Providing A Safe Space And Medical Monitoring To Prevent Overdose Deaths

Health Affairs Blog


According to the Centers for Disease Control and Prevention (CDC), more people died from drug overdoses in 2014 than in any year on record. Most of these deaths—78 every day—involved an opioid. Closer to home in Boston, deaths from opioid overdoses increased by 50 percent from 2014 to 2015 (Note 1). In our practice, Boston Health Care for the Homeless Program (BHCHP), based on the corner of Massachusetts Avenue and Albany Street (the epicenter of Boston’s drug activity), opioid overdoses have become the leading cause of death among our patients.

Overdoses were happening multiple times each week in our lobby, clinic bathrooms, and on the sidewalks and alleys adjacent to our building. Despite significant existing services aimed at the prevention and treatment of substance use disorders (SUD), we were not effectively engaging some of the highest-risk people with SUD. There was recognition among our staff, board of directors, and patients that in addition to improving screening for SUD, expanding access to opioid agonist therapy, broadly distributing naloxone (the rescue drug to reverse opioid overdoses), improving opioid prescribing practices, and expanding housing opportunities, we also needed to reduce the harms associated with ongoing drug use and provide a safe alternative to the street for people who are over sedated. Our goals are to respond with a new service that:

  • Prevents fatal overdose;
  • More effectively connects highest-risk individuals with addiction treatment; and,
  • Addresses the impact of SUD on our patients, our organization, and our neighborhood.

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