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I visited supervised consumption sites in six cities. Here’s what I found. – The Boston Globe

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I visited supervised consumption sites in six cities. Here’s what I found. – The Boston Globe


In Montreal, Vancouver, Toronto, Quebec City, and New York, and in Philadelphia where sites are proposed, I spent hours walking the neighborhood streets and alleyways, sitting at bus stops, talking with people, and lingering in parks and doorways.

In Montreal, at dusk on a Saturday night, I sat on a bench across from a storefront site. Clients of all ages arrived by foot, car, and bike, mostly indistinguishable from the patrons standing in line at a restaurant just down the block. A few waiting restaurant patrons walked by, some with children, seemingly unaware of what was behind the door to the site. Those who stopped and read the information displayed in the window casually meandered back to the restaurant line.

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A site in downtown Montreal was different. On a side street, it was marked by a nondescript door. People quietly came and went until after midnight. The neighborhood featured a busy commercial road at the end of the street and newer, higher-end housing throughout.

In contrast, the Downtown Eastside neighborhood of Vancouver can only be described as jarring. Hundreds of people were wandering the streets and alleys, with many encamped at the time in a nearby park. Old and worn apartment buildings, rooming houses, and hotels fill the area. There are several nondescript supervised consumption sites in the neighborhood, practically invisible among the busy street life.

In New York, I went to scope out the East Harlem site the day before I was to formally visit, but on my first pass, even with the address, I couldn’t find it. A pastor at a local church told me the site was helping those in need with minimal — if any — negative neighborhood impacts.

In Toronto, people loitering outside a community health center hinted that a site was located inside, but it wasn’t entirely obvious within the context of the whole neighborhood. A staff member said they were looking at alternatives to sharing the health center entrance. A police officer working a detail for a movie filming next door was not sure how he felt about such sites but felt location was key in terms of access and limiting neighborhood impacts. In Quebec City, the new site looked like nothing other than a storefront.

Indistinguishable. Nondescript. Practically invisible. Supervised consumption sites blend with their neighborhoods.

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How they look from the street contrasts with how they look inside. In Canada, the rooms appear clinical, almost sterile; in New York, a little less so. All have cubicles with a chair, clean counter, mirror, disinfecting wipes, and a disposal container. Some have rooms for people who inhale drugs, and all have rooms in which clients can relax. They offer clean needles, pipes, and other supplies. Each is staffed with qualified and caring staff, paid and volunteer, ready to respond to an overdose with oxygen or naloxone, a medication used to reverse an opioid overdose.

From what I observed, they treat clients with dignity and respect and develop easy rapports with them, determined by the comfort level of each client. Friendships form, making it easier for clients to access health care and to ask for treatment, something I witnessed in East Harlem.

Viewing the sites and what they do must be put in context. I had heard that some who visited the Vancouver sites on official trips, for instance, were shocked by the neighborhood, concluding that the supervised consumption sites attracted drug users and dealers and were responsible for the jarring conditions.

A police officer with whom I walked the neighborhood after spending a full day there myself said it looked this way long before the sites opened. For years, the officer explained, it was a place where people with untreated mental health conditions ended up after losing jobs and housing. He said he believes untreated mental illness is at the root of the neighborhood’s problems and that while supervised consumption sites are not the full answer, they do save lives.

By walking the streets and visiting the sites, I also learned how these facilities can lessen the strain that drug use puts on local first responders and hospitals. Just off Kensington Street in Philadelphia, within moments of arriving to view an area proposed for a site, I saw fire apparatus and police cars pulling out of a side street. Two firefighters remained to try and help a woman, while the man with her said, “You OD’d girl. You’re purple.”

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In contrast, at a Vancouver site a couple of weeks before I visited, 14 overdoses occurred in a single day at one injection site due to a bad batch of drugs in the neighborhood. Nobody died. Some of those 14 people might have died on the streets if not for the site. There might have been several 911 calls, several police, fire, and ambulance responses, and several transports and emergency room stays. Instead, having trained personnel on hand meant each case could be handled swiftly and appropriately, while simultaneously sparing health care and emergency response resources.

