion
of
other
areas.
Other
locales,
preferably
the
suburbs,
because
no
one
does
more
around
treatment
and
recovery,
then
the
City
of
Boston.
M
But
it
would
be
great
for
the
suburban
communities
to
step
up
to
the
plate
because
they're
not
immune
from
from
treatment,
recovery
issues,
they're,
not
immune
from
from
opioid
and
heroin
action.
In
fact,
when
you
tour
the
facilities
that
up
to
it
most
of
the
men
and
women
that
are
in
those
treatment
of
recovery,
folks
in
halfway
houses
in
three
courthouses
they're,
not
from
the
neighborhoods
of
Boston.
M
So
when
we're
looking
for
a
place
for
our
own
children
to
recover
outside
of
the
neighborhood
outside
of
the
area
where
they've
been
buying
and
selling,
there's
no
beds
available.
So
I
would
ask
you
in
your
circles,
if
you
could
push
back
a
little
bit
or
at
least
open
up
the
discussion
that
there's
some
resistance
in
Boston
and
that
they
ought
to
look
at
some
other
locales
and
bring
those
destinations
and
locations
to
the
table
as
well.
Thank
you
doctor.
Thank
you.
Man,
good.
Basically,.
C
It's
a
Commonwealth,
and
we
would
not
presume
at
the
medical
society
alone
to
make
a
suggestion
where
it
should
be,
but
would
assume
that
state
and
local
governments
would
put
their
thoughts
together
and
come
up
with
the
most
optimal
location
for
such
and
that
would
move
forward
from
there.
We're
not
going
into
this
with
any
preconceived
notion
of
where
it
should
be.
Thank.
C
A
A
A
B
P
And
all
of
those
who
have
interests
for
staying
I'm,
a
primary
care
physician
in
this
incarnation
in
my
life,
but
I've
also
been
a
professor
at
Medical
School
for
close
to
five
decades
at
a
number
of
medical
schools
across
the
country
and
more
recently
here
in
Boston
for
the
last
40
years,
I'm
I
see
patients
every
day.
I
have
patients
from
every
stripe
and
fashion
of
work,
communities
and
stuff.
In
my
practice-
and
we
take
all
insurances-
I,
don't
speak
here
for
Boston
University
or
Tufts
University.
Those
are
my
academic
affiliations.
P
I,
don't
speak
for
Beth
Israel,
Deaconess,
Hospital
Milton,
where
I'm
on
staff
or
Kearney,
where
I've
been
on
staff
for
a
long
time
or
many
other
places
where
I
am
affiliated
with
I
hope
to
bring
some
information
here.
That
hasn't
been
said
so
far
to
give
some
perspective
to
the
counselors
and
their
deliberations
about
this
very
important
issue
and
I
guess:
I,
don't
know
how
this
one
works,
but
if
I
start
pushing
buttons
and
get
the
wrong
one
I
think
forward
might
be
to
the
right.
P
Yes,
there
we
go
figured
it
out
I'm
going
to
go
through
these.
Rather
quickly
because
I
want
to
put
the
notion
of
addiction
in
perspective,
because
we've
been
talking
mostly
about
drugs
and
injectables
and
I,
think
people
forget
there
are
other
types
of
addictions
and
they
should
not
be
neglected
in
how
we
handle
public
health
issues
because
they're
equally
important,
so
because
injected
materials
have
a
greater
risk.
That's
why
we're
all
here
today
to
talk
about
safety?
P
Obviously,
the
consequences
of
addictions
are
known
to
many
of
us
personally
and
through
others
that
were
associated
with
and
I'm,
not
going
to
read,
slides
because
I
think
all
of
you
know
how
to
read,
but
basically
they
have
a
major
impact
on
society
and
the
workplace
and
multiple
other
people
and
parties.
Our
families,
our
friends,
our
neighbors,
so
society
demands
that
our
representatives
do
something
because
we
have
a
bit
of
a
crisis
going
on
I.
P
Don't
want
to
spend
this
time
talking
about
how
we
got
here,
although
its
history
is
very
important,
I
did
know
George
Santayana
when
I
was
at
MIT,
and
history
has
a
way
of
repeating
itself.
If
you
forget
it,
he
said
that
so
we
need
help
from
all
the
stakeholders.
Many
are
here:
some
are
not
we,
we
want
to
look
for
solutions
and
we
want
to
engage
everybody
and
trying
to
get
something
by
focusing
on
what
happens.
P
P
So
that's
problem
solving
which
most
doctors
do,
and
my
colleagues
who
were
here
before
do
the
same
in
their
own
ways
and
in
their
own
places.
Now
we
may
not
all
agree
all
the
time,
but
that
is
our
goal
and
we're
pretty
much
dedicated
to
the
health
and
welfare
of
our
patients,
sometimes
at
our
own
peril.
P
Now
treatment
of
addictions
varies
depends
on
the
type
of
addiction
in
terms
of
substances.
As
has
already
been
said,
relapse
is
common
compounds
which
are
highly
addictive.
That
is
in
a
physical,
biological
physiologic
way
are
much
more
difficult
to
deal
with
because
they
almost
change
the
brain
and
demand
that
they
get
that
again.
P
P
Injectable
substances
of
abuse
now
include
some
of
the
things
that
have
been
mentioned:
I'm
also,
a
medical
review
officer
and
I
review
drug
tests
for
employers,
Coast,
Guard,
Navy
and
many
other
places
to
see
whether
people
have
drugs
on
board
when
they
apply
for
a
job
or
whether
they're
found
in
a
random
search
that
includes
truck
drivers
and
thousands
of
other
people.
So
it
was
said
before.
I
just
want
to
make
a
comment
that
heroin
and
other
things
like
fentanyl
are
not
necessarily
coming
together.
That's
not
100%.
P
These
sips
is,
is
harm
reduction
and
it's
alcohol
at
the
lesser
of
two
evils,
I
mean:
is
it
better
to
have
someone
injecting
in
the
court
and
the
and
the
alleyways
and
the
doorsteps?
Or
is
it
better
to
have
someone
injecting
in
a
facility
where
help
might
be
closer
and
I'm
going
to
dwell
on
some
of
that,
because
a
lot
has
been
said
about
the
conditions
in
Vancouver
and
I.
Think
not
all
the
data
fit.
What
has
been
said,
there
have
been
changes
and
I,
don't
think
they've
been
brought
out
here.
P
A
safe
injection
facility
makes
sense
if
you
have
no
other
alternatives
and
you're
trying
to
look
for
some
form
of
safety,
but
it
comes
at
a
price
and
those
prices
have
been
illustrated
by
councillor
Baker
and
I.
Don't
know
the
names
of
all
the
people
who
spoke,
but
so
I
don't
mean
to
put
pick
on
you
or
highlight
you
in
any
particular
way.
But
safety
is
the
principal
issue
about
what
this
is
seems
to
be
all
about,
but
it's
not
just
the
safety
of
the
person.
P
P
So
let's
look
at
this
recently
published
graph,
showing
deaths
in
overdose
in
British
Columbia
the
whole
the
whole
province,
not
just
Vancouver
but
obviously
Vancouver
and
Lethbridge
and
Chilliwack-
are
some
of
the
bigger
places
here.
I've
been
through.
All
these
places
earlier
in
my
life,
so
you'll
see
that
the
number
of
deaths
where
this
facility
has
been
in
place
for
20-plus
years
have
started
to
climb
in
the
sort
of
the
changeover
into
the
teens.
P
The
2010-2011
and
the
data
that
was
last
published
were
not
quite
these,
but
this
is
what's
going
on
now,
and
this
is
as
of
2015,
so
these
are
a
year
plus
out
of
date.
Now
years
ago,
I
went
down
to
Walter
Reed
to
get
a
when
the
HIV
epidemic
was
in
its
infancy
and
sat
and
listened
to
a
very
intelligent
speaker
named
dr.
P
Redfield,
who
was
talking
about
epidemics,
and
when
you
see
that
something
takes
off
from
the
horizontal
to
the
vertical,
then
you
know
you
really
have
a
problem,
and
the
real
question
is
not
that
you
know
houston.
We
have
a
problem.
The
problem
is,
what
is
the
problem
and
I
will
tell
you
in
advance
the
bottom
line.
Air
is
not
fact
that
people
are
injecting
drugs.
It's
the
fact
that
Centeno
is
now
so
common.
It's
all
over
the
place,
even
in
small
towns,
in
New
England,
in
the
Midwest
and
everywhere
else.
P
We
can
talk
about
why
that
happens,
but
the
reality
of
it
is
it's
so
easy
to
transport.
You
can
put
it
in
an
envelope
and
mail
it
and
because
the
post
office
is
not
in
the
business
of
opening
mail
like
that,
it
goes
all
over
the
country
with
great
rapidity
and
the
real
problem
we
have
is
not
safe
injection
facilities.
P
But
Sentinel
is
a
manufactured
synthetic
drug
as
opposed
to
heroin
which
is
derived
from
poppies,
and
the
question
is
where
all
those
puppies
come
from
and
the
answer
is
Afghanistan
and
we've
been
fighting
a
war
there
for
a
long
time
to
stop
that.
But
apparently
we
haven't
been
very
successful
all
right,
so
car
fentanyl
is
a
more
potent
version
of
fentanyl
so
taking
these
by
themselves.
P
If
you
accept
that
heroin
has
the
same
potency
as
morphine
they're,
both
from
the
same
plant
and
call
that
one
then
the
potency
of
fentanyl
is
about
a
hundred
times
more.
So
if
you
took
a
hundred
milligrams
of
heroin,
one
milligram
of
fentanyl,
which
is
about
the
size
of
a
speck
of
salt,
would
be
the
equivalent
amount
of
100
milligrams
of
heroin.
But
Car
Sentinel
is
a
hundred
times
more
potent
than
that.
P
So
the
difference
between
car
fentanyl,
which
is
pretty
easy
to
get
and
is
now
finding
its
way
to
the
streets
here,
is
10,000
times
more
potent
than
the
heroin
itself
now
for
comparison.
Oxycontin
has
a
morphine
equivalent
of
1.5,
so
it's
only
one
and
a
half
times
what
you
see
in
the
heroin
bottle
and
that's
whether
it's
oxycontin
oxycodone
or
any
of
its
derivatives.
P
Okay,
I,
don't
think
you
can
read
these
very
well
from
back
in
the
back
of
the
room
and
these
data
and
those
pictures
came
from
Canadian
television
and
the
post
in
mail,
which
is
a
The
Globe
and
Mail,
which
is
a
large
paper
in
Toronto.
That
does
very
good
reporting
and
you
can
find
this
stuff
on
the
web
and
that's
where
I
got
it
all.
P
Now
this
is
a
pill
making
machine
and
anybody
can
buy
one
of
these
and
have
it
shipped
in
from
somewhere.
And
why
would
you
want
a
pill
making
machine?
Well
because
you
can
take
very
small
amounts
of
fentanyl
mix
them
up
with
a
little
little
lactose
and
other
binders
and
end
up
with
tells
so
now
you
have
money
how
to
make
money
with
with
fentanyl
one
kilogram
2.2
pounds
of
fentanyl
will
when
divided
up
into
pills,
with
small
numbers
of
milligrams
in
each
one.
P
On
the
right
here,
you'll
see
there's
two
little
packets,
like
those
things
that
come
in
your
electronics
that
keep
things
dry.
This
was
a
bottle
of
urine
dipstick,
and
those
little
packages
inside
are
not
so
innocent
because
those
were
used
to
smuggle
heroin
into
the
country
and
because
they're
less
than
30
grams,
each,
which
is
the
weight
of
a
shot
glass
of.
P
It's
20
dollars
a
pill
for
these
things
on
the
street,
and
it
only
takes
two
pounds
of
fentanyl
to
make
20
million
dollars
and
20
million
pills.
This
is
the
safe
injection
facility.
We've
talked
about
what
they
look
like.
So
what
are
the
benefits
and
risks
of
a
sip?
Well,
the
first
is
there's
some
benefit,
obviously,
for
20
20
years
of
experience,
they
have
contained
the
number
of
deaths.
There
are
more
people
that
are
getting
into
other
treatment
programs
and
all
of
that,
but
Canadians
Canada's,
a
different
country
financing
healthcare.
There
is
different.
P
There
are
some
differences
to
us,
they're,
not
huge,
but
they're
worth
talking
about
and
not
the
subject
of
what
I
want
to
talk
about
today.
So
can
the
Canadian
approach
work
here
and
the
problem
is
the
data
that
have
been
presented
that
it's
done
so
well
and
only
30.
You
know
certain
number
percent
have
been
saved
are
all
changing,
because
I
showed
you
that
graph,
while
suddenly
the
whole
province
of
BC
has
exactly
the
same
problem.
P
We
have
here
in
Boston
last
year
in
this
state
85
percent
of
the
deaths
from
opiate
overdose
involved,
fentanyl,
Plus,
heroin
plus
other
drugs.
It's
mixed
with
cocaine
and
several
other
thing,
and
that's
where
the
real
problem
is
now
our
sifts
got
risk
yeah
they're
expensive
to
operate
I
mean
the
number
that
was
given
out
at
the
Medical.
Society
was
three
and
a
half
million
dollars
for
this
site.
P
How
many
hundreds
of
people
are
going
to
use
that
site?
I
know
you're
going
to
concentrate
people
in
an
area
where
you
may
not
want
them
being
concentrated,
forget
about
NIMBY,
not
my
backyard,
but
think
about
walking
into
methadone
clinics.
You
can
see
people
exchanging
drugs
on
the
outside
I'm,
going
to
have
patients
who
are
methadone,
and
they
tell
me
exactly
what
happens
and
I've
seen
it
for
myself,
so
putting
things
together
doesn't
always
make
a
problem
better.
P
There
are
these
other
problems
that
we've
talked
about,
but
until
these
problems
are
solved,
I
wouldn't
be
in
favor
of
having
something
like
this,
but
I
think
they
could
be
solved
with
very
thoughtful
design
and
structure
and
assistance
designed,
for
example,
you
don't
know
what's
being
injected.
That's
already
been
talked
about,
but
the
technology
so
simple
that
you
could
have
a
mass
spectrometer
sitting
at
the
door
and
actually
tell
them
exactly
of
how
much
of
each
thing
is
there?
P
The
companies
who
do
drug
testing
by
the
millions
in
this
country
do
it
on
millions
of
samples
a
day,
quest,
med
talks,
LabCorp
and
a
number
of
other
ones
in
the
Midwest.
They
go
out
on
the
office
and
a
bag,
and
they
come
back
the
next
morning,
all
analyzed,
so
it
can
be
done.
It's
not
like
it's
rocket
science.
It's
not!
P
These
are
illegal
drugs,
as
has
been
said,
so
it
would
be
impossible
to
do
this
at
all
unless
there
was
some
kind
of
a
waiver
permission
or
whatever
from
the
federal
government.
So
that's
a
big
issue
now
that
creates
other
problems
because
suppose
you're
a
doctor
and
you're
supervising
a
clinic
like
this
and
your
malpractice
carrier
says.
Oh
sorry,
you're
not
covered
anymore,
because
you're
doing
something
that
involves
legal
substances
same
can
apply
to
the
other
staff
there.
P
How
much
narcan
you
have
in
your
hands
or
in
your
closet,
you're
not
going
to
be
able
to
act
fast
enough
and
suppose
10
people
come
in
at
the
same
time
and
do
all
the
same
thing
and
there's
only
3
people
on
the
overnight
shift
and
it's
3
a.m.
it
doesn't
compute.
So
enough
protections
have
to
be
built
into
these
things.
P
P
So
is
there
a
better
way
than
doing
this
than
just
using
sense,
and
the
answer
is
probably
yes,
I
think,
let's
take
a
look
at
how
easy
it
is
for
fentanyl
to
get
in,
though
this
is
a
small
fentanyl
lab
in
a
China.
These
pictures
were
done
by
an
undercover,
investigator
and
published
in
the
Canadian
papers,
but
this
is
a
big
one
and
you
know
you
only
need
to
point
two
pounds
to
make
twenty
million
dollars.
P
I
mean
that's
better
than
the
lottery,
so
here's
what
to
billa
grams
of
powder
will
look
like
next
to
a
painting,
and
this
is
enough
not
just
to
put
down
a
horse,
but
this
is
car
fentanyl.
