As Pooja Bhalla made her way to her job at a Boston nonprofit, she often saw men and women high on drugs falling down in the middle of the street, walking into traffic or slumped in an alleyway.
She and others at the Boston Health Care for the Homeless Program decided these addicts needed a safe place to rest that didn’t put them or others at further risk. A nearby homeless shelter wouldn’t take them in this drug-induced state, so the agency created SPOT, or Supportive Place for Observation and Treatment.
SPOT is a room filled with comfy recliners and monitored by a nurse. Drug users can go there to sleep it off with no questions asked.
The space has proved popular since it opened June 1, with eight to 14 people visiting daily and a line often forming to gain access.
“To our surprise, it’s been very successful,” Bhalla, the agency’s chief operating officer, said in a recent phone interview. “We need a bigger space.”
SPOT is among numerous tactics being tried in U.S. cities in response to the huge spike in deaths from people taking heroin and other opioids. The wide range of solutions includes efforts to prevent death, help addicts recover and stop opioid use before it starts.
A visitor to a busy emergency room doesn’t expect to hear the lilting sounds of a harp.
But St. Joseph’s Regional Medical Center isn’t like other ERs. The hospital in Paterson, N.J., has adopted an unusual approach to pain management that gives patients opioids as a last resort and relies on nonaddictive medicines and therapies, like harp music. The music alone, the hospital found, can decrease some patients’ pain from as high as an eight to a three on a scale of zero to 10.
“The reason is not magic,” said Dr. Mark Rosenberg, chairman of emergency medicine for St. Joseph’s Healthcare System. “The harp chills you out. A lot of pain is from fear.”
Rosenberg, aware of the alarming number of people who become addicted to opioids and then switch to heroin, wanted to find another way to help the 150,000-plus patients who visit his emergency room a year, many grappling with pain. He was disappointed, though, in the lack of choices.
“When you looked in the toolbox, there was Tylenol, Advil and Percocet,” he said.
The hospital began its Alternatives to Opiates Program (ALTO) in January, and has already shown impressive results. The staff is now using 40 percent fewer opioids in the emergency room and prescribing 40 percent fewer opioids for patients to take at home.
Alternatives include using nitrous oxide or “laughing gas” on young patients who need stitches, ultrasound-guided nerve blocks for patients with broken wrists or clavicles and trigger-point injections for back pain.
Opioids still are used if the other methods don’t work and for patients in severe pain, such as someone with a crushed pelvis from a car accident, or those with end-stage cancer, Rosenberg said.
Some patients, including parents of children with sports injuries or people with a history of drug addiction, are choosing this ER over others because it offers alternatives, Rosenberg said.
“We were shocked,” he said. “Our intent wasn’t to increase our volume. It was to do a better job of managing pain.”
Other patients are avoiding his emergency room because they know they’ll have a tougher time getting opioids there, he said.
Instead of making drug addicts seek treatment, Philadelphia is bringing the treatment to them.
“Street teams” go into areas with high overdose rates twice a week to provide information about treatment options. For those who want treatment, team members secure them a spot with a provider, help with insurance or Medicaid authorization and even arrange transportation to the facility.
“We want to make it as easy for folks to access treatment as possible,” said Dr. Geoffrey Neimark, Philadelphia’s chief medical officer for community behavioral health.
Since December, the street teams have helped 461 people get into treatment in this city with about 1.6 million residents. This program is a joint effort with Prevention Point Philadelphia, a treatment provider.
Many of the dozen people on the street teams have struggled with mental health illnesses and addiction and gotten help. Neimark said this is effective because they can speak from personal experience.
Team members also provide information on other topics, including hepatitis B and hepatitis C, a local needle exchange, food and housing.
Neimark thinks other cities struggling with the heroin problem may want to adopt this street-team concept.
“I think it will and can work in other cities,” he said. “A big obstacle of getting into treatment is that first engagement.”
Early drug testing
A New Jersey school district is aiming to curb drug and alcohol use at an early age.
The Lacey Township Board of Education recently voted to expand random drug testing from high school students to seventh- and eighth-graders.
“Research data on early experimentation affirms the age of drug/alcohol use is lowering,” said Craig Wigley, the district’s superintendent. “A random testing program provides additional deterrents to assist young adolescents to say ‘no’ to peer pressure. It also opens the discussion with the family, engaging parents in deeper conversations.”
Wigley recently took over as superintendent of this suburban district with about 4,200 students, but he is supportive of the testing initiative he inherited.
“I love it,” he said. “There’s a lot of support for it locally.”
