The intersections of mental health with substance use and related barriers to treatment among opioid overdose survivors in Boston, MA

Type: Oral Presentation
Date: November 2023


Ranjani K. Paradise, Angela R. Bazzi, Jaylen Clarke, Jeff Desmarais, Dan Dooley, Andres Hoyos-Cespedes, Simeon D. Kimmel, Alykhan Nurani, Shannon O’Malley, Sunday Taylor. “The intersections of mental health with substance use and related barriers to treatment among opioid overdose survivors in Boston, MA”. Presented at the 2023 AMERSA Conference (oral presentation). Washington, DC.


Background: There are significant gaps in receipt of treatment among people who experience opioid overdoses in Boston, MA. Co-occurring mental health (MH) and substance use disorders (SUD) are common, and there is a need for more research on how this affects the experiences and decisions of overdose survivors. 

Objective: To understand how MH impacts access to treatment and service-seeking decisions among Boston residents who have recently survived an opioid overdose 

Methods: The Boston Overdose Linkage to Treatment Study (BOLTS) is a qualitative examination of post-overdose treatment access in Boston. Between 2020-2021, we conducted semi-structured qualitative interviews with 59 Boston residents who had survived an opioid overdose, and 28 key informants with relevant professional or community leadership roles. We used iterative team codebook development and Framework Analysis methods to organize data and synthesize themes related to MH. 

Results: Among overdose survivor participants, 70% identified as Black or Hispanic/Latinx; 71% identified as male; 75% were experiencing homelessness at the time of the interview; and 75% reported their MH status as Poor or Fair. About one-third of participants talked about receiving MH care or having MH concerns or diagnoses, and some described strong emotional reactions following their overdose, including shame, depression, and anger. For some survivors, homelessness and/or COVID-19 caused or exacerbated mental distress, and participants described using drugs to cope.  Participants also described how MH conditions presented a barrier to SUD treatment and vice versa, often in relation to medication access (e.g., “If I could get my [mental health] medication […] I’ll be in the program so fast. In a sober house and working.”). Key informants emphasized the importance of treating MH and SUD together, and described how current systems have limited capacity to effectively treat co-occurring disorders and how people with mental illness can be barred from or kicked out of SUD treatment programs.  

Conclusions: Mental health and substance use disorders are intertwined, compound one another, and can create barriers to treatment and recovery. Findings suggest a need for MH/emotional support during overdose response, as well as more integrated programming that can provide comprehensive and coordinated MH and SUD treatment services.  

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