Boston Overdose Linkage to Treatment Study (BOLTS)

Client: Boston Public Health Commission
Topic Area: Behavioral health and substance use
Service: Applied Research

With funding from RIZE Massachusetts, ICH led a qualitative research study with collaborators from the Boston Public Health Commission, Boston Medical Center, and BU School of Public Health. The study, called the Boston Overdose Linkage to Treatment Study (BOLTS), examined racial/ethnic inequities in access to treatment for people who recently experienced an opioid overdose in Boston. The study design and data collection were guided by input from a wide range of stakeholders, including front line service providers and people in recovery. BOLTS data collection is complete and included in-depth interviews with 59 Boston residents who have experienced an opioid overdose, of which 18 were Black and 23 were Latinx. The study also included interviews with 28 key informants including policymakers, healthcare providers, harm reductionists, first responders, and community leaders. Interviews explored experiences and service-seeking behaviors before and after overdose, and barriers and facilitators to accessing treatment and harm reduction services, including barriers related to stigma and racism. Interviews also explored the impact of COVID-19 on service-seeking and access. The ultimate goal is to develop and disseminate community-informed recommendations for how Boston systems can improve access to opioid use disorder treatment and harm reduction services, particularly for Black and Latinx community members.

Following Boston’s Declaration of Addiction and Homelessness as a Public Health Emergency (October 19, 2021), the BOLTS team conducted a sub-analysis¬† focused on elevating the perspectives of 29 participants who were living on the street in the Mass. and Cass area at the time of their interview. The report has been released and is available here.

BOLTS findings related to housing and substance use treatment have been published in the International Journal of Drug Policy. The manuscript, entitled “Perspectives and recommendations of opioid overdose survivors experiencing unsheltered homelessness on housing, overdose, and substance use treatment in Boston, MA”, is available here.

Related Resources

Elevating the voices of overdose survivors living on the street: MassCass-sub-analysis-slides.pdf
Workforce considerations for improving racial equity in substance use disorder treatment: Workforce-considerations-for-improving-racial-equity-in-substance-use-disorder-treatment.pdf
Reasons for initiating and continuing drug use: findings from qualitative interviews with opioid overdose survivors: Reasons-for-initiating-HoyosCespedes-OMalley-BOLTS-2022-APHA.pdf
Triple stigma: Experiences of racism and addiction-and homelessness-related stigmas among overdose survivors in Boston: Triple-Stigma-Clarke-BOLTS-2022-APHA.pdf
Factors influencing readiness to engage in substance use treatment among opioid overdose survivors in Boston, MA: Readiness-Nurani-BOLTS-2022-APHA.pdf
Missed opportunities following overdose among people who use substances in Boston: Missed-Opportunities-Nurani-BOLTS-2022-AMERSA.pdf
The intersections of mental health with substance use and related barriers to treatment among opioid overdose survivors in Boston, MA: Paradise-AMERSA-2023.pdf