Massachusetts has successful needle exchange programs. At a Montreal site, the director referenced how it originally had been a safe materials site, i.e., a needle exchange program. They knew when they provided a client with clean needles and supplies that the client was walking out the door and to a nearby alley or park to inject. Or, as I thought, to the bathroom of a gas station. Instead, she said, why not let them walk through the door into a supervised setting, eliminating the risks of overdose, needle litter, and infection.

The number of overdose deaths in Massachusetts suggests that, however well-intentioned, signs in gas station bathrooms are not enough. Supervised consumption sites can help bring drug use out of bathrooms, alleyways, and parks, and into safe places.

What I saw and learned in Montreal, Vancouver, Toronto, Quebec City, Philadelphia, and New York leads me to believe that Massachusetts should allow any community that chooses to host a supervised consumption site to do so as a pilot program, using the experience and data to better inform Massachusetts policy makers and residents of the role such facilities can play in efforts to combat the drug epidemic. They can save money, and they will save lives.

Senator John F. Keenan represents Norfolk and Plymouth counties in the Massachusetts Legislature.

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Massachusetts

Police to address Princeton death during child sexual abuse material investigation

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Police to address Princeton death during child sexual abuse material investigation


Authorities will speak Friday after a death occurred while police were serving a search warrant for child sexual abuse material in Princeton, Massachusetts.

The subject of the search warrant “was a person of trust in communities in Worcester and Middlesex Counties,” Massachusetts State Police said.

Authorities said little about the case ahead of the press conference, which will begin at 6 p.m. and be streamed in the player above.

State police will be hosting the conference, which will include Princeton Police Chief Paul Patricia, Worcester County District Attorney Joseph Early Jr. and Middlesex County District Attorney Marian Ryan.

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Check back for more as this story develops.



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Mass. unveils $250 million in subsidies to protect residents from premium hikes – The Boston Globe

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Mass. unveils 0 million in subsidies to protect residents from premium hikes – The Boston Globe


Audrey Morse Gasteier, executive director of the Massachusetts Health Connector, said the financial bulwark that benefited 270,000 residents is “part of the reason that we’re hanging in there in terms of enrollment and keeping people covered.”

But Thursday’s announcement won’t translate into any additional help.

Healey’s news conference coincided with the beginning of an election year in which three Republicans are vying for her job and voters are expected to be particularly focused on the state’s high cost of living. One survey last year found Massachusetts had the second highest cost of living in the country. People who saw their insurance premiums increase this year said it was one pricey bill amid an onslaught of growing expenses.

“I can’t believe how much it is when we go to the grocery store. Our electricity has gone up,“ said Judith O’Gara, whose family was hit with a $400 increase a month in insurance premiums for their ACA plan in January. ”We were just bracing ourselves to try to stretch the paycheck further.”

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O’Gara, of Millis, is a part-time editor at community newspapers, and her husband is a self-employed computer animator and mural artist. She has added hours at work, she said, but it still wasn’t enough to qualify for health coverage through her employer, leaving the couple to buy insurance through the connector.

Healey also used the news conference to weigh in on a high-profile effort in Congress to revive the federal subsidies. Also on Thursday, the US House, with help from 17 Republican defectors facing competitive reelection races, passed a bill that would extend the subsidies for another three years. A small group of senators is considering proposing their own extension of the subsidies.

“We need to see people in Congress step up and take action and fight the president on this and get him to focus on the domestic agenda and how to make life more affordable for people,” Healey said.

The governor said she didn’t announce the influx of funds earlier because she had hoped Congress would act before the end of 2025.

“We gave up until the deadline to see if they take action,” she said.

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ACA open enrollment extends through Jan. 23.

The infusion of funds from the Commonwealth Care Trust Fund brings the state’s total commitment to the insurance marketplace to $600 million, which Healey said is the largest support from any state in the country.

Federally subsidized insurance policies were first made available to people making less than 400 percent of the federal poverty level, or about $128,600 for a family of four, in 2009 under President Barack Obama’s ACA, also known as Obamacare. In 2021, Congress made those subsidies more generous for many recipients and extended them to people earning up to 500 percent of the federal poverty level. The expanded tax credits doubled participation in the ACA exchanges over the past four years, and by last year 337,000 people in Massachusetts received subsidized insurance through ConnectorCare.

