SPOT-ing Overdoses and Fighting the Opiate Epidemic in the South End

Photo: Henry Zbyszynski

Spotting an opiate overdose can be difficult. Someone high on heroin or OxyContin may have difficulty speaking. Their muscles may be slack and may impair normal movement. Or they may “nod out” and seem to be asleep. Overdoses typically cause shallow breathing, loss of consciousness and discoloration of the skin, lips and fingernails. Unless someone is under observation for signs of a potential overdose, the difference may go unnoticed until it’s too late.

Preventing fatal overdoses, which increased in Boston by more than 50 percent between 2014 and 2015, is the main goal of Boston Health Care for the Homeless Program’s (BHCHP) soon-to-be-open Supportive Place for Observation and Treatment, or SPOT, facility.

“A key part of this is to do a better job of saving lives,” said Dr. Jessie Gaeta, chief medical officer at BHCHP.

The SPOT facility will be located on the first floor of BHCHP’s main facility at Jean Yawkey Place on the corner of Massachusetts Avenue and Albany Street in the South End, a central intersection in what has become known as “Methadone Mile.”

Gaeta said they experience between two and five overdoses in their waiting room each week.

“The idea for this program started with thinking about how we could better manage overdoses in our building,” she said. “They’re hard to respond to in busy waiting rooms… I felt we need to devote resources and infrastructure to overdoses,” she added.

The SPOT space will accommodate a maximum of eight people at a time. The goal is that it will be used by people in the area who are over-sedated and at risk of respiratory failure and possible death.

“We want to make it safer and less dangerous [for people who are using opiates] and we also want to be able to build relationships [with addicts and users],” Gaeta said. “We hope that over time people realize we care about you, that we’re not going to turn you away if you continue to use. My hope is that when someone is interested in treatment we can make it happen right there,” she said.

The room will be open Monday through Friday, 10 a.m. to 6 p.m., and it will be staffed at all times by registered medical staff specializing in addiction, a harm reduction specialist and recovering addicts.

“I’m looking forward to it,” said Joanne Guarino, a formerly homeless Boston resident and recovering heroin and opiate addict who was treated by BHCHP and who is also a member of the program’s consumer advisory board. Guarino will be one of the members of the peer group monitoring the SPOT facility.

“[BHCHP] saved my life, but they also taught me things that I didn’t know; that I was worth it, that I could love myself and people could love me,” Guarino said.

“When [SPOT’s] open I’ll be there. It’s important to have a peer group around, people who know what’s going on,” she said.

While Gaeta and Guarino and the staff at BHCHP are excited about SPOT’s launch at the end of April, there are certainly doubts about the program’s efficacy and, for some, its ethics.

“I didn’t believe in it at first,” said Guarino, who used for 30 years before getting clean in the early 2000s.

“I thought it was stupid. Why didn’t we just put them in detox like I used to do? And then one day, I was talking with somebody and a bell goes off in my head,” she said. “It was like an alarm. I realized, you can’t put dead people in detox.”

“I still don’t know if it’s going to work, I think we’re still baby stepping … but something has got to be done, because right now nobody is doing anything,” she said.

Questions surrounding how much use the space will actually get will have to be answered once SPOT is up and running, but the goal is to create a community space where people actively using opiates can come to ride out a high, be monitored for the possibility of an overdose and, when people are ready, be connected to addiction treatment.

However, SPOT is not a supervised injection site. Using drugs in the space is not permitted, per state and federal controlled-substances legislation.

“The main criticism of our program is that it’s enabling drug use,” Gaeta said. “My response to that is that people are already using heroin. The purpose of this program is not to condone use but to make it less dangerous for people who are continuing to use,” she said.

The idea that facilities like SPOT, needle exchange programs and supervised injection sites (which are legal in several other countries including the United Kingdom, Australia and Canada) enable drug use is a firmly ingrained perception, one that Gaeta hopes SPOT can help unravel.

“I don’t like enabling people, but you have to realize what we’re doing here,” Guarino said. “Even if someone’s enabled, we’re saving their life for one day. Something has got to be done,” she said. “So that’s the plan: to do something.”