One Organization’s Fight Against Homelessness and the Overdose Increase in Boston

According to the Boston Public Health Commission (BPHC), there have been 50% more overdoses (both fatal and non-fatal) in August and September. One of the programs working towards reducing these numbers is the Boston Healthcare for Homeless Program (BHCHP). Health Advances’ Caitlin Murphy describes her experience as a volunteer.

I recently had the privilege of volunteering at one of Boston’s most remarkable healthcare providers – the Boston Health Care for the Homeless Program. I signed up to run a bingo with some of the patients with two colleagues, Deirdre Straley and Kathleen Grinnell. I stopped at CVS that morning to pick up some prizes that were on the BHCHP wish list: deodorants, shampoo, etc.  I did not realize, as I browsed the aisles that morning, that I was on my way to one of the more meaningful experiences of my life.

BHCHP aims to provide the highest quality healthcare to homeless men, women, and children in the greater Boston area. The organization operates with an integrated care model which best serves homeless individuals who oftentimes have at least one substance abuse problem, one chronic physical condition, and one psychiatric illness. Substance abuse, an ever-present issue with homeless patients, continues to be front and center at BHCHP, with the opioid epidemic driving in new patients every day.

The corporate relations manager, Catherine Minahan, affectionately referred to as “Cat” by patients, greeted us at the door, immediately receiving big smiles and hellos from some of the homeless patients who were waiting in the entryway. As our tour began, we learned first about the facility’s SPOT program, the “Supportive Place for Observation and Treatment,” a safe medical monitoring space for people at high risk of an opioid overdose. SPOT is where users who have just used opioids and feel they are at risk of overdose can go instead of the ER (an incentive to the State here to reduce the tax dollars and staff needed to deal with the increase in overdoses). For patients, SPOT serves as an entryway to primary care – they may feel comfortable enough around nurses as they taper down off a substance to consider a detox program. For doctors, it provides an unprecedented lens into overdose – exactly what happens and why. It is fascinating to me that in a very small room in an obscure corner of Boston, doctors and nurses are monitoring a revolving group of individuals on the edge of overdose, developing critical information towards understanding insights into this devastating epidemic, and how best to treat those with substance abuse disorder.

We discussed the controversy surrounding Narcan (the brand name for naloxone, the opioid overdose reversal drug). Cat recently provided Narcan from her backpack (all BHCHP staff – clinical and non- clinical – are encouraged to have this) and a nearby off duty nurse was able to administer to the person experiencing overdose. Critics of the drug argue that the availability of Narcan can enable drug abuse just by its existence, the basic argument being that if patients know they cannot die, they are more likely to use. But the increase in overdose and concurrent increase in demand for more potent (deadly) batches of heroin, suggest that fear of death may not be a deterrent to users. BHCHP’s position is of advocate; the argument being that there is no chance of recovery for someone who has fatally overdosed. On September 12th, Bridgewater State University became the first Massachusetts college in the nation with public access to Narcan, after a fatal overdose on campus last year. Even though BHCHP (and other endorsing facilities across the nation) supports the use of Narcan, it is administered as a last resort, because the user immediately suffers highly intolerable withdrawal symptoms and usually seeks to remedy these by using again in the immediate future.

While the SPOT program addresses a massive problem, it is only a small portion of the services BHCHP offers. Cat walked us through various practices — medical, dental, psychiatric — and explained the wide variety of services BHCHP provides to patients. If someone is seeking help, almost any of their needs can be met here, even things not obviously problematic, like picking up mail (to someone with no address, and big medical issues, this is a big one). Staff thoughtfully consider every problem the homeless face, and dignity is the most important message. We learned throughout the day that homelessness is a destination met through many varied circumstances.

One of the biggest personal surprises were the people who chose life on the streets. For people who have lived without homes for decades, the street is their home, and where they feel safe. These people are treated several nights a week right on the streets by the program’s street team and founding physician Jim O’Connell. Cat handed me a copy of his book “Stories from the Shadows,” a collection of anecdotes from his years treating homeless patients. Dr. O’Connell’s name is spoken with reverence at BHCHP. His story is fascinating on its own; upon finishing medical school and residency, he was headed for an oncology fellowship in New York in 1985, and was introduced to the then just-starting program; he halted his plans and became the fulltime doctor at BHCHP, the program becoming his life’s mission.

The patients were warm and friendly as we walked through the halls, many of them making jokes and inquiring about bingo. Bingo is popular, Cat explained, for the prizes and the comradery. And she was right: about twenty five people assembled quietly for Bingo, and we played until each person had a prize. The patients thoughtfully considered their prize choices and decided who should get the prizes (after they had already won), and why. This aspect of the game made it a lesson in kindness – not just for the players, but for the volunteers. Bingo was clearly a carefully chosen game for this group – it was relatively quick and easy, and allowed the staff to give essentials out to the homeless without making them feel like it was charity.

Before we left, Cat shared her own inspiring story: today, she works on the administrative side of BHCHP, but she is also enrolled in nursing school so she can move over to the patient care side someday. We said our goodbyes and left with a combination of heavy hearts for the plight of the homeless people we had met, but also hope that there were kind-hearted facilitators and doctors making such a major, everyday impact on thousands of lives.

To volunteer or donate to the BHCHP please visit: https://www.bhchp.org/about-us

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