Connecting Care

Access to safe and reliable housing has an enormous influence on a person’s health outcomes and ability to meet their needs. However, structural inequities and discriminatory practices associated with substance use can prevent or deter many people who use drugs from participating in formal housing programs and compound the lack of affordable housing. 

This month, the BMC team asks Dr. Karim Khan about his experience practicing street medicine and providing care at a local harm reduction housing program. In this episode, you learn about Karim's belief in this model of care for meeting people’s diverse needs; the challenges in and successes of this approach to care; and the multitude of considerations that providers and people navigate when providing and accessing harm reduction housing services.

“I think that public health departments and cities and policy makers are really central to this and really instrumental and can change an approach from basically throwing people in jail and throwing law enforcement at homeless tent encampments to refocusing and trying to get people into treatment, into housing, into health care, and provide folks with their basic needs.” -Dr. Karim Khan

A collision of drug criminalization, inadequate and discriminatory housing policies, and insufficient mental health and substance use care services has fostered open drug scene encampments in communities around the world. Open drug scene encampments concentrate social, medical, and public health challenges that include HIV transmission and opioid overdose. This month, the Boston Medical Center team talked with Dr. Jessie Gaeta, a national expert who has been a primary care and addiction medicine physician at the Boston Healthcare for the Homeless Program since 2002. Their conversation touches on some of the factors that contribute to the establishment and growth of encampments; how best to talk and ask about housing status; and helpful and harmful approaches to open drug scene encampments and the people who live there. 

Throughout our Connecting Care podcast series, we’ve focused on different communities of adults with HIV and/or substance use disorders (SUDs). One population we haven’t yet covered is the adolescent and young adult population. Treating youth with SUDs requires additional expertise and insight into their physical, emotional, mental, and social development. This month, Dr. Jessica Taylor talked with Dr. Sarah Bagley - a researcher and the Medical Director of the Catalyst Clinic at Boston Medical Center. During the conversation, Jessica and Sarah talk about the substance use risks for youth; developing an SUD; overdose prevention; special legal considerations of treating youth; and how their needs differ from those of older adults.

Methadone can be a life-changing treatment option for people with opioid use disorder. However, a number of federal and state regulations and logistical requirements can inhibit a person’s ability to start and/or maintain methadone treatment. There are regulation exceptions that can help people get the essential care they need, and some providers are using these exceptions to initiate methadone while still complying with the regulatory boundaries.

This month’s podcast covers current regulations directing how and when people with opioid use disorder can access methadone treatment; what clinics can do to deliver life-saving care while complying with regulations; and how supporting clients on methadone can also enhance their ability to maintain antiretroviral therapy or practice HIV prevention behaviors. 

The Americans with Disabilities Act (ADA) is a federal civil rights statute that was enacted in 1990 to protect individuals with disabilities from discrimination by employers, state and local government, and public-serving entities. The rights of people with HIV and opioid use disorder are protected under the ADA, yet these rights are frequently violated. This month, the Boston Medical Center team talks with Greg Dorchak, Assistant U.S. Attorney in the Civil Rights Unit at the U.S. Attorney’s Office in Massachusetts, who has led the charge in protecting people with opioid use disorder. During the conversation they cover the different ways providers, facilities, and systems violate the ADA; how these violations differ from other types of discriminatory policies and practices; and how civil rights statutes can be useful tools in improving care systems for people with HIV and opioid use disorder. 

Building on last month’s episode about providing HIV and substance use care for people who are incarcerated, this month the Boston Medical Center team talks with Dr. Ricky Cruz, a primary care physician and addiction specialist who frequently provides care for people transitioning out of incarceration. During the conversation, Dr. Cruz describes how race shapes the systems and policies around opioid use disorder; shares the challenges of providing care for people recently released from jail or prison; offers advice on how physicians can talk to their patients about a history of incarceration; and highlights experiences that inspire him in his work.

Navigating the HIV and substance use systems of care presents a number of unique challenges, many of which can become more complex depending on a person’s housing, employment, mental health, or economic situation. One system that immediately complicates a person’s access to HIV and/or substance use care is the jail or prison system. This month, the BMC team talks with Dr. Alysse Wurcel, a doctor who provides HIV and substance use care in Massachusetts jails. Among a robust breadth of topics, they cover the complex realities of providing HIV and substance use care for people who are incarcerated; how these complexities are perpetuated and affect a person’s access to care both in and out of the jail and prison system; and how HIV and substance use care in the jail and prison system is slowly starting to change.

In response to an increased risk of overdose, several communities in the U.S. are considering establishing spaces for people to use substances safely. These spaces have been referred to as Supervised Injection Facilities, safe consumption spaces, harm reduction spaces, or overdose prevention sites. Over the past few years, these spaces have garnered more support for their proven ability to reduce overdoses and meet other medical and psychosocial needs for people who use them. This month, our hosts talk through the benefits that these spaces have on HIV prevention, linkage to care and needed support services, fatal overdose prevention, and what it takes to get a sanctioned overdose prevention space in the U.S.