It
would
put
down
an
elephant
now
if
this
got
into
a
human
being,
you
might
as
well
have
picked
out
the
casket
before
you
do
it.
B
P
Car
fentanyl,
it's
10,000
times
more
potent
then
so
this
is
a
just
a
list
of
papers
on
using
heroin
like
they
do
in
England
as
a
substance
for
treat
abuse,
you
get
the
heroin,
but
you
get
pure
heroin
and
you
can
inject
it
in
a
safe
facility
and
doctors
can
write
prescriptions
for
it.
That's
an
alternative
to
walking
in
off
the
street
with
whatever
you
want.
P
So
why
should
we
change
this
I
think
we
have
a
problem
in
that
we
definitely
have
many
drugs.
We
have
definitely
many
people
who
are
addicted
and
addiction
is
a
horrible
problem
for
anyone
who
has
it
are
their
relatives
or
their
counselors
or
everything
else.
It's
not
going
to
be
solved
easily.
But
if
you're
going
to
have
safe
injection
facilities,
we
need
to
make
them
safe.
P
P
That
is
on
the
order
of
ten
times
more
potent
than
it
was
in
the
60s
ten
times
more
potent
there's
nothing
medical
about
that.
Tetrahydrocannabinol
does
not
give
any
medical
properties
to
marijuana,
but
the
plants
have
been
bred
to
do
that.
Why?
Because
people
want
more
of
a
buzz,
a
higher
high
and
all
event,
the
actual
medicinal
drugs
in
marijuana
have
not
been
thoroughly
studied.
P
There
are
some
very
preliminary
studies
that
so
some
of
them
have
benefit
for
very
particular
conditions,
but
the
whole
story
about
medical
marijuana,
in
my
opinion,
is
a
bit
of
a
subterfuge,
and
you
know
I'll
say
it
here
in
public
and
in
front
of
the
TV
and
everything
else,
because
that's
the
truth
in
any
way.
I.
Thank
you
for
having
me
today
and
I'm.
P
Q
My
name
is
Brian
Fitzgerald
and
I'm
a
nurse
practitioner
and
have
been
in
the
nursing
field
for
forty
years.
I
think
all
of
us
in
this
room
on
both
sides
of
the
table,
medical
colleagues
and
nursing
colleagues
and
outreach
workers
are
doing
the
best.
We
can
do
to
try
to
reach
this
population
that
tears
apart
families
and
communities
and
I
do
want
to
acknowledge
that
I'm.
Also
speaking
on
behalf
of
the
Metro
Boston
Alive
program,
which
is
in
Roxbury,
Gregory
Davis
is
a
founder
and
executive
director
and
he
wanted
me
to
speak
on
his
behalf.
Q
Also,
my
opposition
to
safe
injection
sites
come
from
over
35
years
in
the
field,
including
being
part
of
the
original
harm
reduction.
Vanguard
in
Boston
during
another
crisis
see
AIDS
epidemic
during
those
early
years.
The
idea
of
harm
reduction
was
to
meet
the
person
where
they
were
at
and
support
that
part
of
them
that
wanted
to
live.
This
is
what
the
injection
drug
use
group
did.
We
went
out
to
the
suffering
addict
prevention,
education
through
the
provision
of
bleach,
followed
by
clean
needles
and
syringes
was
done
by
addicts
and
recovery
in
the
communities.
Q
Most
impacted
by
HIV,
the
medical
establishment
had
nothing
to
do
with
this
original
impact
in
the
community.
The
recovering
addicts,
the
people
that
had
some
recovery
and
sobriety
under
their
belts
collaborated
with
the
Boston
municipal
and
Roxbury
courts
to
provide
AIDS
education
and
expand
treatment
on
recovery.
Once
again,
the
larger
recovering
community
decreased
the
age,
Theroux
prevalence
rate
from
38
percent
to
14
percent
among
injection
drug
users
in
the
city
of
Boston,
back
in
the
late
80s
and
early
90s
by
the
bottom-up
approach,
not
the
top-down
approach.
Q
The
success
of
these
early
days
of
harm-reduction
were
born
from
the
human
need
to
share
the
experience,
strength
and
hope
and
to
help
others
navigate
the
human
experience
and
let
them
know
that
wellness
can
take
place
in
the
absence
of
a
cure.
That's
what
we
said
about
AIDS
back
in
the
day,
and
that
is
still
true
with
substance.
Abuse,
wellness
and
recovery
can
take
place
in
the
absence
of
a
cure.
Today,
the
idea
of
harm
reduction
has
been
significantly
altered.
Q
Today
we
invite
the
addict
to
come
to
us
to
access
clean
needles,
although
they
are
available
in
pharmacies
to
come
to
us
and
ride
out
there
hi
and
now
the
mass
Medical
Society
is
providing
its
stamp
of
approval
to
invite
drug
users
to
come
into
our
site
and
shoot
up
and
perhaps
die
with
help.
The
idea
of
projecting
any
desires
or
hopes
for
the
clients
that
we
are
serving
to
consider
a
healthier
lifestyle
has
been
eliminated.
Q
Suggestions
are
not
offered
misguided
idea
is
that
the
addict
will
ask
us
for
help
when
they've
had
enough
drug
use
has
been
normalized
in
this
city.
I
see
the
safe
injection
site
is
the
hospice
care
for
end-stage
addiction.
We
have
given
up
hope
on
the
person
walking
into
a
safe
injection
site
with
a
bag
of
drugs
that
they
will
consume
under
our
watchful
eye,
as
denoted
before
who
can
know
what's
in
that
glassine
envelope,
and
what,
if
they
do
die
on
our
watch?
Q
Who
will
pay
for
that
and,
as
speaking
as
a
nurse
I
can
stake,
my
reputation
that
it
will
be
the
nurses
sitting
with
the
patients
and
not
the
doctors,
it
is
enabling
a
behavior
injecting
or
snorting
drugs
of
unknown
quantity
and
quality.
That
has
no
possible
good
outcome.
As
the
National
Institute
on
Drug
Abuse
has
said,
the
brain
has
been
hijacked
by
drugs.
Will
we
then
allow
this
brain
dysregulation
to
go
on,
uninterrupted
and
unchallenged
through
the
paternal
efforts
paternalistic
efforts
of
a
safe
injection
site?
Q
Q
It
is
our
role
as
healthcare
providers
to
help
the
population
address
their
struggle
and
trauma
and
to
offer
ways
to
explore
and
challenge
their
anxieties
and
avoidance,
or
have
we
become
part
of
the
problem?
We
have
thrown
our
hands
up
and
said
in
so
many
words
words.
Giving
you
a
place
to
inject
during
business.
Hours,
of
course,
is
the
best
we
can
offer
right
now.
We
can
do
better
to
help
people.
Q
Almost
people
who
say
they
would
rather
take
their
chances
in
the
bushes
over
the
drug,
infested
and
violence,
fueled,
shelters,
new
arrivals
to
Massachusetts
from
all
over
the
country,
congregate
near
the
department
of
transitional
assistance,
as
they
have
heard.
The
benefits
are
comprehensive
and
easy
to
access
drug
deals
going
on
in
broad
daylight
in
the
sign
only
recently
taken
down
at
the
bubbles.
Q
The
idea
of
a
mobile
van,
which
in
turn
of
itself,
will
eliminate
the
NIMBY
issues
can
be
a
symbol
of
the
crisis
and
the
van
can
be
situated
once
a
week
in
multiple
areas
where
overdose
rates
are
high,
not
just
in
methadone
mile.
There,
Brockton
Hyannis,
New
Bedford
Framingham
Springfield,
the
Department
of
Public
Health,
needs
to
pay
attention
to
this
understand.
Q
Yes,
you
might
actually
have
a
little
area
to
inject
safely
under
the
watchful
eye,
and
there
will
be
the
usual
harm,
reduction
supplies
and
opportunities
to
test
for
HIV
and
Hep
C
recovery
interventions,
however,
will
be
part
of
the
team.
Volunteers
from
learned
to
cope
will
be
available
to
family
members,
recovering
people
who
will
also
volunteer
much
as
they
did.
Q
Aids
access
to
the
medication,
assisted
therapy
or
opiate
replacement
therapy,
as
I
like
to
call
it
will
also
be
available.
The
symbolism
of
the
van
is
that
will
represent
this
opiate
crisis,
it's
more
than
the
addict.
It's
a
family,
the
community
and
all
must
be
educated
and
alerted.
Perhaps
politicians
from
the
communities
outside
of
Boston
visited
by
the
van
will
also
show
up
to
field
questions.
Maybe
the
local
Dunkin
Donuts
will
provide
us
some
refresh
ins.
Q
My
personal
belief
is:
if
we
stop
treating
the
addicted
person
like
a
sick
animal
who
doesn't
know
any
better
if
we
keep
telling
them
that
they
have
no
control
over
their
stopping
and
they
don't,
and
they
never
will.
Let
us
raise
the
bar
from
the
end-of-life
care
to
the
hard
work,
but
invaluable
experience
of
wellness
by
addressing
the
deeper
mental,
emotional
and
spiritual
causes
of
this
disorder.
Thank
you.
G
A
R
You,
first
of
all
for
having
this
conversation,
I
think
it's
very
important
for
us
to
have
an
open
dialogue
with
both
sides,
the
table
being
present.
My
name
is
Allison
burns
I'm
a
registered
pharmacist
I
have
a
doctor
a
pharmacy
degree,
a
two
academic
appointment
at
two
Boston
University's
for
addiction,
medicine
and
pleasant
view's
disorder,
I'm.
R
Also
the
director
of
two
pilot
programs
that
have
to
do
with
increasing
narcan
in
our
community,
including
mobile,
dispensing
I'm,
the
founder
of
a
nonprofit
that
deals
with
getting
pharmacies
more
involved
with
the
substance
use
community,
because
why
not
get
drug
experts
involved
with
drug
addicts
I'm?
Also
an
advisor
and
a
member
of
a
task
force
for
a
government
agency
and
I
haven't
named
any
of
the
facilities
that
I
work
with.
R
So
everyone
knows
that
this
is
my
independent
testimony
and
not
affiliated
with
any
specific
institution
that
all
being
said,
I
think
more
importantly,
I'm
a
Boston
resident
I
lived
in
Dorchester
for
a
while
and
now
I
live
in
Southie
I'm,
also
a
u.s.
Navy
veteran
who
was
injured
and
was
on
opioids
for
years
through
the
VA
and
I'm.
Also,
the
sister
of
an
addict
who's,
not
in
recovering
okay.
So
the
number
one
thing
that
we
have
heard
is
support
of
the
supervised
injection
facilities
have
been
that
they
save
lives,
it
reduces
mortality.
R
So
what
does
that
really
mean
we're
reducing
the
drug
overdoses,
whether
non-fatal
or
the
actual
fatal
overdoses?
And
yet
I'm
not
going
to
disagree
with
the
opposition?
Sif's
do
save
lives,
they
do
reduce
overdose
death,
but
it's
in
the
facility
and
that's
what
is
a
key
point
here.
So
the
statistic
that
you
got
about
Vancouver
in
2011,
with
35
percent
reduction
in
overdose
death
I,
want
everybody
to
be
very
clear,
was
35
percent
within
500
meters
of
the
facility,
all
of
Vancouver
combined?
R
There
was
9%
I'm
not
going
to
cherry
post
statistics
to
make
my
point
sound
better.
This
study
also
was
conducted
to
pre-imposed
opening,
so
it
was
only
January
2001
to
September
2003
and
then
to
December
2005,
but
yet
it
was
published
and
researched
all
the
way
up
to
2011
and
it
failed
to
include
the
full
set
of
data
because
it
wasn't
as
favorable
as
the
35%
and
yes,
the
doctor
before
was
correct.
There
was,
there
has
never
been
one
single
death
with
people
using
fast
who
supervised
facility
using
keyword.
R
I
would
encourage
everyone
to
look
out
and
see
how
many
people
who
use
the
SIPP
died
outside
the
safe
going
ahead.
Read
there
are
other
facilities,
so
there's
a
safe
in
Sydney,
their
own
committee
put
by
the
people
that
run
that
facility
found
that
there
was
no
evidence
that
that
facility
affected
the
number
of
overdose
deaths
in
the
king
cross
area,
where
it
is
moving
on
the
European,
Monitoring
Centre,
2004,
review
of
drug
consumption
rooms,
that's
what
they
call
it
there.
R
They
looked
at
the
number
of
overdose
fatalities,
averted
for
all
25
steps
in
in
Germany
and
for
every
500,000
injections.
It
was
ten
averted
overdose
fatalities
and
that
looks
great
and
I'm
very
happy
that
there
was
10
fatalities
that
were
averted
but
averted
fatalities.
We
have
to
be
very
clear
and
very
precise
when
we
look
at
the
language
of
these
studies.
That
does
not
mean
individual
lives
saved
I'm.
A
pharmacist.
I
have
people
that
come
in
that
overdose
and
because
the
half-life
of
narcan
is
not
that
of
fentanyl,
they
go
into
a
recurrent
respiratory
depression.
R
They
can
have
multiple
overdoses
with
a
single
day,
so
11
or
excuse
me,
10
averted
overdose
fatalities
could
be
not
10
people.
The
data
is
an
inaccurate
portrayal
of
the
target
population.
Based
on
that,
a
more
clinically
appropriate
denominator
is
avert
is
averted
fatalities
per
visit.
So
this
would
even
include
people
that
say:
go
to
the
facility
overdose
go
out
and
then
come
back
in
overdose
again.
It
would
actually
include
that
as
two
separate
instances,
it
would
counted.
R
So
what
I
mean
by
that
is,
if
I
was
to
do
heroin
today,
I
would
probably
only
be
able
to
you
know,
shoot
up
once
but,
for
example,
my
family
member,
my
brother
six,
seven
times
a
day,
we
can't
be
considered
equal
in
that
the
frequency
has
to
be
taken
in
account
because
the
average
number
of
injections
you're
saying
five
hundred
thousand,
if
I'm
doing
ten
injections
a
day,
that's
much
different
than
you
know.
I
might
just
look
at
that.
Bank
all
five
hundred
thousand
people
each
doing
one.
R
So
really
it's
much
less
than
what
you
think
moving
on.
It's
just
a
complete
lack
of
comparative
framework
and
baseline
data,
so
we
really
have
to
have
an
accurate
portrayal,
the
target
population,
the
entire
city,
so
all
Vancouver
that
nine
percent
and
then
the
variations
and
drug
use,
so
it
shouldn't
be.
It
should
be
more
likely
to
be
visits
and
not
injections.
R
So
this
is
a
big
point
when
we're
looking
at
this
we're
really
evaluating
the
estimated
cost
first,
the
cost
of
what
would
be
avoided
if
the
IV
drug
user
associated
harms
such
as
infectious
disease,
societal
burdens,
access
to
treatment.
All
that.
My
main
point
here
is
the
majority
of
the
literature
that
is
out
there.
So
the
statistics
you
heard
before
from
the
doctor
that
was
here
previous
that
were
San
Diego
San
Diego,
doesn't
have
a
safe,
no
place
in
America
has
a
syst,
those
were
researchers
and
a
think-tank.
It's
all
hypothetical.
R
It's
a
mathematical
model
I
like
to
base
data
on
real
things.
I
was
in
the
pilot
program,
the
Navy.
If
I
did,
if
I
did
my
database
on
type
esthetically,
what
I
thought
I
was
going
to
do,
people
would
have
died.
You
can't
do
that.
These
are
people's
lives.
It's
important
that
we
get
it
right,
so
we
can
do
it
right,
the
first
time
so
based
on
maps
mathematical,
modeling,
it's
not
actual
data,
and
why
do
we
keep
going
to
Vancouver?
So
if
you
look
at
sis,
they
then
event
around
since
1980s
in
Europe.
R
Why
are
we
not
looking
at
the
75
other
active
ones
in
the
world,
and
why
aren't
we
looking
at
the
ones
in
Switzerland
that
shut
down
just
something
to
bring
up
an
interest
of
time?
I
won't
go
into.
Why
we're
not
looking
into
those
it's
just
a
question.
I
want
to
raise
so
moving
on
with
the
cost-effectiveness
supporters
say
that
it
improves
sorry,
yes,
it
improve
the
incidence
of
infectious
disease.
So
what
we
talking
about
here
when
you're
given
safe
injection
supplies,
there's
going
to
be
less
transmission
of
HIV
Hep,
C,
Hep
B.
