Most doctors and providers have found it very hard to keep up with the ‘cocktail’ of drugs being used illicitly by those on the streets, and that’s been particularly hard for prescribers in the Mass/Cass area of the South End – where drug use often is one or two steps ahead of those who study it.
That has changed a great deal with the introduction of SPOT at Boston Healthcare for the Homeless, Dr. Jessica Gaeta told the South End Forum’s Opiate Working Group on Tuesday, May 22. SPOT is a pilot program that is two years old and monitors those who are too sedated to remain on the street.
Gaeta said being able to monitor those who are at the epicenter of the opiate crisis on Mass/Cass has helped them to learn what drugs are being used, and most importantly, what prescription drugs are being misused.
“We have learned a great deal about the cocktail of drugs used here and patterns of that cocktail,” she told the Working Group in making a presentation on SPOT’s two-year anniversary.
While opiates are the focal point of the crisis on Mass/Cass, many times users will combine an opiate with another drug to enhance the effects. In times past on Mass/Cass, an opiate was used in combination with Klonopin. However, that has morphed and changed, and Gaeta said some of the drugs now being used heavily would surprise most doctors who prescribe them.
“The one I’m most worried about right now is Clonodine, which is used for high blood pressure and psychotic moods,” she said. “Most prescribers are not aware at all that’s being used. SPOT has helped us to highlight that. I’m still finding a lot of doctors who had no idea it could be misused, but we’re trying to let them all know.”
The drug has a sedative effect, and when combined with an opiate, can really help users to “check out,” as they often describe it. The drug is typically used for high blood pressure, for cancer pain and for some ADHD treatments.
Two other drugs Gaeta said they learned about were ‘Johnnie’s,’ or Neurontin – which is typically prescribed for nerve pain like shingles. The second is Phenergan, which is a drug used to treat nausea or allergies. Phenergan was a complete surprise to the medical community, she said.
“What the patients in SPOT are teaching us is these other meds can exacerbate the sedating effect,” she said. “If your goal is to check out, and the opiate isn’t doing it anymore, these meds will do it. That has impacted our prescribing, but there is still a lot of room to grow.”