New fed prosecutor may be obstacle for supervised drug use sites

Yahoo

29-03-2025

BOSTON (SHNS) – Boosting primary care investments, overhauling insurance requirements for medical treatments, and embracing the long-debated idea of supervised drug use facilities top the list of actions Massachusetts physicians want lawmakers to take this term.
Doctors affiliated with the Massachusetts Medical Society (MMS) detailed the group's legislative priorities Wednesday, including action to create a legal framework for the launch of overdose prevention centers — an idea the Bay State's new federal prosecutor has vowed to oppose.
Dr. Jessie Gaeta, an addiction medicine specialist who practices with the Boston Health Care for the Homeless program, said policymakers need to 'go beyond' existing opioid crisis response strategies and allow medically trained professionals to monitor street drug use, then intervene and prevent an overdose from turning fatal.
At a State House briefing hosted by MMS, Gaeta recounted an experience with a 26-year-old man who fatally overdosed, a story she said is 'happening on repeat in my practice.' Last summer, the man — whom she referred to as Derek — walked into the Boston Health Care for the Homeless Clinic certain he would relapse that day after six weeks of sobriety. A nurse offered to connect Derek to treatment, but he said he wasn't ready.
'What he wanted, simply, was accompaniment while he used. His quote was, 'I'm just looking for a buddy to be with me. I don't want to die,'' Gaeta said.
Staff provided Derek with a naloxone overdose reversal kit and urged him to keep his drug dosage small because his tolerance for fentanyl would be lower after six weeks sober. But they could not allow him to stay and use drugs under their watch.
'Without the legal authority to allow him to safely stay within our building while he used, our staff watched Derek walk out the door for the last time,' Gaeta said. 'When he was found an hour and a half later behind a bush in Clifford Park, virtually in the shadow of world-class medicine as well as our state's largest syringe access program, with naloxone at arm's length but by himself, we found ourselves agonizing again over the limits of our current options for helping people who either don't want or can't access treatment in this moment, and also who don't deserve to die.'
Activists have been pushing for years for state government to pass a bill authorizing overdose prevention centers, sometimes referred to as safe injection sites or supervised consumption sites. Gaeta said the Mass. Medical Society first voted in 2017 to back the approach as a 'legitimate medical intervention.'
The Healey administration announced its support for the idea in 2023, and the Senate approved language last year allowing municipalities to open the sites as part of a broader addiction and substance use bill. However, the House did not mirror that move, and legislative negotiators dropped the provision from the final measure.
The Mass. Medical Society endorsed legislation this term (H 2196 / S 1393) that would include overdose prevention centers in a range of harm reduction services, extending legal protections to staff, clients and operators of those programs.
'Several communities across the state are interested in providing comprehensive harm reduction programming that includes overdose prevention centers, but legislation is needed to establish the legal and regulatory framework for us to do so successfully,' Gaeta said. 'Municipalities need to know the state will not stand in the way of local evidence-based public health efforts. Providers need to know that working in an [overdose prevention center] will not jeopardize our professional license. Participants need to know they will not go to jail for getting help.'
Lawmakers over the years have hesitated to embrace the concept in the face of threats of federal prosecution, and that dynamic might come into play again.
U.S. Attorney Leah Foley, who took office in January, told reporters last month she would oppose efforts to open overdose prevention centers.
'Safe injection sites is a misnomer,' she said, according to WBUR. 'You do not assist someone who is struggling with addiction by aiding and abetting. I believe that whatever resources would go into such sites should be diverted instead to treatment, to actually help these people — not to try to kill them.'
Doctors with the Mass. Medical Society outlined three other priorities for the 2025-2026 legislative term: reestablishing payment parity for telehealth services (H 1130 / S 763), reforming prior authorization by health insurers (H 1136, S 1403), and expanding access to primary care (H 1370, H 2537 and S 867).
Rep. Greg Schwartz, who was a primary care physician before joining the Legislature and filed one of the primary care bills, said Massachusetts faces a 'real crisis' as new doctors flow toward other specialties.
'What turns them off from [primary care] is not the salary, it's the lack of support, and when I say support, I mean administrative support in the settings that they're practicing,' said Schwartz (D-Newton). 'So often, they're the ones who are doing the prior authorizations … doing the forms, filling out the late-night answering of messages. It's actually overwhelming, and as a seasoned plus-20-years veteran of primary care, I can tell you that it continues to be a major drag on these professionals who really are not the right people to be doing some of this administrative work.'
His bill calls for at least 12% of total health care spending in the next four years to go toward primary care, and it would also craft a payment floor designed to ensure community health centers do not get paid less from commercial insurers than they do from MassHealth, according to a summary.
Health care watchdogs have flagged issues in primary care. A report published in January by the Health Policy Commission found Massachusetts has one of the lowest shares of physicians working in primary care, and wait times in Boston for a new patient appointment for a physical are among the highest in the country.
Gov. Maura Healey this year signaled an interest in shifting more resources 'to the front lines' of primary care, and her ability to get the Legislature on board with that push is shaping up as an issue to watch this session.
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