R
Yes,
of
course,
anytime,
you
get
clean
supplies,
there's
going
to
be
a
decreased
transmission,
but
all
that
being
said,
the
actual
data
for
this
is
very
mediocre
at
best.
So
when
you
look
at
what
Vancouver
said
now,
this
is
2005
their
own,
their
own,
the
Canada
Canadian
Center
on
substance,
abuse
so
equivalent
to
what
our
DFAS
would
be.
They
said,
there's
no
firm
conclusion
that
can
yet
be
we
reached
regarding
the
impact
of
cysts
in
relation
to
the
spread
of
infectious
disease.
There
wasn't
a
proper
comparison.
R
There
was
no
studies
that
actually
compared
ID
outcomes
of
the
cyst
to
ID
outcomes
to
current
addiction,
treatment
or
harm
reduction
programs
such
as
needle
exchange
in
the
United
States.
We
use
empirically
based
data,
so
one
of
our
most
current
effective
ways
we
found
to
prevent
HIV
and
Hep
C
and
happy
any
type
of
zhan
needle
born
of
love,
born
transmission
of
disease
in
the
IV
drug
user
populations.
We've
seen
the
success
of
Matt
and
we've
seen
the
success
of
Education
and
we've
seen
the
success
of
other
harm
reduction
programs.
R
We
also
say
that
supporters
will
say
that
it
improves
health
and
it
reduces
risky
behavior.
So
what
do
I
mean
by
that?
So
decrease
use
of
be
unsanitary
equipment,
so
clean
needles
decrease
sharing
of
needles
because
they
actually
have
access
to
the
needles
and
the
decreased
hurt
injections,
which
would
cause
some
type
of
soft
skin
tissue
infection.
R
So
when
you
actually
look
at
this,
data
is
also
mediocre
and
what
I
mean
by
that
is
so,
if
you
can
see
up
there,
Vancouver
had
a
quest
canary
that
was
given
six
months
and
13
months
after
opening,
and
it
showed
that,
even
though
they
were
offered
to
get
pre-screen
Ito's
clean
needles,
every
single
time
self-reported
in
the
facility
16.5%
still
share
needles.
There's
a
lack
of
education
there,
not
a
lack
of
access
to
the
clean
equipment.
That's
important
important
thing
to
know.
R
Sydney
same
thing,
surveys
were
given
to
a
cohort
of
randomly
sampled
SIPP
users
in
2000,
2001
2002,
and
the
results
showed
that
using
new
needles
did
happen.
I
won't
ever
say
that
just
there
wasn't
support
for
that.
Of
course,
it
was
64
percent,
75
percent
and
79
percent.
That's
great.
However,
the
same
time,
the
actual
education
and
culture
around
a
needle
sharing
did
not
change
19
percent
in
2016
percent
in
2001
and
18
percent
2002,
even
though
they
had
access
to
these
materials.
It
did
not
change
this
behaviour.
R
We
need
to
look
at
behavior
modification,
that's
just
an
important
another.
Important
topic.
I
wanted
to
bring
up.
So
when
we
look
overall
at
risky
behavior,
the
results
of
the
study
are
primarily
based
on
these
self
questionnaires.
People
coming
into
the
SIF
and
you're,
giving
them
a
questionnaire,
and
that's
great,
because
you're
getting
in
contact
with
the
actual
user.
However,
are
these
reliable
results
when
are
these
given?
Are
they
given
before
injection?
Are
these
people?
R
What
is
the
actual
judgment
and
Mental
Status
level
of
the
respondents,
because
I
think
it's
very
important
to
have
addicts
at
the
table?
I
think
it's
in
a
should
have
a
seat
at
the
table
because
they
are
the
ones
that
are
using
the
facility
they're,
the
ones
that
have
the
most
efficient
most
facility,
so
I
want
to
hear
their
opinion.
I,
don't
want
to
hear
their
opinion
after
they
shot
up
and
I
don't
want
to
hear
their
opinion
when
they're
high
I
want
to
hear
their
actual
opinion.
R
So
there
was
never
any
baseline
mental
status
studies
done
that
showed
when
these
questionnaires
were
given.
Are
they
given
before
or
after,
or
were
they
given
even
to
people
that
there's
a
lot
of
dual
diagnosis
so
untreated
mental
illness
and
other
conditions
or
their
emotional
state?
The
self
questionnaires
are
important,
but
they
have
to
be
administered
at
the
correct
time.
So
because
there's
an
absence
of
comparative
data
here,
it
does
not
really
compare
that
the
respondent
baseline
needle
sharing
to
sift
needle
share.
So
you
would
need
that
I
have
no
problem
with
saying
that.
R
Thus,
if
had
these
many
clean
needles-
and
this
was
the
sharing
their
verse-
a
harm
reduction
such
as
the
needle
sharing
programs,
we
already
have
in
that
area
in
Boston
and
seeing
how
many,
how
the
needle
sharing
happened,
they're
given
the
same
questionnaire
and
compared
it
don't
base
it
on
mathematical
models.
Don't
make
a
statement
that
you
can't
back
up
with
real
data
and
I'm
sure
if
you
look
in
Vancouver,
they
do
have
needle
sharing
programs.
R
So
when
we're
looking
at
access
to
services,
so
this
is
a
big
component
of
this.
A
lot
of
support
is
said.
This
is
an
increased
access
and
gateway
to
social
services
and
addiction
treatment.
But
the
measure
of
outcome
that
they
use
for
this
is
for
increased
access
to
services.
Is
the
number
of
referrals,
given
it's
a
very,
very,
very
weak
indicator
of
success
and
I'll.
Tell
you
why
it's
an
inaccurate
portrayal
of
clinical
significance,
so
there's
a
difference,
especially
in
pharmacy
and
medicine.
We
have
statistical
significance
and
we
have
clinical
significance.
R
You
can
be
statistically
a
significant
number,
but
if
it
is
not
clinically
significant,
it
is
not
cost-effective
and
it
does
not
reach
your
target
population.
So
be
very
careful
again
when
looking
at
these
studies,
it
wasn't
of
clinical
significance.
Most
of
the
studies
have
been
based
on
the
assumption
that
the
referral
given
leads
to
the
uptake
of
treatment
or
partial
completion
of
treatment
or
even
completion
of
treatment.
Now
I
know
because
I
work
in
residential
treatment
facilities.
Completion
is
very
hard.
R
Relapse
happens
all
the
time,
so
I'll
even
throw
that
out
the
window
and
say
let's
just
follow
up
and
see.
If
that
person
was
given
a
referral,
did
they
get
into
treatment,
not
even
if
they
finished
it,
not
if
they
partially
finished
it
I'm
talking
an
interview
at
the
place.
That's
all
I'm
asking
for
and
there's
no
data
for
that.
The
referrals
are
a
starting
point.
It's
erroneous
to
call
these
an
ending
point.
R
It
is
not
an
can't
use
that
way
to
compare
data
referrals,
provide
information
regarding
the
potential
service
uptake
the
potential
to
get
into
a
social
service
or
m80
program,
but
it
says
nothing
about
actual
uptake
a
more
appropriate
way
to
to
look
at
this.
Of
course,
if
I'm
going
to
criticize
their
data,
I
want
to
offer
something
that
they
could
use
in
comparison.
So
what
they
could
do
is
the
actual
number
of
referrals
and
then
beyond
that,
the
actual
uptake
from
those
so
the
actual
uptake
and
treatment
for
referral.
R
R
R
Okay,
that
okay,
so
and
Vancouver
in
2015
bid
200
well
over
200,000
visits.
So
you
look
at
that.
263
713
visits
by
6532,
the
unique
individuals
and
I
think
that's
great
I'm
not
going
to
deny
that
is
great
and
then
five
thousand
three
five
thousand
368
referrals
were
given
four
hundred
sixty-four
referrals
to
detox,
which
is
actually
translates
to
six
percent.
So
it's
important
to
look
at
these
numbers
as
they
are,
and
262
actually
completed
treatments,
that's
2%,
so
ninety-eight
percent
of
the
people
in
there
they've
got
referrals
didn't
finish
treatment
again.
R
Addiction
is
a
relaxing,
chronic
condition.
I
don't
expect
them
to
finish
treatment,
but
I
would
hope
that
they
get
in
it
and
get
that
opportunity
to
be
well.
The
referrals
to
detox
again,
100
percent
they're,
going
in
they're
only
six
percent
are
even
getting
a
referral
to
detox.
So
it
does
not
account
for
also
the
individuals
that
received
multiple
referrals.
R
So
if
I
go
in
there
and
I
get
I
would
say,
I
want
I
want
to
go
to
detox
and
after
that,
I
want
to
go
to
a
residential
facility
and
I
also
want
services,
because
I'm,
homeless
and
I
also
want
to
get
employment
opportunities.
That's
that's
like
four
different
referrals
right
for
one
person.
So
again
it's
not
it's
not
an
accurate
portrayal
of.
What's
really
going
on.
So
a
better
way
to
look
at
it
is
I
actually
did
find
some
data
where
it
broke
it
down
to
the
referrals
per
individual.
R
So
if
you
can,
if
you
don't
have
those
results,
though-
and
all
you
have
is
number
of
visits
now
remember
when
they
come
in
multiple
time,
so
I'm
even
giving
them
at,
and
you
actually
look
at
the
5368
referrals
that
were
given
out
among
the
260
260
know
over
two
thousand
visit.
You
see
that
it's
actually
only
two
percent.
R
It's
only
two
percent
I'm
getting
referrals
visit,
so
I'm
saying
even
in
the
visit
you
can
get,
as
you
know,
as
mayor
folks,
I'm,
even
given
them
that
if
you
actually
look
at
March
2004
to
April
2005,
you
see
again
over
200,000
visits
by
four
thousand
seven
hundred
and
sixty-four
unique
individuals
with
2171
referrals,
given
they
actually
did
follow
up
on
this
one,
and
they
saw
that
there
was
eight
hundred
and
four
individuals
that
actually
receive
those
referrals.
So
16
percent
of
the
people
actually
received
the
referral.
R
They
had
no
data
on
how
many
were
actually
got
into
treatment
or
actually
use
those
referrals,
so
in
Massachusetts
to
put
in
context
we're
always
talking
about
the
limited
number
of
beds
and
and
eliminated
ability
to
get
into
treatment.
So
say
we
do
all
them
on
these,
and
we
do
actually
are
much
better
than
Canada.
We
do
it.
We
do
it
right
and
we
make
sure
everyone
works
out
with
a
referral.
Where
are
they
going?
Where
are
they
going?
R
We
can't
get
referrals
to
everyone
right
does
not
know
edge
is
not
enough
treatment.
Are
they
going
I'm
going
to
put
them
out
in
the
street
I,
don't
know
where
they're
going
it's
just
something
to
bring
up.
Another
thing
is
we're
all
concentrating
on
the
fifth
state
they
target
and
reach
the
most
at-risk
population,
so
we're
talking
again
that
corner
of
melds
Nia,
Cass
and
math
my
actual
clinical
site.
R
My
primary
site
is
right
there,
so
I'm
very
familiar
with
that
area,
but
what
we
need
to
look
at
so
I'm
I'm,
going
to
give
the
actual
data
as
it
is.
There
is
support
that
does
prove
this.
So
if
we're
looking
in
Germany
in
Frankfurt
and
Zurich
we're
seeing
that
actual
50
users,
they
use
it
five
times
per
week
enough.
That's
good!
That's
great
I'm,
glad
that
they're
getting
off
the
street
and
they're
using
it
in
a
safe
environment
in
Rotterdam
they're,
using
it
an
average
of
six
days
per
week.
Okay,
that's
good!
That's
Germany!
R
Let's
expand
it
now,
because
remember
every
place
is
a
little
different.
Let's
go
to
Sydney
and
Madrid
over
the
periods
of
eighteen
and
twenty
six
months,
clients
average
fewer
than
two
visits
per
month.
Clients
in
that
area
that
we're
targeting
to
2%
I,
don't
I,
don't
understand
they
knew
that
it
was
there.
So
what
is
that
component?
Why
aren't
they
using
it?
Then
we
look
at
Vancouver
and
it
showed
that
only
45%
of
the
this
is
their
own
statistics
that
they
provided,
that
their
government
provided.
R
Forty
five
percent
of
the
sample
of
active
IV
drug
users
reported
ever
using
it
ever
they
went
around,
they
handed
out
surveys
and
asked:
did
you
ever
use
it
and
those
the
majority?
The
57
percent
used
the
facility
fewer
than
a
quarter
of
time
for
their
injections,
so
that
that's
that
scares
me,
but
they're
still
using
it
on
the
street
when
they
have
this,
so
what
I
would
say
is
the
data
really
is
very
inconclusive.
R
So
if
you're
going
to
do
basic
utilization
statistics,
you
have
to
be
able
to
definitively
show
that
the
target
population
has
been
breached
and
it
really
hasn't
been
done.
Yet
in
these
studies
we
need
a
more
detailed
and
accurate
picture
of
the
overall
drug
use,
such
as
the
findings
in
terms
of
proportionality
of
usage
and
what
else
is
going
on
in
that
area.
R
So
if
we
look
at
actual
heroin
use
in
in
Vancouver,
so
if
we
look
at
before
the
stuff-
and
after
that,
you
can
see,
there
hasn't
been
there,
wasn't
that
much
of
a
difference
so
we're
looking
at
now
we're
not
looking
at
96
we're
looking
at
2001.
So
if
you
compare
2001
to
2011,
so
the
sift
from
it
when
it
opened
2011
we're
looking
at
a
couple
percent,
didn't
really
alter
this.
R
R
So
pretty
much
more
think
about
this
overall
data
just
see
applicability,
study
results
really
should
be
interpreted,
I
think
with
the
knowledge
that,
yes,
they
give
us,
they
give
us
some
background
and
it's
important.
It
starts
the
conversation.
It's
important
to
look
at
this
data,
but
they
don't
necessarily
reflect
or
apply
to
every
city
around
the
world
in
the
same
manner.
R
So
really
there
are
great
differences
and
variances
and
drug
culture
in
terms
of
just
the
culture,
the
economics,
racial
differences,
drug
availability,
so
going
to
the
United
States,
you
look
at
the
southwest
versus
North
East
you're,
going
to
see
mess
in
the
south
they're
going
to
see
opioids
and
heroin
and
in
the
Northeast
it's
just
completely
different
and
the
United
States
as
a
whole.
We
got
to
think
about
our
culture
and
we
consume
80%
of
the
world's
opioids
and
we
are
five
percent
of
the
world's
population.
R
A
R
A
lot
of
people
say
in
the
so
in
that
camp
that
the
government
really
shouldn't,
facilitate
or
enable
this
type
of
model
pretty
much
Lucien
enable
drug
using
or
SIF
and
I
think
that's
more
of
an
opinion
than
a
factual
statement,
so
I
want
to
make
that
clear.
The
reality
is
is
that
there
will
be
a
significant
legal
wrangle
to
make
these
a
sustainable.
If
the
sis,
if
placed
in
Boston,
would
have
to
obtain
an
exemption
from
the
title:
21
United,
States
Code
of
Controlled
Substances
Act,
which
dates
back
to
1970s,
also
mind
you.
R
Exemptions
are
not
permanent,
they're,
not
lifelong,
so,
for
example,
in
Vancouver,
their
exemption
from
their
actual
law
was
only
for
three
years,
and
then
you
get
into
the
question
of
what
happens
after
the
three
years.
I
say
we
get
it
for
two
years.
Five
years
ten
years
the
government
says
we're
not
going
to
extend
it.
What
do
we
do
with
the
facility?
What
happens
to
it
and
we
challenged
in
the
Supreme
Court?
What
happened?
We
shut
it
down?
What
happens
with
changing
administrations?
There's
so
many
questions.
R
They're
really
want
to
invest
time
and
money
in
an
option
that
might
be
shut
down.
I
would
rather
spend
it
on
an
option.
I
know
will
stay
open
to
help
these
people
they
need
help
and
it
needs
to
be
sustainable.
Finally,
in
the
situation
we
are
right
now
with
the
federal
government.
The
federal
prosecutors
have
already
said.
They've
already
made
the
statement
that
the
United
States
must
maintain
control
over
drug
policy
and
sifts
fragment
the
rules
of
our
nation
and
federal
authorities
just
to
bring
it
back
to
a
couple
of
things.
