Connecting Care 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.