Supportive Place for Observation and Treatment (SPOT)

Overdose is the leading cause of death among BHCHP patients, accounting for 1 in 3 deaths in the fentanyl era (2014 – present). For years, our staff have been responding to countless overdoses each week inside our Jean Yawkey Place building, not to mention the surrounding streets outside. As this public health crisis intensified, we knew it would require bold innovation in our programming in order to engage people who use drugs actively and prevent overdose fatalities.

One such innovation is Supportive Place for Observation and Treatment (SPOT)–a former conference room turned drop-in program in 2016, which offers support for up to 10 people who have used substances nearby and are over-sedated. SPOT—the first facility of its kind in the nation, located in our Jean Yawkey Place building—provides lifesaving medical monitoring and compassionate care of overdose, with the goals of preventing fatalities, building deeper relationship with people who are actively using drugs, offering easy access to substance use disorder treatment when desired, and intentionally integrating harm reduction into our clinical work.

Ensuring Access

SPOT epitomizes low-threshold care: Any patient in need of its services can walk in and immediately has access to lifesaving resources. What’s more, SPOT serves as a low-barrier entry point to long-term care around substance use disorders. Staff build relationships with patients who mistrust the medical system, offer education about overdose prevention and safer injection techniques, and connect people as possible to other services, including urgent care, primary care, and substance use disorder treatment. Ultimately, SPOT serves as a simple way for people who have used substances nearby to prevent fatal overdose, as well as a pathway to myriad other health care services.

Quality Care

At SPOT, patients receive close medical monitoring after drug use to prevent fatal overdose, along with compassionate, nonjudgmental support and various harm reduction and clinical resources.

A nurse specializing in SUD cares for up to 10 patients at a time, monitoring vital signs, using oxygen for mild or moderate respiratory depression, and administering naloxone for respiratory arrest. Frequently, the nurse also tends to complex skin and soft tissue wounds and triages many other clinical issues that surface in SPOT, including the need for HIV prevention measures, primary care, and reproductive health. Meanwhile, a harm reduction specialist is present to build relationships with patients, provide safer use supplies and education, assist with case management needs, and offer immediate connection to any SUD treatment a patient may desire.

Thought Leadership

SPOT has saved countless lives and connected patients with long-term SUD treatment, garnering nationwide interest from public health departments and hospitals as well as universities, academic journals, and the media.

Our team’s efforts to build trust with patients over the years, including those with multiple visits to SPOT, has resulted in a better understanding of various patterns of drug use locally, including the ways substances are layered and combined. These insights help us understand an epidemic that is difficult–but critical–to track. Drawing on data from SPOT, BHCHP researchers have published studies in medical journals such as Substance Abuse and International Journal of Drug Policy, offering a model for care that we hope can be replicated in settings and cities across the country.

“From the beginning, we’ve designed SPOT by trying to listen, as best we can, to the previously unheard needs of people who actively use drugs. Down to its core, SPOT has been a program built on engaging people who mistrust the medical system. Our aim is to save lives, and to let people know that, no matter what is happening right now, we want to care for you, we love you, and you have worth. You don’t have to stop using substances before we can start helping you.”

Jessie M. Gaeta, MD, internal medicine & addiction medicine at BHCHP

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Boston Health Care for the Homeless Program receives HHS funding and has Federal PHS deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.

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780 Albany Street
Boston, MA 02118

Tel: 857.654.1000

Fax: 857.654.1100

info@bhchp.org

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