R
If
we
say
oh
they're
not
going
to
actually
act
on
this
I
have
no
opinion
on
medical
marijuana.
I
just
want
to
make
that
clear,
no
opinions,
but
if
we're
looking
at
that,
they've
raided
and
shut
down
medical
marijuana,
dispensaries
that
were
legal
within
their
own
states
in
Colorado,
California
and
Washington.
So,
what's
going
to
say,
are
they
not
going
to
come
in
here
and
shut
down
this,
but
it's
working
I,
don't
want
us
to
be
shut
down.
R
It's
something
to
think
about,
and
just
remember
when
we're
talking
about
if
the
feds
can
go
in
there,
we
are
Massachusetts.
So
it's
very
important
to
remember
this
because
I
understand
this
in
pharmacy.
I
think
this
is
something
that's
not
brought
up
a
lot
as
soon
as
that
drug
crosses
state
lines.
It
is
now
federal
law,
so
remember
we're
not
giving
them
the
heroin.
So
if
I
have
somebody
from
Rhode
Island
but
Rhode
Island
doesn't
have
a
sip
may
buy
heroin
in
Rhode
Island,
they
drive
up
to
Boston
and
they
go
in
thats.
R
If
the
federal
government
can
come
in
across
state
lines
where
a
small
state
we're
not
Texas,
you
know
it
doesn't
take
long
to
get
from
New
Hampshire
Vermont.
That
scares
me
that
scares
me
for
the
user
and
the
people
in
there
what's
going
to
happen
when
they
come
in.
So
all
this
being
said,
this
is
the
end.
Thank
you
for
your
time.
R
So
I
also
want
to
ask
about
funding,
because
where
is
this
funding
going
to
come
from
and
if
this
funding
is
going
to
decrease
the
funding
we're
already
using
for
that
pool
of
substance,
use
and
addiction
treatment?
If
it's
going
to
take
away
from
that
and
that
local
outreach
I
would
almost
say
that
the
social
injustice,
those
people
that
use
it?
What
about
our
brothers
and
sisters
on
the
vineyard
and
the
cave
we're
going
to
take
money
from
those
programs?
We
have
to
be
very
clear
about
where
the
funding
is
coming
from.
R
First
of
all,
and
where
do
we
go
from
here
say
we
need
to
go
up
from
here.
I
know
people
talked
about
actually
providing
heroin.
Are
we
going
to
decriminalize
drugs
in
the
United
States
anytime?
Soon,
probably
not,
then
we're
going
to
get
into
a
legal
wrangle
there.
It's
a
very,
very
complex
problem,
so
I
really
think
that
this
is
more
of
a
stopgap
than
a
solution.
I
would
caution
against
having
a
staff.
R
Without
you
know,
comprehensive
longitudinal
studies
and
an
actual
mitigation
look
at
the
harm
mitigation
programs
are
using,
so
I
would
support
something
like
spot.
We
have
spot
right
here
in
Boston,
it's
a
supportive
place
for
observation
and
treatment.
It
offers
the
same
almost
the
same
exact
benefits
of
the
safe.
The
only
difference
is
you
can't
inject
in
a
facility
after
you
inject
you
go
into
the
facility
I
believe,
there's
eight
chairs
I'm,
not
sure
how
many
you
go
in
there
under
the
watchful
eye
of
a
nurse
or
medical
member
there.
Whoever
is
manning
it.
R
A
B
P
I
went
to
all
the
drug
summits,
summits
that
were
held
at
the
Medical
Society,
with
all
the
state
and
federal
people
and
listened
to
all
the
experts.
We
got
there
because
we
have
not
been
mindful
of
how
narcotics
are
misused
and
they
were
freely
available
on
the
street.
You
know
$20
a
milligram
so
to
speak,
for
your
grandmother's,
oxycontin
that
you
got
from
her
medicine
cabinet
from
her
broken
hip
and
as
when.
B
Back
right,
92,
and
in
can
you
brain?
Can
you
talk
a
bit
about
replacement
therapy
and
like
where
we
are
because
I
think
you
you
made
a
statement
earlier
like
maybe
we
might
be
going
about
this
the
whole
way
wrong.
The
entire
way
and
I
think
the
replacement
therapy
is
I,
see
value
in
it,
but
but
I
see
I,
see
kids
getting
off
heroin
getting
on
methadone
for
the
rest
of
their
life.
Where
is
the
end
on
that?
Can
you
talk
about
a
little
bit
that.
Q
Is
a
question
about
I
mean
I'm
all
for
replacement
therapy
with
the
beginning
of
middle
and
an
end
right.
There
is
no
in
the
National
Institute
of
drug
abuse.
It's
going
forces
the
Big
Pharma
to
find
new
way,
you're
a
big
new
medical
way,
I
think
the
medicalization
of
the
addiction
treatment.
As
far
as
women
yeah.
J
B
P
R
P
R
Have
to
I
have
to
disagree
with
that,
for
somebody,
I
have
a
hundred
and
fifty
patients
I
take
care
of
all
their
medications
over
50%
are
on
medication,
assisted
treatment,
so
I
completely
support
that.
But
actually
you
can
get
high
on
suboxone
to
permanency
longest
acting
opioid.
We
have,
which
is
why
you
use
it,
because
it
breaks
that
reward
cycle,
so
only
thing
that
makes
it
not
abusable
as
the
naloxone
in
there
and
why?
Because
when
you
shoot
a
naloxone
you're
going
to
Pizarro?
R
So
actually,
if
you
take
it,
you
don't
you
haven't
used
opioids,
then
you're,
just
getting
a
long-acting
opioids,
so
I
have
guys
in
my
facilities
that
actually
started
with
things
like
suboxone
and
pills
like
that.
You
actually
buy
suboxone
with
heroin
right
now.
Just
go
outside
mess
on
Mike
and
handle.
P
Bigger
I
didn't
completely
answer
your
question
before
and
I
think
that
the
problem
is
is
that
our
society
tends
to
self-medicate
and
that's
where
a
lot
of
addictions
come
from,
whether
it's
cigarettes
which
make
you
feel
more
comfortable
because
nicotine
czar
relaxant,
or
whether
it's
alcohol,
which
is
a
depressant.
So
when
you're
anxious
you
take
that.
But
then
you
get
hooked
on
these
things
physically
and
that's
when
the
problems
really
come
in
so
I
think
we're
talking
about
the
same
thing
in
a
different
way
and
I.
B
Not
going
to
be
I
could
talk,
we
could
talk
all
night
like
certain
things
in
the
deep.
Your
first
experience
with
with
the
toxins
of
three
or
five
day
you
setting
people
up
for
failure.
There
there's
no
way
someone
can
come
in
on
heroin
and
five-year
five
days,
get
it
out
of
their
system.
I
mean
we
should
as
a
state.
We
should
be
talking
about
30-day
detox,
that's
that's
it
there's
nothing
under
30
days
and
we
shouldn't
I
mean
those
are
the
types
of
discussions
we
should
be
having
here,
that's
a
huge
huge
problem.
B
It
I
mean
you
brought
up
some
interesting
points
about
methadone
in
in
in
neo
pharmacies.
That
was
that
would
kind
of
end
some
stigma
there.
They
wouldn't
be.
There
wouldn't
be.
You
know,
2,000
people
down
on
the
South,
Hampton
Street
corridor,
so
very
interesting
points
and
you
talked
about
so
in
England.
They
they
replaced
so
their
replacement
therapy
is
heroin.
B
P
B
P
P
And
they're,
under
strict
control,
doctors
can
prescribe
that
to
addicts
to
keep
them
stable.
Those
of
us
who
practice
primary
care,
let's
say,
are
not
licensed
to
treat
addiction
in
our
practice
unless
we
get
a
special
certificate,
so
I
can't
prescribe
methadone
to
my
patients
for
substance
abuse
treatment.
B
K
K
You
know
and
I
kind
of
as
you
were,
going
through
those
stats
and
breaking
down.
That
really
seems
to
be
what
these
data
points
are
being
used.
Support
not
illumination
and
I,
appreciate.
I,
certainly
know
you're
going
to
those
we'll
have
the
copy
of
her
testimony.
I
certainly
want
to
go
through
those
because,
as
I
create
my
own
thoughts
regarding
this
and
and
as
I
said
in
my
opening
statement,
I,
don't
think
this
is
a
good
idea.
I
never
have
but
you're
the
statistic
that
you
have
thrown
out
there
in
your
10.
K
M
A
M
Is
a
very
impressive
piano
dr.
L
note
he
said
society
itself,
it's
a
self
self-medicating
society
I
also
allowed
that
doctors
and
dentists,
also
over
prescribed
at
a
friend
of
mine,
that
just
went
for
a
tooth
extraction
and
he
got
forty
was
subscribed,
prescribed
forty
oxys.
That
person
was
derelict
in
the
responsibilities.
Of
course,
he
refused
and
said
knowledge
going
to
go
old-school
I'm
going
to
use
tylenol
I
agree.
M
Had
a
loved
one
that
just
had
a
major
knee
surgery
and
after
the
anesthesia
and
we
had
asked
for
a
block
and
then
after
that
it's
been
tylenol
and
motrin
she's
been
an
absolute
champ
in
some
pain
but
nonetheless
realizes
and
recognizes
that
a
significant
number
of
our
addicts.
It
all
started
with
the
doctor,
a
dentist
appointment
or
surgery
so
kudos
to
her
for
weathering
the
storm,
but
that's
what
we
need
to
be
doing
I
think
more
often
it
is
weathering
storm
through
pain
and
pain
management.
So
and.
G
M
Just
one
on
a
footnote,
Allison
observed
here
is
the
longest-serving
City
Council
I
have
to
say
that
that
even
probably
one
of
the
more
impressive
individuals
who
have
given
testimony
here,
you
were
very
personal,
very
thoughtful,
very
thorough,
very
compassionate
and
also
very
factual.
I.
Think
you
completely
discredited
the
first
panel
I
was
questioning
sort
of
the
bogus
stats
that
they
were
presenting
from
Vancouver,
British,
Columbia
and
others,
but
I
have
to
say
that,
from
from
my
perspective,
there
was
an
enormous
help
to
me.
I'm
sure.
M
It's
an
enormous
help
to
my
colleagues
I'm,
going
to
make
sure
that
my
colleagues
who
weren't
here
get
a
copy
of
this
testimony,
the
time
and
effort
that
you
and
Rhiannon
the
dark
to
put
into
coming
here
and
taking
this
matter
as
serious
as
he
did.
It's
very
appreciative
in
and
also
as
a
footnote.
Thank
you
for
your
your
service
to
our
country
as
well.
Thank.
A
N
Add
my
voice
to
the
chorus
and
just
thank
you
for
lending
your
expertise
and
your
point
of
view
really
appreciate
your
comprehensive
testimony
and
again
what
you're
doing
a
community
everyday
I
would
say
it's
you
know,
I,
don't
know,
I
guess
it's
just
the
Times
ran
that
it
seems
that
debates
can
vary.
N
You
know
to
my
dad,
as
we
often
do
in
these
discussions,
my
father
battled
a
heroin
addiction
for
almost
20
years
and
was
only
able
to
get
sober
while
incarcerated,
which
is
a
story
for
so
many
and
very
proud
of
him,
and
you
know,
he's
now
gone
on
to
attain
two
advanced
degrees,
he's
a
professor
of
journalism
and
a
published
author,
and
we
almost
missed
out
on
all
that
brilliance,
so
he's
28
years
sober
so
not
going
to
wait.
But
just
thank
you.
B
Just
one
quick
statement
took
to
wrapping,
it
seems
like
with
the
proliferation
in
the
way
this
looks
like
business
to
me.
I
doesn't
look
like
anybody's,
getting
sober
or
anybody's
like
we
call
it
recovery
road
down.
It
doesn't
look
like
anybody's
recovering,
but
it's
more
and
more.
We
need
this
replacement
therapy.
We
need
this
replacement.
30
I
think
we
should
be
looking
at
a
totally
different
like
like
and
and
I
kind
of
Presley's
father
as
a
miracle
I
always
believe
that
anybody
on
heroin
it's
so
so
difficult
to
get
off.
B
If
you
get
off
it
you're
a
miracle
and
I
just
think
prolong
it
with
the
methadone
and
everything
else.
I
just
think,
but
I
don't
discount
the
value
in
it
for
helping
you
to
get
off,
but
like
what
you
said,
the
most
important
thing
is
today
is
there's
no
end.
There's
no
end
to
that.
We're
going
to
get
you
on
methadone,
we're
going
to
get
you
on
heroin
and
then
put
you
on
methadone
feel
like
I.
Just
don't
I,
don't
see
how
it's
really
that
different.
Take.
B
Replacement
therapy
and
I
think
we
should
be
reexamining
the
whole
thing
like
like
council
pressing
my
father.
He
got
sober
50
something
years
or
on
alcohol.
How
would
how
would
it
be
different
if,
when
he
put
the
drink
down
like
he,
was
hitting
cough
syrup
or
or
or
or
mouthwash?
So
how
is
it
different?
It
doesn't
seem
that
different
I
know
that
may
not
be
a
great.
You
know
like
our
level
story
analogy,
but
that's
the
way
I
look
at
it.
You
know
I,
just
think.
B
A
M
M
Are
there
any
facilities
out
there
where
someone
can
come
in
and
I
guess,
drink
their
face
off
and
we're
just
committing
that
they're
not
going
to
drive
drunk
and
we're
going
to
watch
them
and
I'm
going
to
they're
going
to
finish
the
whole
bottle
and
we're
going
to
be
there
to
hit
them
with
the
paddles?
If
they
don't
so,
is
there
enough?
M
Does
that
other
than
a
bar
I'm
talking
about
in
a
controlled
environment
with
medical
professionals,
fires,
nurses,
medical
professionals
there,
so
someone's
going
to
come
in
an
alcoholic
who
should
be
do
be,
could
be
seeking
recovery
and
trying
to
put
their
family
and
their
life
back
together?
Is
this
where
we're
going?
If
this
you
do
you
envision
it?
Something
like
this.
Q
N
You
know
I
am
taking
copious
notes
and
active
listening
as
well,
so
there
may
be
some
things:
I,
miss
and
I'm
going
to
go
back
and
watch
the
video
since
I
did
arrive
a
little
late
and
I
apologize.
As
for
that,
you
know,
but
again,
as
I
said,
it's
very
challenging
because
these
debates
can
very
easily
for
any
issue
that
comes
before
our
body
turned
into
us
versus
them
and
as
a
policymaker.
N
If
you
ask
us
if
we
all
want
to
see
improved
outcomes
in
our
schools,
of
course,
but
we
all
have
different
ideas
about
how
to
get
there,
and
we
all
every
single
person
here,
wants
to
save
lives
and
address
this
scourge
in
this
epidemic
which
does
not
discriminate.
Even
if
you
know
it
just
does
not
discriminate.
N
And
so
could
you
just
tell
me,
you
know,
for
those
people
that
are
looking
at
us
and
saying
I
can't
go
to
the
public
library
with
my
kid
and
it's
because
the
bathroom,
the
bathroom
door
is
locked
because
it's
a
needle
gallery,
you
know
I,
don't
want
to
walk
on
the
comments
because
I'm
afraid
of
what
might
creep
me
I'm
afraid
me.
What
are
we
supposed
to?
They
want
to
know
that
we
are
engaging
and
employing
every
tool
available
to
address
this.
So
what
should
we
tell
those
families?
What's
the
response?
N
N
P
It's
how
you
apply
it
and
doing
it
in
a
sensible
way,
and
the
only
way
to
do
that
is
to
collect
data
analyze
it
in
a
meaningful
way.
Not
just
you
know,
as
my
colleague
here
said,
you
can
lie
with
statistics
very
easily
and
statistics.
Don't
matter
if
there's
no
outcome,
I
mean
statistics
vary
in
the
drug
business
so
that
you
can
get
your
claimant
of
the
FDA
and
you
can
say
well.
Our
drug
is
slightly
better
than
their
drug,
but
from
a
clinical
point
of
view,
it's
probably
not
very
very
much.
P
Sometimes
when
you
see
a
ten
times
difference
or
a
ten
percent
difference,
that's
still
something,
but
when
you
see
these
little
small
blips,
it's
very
hard
to
figure
out
what
they
really
are,
and
you
just
have
to
make
huge
studies
to
find
some
statistical
significance
in
that
that
don't
really
pan
out
clinically
very
much.