Wigley acknowledged, though, the reaction has been mixed.
“I would rather you test my kid academically and leave the drug and alcohol testing at home,” one reader commented on NJ.com.
“If you want to continue to hold schools’ feet to the fire for student performance, you sure as heck better give them some power over controlling if a kid is sitting in class high as a kite,” another argued.
The district has been drug testing high school students involved in extracurricular activities and sports for two years. The testing will expand to middle schoolers this fall.
Under the district’s policy, up to 40 students will be tested per month during the school year. Students who test positive may be suspended from participating in extracurricular activities or sports, but face no additional sanctions. They will be offered assistance and counseling, Wigley said.
Students and parents must consent to the testing, and this consent is required for students to participate in sports or extracurricular activities or to get a parking permit, according to the policy.
“Why would any other community not consider such a bold statement and valiant effort to truly address the serious but sometimes unspoken life-threatening issue we all face?” Wigley asked.
Many U.S. cities have paramedics and police carrying the heroin-antidote naloxone, but Baltimore has a loftier goal.
City leaders want to get the lifesaving drug into the medicine cabinet of every resident, alongside bandages and aspirin.
“This is one of the true antidotes in modern medicine,” said Mark O’Brien, Baltimore’s director of opioid overdose prevention and treatment. “A person can be on the floor turning blue and, after naloxone, within minutes their life is saved. They are walking around, a little irritable.”
Since January 2015, the Baltimore Health Department has trained 14,000 of the city’s 620,000 residents how to administer naloxone. Dr. Leana Wen, Baltimore’s health commissioner, wrote a standing order prescription for naloxone that covers every resident.
The health department has distributed nearly 11,000 naloxone kits to residents who have gone through the training and written prescriptions for the drug to others who have been trained and are able to afford the expense of the drug.
The cost of a double dose of the antidote in Baltimore is about $75. Naloxone was recently added to Baltimore’s Medicaid-preferred drug list. As of July 1, those on Medicaid can buy the drug for $1.
Of those who received training, 375 reported to the health department they used naloxone to revive someone who overdosed. O’Brien thinks the actual number likely is higher.
The training was offered to people waiting in line to vote during the primary election, an option that will be repeated in the November election. The city also is providing training in neighborhoods with high overdose rates and at community-based organizations, churches and workplaces.
Baltimore plans to train 1,000 people at 14 locations Wednesday in honor of International Overdose Awareness Day.
The city also is offering online naloxone training at dontdie.org/getcertified. (The training is open to anyone, but the certification is only given to Baltimore residents.) About 900 people have completed online training, passed a quiz and received a naloxone prescription, O’Brien said.
The next step the city plans is to provide naloxone training to anyone who comes into a hospital for an overdose and their family members.
Boston’s safe room for addicts is located on a block dubbed “Methadone Mile.”
Within the block are numerous service providers for the homeless, a drug-treatment facility and an emergency room.
“We can’t walk into our building without running into someone who is under the influence,” said Bhalla, COO of Boston Health Care for the Homeless.
Her agency opened the SPOT three months ago in a former conference room. The room can fit eight to 10 addicts at a time.
The SPOT is voluntary, and those who frequent it can come and go. The nurse on duty hooks them to a monitor, but doesn’t force any medical care on them. The nurse tells them, “We’re just going to keep an eye on you.” A doctor is a phone call away, and an emergency room is across the street.
On-site drug use, however, is prohibited.
Several cities in other countries, including Vancouver in British Columbia and Sydney, have safe injection sites where people can shoot up drugs and then ride out the high while being monitored by medical personnel.
This is currently prohibited in the United States, though several cities are discussing the possibility. A heroin task force in Seattle, for example, recommended earlier this month creating a safe-use site and is exploring the obstacles.
The Boston police have been supportive of the SPOT, with the understanding that on-site drug use isn’t allowed.
Critics of SPOT and the safe-use sites say they enable drug users rather than treating them.
Bhalla said SPOT offers treatment information to those who want it, but many aren’t yet ready.
“Our goal is to keep them safe and inside,” she said.
Bhalla recalled a homeless woman who was brought to SPOT by a friend after she passed out from using drugs. When the woman woke up, she felt the pillow beneath her head and said, “My God, where am I? I’ve not had a pillow for years to sleep on.”
“I think everyone deserves a chance, and there are people out there who need that chance,” Bhalla said
Stephanie Warsmith can be reached at 330-996-3705 or firstname.lastname@example.org. Follow on Twitter: @swarsmithabj and on Facebook: www.facebook.com/swarsmith.