A BHCHP clinician demonstrates to a patient how to use Naloxone, also known as Narcan.
Download our Guidelines for Opioid Overdose Preparedness and Response in Congregate Housing & Shelters
These guidelines, developed by the Boston Health Care for the Homeless Program in partnership with the Boston Public Health Commission and its needle exchange program, AHOPE, are intended to increase the preparedness of people in congregate housing and shelters to respond safely and effectively to opioid overdoses.
Last Updated: February 2018
To receive notifications of future updates to these guidelines, please email ODguidelines@bhchp.org
Overdose: A Leading Cause of Death
According to a study by BHCHP and Massachusetts General Hospital published in 2013, drug overdose has replaced HIV as the major cause of death among the homeless population. Dr. Travis Baggett and colleagues found that opioid overdose accounted for over 80% of overdose deaths. This reality prompted BHCHP to establish and expand program-wide interventions to better serve homeless individuals with substance use disorders.
BHCHP observes Overdose Awareness Day on August 31. Learn more about BHCHP's Overdose Awareness Day efforts here:
In response to the to the city’s increase in opioid overdoses, which are magnified among people experiencing homelessness, BHCHP has implemented a program called Supportive Place for Observation and Treatment (SPOT) located at our main site, 780 Albany Street. SPOT offers engagement, support, medical monitoring, and serves as an entry way to primary care and treatment on demand for 8-10 individuals at a time who are over-sedated from the use of substances and who would otherwise be outside on a street corner, alleyway, or alone in a public bathroom, at high risk of overdose. SPOT is staffed by addiction nurses, harm reduction specialists, and peers who are in recovery themselves. While the immediate goal is to reduce the harms associated with substance use in a population which lacks stable housing and supports, our ultimate goal is to help medically-complex individuals access treatment for substance use disorders, including medication-assisted therapies, counseling, or detoxification followed by inpatient or outpatient support.
Office-Based Opiate Treatment
BHCHP launched its opioid treatment program at our largest outpatient clinic located at Jean Yawkey Place in 2008. We expanded this service to our clinic at St. Francis House in 2013 and to Casa Esperanza in 2015. Specialists work with addicted patients using a combination of Suboxone treatment, counseling, and case management.
Even for those using large doses of highly addictive drugs like heroin and oxycodone, Suboxone treatment can offer rapid, pain-free withdrawal in an outpatient setting — at a cost much lower than traditional hospital inpatient programs.
The Addiction Collaborative and Expedited Support Services (ACCESS) team follows a chronic disease management approach, using BHCHP's multidisciplinary, patient-centered model. With recovery as the ultimate goal, the team focuses on harm reduction strategies and draws on motivational approaches to promote self-driven care.
The ACCESS team serves patients who are at highest risk for overdose death— those who have had an unintentional drug overdose within the last 12 months. Services include:
- Expedited access to primary medical care
- Suboxone therapy
- Behavioral health care
- Weekly substance abuse groups
Our intensive case management services include accompaniment, home visits, assistance with detox and transitional programs, naloxone education, harm reduction and overdose prevention counseling.
Naloxone, also known as Narcan, is a safe and effective prescription medication that reverses opioid overdose. BHCHP provides prescriptions for Naloxone and educates patients on how to use the medication.
In October 2012, BHCHP began offering addiction support groups, first at the Barbara McInnis House, our 104-bed respite program, and then at our outpatient clinic at Jean Yawkey Place. Facilitated by social workers skilled in addiction counseling, these groups are held daily and are well attended by patients in both settings.