So
the
real
question
is
we're
a
headline
Society
now
you
know
how
many
people
really
read
the
whole
article.
P
P
You
have
to
say:
where
is
the
real
center
of
gravity
on
this
issue,
and
where
do
we
put
the
pressure
to
make
a
change
and
what
I
was
trying
to
say
before
is
follow
the
money
which
is
where
the
drugs
are
coming
from,
and
the
thing
that
we
I
wanted
to
say
before
when
I
was
listening
was
where
does
the
money
go?
That
goes
for
the
drugs?
In
other
words,
these
addicts
or
whoever's
buying
drugs
are
giving
them
or
whatever
they're,
buying
them
with
real
cash
or
something.
Where
does
that
money?
P
Go
I
mean
if
you
can
make
20
million
dollars
off
two
pounds
of
fentanyl
who's
got
that
20
million
dollars.
You
follow
that
money
you'll
find
out
where
it's
coming
from
and
why
this
continues
and
those
things
corrupt
all
elements
of
the
society.
You
can't
just
smuggle
in
stuff
with
you
know,
clever
idea,
so
I
got.
N
At
all,
I
mean
I've
done
incredible
work
working
with
young
parents
to
reduce
those
numbers,
and
there
are
many
people
that
didn't
want
us
to
have
condoms
in
the
schools,
because
they
thought
that
that
was
then
endorsing
being
sexually
active
and
they
didn't
believe
that
it
would
actually
be
a
deterrent.
So
those
are
things
that
were
considered
very
polarizing
and
very
provocative.
So
I'm
really
asking
you.
N
If
you
were
to
give
me
three
points
and
families
that
are
coming
to
us
and
saying
you
know
we're
seeing
zombie,
land
and
I'm
afraid
every
day
my
kid
is
going
to
die.
Are
you
doing
everything
possible
to
save
my
kid?
If
the
answer
is
no,
what
should
we
be
doing?
What
are
the
three
things
that
we
need
to
be
doing
and.
P
R
R
And
it
saddens
me
that
they're
just
polarizing
different
criminal
laws
but
ensure
its
it
shouldn't
be
that
way
so
I
think,
first
and
foremost
it
and
it's
free,
just
educated,
like
education
like
get
the
word
out,
I
mean
I,
know
that
sounds
very
shallow,
but
there's
a
lot
of
outreach
facilities
that
can
get
the
word
out.
We
need
to
educate
people
about
about
about
addiction
about
the
fact.
A
lot
of
people
ask
me:
I,
don't
understand
how
people
went
from
you
know,
oxycodone
to
heroin
I
go.
R
Will
you
know
heroin
is
a
pro
drug
for
morphine
right
and
we
give
morphine
like
things
like
that
people
don't
understand
so
I
just
think
it's
an
education
point
getting
education
outside
Abay
and
humanizing
this.
These
are
people
with
lives,
they
matter
and
and
also
ramping
up
things
we
know
do
work.
We
know
access
to
narcan
works.
We
know
it
works
and
it's
really
expensive
for
the
new.
The
new
narcan
I.
Don't
know
what
needs
to
be
done
there
on
the
expense
side,
but
I
mean
I.
R
I
want
to
give
my
stuff
out
for
free
now,
I
pretty
much
do
to
anybody.
I
can
which
some
people
might
disagree
with
that
they
think
you
should
charge
I,
don't
think
I
should
ever
tell
somebody
I'm
not
going
to
give
them
a
tool
that
might
save
their
kid's
life
or
a
loved
one's
life
or
strangers
like
okay
and
so
ramp,
up
things
for
narcan,
educate
and
also
treatment,
be
more
beds
or
just
things
around
treatment
and
recovery.
I'll
expand
it's
that.
Thank.
Q
G
Q
By
offering
them
spin
dries,
they
come
to
detox,
they
leave
our
Thursday
because
it's
going
to
be
the
weekend
and
then
they
come
back
on
Monday
there's
no
wrong
door.
You
can
go
to
detox
anytime,
you
want
that's
the
short-sighted
thought
of
DPH
no
wrong
door,
so
you
just
keep
spinning
in
and
out
all
the
time.
Thank
you
I
would.
B
R
Know
it
used
to
be
when
you
would
see
somebody
with
no
hair.
Nobody
want
to
talk
about
cancer.
Things
like
that
way.
Back
one,
and
now,
when
you
see
a
child
goes,
you
know
mommy
daddy.
Why
doesn't
that?
First
time,
no
hair,
not
because
they're
trying
to
be
insensitive
their
children,
they
just
don't
understand
and
then
the
parents
will
explain
to
them.
Well,
Johnny
do
very
they're
very
ill,
and
you
know
it
would
be.
P
The
bad
things
are
going
to
happen
to
you.
Type
of
deterrence
and
medicine
has
been
shown,
never
to
work
very
well,
because
there's
a
disconnect
between
the
act
and
the
consequences,
whether
it's
smoking
and
cancer,
or
cholesterol,
and
heart
disease
or
tooth
brushing
and
tooth
decay
or
whatever
it
is.
Those
things
don't
work
because
people
say
not
me
not
now
and
they
push
it
out
of
their
mind.
So
you
have
to
use
different
approaches
very.
A
Good,
thank
you
very
much
this
panel
and
that
you're
welcome,
certainly
to
stay
for
public
testimony
we're
going
to
separating
folks
down.
We
are
behind
the
schedule
that
I
was
going
to
try
to
keep.
We
do
have
two
podiums
for
public
testimony,
so
I'll
call
a
handful
up
at
a
time
if
you
could,
on
your
own
queue
up
on
either
side
and,
of
course,
as
we
always
welcome
to
the
city
council
chamber,
people
of
different
opinions
and
positions,
I
expect
and
certainly
plan
on
having
a
respectful
opportunity
for
public
testimony.
A
We
are
going
to
try
to
speed
things
along
for
public
testimony.
I
know
some
of
my
colleagues,
including
councilor
Baker,
do
have
to
scoot
out
because
we're
a
little
bit
over
time
and
I
trust
that
my
colleagues
that
do
leave
during
public
testimony
will
review
the
tape
and
I'll
share.
What's
most
important,
so
we
have
Steven
Fox,
Tegan,
Doran,
Ben,
Murphy,
Kate,
Nathan
and
Lizzy
McLaughlin
to
start
and
if
you'd,
on
your
own
queue
up
on
either
side.
Even
if
you
don't
mind
just
moving
the
laptop
that'd
be
helpful.
A
T
Good
afternoon
I'm
Steve,
Fox
and
I'm
the
chair
of
the
South
End
forum,
which
represents
the
17
independent
neighborhood
associations
of
the
south
end
first
I
wanted
to
thank
councilor,
savvy
George
and
councillor
Baker
in
particular,
not
only
for
calling
this
hearing,
but
also
for
the
tremendous
amount
of
support
that
you
have
shown.
The
South
End
in
the
creation
of
a
now
year-long
working
group
on
addiction,
recovery
and
homelessness.
T
This
is
not
our
first
time
talking
about
this
in
the
South
End
and
we
have
had
ongoing
multidisciplinary
discussions
about
this
issue
about
other
issues
related
to
addiction,
recovery
and
homelessness
every
month,
and
so
I
want
to
thank
you
for
your
support
on
that.
I
also
want
to
thank
the
mayor
for
also
supporting
the
work
on
the
on
the
working
group,
and
particularly
the
people
from
the
bus
and
Public
Health
Commission
they've
been
really
terrific.
I
think
that
I
have
I
have
three
points
that
I
want
to
make
today.
T
T
You
can
you
can
do
searches
left,
right
and
sideways
and
can
find
competing
views.
You
can
find
articles
that
say
that
this
report
of
a
35%
reduction
is
not
valid
because
of
this.
That
and
the
other
thing
so
I
want
to
be
clear
that
we
think
that
there
needs
to
be
significantly
more
research
before
we
embrace
the
concept
of
a
safe
injection
site
anywhere
in
the
Commonwealth.
T
The
second
issue
is
that
I
think
that
all
members
of
the
Boston
City
Council
are
probably
aware
that
the
Southend
feels
as
though
we
are
the
epicenter
for
all
of
the
addiction,
recovery
and
homelessness
services
and
private
and
providers
in
the
entire
city,
I,
don't
think
there's
any
neighborhood
that
has
more
stuff
located
in
the
south
end
and
what
that
means
is
that
we
are
a
welcoming
community.
We
have
tolerated
all
of
this.
T
T
What
we
want
to
do
is
we
want
to
monitor
medically
some
of
the
people
that
are
walking
in
our
front
door,
sitting
down
and
in
our
in
our
lobby
and
then
overdosing,
and
we
need
a
place
to
deal
with
that
as
part
of
our
primary
care,
and
we
supported
that
because
it
wasn't
an
outreach
into
the
larger
Boston
community
saying
come
to
the
South
End
and
and
get
this
get
this
this
place.
It
was
part
of
primary
care,
same
thing
with
Southend
Community
Health
Center,
when
they
wanted
to
inaugurate
suboxone
program.
T
As
long
as
it's
part
of
primary
care,
we
thought
this
is
the
right
way
to
do
it.
There's
going
to
be
drug
testing,
there's
going
to
be
mana,
there's
going
to
be
therapy
involved.
This
is
the
way
that
we
thought
it
needed
to
happen
so
for
us
in
the
South
End
I'll
just
make
it
a
blanket
statement.
We
believe
that
any
safe
injection
site
or
for
that
matter,
any
additional
service
that
comes
in
to
the
South
End
is
probably
inappropriate
for
us
we're
at
the
breaking
point.
T
We
are
dying
death
by
a
thousand
cuts
and
the
problem
is
getting
worse
and
worse
every
day,
but
all
is
not
lost
because
I
have
a
proposal
to
make.
We've
been
talking
in
the
South
End
and
with
my
colleagues
from
Newmarket,
and
what
we'd
like
to
do
is
to
is
to
propose
that
we
have
a
public-private
partnership
and
we
get
the
state.
T
We
need
treatment
on
demand,
we
need
multimodal
therapy
opportunities
and
we
need
a
rehabilitation
campus
and
we
challenge
the
political
will
of
everybody
from
the
city
through
the
state,
together
with
all
of
the
people
who
represent
corporate
interests
in
the
city.
To
begin
to
come
to
us
and
say
this
is
the
right
thing
for
us
to
do.
This
is
the
way
for
us
to
deal
with
this
issue
here.
Thank.
U
I'm
Seguin
John
Peggy
and
Orin
and
I'm
here,
representing
Cavalier
coach
Trailways,
located
at
905
Mass
Ave
in
the
heart
of
the
New
Market
area,
commercial,
industrial,
commercial,
neighborhoods.
We
are
the
largest
coach
carrier
in
Greater
Boston
and
are
both
the
Department
of
Defense
and
a
Department
of
Transportation
carrier.
We
are
opposed
to
the
safe
injection
site
in
Newmarket.
For
obvious
reasons.
U
This
area
cannot
take
any
more,
not
one
more
service
on
our
streets,
businesses
in
the
new
Market
area
responsible
for
the
distribution
about
about
90%
of
the
fresh
food
in
Boston,
90%
of
Boston's
trash
and
recycling
activities,
and
are
involved
in
approximately
50%
of
the
building
material
distribution
in
Boston.
In
addition,
there
are
two
major
bus
transportation
companies
located
here
that
transport
thousands
of
students
and
adults
daily
as
a
result,
more
than
3000
trucks
and
buses
drive
through
this
area
every
single
day.
U
Current
conditions
are
already
such
the
driving
a
truck
or
car
through
the
Newmarket
area,
has
become
a
hazard
effectivity.
The
number
of
impaired
individuals
in
and
around
the
roadways
has
reached
extreme
levels
and
severely
limits
the
mobility
of
the
distribution
activity
of
this
area.
Anyone
who
thinks
this
will
change
with
the
introduction
of
a
safe
injection
site
has
not
been
following
the
police
reports
and
news
reports
in
Vancouver
over
the
past
several
years
and
in
Vancouver
the
police
are
working
night
and
day
to
stop
the
drug
dealing
in
the
area
around
the
safe
injection
sites.
U
People
are
often
not
waiting
in
the
long
lines
to
go
inside
and
are
opting
to
shoot
up
on
the
street
in
Vancouver,
where
the
only
North
American
safe
injection
site
is
located.
The
City
Council
has
even
gone
as
far
as
to
reduce
the
speed
limit
to
18
miles
per
hour
to
protect
addicts
unable
to
tell
the
road
from
the
sidewalk.
We
have
enough
trouble
in
New
Market
right
now
and
we
do
not
want
to
exact
disaster
basis.
Thank.
J
You
hi,
my
name
is
Kate
Nathan
and
I
am
here
representing
Steve
Connolly
seafood
company,
a
new
market
business
since
1981
we
are
a
family
owned
company
and
were
awarded
the
SBA
Small
Business
Person
of
the
Year
award
from
Massachusetts
in
1990,
and
every
day
we
distribute
thousands
of
pounds
of
fresh
fish
across
the
city
and
around
the
world.
We
are
opposed
to
a
safe
injection
site
in
Newmarket.
It
will
not
solve
the
problems
here
and
may
serve
to
make
them
worse.
Addicts
going
to
safe
injection
sites
still
have
to
buy
their
own
drugs.
J
Therefore
they
be
money.
As
a
result,
we
will
continue
to
see
break-ins
assaults
and
aggressive
panhandling
in
the
area
close
to
the
site.
A
June
10th
Boston
Herald,
article
titled,
safe
drug
sites,
no
recovery
Road
describes
the
Vancouver
area
where
the
safe
injection
facility
in
site
is
has
remained
quote:
high,
incest,
assault,
drug
dealing
and
a
hotspot
for
stolen
goods.
End
quote:
yes,
there's
not
been
a
dramatic
increase
in
crime,
but
there
has
not
been
a
decrease
either.
J
In
fact,
11
years
after
insite
opened,
Vancouver
police
are
still
trying
to
get
people
to
use
the
facility
on
August
6
2014
police
said
there
were
seven
suspected
overdoses
on
that
day
in
the
city's
downtown
East
Side,
where
the
injection
facility
is
located.
The
fact
that
the
police
have
to
ask
people
to
use
insite
demonstrates
that
is
not
as
effective
as
it
seems.
What
we
have
found
out
leads
us
to
think
that
the
claims
of
success
by
those
in
favor
of
supervised
injection
facilities
are
not
thoroughly
researched.
J
As
said
during
the
panel,
the
most
relied
upon
study
the
same
studies
showing
a
35
percent
decrease
in
overlooked
dose
related
deaths
in
Vancouver,
published
in
medical
journal.
The
Lancet
only
looked
at
the
period
two
years
before
and
two
years
after
the
center
opened
January
21st
2001
to
December
31st
2005,
not
the
ensuing
decade.
J
Furthermore,
the
research
was
funded
by
Vancouver
Coastal
Health,
which
operates
in
sight
the
facility,
so
their
outcomes
may
not
be
entirely
objective.
All
we
see
happening
is
more
and
more
addicts
coming
to
New
Market,
because
now
they
know
they
can
use
the
drugs
and
that
people
will
make
sure
that
they
don't
die.
We
don't
need
doctors
to
create
a
safe
place
for
addicts
to
inject.
We
need
them
to
doctors,
to
figure
out
how
to
stop
them
from
meeting.
Thank
you.
Thank
you.
V
My
name
is
Ben
Murphy
and
I
am
here
today
on
behalf
of
food
pack
Express.
We
are
a
wholesale
food
company
with
four
locations
in
the
state,
and
we
have
been
a
new
market
for
over
20
years.
We
mentally
protest
the
city's
use
of
our
neighborhood
as
a
dumping
ground
for
all
the
unwanted
facilities
for
which
other
towns
do
not
take
their
fair
share
of
responsibility.
It
is
incomprehensible
to
me
that
anyone
would
think
that
lumping
all
services
into
one
area
can
be
a
safe
environment
for
anyone.
V
New
market
already
contains
two
homeless
shelters,
but
to
get
a
house
almost
1,000
people
each
night.
Additionally,
approximately
1300
methadone
patients
are
treated
every
day
in
New
Market.
This
concentration
of
at-risk
populations
in
the
area
already
attracts
drug
dealers
who
prey
on
the
disadvantaged
and
the
already
addicted.
