Since April 2016 when BHCHP opened our Supportive Place for Observation and Treatment (SPOT) in a former conference room, at least 10% of our visitors have immediately sought treatment for their disease. Here, at SPOT, the only program of its kind in the country, we provide medical monitoring following opioid use to prevent fatal overdose and promote access to long term treatment.
“The fact that, so far, 10% of our SPOT visitors — and probably more — have accessed treatment is terrific,” says BHCHP Chief Medical Officer Jessie Gaeta, MD, the creator of SPOT. “People who come to SPOT are often not well engaged with the healthcare system. They are often living on the streets where drugs are easily available and they have few social supports.”
As SPOT nears its one year anniversary, its numbers are striking. Since April 2016, 424 men and women struggling with opioid use disorder have used SPOT. Those 424 people, who are over-sedated and at risk for respiratory failure and death, have accounted for 3,291 visits. These multiple visits are to be expected for our patient population says Gaeta, “The stigma associated with homelessness and addiction presents a constant barrier to engage in services. The hill our fragile patients must climb to be successful in recovery is very, very steep. It may be after multiple visits to SPOT that our patient will eventually be connected to treatment.” According to Dr. Gaeta, if SPOT were not available, about 1/3 of SPOT encounters would have necessitated more expensive hospital emergency room visits or may have resulted in death.
Today, opioid overdoses is one of our nation’s biggest public health challenges. The opioid addiction crisis has hit our patient population particularly hard. Overdoses are the leading cause of death for our patients and until SPOT opened, we responded to between two and five opioid overdoses in Jean Yawkey Place every week. “Everything would come to a grinding halt for 20-30 minutes as our rapid response team resuscitated the patient,” explains Dr. Gaeta. “It became clear that we had to build some infrastructure to manage the sheer volume of overdoses. Ultimately, we also want to provide non-judgmental support to anyone with this disease, including people not currently able to access treatment.”
That infrastructure is now SPOT, where up to 10 people, at a time, who are at risk of a fatal overdose are monitored and cared for by a skilled nurse with a specialty in addiction. A harm reduction specialist is also present in the room, to forge relationships with patients, provide overdose education, and hopefully, connect them with long term treatment. No drugs are allowed on the premises.
An Unequivocal Success
“The staff has done a tremendous job of building trust with people who often have eschewed involvement with the healthcare system — or any kind of ‘institution’ — for years,” says BHCHP CEO Barry Bock. “And that trust, as anyone who works in the field of substance use disorders knows, is critical to getting people engaged with treatment.”
SPOT has been an unequivocal success on many levels, according to Dr. Gaeta, who has fielded queries from public health officials and clinicians from all over the country (indeed, all over the world) who are considering opening similar programs. “The staff of SPOT has prevented or reversed dozens and dozens of overdoses and saved lives,” says Dr. Gaeta. And by having resources dedicated exclusively to reversing overdoses, it has taken the strain off of other parts of our organization and of the city. “SPOT is also teaching us a lot about patterns of substance use in this highly vulnerable patient population,” adds Dr. Gaeta.
What We’re Learning From SPOT Can Provide a Blueprint
The SPOT program has brought to light a tremendous amount of knowledge about the drugs patients are using and the effects on their bodies. Because our staff has worked hard to build trusting relationships with our SPOT patients, they are often very forthright about the substances they have injected and consumed. Many have combined opioids— heroin and fentanyl— with several other drugs and medications. The way the body responds to this “drug cocktail” is different from its reaction to an opioid alone, and reversing these types of overdoses can be more difficult, explains Dr. Gaeta.
With these insights from SPOT, BHCHP researchers have submitted two SPOT-related studies for publication in medical journals. We hope that the learnings from this harm reduction approach to care for people with opioid use disorder will provide the blueprint for a replicable model that can be used in other settings and other cities across the country.
SPOT has been completely funded through the generosity of our private donors and foundations. We are so grateful for this generous philanthropic support to sustain SPOT for its first year. We are working hard to obtain public funding for certain services provided in SPOT, but that is uncertain. SPOT will continue to need support for the crucial “engagement” work of our staff to connect these struggling individuals with long term treatment and recovery.
SPOT By the Numbers*
282 men, 141 women and one transgender individual have used SPOT since it opened in April 2016
3,291 total visits
10% of SPOT visitors have gone into treatment immediately after visiting
1/3 of visits would have resulted in an ER visit if SPOT didn’t exist
*All numbers were from April 2016 - March 2017.