The increases were slated to expire after four years, and without congressional action to preserve them, premiums reverted to pre-2021 levels for this year. People earning more than 400 percent of the poverty level became ineligible to receive subsidized insurance. State officials have estimated roughly 300,000 people could become uninsured statewide over the next decade, in part due to the expiration of the tax credits.

Democrats staged a 43-day shutdown last fall, the longest in US history, in an unsuccessful effort to preserve the expanded subsidies.

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The Commonwealth Care Trust Fund predates the 2021 coverage expansion, said Doug Howgate, president of the Massachusetts Taxpayers Foundation, a nonprofit budget watchdog, and was established to support ConnectorCare programs. Massachusetts has long had a robust public insurance program, and the 2021 expansion essentially allowed the state to shift the cost of subsidies it had been paying to the federal government. Tapping the trust fund now essentially returns Massachusetts to the support levels it provided prior to 2021, Howgate said.

Regardless of the timing of Healey’s announcement, it is a reality that Massachusetts has a uniquely robust commitment to health insurance access, Howgate said.

“I do think that the idea that the state is able to offset some of those impacts is an important message to get out there,” he said. “This is real money.”

According to Healey’s office, a 45-year-old couple with two kids making $75,000 in Fall River previously paid $166 per month for the lowest-cost coverage. Without state action, their premium would have more than doubled. But with the infusion from the trust fund, they will pay $206 per month.

There’s only so much the state can do to mitigate the impacts of the expired subsidies, though. Because Congress didn’t extend them, people between 400 and 500 percent of the federal poverty level simply are ineligible to sign up for subsidized policies through the ACA marketplace. There are roughly 27,000 people statewide who cannot benefit from the state’s effort to compensate for the lost federal money, and those people are among those facing the biggest new insurance expenses.

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Christa, 56, a hair dresser, and her husband, Gary, 69, a truck driver, earn less than $105,750 annually combined, just shy of 500 percent of the poverty level. The couple, who asked not to be named to protect their privacy, went from paying $282-a-month for Christa’s insurance with no deductible, to a private plan costing $725 a month with a $2000 deductible.

Gary, who is enrolled in Medicare, is still counting on Congress for a reprieve.

“I believe the Senate will be forced to do something, and we’re hoping,” he said.


Jason Laughlin can be reached at jason.laughlin@globe.com. Follow him @jasmlaughlin.





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Healey shares plan to limit health insurance cost increases for Massachusetts residents

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Healey shares plan to limit health insurance cost increases for Massachusetts residents



Gov. Maura Healey said Thursday that the state is spending an additional $250 million to limit premium increases for residents who have insurance through the Massachusetts Health Connector.

After Congress let Affordable Care Act tax credits expire at the end of last year, more than 300,000 people in Massachusetts have been facing a potentially steep increase in their health care bills. 

The governor’s office said those enrolled in ConnectorCare who make below 400% of the of the federal poverty level, which is $62,600 for an individual or $128,600 for a family of four, will see “little to no premium increases.”

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Under the plan, Healey’s office said a 45-year-old couple with two kids in Fall River will see their monthly health insurance costs rise from $166 to $206. Without the new funding, the governor says they would be paying $452 a month.

“While President Trump continues to increase health care costs, we are taking the strongest action in the nation to address them and keep costs as low as possible for families,” Healey said in a statement. “Despite this increased state investment, far too many people will still see their premiums increase because of the White House.”  

The U.S. House of Representatives is set to approve a three-year extension of the health care tax credits. While it appears unlikely to pass the Senate, senators have talked about a compromise plan that could include a two-year extension with added reforms. President Trump hasn’t offered a specific health care plan, but said subsidies going to insurance companies should “go to the people” instead. 

The $250 million is coming from the Commonwealth Care Trust Fund, which gets its money from employer medical assistance contributions and financial penalties from residents who violate the state’s health care insurance mandate. 

Massachusetts residents can sign up for health insurance coverage or switch their Health Connector plans until Jan. 23 if they want to be covered by Feb. 1. 

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