Adding
a
safe
injection
site
would
only
exacerbate
this
problem,
even
in
the
best
case
scenario.
V
If
the
safe
injection
site
did
not
attract
any
more
addicts
to
new
market,
it
would
not
reduce
the
number
of
people
on
the
streets
once
they
left
the
facility
after
shooting
up
since,
on
average
they're.
Only
in
the
facility
for
approximately
half
an
hour.
Our
business
has
suffered
enormous
Lee
with
needles
all
over
our
streets,
robberies,
vandalism
and
harassment.
A
solution
to
combating
overdoses
is
not
to
enable
them.
If
we
are
serious
about
fighting
the
opioid
epidemic,
then
stopgap
measures
like
a
safe
injection
site
are
are
useless
for
our
ultimate
goal
of
ending
the
crisis.
V
W
My
name
is
Lizzy
Mullen
and
I'm
here,
representing
Newmarket
Community
Partners,
a
non-profit
in
the
New
Market
area,
focused
on
job
growth
and
increased
community
employment.
We
have
got
to
stop
the
enabling
process
instead
of
the
fixing
the
root
of
the
problem.
We
are
just
enabling
more
and
more
similar
behavior
take
methadone
as
a
treatment
is
not
fixing.
The
problem
is
giving
addicts
an
alternative
high
that
they
can
live
with.
We
need
to
deprive
a'
Tai's
methadone
clinics,
because
patients
are
not
being
proper.
W
We
weaned
off
of
methadone
private
owners
do
not
have
the
incentive
to
make
patients
better
when
they're,
making
a
$5
profit
per
person
every
single
day.
We
are
at
a
point
now
that
more
methadone
patients
are
on
methadone
for
life
than
ever
before.
To
stop
the
spread,
a
disease
we
started
giving
out
needles.
Now
we
don't
just
give
out
one
or
five
we
give
out
500
needles,
even
though
this
saves
lives.
We
are
once
again
enabling
and
ignoring
the
root
of
the
problem.
W
Now
we
want
to
create
safe
injection
sites
where
people
can
shoot
up
at
will
and
know
they're
being
watched
over.
Yes,
it
decreases
the
amount
of
deaths
of
people
just
using
it
in
that
space,
but
how
many
more
people
are
using
it
because
they
know
they
won't
die
in
Vancouver,
the
safe
injection
site
in
sight
is
often
touted
as
a
poster
child
for
success
when,
in
fact,
we
do
not
have
nearly
enough
information
to
reach
and
research
about
their
progress.
W
The
root
of
most
of
the
problem
is
the
over
prescription
of
opiates
in
the
United
States.
The
United
States
is
the
largest
per
capita
consumer
of
opiates.
If
you
can
even
believe
in
2015,
American
physicians
wrote
seven
hundred
and
seventy
five
opiate
prescriptions
for
every
1000
people.
Last
summer
the
US
Surgeon
General
wrote
to
every
physician
in
the
country
asking
for
their
help
in
turning
the
tide
on
the
country's
opiate
epidemic.
In
his
letter,
dr.
W
Murthy
signaled
that
over
prescription
was
the
root
of
the
issue,
spurred
by
decades
of
aggressive
marketing
from
pharmaceutical
companies
by
allowing
a
safe
injection
site,
we're
sending
the
message
that
drug
use
is
okay
and
that
addicts
do
not
have
the
capability
to
get
off
of
the
drugs.
For
all
these
reasons,
we
are
completely
opposed
to
a
safe
injection
site
in
Newmarket.
Thank.
X
What
you've
heard
from
the
last
several
speakers
have
been
faxed
and
they've
been
faxed
culled
by
hours
and
hours
of
research.
Okay
for
several
years,
we
and
Newmarket
have
worked
closely
with
the
city
in
the
Public
Health
Department
and
the
mayor
to
change
the
course
of
addiction
and
homelessness
in
our
area
that
you
know
is
methadone
mile.
We
have
been
supportive
of
incremental
steps,
needle
exchanges,
outreach
workers,
the
spot
facility,
okay,
and
today
we
still
have
more
and
more
people
using
drugs
than
ever
before.
X
All
you
have
to
do
is
walk
around
with
me
for
a
half
an
hour
in
Newmarket
and
look
at
the
50
used
needles
in
the
clifford
park
or
the
200
used
needles
behind
Bubbles
car
wash
or
watch
the
person
who
just
walked
up
to
a
car
at
the
intersection
handed
someone
inside
ten
dollars
and
the
person
inside
prick
a
needle
and
put
it
in
the
gentleman's
neck
to
give
them
a
high
right
there
at
the
intersection,
I've
seen
that
twice
this
week.
Okay,
the
answer
is
not
to
enable
them
to
do
more
drugs.
X
We
have
some
of
the
best
vines
in
the
world
here
in
Boston
and
you're
telling
me
that
the
best
we
can
do
is
to
come
up
with
a
safe
injection
site
issue.
The
solution,
the
mathematical
Society-
should
be
ashamed.
It
should
be
ashamed
that
this
is
the
best
answer
they
can
come
up
with
so
right
now,
I
am
our
235
businesses
and
our
28,000
employees
that
we
represent
down
there.
We
challenge
everyone.
We
challenge
the
governor.
X
We
challenge
the
mayor,
the
legislators
and
the
doctors,
and,
yes,
we
challenge
ourselves
right
along
with
you
to
come
up
with
a
real
solution.
We
to
figure
out
how
to
change
a
cycle
of
behavior.
We
need
to
figure
out
how
to
help
our
addicts
and
homeless
to
embark
on
a
new
way
of
life
and
not
to
ignore
this
inhumane
existence.
X
We
see,
day
after
day
on
the
streets
of
New
Market
and
across
the
city
and
across
the
state,
people
sleeping
on
concrete
sidewalks
people
defecating
in
alleyways
and
people
impaired,
such
that
they
weave
into
the
streets
in
front
of
oncoming
traffic.
These
people
are
dying
in
our
streets
and
we
need
to
figure
out
how
to
change
this.
The
answer
is
not
to
enable
them
to
shoot
up
freely.
A
few
years
ago,
we
had
to
close
a
Long
Island
shelter.
Now
the
Long
Island
Shelter
wasn't
perfect,
but
it
certainly
was
a
step
in
the
right
direction.
X
It
provided
a
broad
spectrum
of
services
in
one
place
and
a
relatively
enclosed
setting
like
Steve
Fox
and
our
friends
in
the
South
End.
We
believe
we
should
be
able
to
perfect
this
model
and
design
truly
state-of-the-art
campus
style
facilities
across
the
Commonwealth
beginning
right
here
at
that
Shattuck
hospital
area
that
Steve
talked
about
earlier.
X
The
mass
Medical
Society
should
be
advocating
for
these
locations,
where
at-risk
individuals
can
access
low-threshold
areas,
addiction,
treatment,
beginning
from
detox
all
the
way
through,
not
just
30
days,
but
all
the
way
to
the
next
step
in
the
next
up,
including
temporary
shelter
and
transitional
housing
and
more.
These
facilities
should
have
self
services,
both
physical
and
mental.
X
If
all
of
our
hospitals
can
have
satellite
offices
to
fix
knees
and
shoulders,
and
all
in
Dedham
and
Waltham
and
everywhere
else,
they
should
be
able
to
work
with
our
public
health
departments
to
create
satellites
in
a
facility
such
as
this.
But
guess
what
everyone's
going
to
say?
This
cost
too
much
and
everyone
will
say
they
don't
want
one
in
their
community.
In
the
end
it
comes
down
to
money
and
political
will.
X
There
isn't
one
community
in
the
Commonwealth
where,
as
citizens
are
not
affected
by
opioid
abuse,
it's
everyone's
issue.
Does
the
solution
cost
too
much?
What
are
we
spending
now?
Spinning
our
wheels
and
advocating
safe
injection
sites,
it's
not
can
we
afford
to
pay
for
the
right
solution,
but
rather
can
we
afford
not
to
both
the
public
and
the
private
sector
have
to
work
together
to
make
this
work?
It's
all
of
our
problem.
I
was
brought
up
with
a
belief
in
treating
the
whole
self,
not
just.
X
How
do
we
keep
someone
from
dying
at
a
particular
moment
at
a
safe
injection
site,
because
I'll
tell
you
that
there
are
thousands
of
people
dying
out
here
every
day,
they're
just
not
dead,
one
thing
is
for
sure
they
certainly
aren't
living.
Can
you
really
sleep
at
night?
Knowing
that
we're
not
doing
everything
we
can
to
make
a
difference,
and
the
best
we
can
do
is
provide
a
location
where
an
addict
can
shoot
up,
while
medical
personnel
watch
through
a
mirror
to
make
sure
they
don't
die.
I
can't.
Y
Good
afternoon,
I'll
be
brief.
Thank
you
for
the
opportunity
to
share
some
views
on
this
topic.
Well,
my
name
is
Michael
Rothfeld
I'm,
the
president
of
the
New
Market
Business
Association
I've,
been
a
business
and
property
owner
in
the
area,
basically
my
entire
life
and
continue
to
work
on
improving
the
area
for
everyone
that
calls
it
home.
In
fact,
my
father
was
one
of
the
original
members
that
helped
create
the
association
that
has
assisted
hundreds
of
businesses
in
the
last
40
years.
Y
The
Knik
district
is
a
vibrant,
diverse
business
district
with
hundreds
of
businesses
of
all
shapes
and
sizes,
is
a
vitally
important
light
industrial
district
that
provides
many
of
the
services
upon
which
most
of
the
city
depends.
While
many
of
our
companies
are
thriving,
the
burden
they
face
grows
constantly
in
light
of
the
opioid
Demick
that
is
ravaging
our
city
and
state.
Y
While
the
area
strives
to
create
thousands
of
jobs
over
the
next
five
to
ten
years,
this
task
becomes
more
difficult
every
day,
with
the
focus
being
shifted
to
dealing
with
all
the
adverse
impacts
from
being
located
in
such
a
drug
centric,
environment,
methadone
mile
is
a
moniker
that
we
are
desperately
trying
to
shed.
Our
little
area
has
become
synonymous
with
methadone
and
drug
abuse.
What
we
have
struggled
with
for
over
20
years
is
a
number
of
people
coming
in
from
all
over
the
state
for
treatment
in
quotes
that
never
seems
to
end
every
day.
Y
Our
public
health
agency
struggle
costs,
escalate
resources
get
consumed,
but
the
problem
still
grows.
While
the
answers
to
this
problem
elusive
to
all
what
will
not
be
helpful
as
a
safe
injection
site,
this
only
perpetuates
the
problem
and
could
attract
addicts
from
all
over
the
state
and
even
beyond,
especially
if
there
is
no
registration
process,
as
we've
been
led
to
believe.
This
program
will
be
an
absolute
unmitigated
disaster,
if
allowed
to
happen
in
an
area
already
overwhelmed
with
these
issues,
rather
than
advocate
for
a
safe
injection
site,
we'd
prefer
to
advocate
for
a
real
solution.
Y
Such
as
the
one
we're
going
to
be
proposing
at
the
Shattuck
hospital,
the
root
causes
are
many.
We
all
know
them
both
legal
and
illegal
I'm
not
going
to
get
into
them,
but
what
we?
What
we
want
to
bring
to
bear
and
call
to
people's
attention
a
little
bit
is
the
issue
of
the
methadone
problem
that
we
face.
Methadone
has
become
a
business
we've
seen
it
from
ground
zero
when
it
started
20
years
ago,
when
it
got
legislated,
it's
become
a
very,
very
profitable
industry
and
it's
a
perverse
incentive
to
keep
people
on
methadone
indefinitely.
Y
These
clinics,
the
methadone
clinics,
make
millions
with
no
incentive
to
get
people
off.
Many
of
them
are
owned
by
doctors
and
private
equity
firms.
So
I
think
we
need
to
look
deeper
into
the
business
of
methadone
and
try
to
take
the
profit
out
of
methadone
and
use
it
for
better
treatment
facilities
for
the
addicts
that
really
need
it.
Thankfully,
there
are
new
treatments
available
in
terms
of
alternative
drug
alternatives
and
distribution
mechanisms
that
have
proven
more
effective
than
the
current
model.
We
don't
need
another
program
that
enables
addicts
to
use
more
and
more
drugs.
Y
Z
I'm,
actually,
an
attorney
and
I'm
connected
with
the
church
and
I'm
connected
with
multiple
businesses,
including
the
taxi
industry
and
the
real
estate
industry,
and
you
know
my
question
to
you
is:
if
someone
has
the
flu,
they
have
multiple
symptoms,
for
example,
maybe
a
fever
maybe
a
cough,
maybe
a
runny,
nose
and
I
feel
that
what's
been
going
on
is
there's
been
treatment
to
the
symptoms.
Someone
will
go
and
take
cough
syrup
to
do
with
the
cough.
Z
Take
aspirin
to
lower
the
fever,
use
a
tissue
to
blow
their
nose
and
it'd
be
busy
running
around
treating
all
the
symptoms
if
they
don't
take
it
from
the
top
down
and
deal
with
what
is
actually
causing
the
problem.
So
now
the
doctors
will
say:
well,
it's
a
bug:
it's
a
virus,
it's
a
germ
and
honestly
I
think
it's
a
lie
and
that's
I,
don't
care
if
you
agree
with
me
or
not.
My
feeling
at
this
time,
based
on
my
life
and
based
on
the
people
I've
spoken
with,
is
as
a
taxi
owner.
Z
There's
a
lawsuit
going
on
right
now
against
uber,
because
there's
something
out
there.
That's
considered
electronic
conspiracy
that
is
causing
problems
within
the
business
and
what
it
is,
is
the
telephones
and
the
computers
are
being
used
in
order
to
do
tear
business
datura
business
away
from
the
taxi
business
and
towards
Zuber.
Now
I'm,
not
here,
to
argue
that
case,
because
none
of
you
really
care
but
I've
also
found
that,
as
an
attorney
I've
seen
information
that
I
am
attempting
to
send
to
someone
be
changed.
Z
G
Z
A
Z
To
Japanese
yeah
and
what
I'm
saying
to
you
right
now
is
this
problem
that
is
going
on
with
computers
and
telephones
has
created
non
trusting
any
kind
of
machinery.
We
don't
have
any
trust
in
the
hospitals.
We
don't
have
any
trust
in
the
diagnosis
of
people.
People
do
not
want
to
go
and
get
diagnosed
by
doctors,
and
they
feel
that
that
between
the
machine
on
trust,
the
machines
and
non
trust
of
the
ear
waves,
I,
don't
really
even
want
an
opinion
of
a
doctor
anymore.
I.
Z
Don't
even
believe
that
these
people
are
being
treated
fairly,
I.
Consider
them
victims,
I
feel
that
they
are
being
victimized
in
order
for
other
people
to
make
money
off
of
them
and
that
they
are
being
influenced
by
outside
sources
and
I.
Think
it's
time
for
Boston
City
Council
to
unite
with
the
state
Reps
and
go
to
Washington
and
say
something
about
the
way
the
people
in
Boston
are
being
treated,
we're
being
pushed
around
like
robots
and
it's
being
done
electronically
and
through
either
ways
and
I.
Z
Don't
care
if
you
agree
with
me
or
not,
but
that's
what's
going
on
and
I,
don't
believe
that
Boston
City
Council
is
responsible
for
it.
I
think
that
different
organizations
with
different
agendas
are
pushing
their
issues.
I
want
to
make
money
through
the
food
food
industry
I
want
to
make
money
through
the
medical
industry.
I
want
to
make
money
through
this
lawyer,
industry
and
other
people's
expense.
I'm,
not
promoting
I'm,
not
trying
to
say
anything
bad
about
the
medical
profession.
Z
I
think
that
there's
actually
attempting
to
help
people
and
I
know
you're
actually
attempting
to
help
people
I
know
the
attorneys
are
too,
but
it's
like
treading
water.
It's
like
the
Dutch
boy,
sticking
his
finger
in
a
dam
and
it's
waste
of
time
until
some
actual
truth
and
honesty
and
respect
for
individuals
and
humanity
is
shown
and
you're
not
going
to
be
able
to
do
it
unless
it
comes
from
the
federal
government.
