Faculty Editor: Professor Jeffrey DaCosta

In response to the increasing incidence of opioid-related deaths in Massachusetts since 2014, Boston organizations are taking initiative with the introduction of progressive methods for overdose prevention and harm reduction.

In 2018, there were 181 opioid-related overdose deaths reported in the city of Boston alone.  Beginning in the early 1990s, opioid-related deaths were endemic as prescription rates surged in the United States.  This frequency has been growing steadily since a second wave of the epidemic appeared once again in 2010 (Number of Opioid-Related Overdose Deaths, 2019). With more stringent policies related to the prescription of opioids, attention turned to heroin and synthetic opioids like fentanyl. These synthetic varieties have proven even more deadly, as some forms of fentanyl are estimated to be over 10000x more potent than prescribed versions of opioids like morphine (O’Donnell, 2017).  With fentanyl being pressed into counterfeit pills or mixed into other substances, the product has become highly accessible, especially to vulnerable populations like Boston’s homeless community.

As legislative action has been slow to create change in many affected communities, some organizations have been taking matters into their own hands. The Boston Health Care for the Homeless Program has guided a progressive campaign since 2016 with the opening of their Supportive Place for Observation and Treatment (SPOT) program, which provides treatment for individuals who would otherwise face overdosing on the street. The program has reported >7000 visits in Boston within the first two years opening and of these visitors, hundreds qualified for treatment of overdose symptoms (Gaeta, 2016).

Another tactic, employed by the Kraft Center of Community Health, is focused on mobilizing care in the Greater Boston areas adversely affected by the opioid epidemic including Downtown Boston, Fenway and Roxbury. The CareZone van is inspired by the same notion that in order to combat the epidemic, treatment must be just as accessible as the drugs themselves. The van connects vulnerable populations with care through addiction services, harm reduction, and prevention (Briefing On CareZONE Program, 2019).

These programs hope to counteract the disconnect between Boston’s homeless population and health services. As Dr. Jessie Gaeta of Boston Health Care for the Homeless Program said in reference to the SPOT program, “The stigma associated with homelessness and addiction presents a constant barrier to engage in services. The hill our fragile patients must climb to be successful in recovery is very, very steep” (Harrington, 2017).

Although these programs have seen success in Boston, many still question the cultural impact and ethicality of creating environments that support those using illegal substances. One contentious solution has been safe injection sites (SIS) which provided medically supervised spaces for illicit drug use with the intention of preventing overdose and public nuisance. U.S Attorney for the District of Massachusetts Andrew Lelling issued a statement last July about proposed injection sites in the state: “I cannot envision any scenario in which sites that normalize intravenous use of heroin and fentanyl would be off limits to federal law enforcement efforts” (Lelling, 2018).  However, proponents for safe injection sites in Massachusetts argue that current measures are not enough to counter the impact of synthetic opioids.

Many of Boston’s medical providers assert that these new progressive methods are necessary in order to see a decline in opioid-related deaths.  Inadequate governmental action surrounding theses issues has placed the responsibility of care on the shoulders of individual Boston organizations.  Undeniably, they have been successful: no other program thus far has matched the accessibility of independent initiatives like CareZone and SPOT in the areas of treatment and preventative care.


  1. Gaeta, J., Bock, B., & Takach, M. (2016, August 31). Providing A Safe Space And Medical Monitoring To Prevent Overdose Deaths. Health Affairs. doi: 10.1377/hblog20160831.056280
  2. Harrington, D. (2017, March 20). SPOT is Saving Lives. Boston Health Care for the Homeless Program.
  3. Lelling, A. (2018). Statement from U.S. Attorney Andrew Lelling Regarding Proposed Injection Sites. Statement from U.S. Attorney Andrew Lelling Regarding Proposed Injection Sites. Department of Justice U.S. Attorney’s Office District of Massachusetts.
  4. Massachusetts Department of Public Health. (2019). Briefing On CareZONE Program. Kraft Center for Community Health.
  5. Massachusetts Department of Public Health. (2019). Number of Opioid-Related Overdose Deaths, All Intents by City/Town 2014-2018. Number of Opioid-Related Overdose Deaths, All Intents by City/Town 2014-2018
  6. O’Donnell, J. K., Halpin, J., Mattson, C. L., Goldberger, B. A., & Gladden, R. M. (2017). Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700 – 10 States, July-December 2016. MMWR. Morbidity and mortality weekly report, 66(43), 1197–1202. doi:10.15585/mmwr.mm6643e1

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