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Supportive Place for Observation and Treatment (SPOT)

A drop-in facility in Boston, MA that provides observation and referral to treatment for those at risk for an overdose after using drugs

SPOT was developed by the Boston Health Care for the Homeless Program (BHCHP) and opened in April 2016. It is a one-room observation center equipped with reclining chairs and staffed by health professionals. People walk in on their own or sometimes are assisted by friends or outreach workers. Drug use is not allowed in the facility.

The goals of SPOT are to prevent overdose, connect people to treatment, and decrease stigma in the community. The services offered include:

  • Medical monitoring
  • Treatment for overdose (oxygen, IV fluids, naloxone)
  • Counseling about safer injection techniques
  • Connection to primary care, behavioral health services, and addictions treatment
  • Naloxone rescue kit distribution

SPOT is staffed by a registered nurse specializing in addiction, a harm reduction specialist or case manager who builds relationships and links people to treatment, peers who are in recovery and offer support, and a rapid response clinician (medical doctor/nurse practitioner/physician assistant) is available in an emergency.

SPOT is open Monday through Friday 8:30am-5pm. Initial funding for the facility came from Blue Cross Blue Shield of Massachusetts Foundation and private sources. SPOT now has the ability to bill Medicaid fee-for-service for medically necessary encounters. The biggest strengths of SPOT are its ability to divert patients from emergency departments, prevent overdoses, and refer patients to treatment. In addition to reducing public health risks, these outcomes can also be linked to local cost savings.

More information on the program can be found in presentations here and here. 

There were an estimated 987 emergency department diversions and 24% of patients were directly referred to addiction treatment.

Continuum of Care
Harm Reduction
Type of Evidence
Report with evaluation
Response Approach
Outreach
Overdose prevention
Safe Injection Site
Peer-reviewed Article
Providing A Safe Space And Medical Monitoring To Prevent Overdose Deaths
Related Resources
A Review of the Impact of Safe Injection Sites as an Effective Harm Reduction Strategy
SAMHSA Opioid Overdose Prevention Toolkit
Guidelines for Medication for Addiction Treatment for Opioid Use Disorder within the Emergency Department
A Systematic Review of Harm Reduction Strategies
Evidence-Based Strategies for Preventing Opioid Overdose: What’s Working in the United States
The Fentanyl Epidemic: State Initiatives to Reduce Overdose Deaths
Routes of Non-Traditional Entry into Buprenorphine Treatment Programs

Evidence of Program Effectiveness

In terms of patient profile, those who visit SPOT are largely male, chronic IV drug users, and homeless. SPOT was strategically placed in downtown Boston right next to a large population experience homelessness. People do not travel far to visit; most of their patients come from the neighborhood. By April 2018, SPOT had two-year follow up data to share with the public. Over its first two years, 839 people made a total of 7,139 visits; 34% of patients identified as women; staff administered naloxone 47 times and oxygen 488 times; there were an estimated 987 emergency department diversions; 24% of patients were directly referred to addiction treatment; and 22% were directly connected to medical and/or behavioral health care (findings can be found here).