Z
AA
Hi,
my
name
is
Olivia
Richard
and
I'm,
setting
a
timer,
so
I'm,
a
resident
of
Brighton
I
appear
to
be
the
only
wheelchair
user
in
the
room
and
I
experience,
unique
phenomena
that
the
rest
of
you
may
not
know,
and
that
is
what
you
get
in
your
feet:
I
get
on
my
hands.
AA
Needless
to
say,
this
opiate
crisis
has
led
to
quite
a
few
close
calls
with
needles
and
such
getting
stuck
to
my
tires
I'm,
a
proponent
of
literally
anything
that
will
make
a
difference.
I
say
if
we're
talking
about
citing
heck
I
would
love
to
live
next
to
one
of
these
things,
because
you
know
what
at
least
I
would
be
next
to
something
that's
productive.
AB
To
be
very
quick
to
thank
you
very
much
for
having
us
councilor
Pressley,
it
was
good
to
hear
about
your
father's
sobriety.
I'm
a
nurse
I
also
live
into
our
Chester
I'm,
a
nearly
20-year
resident
and
civic
association.
President
past
Civic
Association
president
and
I'd,
like
to
speak
in
favor
of
the
set
I
currently
work
in
the
SIP
in
the
spot,
clinic
that
several
people
have
spoken
about
where
we
monitor
people
who
have
taken
drugs
until
they're,
safe
to
leave
on
their
own.
We've
prevented
countless
emergency
room
visits
and
probably
some
deaths
as
well.
AB
If
the
SIP
opens
and
I
would
be
privileged
to
work
there,
I
can
tell
you
that
my
goals
that
I
have
in
spot
would
not
change.
The
goal
that
I
have
every
day
when
I
go
to
spot
is
to
help
folks
who
are
using
drugs
to
get
stable,
to
be
able
to
live,
to
be
able
to
experience
life
to
have
hope
to
know
that
they're
valuable
I
try
to
tell
each
and
every
one
of
them.
You
know
we
love
you.
We
you
have
such
a
bright
future
ahead
of
you.
What
can
we
do
to
help?
AB
You
every
single
day
we
offer
to
make
calls
to
for
these
folks
if
they
want
to,
if
they're
ready
to
go
to
treatment
if
they
are
ready
and
we
make
calls
they're
frequently
aren't
beds
on
the
days
when
there
are
beds
available,
we
move
and
they
want
to
go.
We
move
heaven
and
earth
to
get
them
there.
We
cab
them
to
Worcester
to
Stoughton
to
wherever
there's
a
bed,
I'll
buy
em
cigarettes.
AB
I've,
frankly
been
appalled
by
many
of
the
comments
people
have
made
hear
about
the
folks
who
hang
out
around
the
layeth
past
Boulevard
I
can
tell
you
from
experience.
I
know
many
many
of
them.
They
grew
up
in
the
neighborhoods
where
I
have
lived.
They
participate
in
sports.
That
I
take
my
kids
to.
They
went
to
Savin
Hill
Little
League.
They
went
to
Sully's
and
opening
days,
and
this
is
where
they
are
right
now.
AB
As
a
nurse
I
will
treat
every
patient
who
comes
in
with
a
dignity
that
they
deserve
and
I
think
part
of
that
is
to
help
them
stay
alive.
This
facility
will
help
them
to
stay
alive
until
we
can
get
them
into
treatment.
You
know
when
they
leave
us
and
they
go
inject
and
target
the
bathrooms
and
McDonald's
or
wherever,
and
they
don't
make
it
there's
nothing
left
for
us
to
do.
We
can't
offer
a
treatment,
there's
nothing.
AB
AC
Hi,
my
name
is
Sarah
CCI
I'm,
somebody
who
worked
with
people
who
use
drugs
and
first
I
would
just
like
to
say
that
people
who
use
drugs
matter
their
lives
matter
and
I
appreciate
all
of
the
people
here
who
self-identify
as
people
who
said.
Thank
you
for
being
here
and
I'm.
Sorry.
This
was
it
all
senses
you
do
it
anyway.
That
being
said,
I
had
things
written
and
then
felt
moved
to
let
those
stand
alone
and
say
things
that
kind
of
cropped
up.
AC
I,
think
it's
important
to
adults
that
as
elected
officials,
you
represent
not
only
that
taxpayer,
but
all
of
your
existed
to
it,
and
especially
perhaps
those
folks
who
are
not
doing
so
bad.
And
that
being
said,
people
who
use
drugs
can
choose
to
use
drugs
for
any
number
of
reasons
and
I
think
that
a
supervised
injection
facility
simply
allows
people
to
do
what
they
want
to
do
in
that
moment
in
a
way
that
is
safe
and
healthy
and
supportive.
AC
I
think
your
question
about
what
do
you
say
to
folks
who
are
afraid
to
let
their
children
go
to
the
park
and
run
around
in
their
flip-flops?
Is
you
know
like
folks
who
use
drugs,
feel
stigma
and
isolation,
and
if
services
were
provided
to
them
in
a
comprehensive
non-judgmental
non
shaming
framework,
they
would
access
those
services.
People
who
use
drugs
also
have
children.
They
too
want
their
children
to
run
around
in
the
grass
right
like
providing
services
and
places
where
people
feel
comfortable
and
able
to
go.
I
think
is
at
the
heart
of
it.
A
AD
AD
This
is
a
written
statement
from
James
Shearer
he's
the
Boston
resident
co-founder
and
president
of
homeless
empowerment
project
and
spare
change.
News
says
to
the
City
Council
a
few
years
ago,
I
lost
a
friend
to
an
overdose
that
could
have
been
prevented.
Her
name
was
Bobby
and
she
was
an
addict.
She
was
also
a
daughter,
a
mother,
a
sister,
a
friend,
a
human
being.
AD
We
seem
to
forget
that
when
we
talk
about
people
who
use
drugs
instead,
we
see
instead,
we
see
and
treat
them
as
far
less
than
people
were
caught
up
in
our
moralistic
superiority
and
can't
even
imagine
that
a
safe
injection
site
could
save
lives.
Bobby
could
have
been
one
of
those
lives,
she's
just
been
released
from
jail
and
almost
immediately
began
to
use.
AD
Of
course,
she
overdid
it
wound
up
in
a
shelter
where
there's
very
little
in
the
way
of
medical
supervision,
the
shelter
personnel
not
trained
to
spot
that
she
had
too
much
drugs
and
alcohol
in
her
system
simply
threw
her
on
a
bed
instead
of
sending
her
to
a
hospital
once
they
realized.
What
was
wrong.
It
was
already
too
late
now,
I
know
what
you're
thinking
would
she
have
went
to
the
site
if
it
was
available.
Perhaps
if
only
she
had
had
that
option,
the
bottom
line
is
this:
injection
sites
will
save
lives.
AD
A
Someone
signed
him
in
the
plan.
Thank
you
and
then
after
Whitney
we
have
dr.
mark
Eisenberg,
dr.
Erving,
Fernandez
and
Judith
Hudspeth
hi.
S
Going
to
say
what
I've
been
a
heroine
for
30
years
and
I
overdosed
11
times
in
January
in
February,
the
end
of
March
and
if
I
had
had
a
safe
injection
site
to
go,
who
I
would
have
gone,
but
I
died
11
times
and
they
finally
sectioned
me
in,
but
on
human
being
and
I'm
not
going
to
stop
using
heroin.
So
for
me,
I,
wouldn't
I
need
a
safe
injection
site.
I
don't
want
to
die
in
a
porta
potti
and
my
life
does
matter
with
all
this
to
help
people
every
day.
AC
I
read
on
behalf
of
Tsar,
Eisenberg,
yep
and
so
dr.
mark
Eisenberg
is
a
primary
care
and
infectious
disease
specialist
out
of
Charlestown
I
am
a
primary
care.
Physician
and
infectious
disease
specialist
at
MGH
Charlestown
Health
Center,
barely
3
miles
from
where
we
are
meeting
in
the
last
two
months.
I
have
lost
four
patients
to
opioid
opiate
overdose,
death,
I
am
sick
and
tired
of
attending
wakes
and
funerals
for
those
dying
needlessly.
We
are
in
the
midst
of
a
true
public
health
emergency
that
requires
a
radical
rethinking
of
the
way
we
are
conducting
business.
AC
Last
year,
more
people
died
of
drug
overdose
in
Massachusetts
and
died
of
AIDS,
the
peak
of
the
AIDS
epidemic.
Naturally,
drug
overdose
is
the
leading
cause
of
death
in
those
under
50.
In
addition
to
prevention
and
treatment,
we
need
to
provide
a
safe
place
for
people
to
inject,
who
are
not
ready
to
stop
their
drug
use.
Keeping
these
people
our
brothers
and
sisters
and
Friends
alive
and
healthy
until
they
are
ready
for
help
needs
to
be
our
priority.
I
recently
visited
project
insight
in
Vancouver.
AC
They
have
demonstrated
a
myriad
of
benefits,
a
30%
increased
uptake
in
drug
treatment,
a
35%
decreased
overdose
rate
and
a
decrease
in
public,
injecting
and
syringe
discarding.
Multiple
studies
have
demonstrated
that
this
intervention
will
save
money
by
preventing
the
infectious
complications
of
drug
use.
Massachusetts
has
led
the
way
in
so
many
public
health
metric
measures,
let's
be
a
shining
example
to
the
rest
of
the
country.
Thank
you.
A
Thank
you
if
you'd
like
to
submit
those
as
well
a
dr.
Walley,
dr.,
Kim
su
and
then
I
have
an
a-hole
participant,
one
or
I,
and
then
I
also
have
H
a
hope
participant.
You
called
dr..
Fernando
I
did,
but
you
can
I
read
sweet
for
him.
Yes,
please
and
then
I
don't
mind
if
you
want
to
submit
after
this
the
testimony
of
those
that
aren't
here,
because
there
are
a
number
people
that
are
still
here
and
I
want
me
to
ever
get
to
them
on
this.
F
Written
testimony
is
from
a
physician,
dr.
Yeoh
Fuhrman
Fernando
was
an
addiction
psychiatry,
fellow
at
Boston
University
and
a
proud
member
of
SIF
and
may
know,
as
the
testimony
from
mathematical.
Society
has
shown
their
strong
evidence
and
sifts
can
not
only
see
lives
and
millions
of
dollars
from
reduced
infectious
diseases,
but
it
can
also
increase
access
into
addiction.
Treatment.
I
would
like
to
expand
on
this
point,
as
it
is
often
not
discussed
in
linked
working
directly
in
the
addiction
field.
I
see
firsthand
a
huge
gap
that
we
currently
have
in
our
treatment
model.
F
According
to
the
national
institute
of
drug
addiction,
which
is
part
of
the
federal
government,
addiction
is
defined
as
a
chronic
relapsing
brain
disease.
However,
one
person
does
not
one
does
relapse
either,
while
at
a
residential
treatment
program
or
while
taking
medication
assisted
treatment.
There
are
many
instances
in
which
these
people
are
then
kicked
out
of
treatment.
At
that
point,
where
do
these
people
go
if
they
have
no
access
to
addiction,
treatment?
Sif's
fill
this
huge
gap
in
our
treatment
model.
F
Sif's
give
the
drug
user
the
opportunity
to
speak
to
an
addiction
counselor
which
in
turn
develops
a
relationship
of
trust
without
fear
of
losing
access
to
treatment.
I
do
not
believe
I
need
to
convince
anyone
in
this
room.
Just
how
devastating
this
crisis
is.
I
do
hope.
We
have
the
bravery
to
implement
a
solution
that
has
worked
so
well
for
many
other
countries.
Please
allow
safe
convection
facilities
to
provide
the
medical
care
that
people
so
desperately
deserve
and
need.
Thank
you
and
please
don't
hesitate
to
contact
me
with
further
questions.
A
AE
AF
That's
wonderful,
but
that's
another
hearing
altogether
we're
here
to
talk
about
harm
reduction
strategies
and
supervised
injection
facilities
and
I'm
going
to
talk
to
go
back
a
little
in
history
like
about
2005
when
there
was
a
picture
on
the
front
page
of
The
Herald
of
a
young
gentleman
in
his
theories
overdosing
on
the
Commons,
his
picture
was
taken
plastered
on
the
paper
the
person
died.
He
died
later
on.
That
was
the
last
pictures.
AF
Parents,
I
loved
him
alive,
okay,
with
the
up
ticks
and
overdoses,
we're
seeing
more
and
more
people
overdose
in
automobiles
in
parking
lots,
we're
seeing
more
people
all
the
doors
in
McDonald's,
because
we
have
injection
facilities
all
over
Boston
mcdonalds,
dunkun
doughnuts,
all
of
those
merchants
they're
from
the
north,
the
new
market
like
under
their
stairs
like
behind
their
trucks.
That's
the
injection
facilities.
What
does
it
do?
Some
of
the
overdosing
in
Boston
Commons
for
our
tourism?
AF
What
does
it
do
for
tourism?
I
come
from
Indiana
I
see
somebody
dying
on
the
Boston
Commons,
my
kids
walking
up
my
grandchildren,
walking
home
I
have
seven
grandchildren,
they're
walking
home
from
school,
watching
somebody
injecting
their
car
because
they
have
no
place
else
to
go.
I
want
to
get
in
the
bathroom,
McDonald's
and
I
go
in
and
I
find
somebody
blue,
dead
and
overdosed.
This
is
we're.
Looking
for
something
calm
reduction
is
to
reduce
drug-related
consequences
of
the
individual,
the
family
and
the
commune.
We
all
have
a
lot
in
common.
AF
We
want
to
help
the
community
I
want
my
grandchildren
to
be
able
to
walk
down
the
street
I
want
people
I
bring
into
Boston
to
visit,
to
see
a
healthy
community
I
want
like
to
go
into
a
restaurant
and
not
have
to
fight
and
get
stuck
with
a
syringe
that
somebody
had
no
place
else
to
describe,
but
in
the
in
the
restroom
I'm.
Sorry,
the
the
count.
AF
Thank
you
for
saying,
thanks
for
staying,
because
the
other
counselors
that
stated
that
the
cherry-picking
stuff
of
640
detox
placements
at
insight
and
Canada
that's
on
site,
because
they
built
the
detox
up
there
upstairs
at
the
request
of
the
participants
that
wanted
to
get
into
detox.
They
also
refer
out
to
a
wide
range
of
detoxes
blood.
Blood
alley
was
death
alley
in
18
years
ago.
That's
what
it
was
18
years
ago,
people
overdosing
on
the
streets
there's
never
been
a
documented
fatal
overdose
in
any
injection
facility
around
the
world
ever
so.
AF
These
are
the
two
statements
from
the
participants
age,
a
space
to
safely
get
high
for
reasons,
life
less
needles.
He
supports
it,
100%
Tory
Jenkins.
It
helps
prevent
the
spread
of
HIV
in
depth.
Thank
Liferay,
hope,
I,
just
hope.
You
can
really
continue
this
conversation
on
because
we
haven't
even
scratched
the
surface
around
supervising
check
your
facilities
in
harm
reduction.
This
isn't
treatment.
This
isn't
like
addiction
services.
This
is
trying
to
keep
people
alive.
Harm
reduction,
reducing
the
consequences
of
drug
use
not
like.
AF
AE
Hi,
my
name
is
George
Karen
Dino's
I
am
a
fourth
year
MD
PhD
student
at
Harvard,
Medical
School,
but
even
before
medical
school
I
saw
the
suffering
of
addiction
up
close
while,
as
an
anthropologist,
I
lived
for
four
years
on
an
open-air
heroin
selling
corner
in
the
heart
of
Philadelphia's
drug
market,
interviewing
dealers,
users,
their
families
and
our
other
neighbors.
Over
those
years,
dozens
of
people
died
of
overdoses
in
the
garbage
filled,
train
tracks
immediately
adjacent
to
my
block.
AE
Sadly,
a
month
ago,
my
friend
Paul
Yeager,
a
committed
activists
added
his
life
to
this
tragic
count.
I
know
the
very
tracks
where
Paul
was
found
face
down
among
hundreds
of
discarded
syringes.
A
bitter
irony
of
Paul's
death
is
that
he
was
in
the
midst
of
advocating
for
a
safe
injection
facility
to
replace
the
filthy,
dangerous
spaces
like
the
one
where
he
died,
the
thought
that
Paul
could
have
safely
navigated.
