BOSTON — The leading cause of death among homeless people in Boston has changed. It used to be HIV, but that’s declined due to better treatment and prevention efforts. That’s the good news. The bad news is that drug overdoses are now more responsible than any other cause for the deaths of men and women living on Boston’s streets.
WBUR’s All Things Considered host Sacha Pfeiffer spoke about this shift with Dr. Travis Baggett, the lead author of a new study by Massachusetts General Hospital and Boston Health Care for the Homeless that documented this changing trend.
Travis Baggett: What was so disturbing about our study findings was the magnitude of the problem. The rate of drug overdose death among homeless people in Boston was about 20 times higher than what we see in the general population of the state. One in three deaths among people less than 45 years old was due to overdose. And so while this has been a problem across the board for everybody, it’s been a particularly devastating problem for homeless people.
Sacha Pfeiffer: And your study found that the vast majority of those overdoses among homeless adults, more than 80 percent, are caused by opioids. Would you remind us what falls in that drug category?
That’s correct. Opioid is an umbrella term that refers to prescription painkillers like hydrocodone, oxycodone, codeine, morphine as well as a medication called methadone, and heroin.
Many homeless people in Boston, thanks to programs like yours — Boston Health Care for the Homeless — have access to substance abuse counseling and mental health services, but overdoses continue. So what is missing in the system if this continues to happen?
There are two answers to that question. First is that even though we have what I think is a fantastic program that does wrap around behavioral health services with other aspects of care, there’s still a need for even more of that. And I think that points toward, broadly, a need for increased funding directed toward mental health and substance abuse problems in this and other populations. And I think that the cornerstone of any approach to reducing overdose deaths among homeless people is to begin by first recognizing that addiction is a chronic illness that requires compassionate care and not judgment. Everything else follows from there.
As you mentioned, many of these are prescription drugs. Where are homeless people getting access to these? Are they getting them from doctors?
Well, at some point these medications have to come from a doctor. Whether they were coming from the doctors in our program or somewhere else is something that we couldn’t tell based on our data. But in many cases, often these things are passed along from person to person before it gets to a person who ultimately consumes it.
So how should a doctor who treats homeless patients take this into account? That if you have a homeless patient who may have mental illness, who may have a substance abuse problem already, and who may be more likely to abuse the drug you give them or to give it to someone else — how does a doctor consider that before writing a prescription?
This is one of the challenges that we face every day. We have a vulnerable population that has a great need, and one of those needs is that our patients have a lot of chronic pain in addition to all of the other issues that they bring to the table. And this has been a springboard for us to really thoughtfully examine how we approach the management of chronic pain.
What does the Boston medical community plan to do specifically in response to these findings?
— One is that we’re going to increase the distribution of Narcan, which is a drug that can be a life-saving antidote in the setting of opioid overdose.
— Second, we’re looking at ways that we can expand our Suboxone, or Buprenorphine, treatment program, which is a treatment for opioid dependence.
— Third, we’ve used this as an opportunity to examine our own opioid prescribing practices and whether there’s an opportunity to use more comprehensive treatment strategies that rely less on medications, and more on therapies and other things that go beyond pills.