Doctor at opioid ‘safe space:’ Narcan not always needed

By monitoring vitals during drug use, nurses can administer oxygen and IV fluids to keep patients alive

By EMS1 Staff

BOSTON — Drug users who find themselves at the doors of Boston’s Supportive Place for Observation and Treatment, or SPOT, are allowed to ride out their high under medical supervision.

If the patient can speak, a nurse will ask what they took before settling them into one of the facility’s nine armchairs. Over the course of their high, the patient’s vitals are closely monitored using a blood pressure cuff and pulse oximeter.

Some patients are so far gone that they don’t respond to verbal or painful stimulus. While the first instinct is to give them a shot of Narcan, nurse April Donahue says that sometimes, oxygen and IV fluids are all that’s necessary to keep the patients alive.

Patients who slip into “overdose syndrome” — about 75 percent of the visitors at SPOT — may appear to be unconscious, but their vitals are “rock solid.”

“What you see subjectively looking at someone and what their vital signs are don’t always match up,” Donahue told KHN News.

The reason? Many of the SPOT patients report that, in addition to their opioids, they’ll consume a drug cocktail of prescription medications like clonidine, Klonopin and gabapentin to make their high longer and more intense. This means that while their blood pressure may be low enough to leave them unconscious, their breathing is actually normal.

“I’m not sure that we’d have seen that without doing this kind of monitoring,” said Dr. Jessie Gaeta, the chief medical officer for the program. The vital signs they record from the drug cocktail are markedly different from classic opioid signs, even though they both look identical on the surface.

After safely coming down from their highs, each patient is asked to speak with a nurse about seeking treatment for their drug use. While it’s still a work in progress, SPOT staff members can see that they’re doing some good for their patients.

“I think what’s struck me the most is the gratitude — just to get out of that environment, even for a little while, to get off the street and be cared for,” Donahue said. “I mean, so many of our participants don’t have anyone who’s caring for them.”

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