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Tommy Blais was only 16 when a motorcycle accident left him with a painful broken bone and a dependence on prescription opioids. After his doctor tried to cut the number of pain pills Blais was taking, he found the drugs on the street and eventually turned to sniffing and injecting heroin. Now he’s in recovery, but not before seeing the dangers of illegal drugs.

“I’ve found people dead, and I’ve had people die in front of me,” said Blais. Before he quit, he had to be revived a number of times, with a shot of naloxone that got him breathing again. And he estimated he has resuscitated at least 30 other people with shots of the overdose antidote.


“The drug war has been lost,” he said. “We need new ways to help addicts.”

One of those new ways is SPOT, which opened in Boston earlier this year to give drug users a safe place to go when they’re high. A nurse monitors users for signs of an overdose, and the facility also connects people to rehab programs.

In less than six months, SPOT has been visited more than 1,500 times by 275 different people, including several friends Blais brought in because they seemed overly sedated. Not a single user has fatally overdosed, and many have come back repeatedly.


“People feel that they are valued, no matter where they are from or what they are doing,” said Kate Orlin, a nurse and director of SPOT. “We can capture people without access to health care, and give them stability and care consistently.”

Boston Health Care for the Homeless opened SPOT after seeing opioid overdose deaths in Boston rise more than 60 percent between 2012 and 2014. Although not every drug user is ready to quit, “we need to keep people alive so they can consider recovery,” said Dr. Jessie Gaeta, the program’s chief medical officer. The staff has used naloxone to revive people about 30 times.

SPOT — shorthand for a supportive place for observation and treatment — relies on a public health strategy known as harm reduction. It’s the principle behind needle exchange programs and supervised drug injection facilities, which are found in Canada, Europe, and Australia.

InSite, an injection facility in Vancouver — and the first of its kind in North America — opened in 2003 and treated 768 overdoses last year alone. Research shows supervised use facilities also cut disease transmission and engaged marginalized people in health care and rehabilitation. Still, they have been controversial in some places because of critics’ concerns that they sanction drug use. Injection sites are illegal in the United States, so drug users can’t inject at SPOT.

Proponents of supervised use facilities say they are trying to open sites in Seattle and New York. Under state laws, some state and local governments can allow supervised use facilities. But if the federal government chooses to, it has the ability to overrule them under the Controlled Substance Act.

Daniel Raymond, policy director at the Harm Reduction Coalition, said he is backing a New York City facility because of his experience working at needle exchange programs in the 1990s.

“People would come to us over and over again, and they would say, ‘We came for the needles, now can you help us with health care, drug treatment, and housing?’” Raymond said. “A needle exchange program’s superpower is that it’s an amazing engagement strategy.” Supervised use and monitoring programs have the same effect, according to proponents.

Still, like needle exchanges before them, supervised use facilities have their opponents. In 2011, Canada’s federal government attempted to shut down InSite, the Vancouver facility, but the Canadian Supreme Court granted the site an exemption from penalties under Canada’s drug laws. The next year, the Ontario government opted not to open a site despite the urging of public health experts to do so, stating that the value of these facilities was not clear. Canada’s government now officially supports harm reduction strategies, including supervised use facilities.

“International and Canadian evidence shows that, when properly established and managed, supervised consumption sites have the potential to save lives and improve health without increasing drug use and crime in the surrounding area,” Andre Gagnon, a spokesman for Health Canada, said in an email.

Cecilia Gentili
Cecilia Gentili, an assistant policy director at a New York health organization, is a strong advocate for the planned supervised use facility in the city. Alice Proujansky for STAT

Cecilia Gentili is a strong advocate for the planned supervised use facility in New York. As a teenager in Argentina, she started using cocaine, and when she relocated to New York City a few years later, she added heroin and meth. She said that after she became a sex worker, drugs masked the flood of memories of abuse her work revived and soothed the anxiety she faced about her safety as a transgender woman.

Drugs quieted her inner terror, and she didn’t stop using them until an overdose just about killed her. An acquaintance saved her life with naloxone, she said. By that time, she had contracted hepatitis C from a shared needle.

“I was scared of dying, but I still couldn’t stop using drugs,” Gentili said.

She considers herself lucky, but feels she could have gotten into recovery faster — and avoided a potentially life-threatening infection — if provided a safer place to use and readier access to resources to quit.

“The person that makes the decision to use drugs is going to do it,” said Gentili, now assistant policy director at GMHC, formerly Gay Men’s Health Crisis, in New York City. With safer use facilities, she said, “they are just going to make sure that while they are doing it, they don’t die or contract any chronic diseases.”

Yet supervised injection facilities do more than prevent death: They provide access to resources to help users quit or to address mental health problems. Last year at InSite, users were referred to recovery programs more than 460 times.

What starts as keeping users safe can ultimately turn into quitting drugs, said Anna Marie D’Angelo, spokeswoman for Vancouver Coastal Health, the regional health authority that runs InSite.

“You’re taking what is a big step for some people,” D’Angelo said. “You are doing something for your health.”

People who frequent supervised use or monitoring facilities often build relationships with staff members who can direct them to rehab services. And these spaces also simply offer what for many drug users is the only place they do not feel judged.

“You are talking to people who have felt marginalized from society, and who have internalized a lot of shame and stigma,” said Raymond.“When you give people this level playing field, they really open up in a transformative way.”

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