Recovery Services

Even before the overdose crisis came to public attention, a 2013 study by researchers from the BHCHP Institute and Massachusetts General Hospital showed that in the 2000s, mortality among people experiencing homelessness was the same as in the AIDS era—but drug overdose had replaced HIV as the major cause of death. Opioid overdoses accounted for over 80% of those deaths.

In the last ten years, this crisis has only intensified: first, as people moved from prescription opioids to heroin, and then, even more dramatically, since the fentanyl era started in Boston in 2014. Now, overdoses account for 1 in 3 deaths among BHCHP patients. The average age of patients dying from overdose is 43, and overdoses account for the majority of deaths in our younger patients.

BHCHP has established and expanded program-wide interventions to better serve individuals experiencing homelessness and living with substance use disorders. We’ve developed a wide variety of accessible, effective services, from office-based opioid treatment to intensive support for people being released from jail. We maintain a multidisciplinary approach to treat substance use disorders alongside other problems, from mental health disorders to HIV to hepatitis C. And we regularly conduct and publish research to share our discoveries on the needs of people living with substance use disorder and how to best address these needs.

Underpinning all of this work is a dedication to harm reduction. We are committed to especially focusing our efforts on improving the well-being and survival of those who are at the greatest risk of overdose death, and not just those who show the most readiness for large changes. We take a patient-centered approach, supporting multiple paths to patients’ recovery goals as they themselves define them. This includes people who seek to entirely stop using some or all intoxicating substances, as well as people who want to make their use safer, less frequent, or less disruptive to their lives. In the words of the harm reduction movement, we support “any positive change.”

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Our Impact

reduction in mortality during months of contact with our outpatient opioid use disorder treatment program

350

patients enrolled in outpatient opioid use disorder treatment program

178

incarcerated individuals living with opioid use disorder cared for in the first three years of our RISE Project

Ensuring Access

BHCHP’s street outreach teams proactively develop connections with people experiencing homelessness and connect them to care, which commonly includes substance use disorder treatment. Once in care, patients work with case managers alongside clinicians to ensure that their comprehensive needs are met, allowing them to focus more energy on their treatment and recovery. And treatment is made easy to come by, available on a same-day basis. We also prescribe and distribute naloxone (Narcan), a medication that can reverse overdoses, and educate patients on how to administer it, empowering them to save the lives of others. We offer treatment for opioid use disorder on a continuous outpatient basis, lowering the threshold for patients to access and adhere to lifesaving care.

Quality Care

In addition to our CCIR mobile addiction van and Supportive Place for Observation and Treatment, BHCHP offers specialized programs:

Office-Based Addiction Treatment (OBAT): Patients receive treatment on an outpatient basis, with intensive care management for medication for opioid use disorder, and engagement and prescribing to help people with other substance use disorders. A nurse care manager model (known as “the Massachusetts Model”) allows for intensive and flexible access to medication. Nurses, therapists, case managers, recovery coaches, and prescribers specialized in addiction medicine, support a holistic approach to recovery as our patients define it. For opioid use disorder, we prescribe buprenorphine (both as Suboxone and its long-acting form Sublocade) and naltrexone (in short acting pills and long-acting Vivitrol), and facilitate connections to methadone programs. We also support other medications for other substance use disorders both within OBAT, and through our primary care and outreach efforts.

RISE Project: Data from Massachusetts shows that people released from incarceration are 125 times more likely to die of overdose than the general population—with most of the overdoses occurring in the first few weeks after release. In response to that dire risk, as well as the vicious cycles that too often arise between incarceration, homelessness, opioid use, and overdose, BHCHP created the RISE Project, in which case managers connect with incarcerated or detained individuals who are living with opioid use disorder and approaching their release date. Working with people in Suffolk County jails, patients begin receiving case management and support groups months before release, and are assessed by clinicians over secure confidential phone lines to plan for the transition to outpatient care. When they walk out of jail, care—including medication for addiction treatment, as well as Hepatitis C treatment, support for obtaining identification, rapid mental health assessment and treatment access, legal case management, and applications for housing—can continue seamlessly amid a notoriously vulnerable time.

Support groups: Facilitated by therapists and recovery coaches specialized in working with people with substance use disorders, BHCHP holds daily support groups for both inpatients and outpatients at our home at 780 Albany Street—providing a safe, nurturing space for patients to share, connect, and offer and receive support among staff and peers.

Thought Leadership

BHCHP’s approaches in substance use disorder care have become widely-recognized models. The OBAT program is among the largest programs of its kind among community health centers in Massachusetts. Additionally, BHCHP and collaborating researchers have published extensive research on care at the intersection of homelessness and substance use disorders, in respected medical journals. Staff also contribute to mainstream media outlets such as The Washington Post, and sit on city and state commissions addressing the opioid crisis such as the Commonwealth’s Harm Reduction Commission.

“I’ve been sober for three years now. I continue to work at it every day. It gets harder before it gets easier, but it does get easier. BHCHP has seen me at my worst, and they’re seeing me where I am now. I have good people surrounding me, support from this place. Hopefully the staff can feel as good about it as me; they never do want to take credit, but they are owed a lot of credit.

It’s important to have facilities like BHCHP because they can bring a person back to who they used to be, not the person they’ve become. No one can do this on their own; you need help. And these people actually care.”

Sean, patient

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The best way to make an appointment is to call our main number at 857-654-1600. This phone line is answered Monday – Friday, 8:00am – 5:00pm.

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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.

Contact

780 Albany Street
Boston, MA 02118

Tel: 857.654.1000

Fax: 857.654.1100

info@bhchp.org

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