Reducing deaths from overdoses of fentanyl and other opioids requires stepping outside brick-and-mortar health clinics and taking substance use services to the streets, panelists said at AHCJ’s fall summit, “Homelessness and Health Care.”
The day-and-a-half gathering of about 100 researchers, clinicians, activists, journalists and policymakers took place Nov. 2-3 in Oakland, Calif. The local host of the event was California Health Care Foundation; the sponsors were The Commonwealth Fund and the Robert Wood Johnson Foundation.
People who are homeless have disproportionately high rates of death due to opioid overdose, said panel moderator Molly Harbarger, editor of Project Homelessness at The Seattle Times.
“The rates of drug use are highest amongst marginalized people,” said Sean Soth, director of health integration and innovation for Evergreen Treatment Services in Seattle. “When we’re talking about folks who are living homeless, we’re talking about some of the most marginalized populations in our society.”
Mobile health teams allow clinicians to connect with people who would otherwise not travel to a treatment center, but pushing treatment onto people who don’t want it doesn’t work, said Juliana DePietro, overdose prevention manager for Central City Concern in Portland, Ore.
“We can’t expect folks to accept services immediately, and there can’t be preconditions or expectations that they ever will,” she said. Even if someone initially declines services, continued visits can help build trust over time, she said.
For people who do choose treatment for substance use disorder, Treatment in Motion, administered by Evergreen Treatment Services, offers a mobile methadone clinic. Methadone helps people addicted to opioids stop using illegal drugs without experiencing withdrawal. But Treatment in Motion isn’t just about providing medication, Soth said. “We also have case managers, counselors, medical providers, nurses, all as part of that team,” he said.
Reducing overdose deaths goes beyond helping people stop using opioids, panelists said. It also requires offering harm reduction resources, like sterile needles, that make using less dangerous. Providing tools to use illegal drugs more safely doesn’t conflict with efforts to help people stop using them, Soth said. “I personally believe that harm reduction is treatment, and it’s part of the treatment continuum,” he said. “If people are dead, they’re not going to recover.”
Clinicians with Homeless Health Care Los Angeles walk through encampments offering medications that can reduce the risk of death from overdose. In 2006, the group started using naloxone, now a common tool for harm reduction. Naloxone can reverse overdoses, but it can also “pull someone into a withdrawal” said JoAnn Hemstreet, a licensed clinical social worker with Homeless Health Care Los Angeles. “Someone might need to go use again in order to make themselves feel better, which could put them at risk again,” she said.
The teams also use compressed oxygen, which “is much more gentle,” Hemstreet said.
In addition to overdose prevention, homeless people who use opiates need shelter options that don’t require them to be in addiction treatment, Hemstreet said. Motel voucher programs can be especially helpful, she said.
“Once someone has a safe space to rest their head, lock a door and just rest,” their mental health improves, Hemstreet said. “And then that just organically starts to change a lot of other things.”
Jesse Kathan is a reporter for Santa Cruz Local. They are a 2023-25 California Local News Fellow.