Summary: Today we are joined by Dr. Dennis Dimitri, the immediate past-president of the <a href="http://www.massmed.org/" target="_blank" rel="noopener noreferrer">Massachusetts Medical Society</a> (MMS) and current chair of the society’s Task Force on Opioid Prescribing and Physician Communication, to discuss supervised injection facilities, or SIFs. A SIF is a location where individuals may use illegal drugs under the supervision of a medical professional ready to assist in case of an overdose requiring treatment.<br> Later this month, the MMS will vote on whether to advocate for a task force to assess the feasibility of a pilot SIF in the state of Massachusetts. If the proposal is approved, the <a href="http://www.wbur.org/commonhealth/2017/04/05/supervised-injection-facility-debate" target="_blank" rel="noopener noreferrer">MMS will become the first statewide physician organization</a> in the Bay State to advocate for such a pilot program.<br> We discuss with Dr. Dimitri what it would mean should the MMS advocate for SIFs. We review the evidence on the effect of SIFs on <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62353-7/fulltext?rss=yes" target="_blank" rel="noopener noreferrer">rates of fatal overdose</a>, <a href="http://www.globaldrugpolicy.org/Issues/Vol%201%20Issue%203/A%20Critical%20Evaluation.pdf">uptake of Substance Use Disorder</a> treatment, and <a href="http://www.globaldrugpolicy.org/Issues/Vol%201%20Issue%203/A%20Critical%20Evaluation.pdf" target="_blank" rel="noopener noreferrer">rates of transmission</a> of HIV and HCV. We talk about the ethical considerations of such a program, whether SIFs enable behaviors harmful to people’s health or they represent harm reduction, and the complex legal considerations involved with a potential pilot program.<br> Major events of the opioid epidemic in the last few years, such as business owners planning for the possibility of <a href="http://www.wbur.org/commonhealth/2017/04/03/public-bathrooms-opioids" target="_blank" rel="noopener noreferrer">overdose in bathrooms</a> and a recent HIV outbreak <a href="https://www.nytimes.com/2016/08/08/us/politics/mike-pence-needle-exchanges-indiana.html?_r=0" target="_blank" rel="noopener noreferrer">stemmed by a needle exchange program</a> in Indiana, raise the potential benefits of SIFs. If you’re interested in reading more, check out recent guest <a href="http://rospod.org/2017/03/07/sara-wakeman-treating-patients-with-substance-use-disorders-the-opioid-crisis/" target="_blank" rel="noopener noreferrer">Dr. Sarah Wakeman</a>‘s compassionate and evidence-based case for SIFs in <a href="http://www.nejm.org/doi/full/10.1056/NEJMp1613651" target="_blank" rel="noopener noreferrer">this recent NEJM article</a>. You can also listen to <a href="http://rospod.org/2017/02/07/jessie-gaeta-spot-supportive-place-for-observation-and-treatment/">our past episode Dr. Jessie Gaeta</a> on the SPOT program (supportive place for observation and treatment) when she also gave her thoughts on SIFs.<br> Dr. Dimitri is a family physician and Vice Chair of the Department of Family Medicine at University of Massachusetts and the UMass Memorial Medical Center.<br> What do you think? In the face of the opioid epidemic, could pilot SIFs in the US also reduce overdose deaths as in Canada and Australia? Tweet us your thoughts at @rospodcast or leave a comment on our facebook page at <a href="http://www.facebook.com/reviewofsystems" target="_blank" rel="noopener noreferrer">www.facebook.com/reviewofsystems</a>. Or, drop us a line directly at <a href="mailto:contact@rospod.org">contact@rospod.org</a>. We’d love to hear from you – and thanks for listening.<br> Graphic from of Centers for Disease Control, <a href="https://www.cdc.gov/drugoverdose/data/" target="_blank" rel="noopener noreferrer">Opioid Overdose</a>.<br>