AE
His
relapse
at
such
a
facility
is
almost
too
painful
to
bear
in
his
relapse,
Paul
faced
historically
unprecedented
risk,
given
the
fentanyl
that
has
flooded
the
streets,
that
is
a
hundred
times
more
potent
than
heroin.
But
let's
be
clear,
there
is
no
mystery
to
why
fentanyl
is
taking
over.
It
is
the
direct
consequence
of
market
pressures
produced
by
drug
interdiction
under
the
war
on
drugs,
drugs
have
become
stronger
and
more
frequently
synthetic
because
they
are
easier
to
smuggle
and
easier
to
produce.
Acres
of
poppy
fields
have
turned
to
small,
easy
to
hide.
AE
Labs
and
kilos
of
heroin
have
turned
into
grams
of
fentanyl
when
we
crack
down
on
marijuana,
establish
smuggling
routes
or
repurpose
for
the
more
compact,
pricey
and
deadly
cocaine.
Each
Pyrrhic
victory
of
the
war
on
drugs
has
given
us
stronger,
cheaper
drugs
and
the
result,
and
their
use
has
only
become
more
deadly.
As
a
result,
you
cannot
win
the
war
on
fentanyl
any
more
than
you
can
win
a
war
on
any
drug.
A
safe
injection
facility
can
reverse
this
trend,
minimize
the
risk
of
relapse
and
give
people
like
Paul
a
fighting
chance
to
stay
better.
AE
G
AG
My
name
is
Molly
Dugan
and
I
am
here
today
to
access
my
enthusiastic
support
for
safe
injection
sites
in
Boston
as
a
social
worker
who
specializes
in
addiction
I,
often
work
to
educate
my
patients
around
overdose
prevention.
We
talk
about
how
to
keep
your
keep
your
equipment
safe,
how
to
do
test
shots,
how
to
get
access
to
narcan,
but
one
of
the
most
important
pieces
we
talk
about
is
not
using
a
loan.
People
who
struggle
with
addiction
are
used
to
hiding
what
they
do
for
a
lot
of
reasons.
AG
But
a
driving
force
is
the
shame
that
is
reinforced
by
the
society
at
large,
my
patients
inject
alone
in
lofts
bathrooms,
because
they
don't
want
to
disappoint
their
families,
friends
and
co-workers
they
use
in
secret
because
they
have
learned
that
asking
for
help
brings
about
negative
consequences.
They
lie
about
using
because
we
criminalize
their
behavior
when
they're
honest
our
systems
make
people
want
to
use
alone
and
that
stigma
exacerbates
the
opioid
crisis.
What
I've
learned
in
doing
this
work
is
that
people
are
going
to
do
drugs.
AG
Some
people
want
help
with
that,
and
some
people
aren't
there
yet.
But
a
consequence
is
not
great
enough
to
deter
someone
if
they
are
not
ready
to
stop,
and
we
know
this
because
we
know
the
overdose
numbers
from
the
past
few
years.
So
what?
If,
instead
of
punishing
these
people,
we
support
them.
We
acknowledge
that
one
way
or
another
people
are
going
to
use
heroin
and
it
doesn't
make
them
unworthy
of
care,
and
we
let
them
do
it
in
a
safe
space.
AG
It
might
be
radical
and
it
might
be
something
we
haven't
tried
before
what
if
what
we
were
doing,
we're
working
if
drug
courts
and
everything
else
that
was
referenced
here
today,
we're
working,
we
wouldn't
be
referring
to
it
as
an
epidemic,
I'm,
proud
of
what
I
do
and
I
love
the
people
I
work
with
and
I'm
willing
to
support
anything
that
will
make
it
easier
for
them
to
heal.
There's
no
research
that
says
that
by
helping
someone
be
safe,
we
make
the
problem
worse.
AG
AG
AG
I
just
wanted
to
say
that
I
was
disheartened
to
watch
the
conversation
shift
from
a
conversation
about
safe
injection
sites
to
a
critique
of
already
medically
approved
treatment
like
suboxone
or
methadone
or
things
that
are
effective
to
treat
our
patients,
and
it
was
hard
to
be
encouraged
that
this
body,
before
we're
thinking
when
we're
not
approving
of
what's
already
out
there.
Thank
you
Thank.
AH
Name
is
Dan
Hogan
I'm,
a
clinical
social
worker,
also
master's
in
public
health,
from
Boston,
University
and
I
work
in
community
health,
thanks
to
everyone.
Who's
present
today,
especially
the
New
Market
business
representatives,
who
stuck
around
to
work
on
this
problem,
I
think
it's
imperative
to
our
public
health.
You
mean
to
our
patients,
clients,
friends,
family
strangers
and
individuals
who
are
not
even
aware
what
an
opioid
yet
is
that
we
come
to
some
sort
of
solution
for
the
problems
that
we're
talking
about.
AH
I'm
sharing
someone
with
multiple
perspectives
on
this
issue,
I
work
in
community
health
and
I
support
the
individuals
of
the
health
of
individuals
who
use
substances.
Many
of
the
patients
that
I
work
with
have
been
dealing
with
opioid
dependence
for
much
of
their
lives
and
are
seeking
treatment
in
our
program.
AH
I'm
sharing
is
someone
who
recently
lost
a
cousin
to
overdose
at
age
28
after
struggling
with
dependence,
most
of
his
adult
life,
someone
who
grew
up
and
I'm
someone
who
grew
up
north
of
Boston
instead
seen
numerous
classmates
died
following
my
karate
school
graduation
in
2000,
I
can't
count
how
many
friends
and
acquaintances
about
about
lived.
I'm,
sharing
today
is
someone
who
was
dependent
on
heroin
from
2004
to
2008,
who
never
overdosed
and
was
fortunate
to
have
been
introduced
to
the
philosophy
of
harm
reduction
at
a
young
age.
AH
I,
don't
know
if
that
would
have
mattered
as
much
if,
when
I
was
using
the
more
than
forty
three
fentanyl
related
compounds
that
we
see
in
the
drug
supply
today
we're
as
pervasive
as
they
currently
are.
We
train
and
distribute
naloxone.
It's
not
always
potent
enough.
We
enroll
people
on
buprenorphine,
mailtraq
so
and
methadone,
but
they
don't
always
sufficiently
blockade
receptors
against
fentanyl
related
compounds.
We
teach
people
to
using
groups
so
that,
if
someone
overdoses,
another
person
can
help,
but
we
offer
no
safe
spaces
to
do
that.
AH
The
places
that
people
are
able
to
do
that
we
call
shooting
galleries
or
crack
houses.
There
are
no
nurses
or
social
workers,
physicians
or
educators
on
staff,
just
drug
users
and
drug
dealers.
I
honestly
can't
think
of
one
logical
reason
as
to
why
we
shouldn't
embrace
the
idea
of
moving
forward
with
services
like
this.
It
would
reduce
the
burden
on
police.
It
would
reduce
the
impact
on
retail
owners.
It
would
reduce
the
overall
overdose
rate.
It
would
reduce
the
drain
and
trauma
that
are
urgency.
Medical
services
in
hospital
Edie's
face
every
day.
AH
It
would
reduce
the
presence
of
active
drug
use
on
the
street.
In
view
of
children
reduce
the
number
of
discarded
syringes
in
our
parks
on
our
sidewalks
or
thrown
in
city
barrels
and
restaurant
toilets.
It
would
literally
improve
the
lives
of
people
who
think
that
folks
who
struggle
with
addiction
are
despicable,
while
also
improving
the
lives
of
the
people
who
live
with
addiction.
At
the
same
time,
it
would
improve
my
life
because
I'd
see
less
of
my
patients
die.
I'd
have
a
place
to
collaborate
with
and
to
engage
with
or
contact
new
patients.
AH
Well,
I
would
be
able
to
provide
education
and
outreach.
It
improved
the
day
to
day
experiences
of
every
cop
doctor,
restaurant
manager,
Park
Service,
Worker,
landscape,
landscaper,
janitor,
Taurus
and
Taurus
and
Boston
in
a
way
that
has
evidence
showing
that
it
works.
It
would
also
be
one
more
way
to
remember
that,
just
because
someone's
head
is
in
a
bad
place
in
their
life
they're
still
human
and
they're
still
worth
some
basic
dignity
that
they
matter
Thanks
Thank.
A
AI
Welcome
good
afternoon
my
name
is
April
o
Garko
and
for
some
context,
before
I
begin
I'm
a
certified
addictions
registered
nurse
at
Boston
healthcare
for
the
homeless
program,
a
member
of
the
international
nurse's
society
on
addictions
and
a
sister
to
an
active
IB
drug
user.
I
wish
the
full
panel
and
audience
was
still
here
listening
to
those
who
are
would
be
most
affected
by
this
bill.
AI
I'll
try
to
be
succinct
with
my
two
minutes,
and
one
of
the
arguments
I
heard
here
today
was
that
not
in
my
backyard
argument
but
I
think
you
would
want
this
in
your
backyard
for
when
syringes
from
the
environmental
standpoint,
you
are
minimizing
syringe
waste
in
public
spaces
or
animals
in
your
children
play
I.
Can't
I
can't
count
the
number
of
times
I've
had
to
call
a
hope
and
sit
and
wait
next
to
the
syringe
and
try
to
trap
like
direct
traffic
around
these
syringes.
AI
The
second
would
be
tax
dollars
from
a
fiscal
standpoint.
Safe
injection
sites
save
countless
tax
dollars.
The
latest
federal
report
noted
that
Massachusetts
has
the
highest
rate
of
opioid
related
visits
to
emergency
departments,
a
hospitalization
for
one
of
the
less
serious
complications.
Cellulitis
can
cost
anywhere
from
6,000
to
over
$25,000
the
medication
to
treat
hepatitis
C
is
$1,000
per
pill.
A
typical
course
of
treatment
will
last
12
weeks
and
run
eighty
four
thousand
dollars,
plus
the
cost
of
necessary
companion
drugs.
AI
AI
The
advocacy
of
safe
injection
sites
is
not
the
end
solution,
as
some
have
said,
as
proposed
by
others.
Here
we
need
to
look
at
mental
health
and
prescribing
practices
and
access
to
detox
beds.
That
still
all
needs
to
be
done.
This
isn't
the
ultimate
solution
to
end
addiction.
This
keeps
people
alive
so
that
they
can
even
access
the
other
resources
that
we're
proposing.
In
my
experience,
working
in
the
city's
health
safety
net
I
often
see
my
patients
being
pushed
away
from
the
street,
pushed
away
from
visibility
and
pushed
away
from
potential
help.
AI
A
F
A
AE
I
am
testifying
for
dr.
Kimberly
sue
of
Massachusetts
General
Hospital
in
Charleston
here
esteemed
Boston,
City
Council
members.
I
am
a
resident
physician
at
MGH
with
a
primary
care
practice
in
Charlestown
I'm
here
to
testify
that
the
opioid
overdose
crisis
is
at
its
worst
ever,
and
this
current
death
toll
and
tragedy
are
simply
unnecessary.
AE
The
response
time,
the
life-saving
therapy
is
immediate.
In
the
years
since
insite
Vancouver's
supervised
injection
site
was
founded
in
2004.
They
have
had
zero
overdose
deaths
in
their
facility
and
the
over
100
supervised
injection
sites
around
the
world
that
have
been
to
zero
depth.
The
Health
Ministry
in
Canada
just
approved
several
more
supervised
injection
sites,
given
their
clear
evidence,
seeing
how
Vancouver
operates
linking
these
sites
to
detox
and
short
and
long
term
treatment
facilities
for
addiction
treatment.
AE
It
is
a
simply
wonderful
thing:
people
use
the
facilities
because
the
police
were
frustrated
simply
at
finding
people
dead
alone,
the
police
in
Vancouver,
even
calling
for
more
prescription
heroin,
because
the
street
drugs
are
so
contaminated
and
unsafe
with
fentanyl
and,
in
fact,
the
area
that
the
Downtown
Eastside
drug
use
scene
occupies
has
decreased
over
the
many
years.
Contrary
to
what
many
people
have
suggested,
it
is
imperative
that
we
start
a
facility
here
in
the
Boston
area.
This
is
our
generation
HIV
epidemic.
AE
AJ
If
I
can
just
give
a
very
brief
personal
testimony.
I
was
somebody
who
is
very
Pro,
abstinent,
very
Pro
abstinence,
based
policies
up
until
2012
and
then
one
day
I
walked
in
to
a
hope
on
unmask
out
and
I'm
ever
walking
in
because
I
went
to
come,
say
hi
to
Sara,
Mackin
and
I.
Remember
seeing
a
wall
and
I'll
still
never
forget
it.
To
this
day,
I
remember
looking
at
the
I
remember
looking
at
the
wall
and
I.
Remember
an
african-american
man,
I
remember
his
eyes
and
I'll.
AJ
Never
ever
ever
forget
that
moment
and
I
knew
what
those
faces
were
for
and
I
knew
they
weren't
coming
back
and
I've
known
ever
since
that
day,
that
harm
reduction
has
a
way
to
save
those
people's
lives
and
that
those
faces
on
the
wall
don't
have
to
appear
there
I'm
somebody
who
is
used
your
building
as
a
safe
injection
facility
in
2010
I'm
somebody
who's
used.
Our
Statehouse
is
a
safe
injection
facility,
I've
used
in
numerous
bathrooms
surrounding
this
area.
AJ
Ma'am
and
although
I
am
somebody
who
was
at
the
height
of
my
use,
being
in
Medford,
probably
would
have
never
ever
been
able
to
use
it.
I
watch
I
go
down
to
Mass
Ave
once
a
week
now
and
those
faces
keep
changing.
Those
pieces
of
faces,
keep
changing
not
because
they're
getting
in
a
recovery
and
they're
going
somewhere
great
those
faces,
keep
changing
because
they're
not
coming
back.
80%
of
our
homeless
population
dies
from
fatal
drug
overdoses.
If
that
happened
to
you
or
I
today,
imagine
the
way
in
which
we
would
respond
to
that.
AJ
We
would
do
everything
in
our
power
possible
to
do
it
so
I
die.
I
will
never
understand
the
stigma
that
surrounds
the
public
health
policies
with
regards
to
drug
addiction,
I
I
am
a
huge
proponent
of
safe
injection
facilities.
I've
studied
the
I've
studied
about
22
various
studies
from
Germany
to
the
ones
and
Titan
even
probably
started
to
death
today
on
every
every
every
form
of
data
based
analysis
possible.
But
I,
don't
doubt
without
questions
that
this
would
work.
25
years
ago
we
questioned
whether
or
not
needle
exchanges
would
work.
AJ
We
have
any
I,
don't
think
we
have
any
questions
about
the
viability
of
how
needle
exchanges
play
in
our
society
and
how
beneficial
they
are.
But
I
will
be
reading
the
testimony
dr.
Alex
Walley,
who
is
from
the
beat
from
Boston
Medical
Center
BU
School
of
Medicine
to
the
Boston
City
Council
Committee
on
homelessness,
mental
health
and
recovery.
Thank
you
for
providing
a
public
hearing
on
medically
supervised
injection
facilities.
I
am
unable
to
make
it
in
person,
but
I
want
to
express
my
strong
support
for
a
facility
in
Boston.
AJ
AJ
A
whole
program
is
the
largest
of
the
participating
program.
Despite
improving
opioid
pain,
medication,
prescribing
practices,
increasing
access
to
naloxone,
rescue
kits
and
more
access
to
evidence-based
addiction,
treatment
overdoses
continue
to
increase.
This
ongoing
surge
is
largely
due
to
fentanyl
in
the
heroin
supply.
It
is
crucial
that
we
continue
to
increase
access
to
naloxone
and
evidence-based
treatment.
Finding
the
vulnerable
groups
we
are
missing.
AJ
A
collaborative
effort
between
the
CDC
and
the
MD
ph.d,
the
surgeon,
fentanyl
overdose
in
Massachusetts
and
recently
published
its
findings,
which
I
have
attached
in
this
investigation
findings.
Findings
indicate
that
persons
using
fentanyl
have
an
increased
chance
of
surviving
overdose
if
directly
observed
by
someone
trained
and
equipped
with
sufficient
doses
of
naloxone
optimally.
This
should
be
public
health
personnel,
with
medical
expertise
in
access
to
to
addiction,
treatment
again,
I
welcome
the
City
Council,
considering
medically
supervised
injection
facilities
as
an
effective
tool
to
address
the
surging
overdose
death.