Opioid Epidemic: Special Considerations for PLWHA and Those at Risk
Joe Wright, MD, Bio
Boston Health Care for the Homeless Program
Medical Director for Office-Based Addiction Treatment Program
I am a physician who responds to epidemics of early death. I spent most of the 1990s confronting the AIDS epidemic in San Francisco. This experience eventually led me to pre-medical classes, a year in an NIH immunology lab with theorist and T-cell expert Polly Matzinger, and to Harvard Medical School. Starting while working in the lab, and continuing through medical school, I was a frequent commentator for the radio program All Things Considered. In medical school, I worked for a summer with South Africa’s Treatment Action Campaign, a pioneering AIDS activist group, and wrote an honors thesis on the early history of activism by and for people with AIDS.
I trained in internal medicine, in a primary care track, at the Beth Israel Deaconess Medical Center, where I was honored for my commitment to humanism. In my first year as an attending in the clinic where I had trained, I also was the sole fellow in HIV and primary care in a fellowship I co-designed, funded by HRSA as well as project funds from a PEPFAR-funded project in Vietnam.
In my four and a half years in an academic primary care clinic, I became part of a core group of faculty teaching the ambulatory care curriculum to medicine residents; my focus was on HIV and behavioral health topics.
In 2015, in order to put greater focus on responding to the growing opioid epidemic in Boston, I joined Boston Health Care for the Homeless Program (BHCHP) where I soon became the medical director for BHCHP’s Office-Based Addiction Treatment program, leading a rapid expansion of access to care and a new focus on low-barrier buprenorphine prescribing. In addition to supervising a team of nurses, therapists, recovery coaches, and case managers, I care for a small primary care panel with a nearly exclusive focus on two groups: people living with HIV (all of whom have substance use disorders, some active and some in remission), and people at high risk for drug overdose. I am supervising a SAMHSA-funded pilot program to provide buprenorphine-naloxone to incarcerated individuals; and am a clinician for a mobile van providing low-barrier buprenorphine-naloxone and other harm reduction services to people at high risk for harm from drug use.
Participants should by the end of the talk be able to:
- Describe and promote HIV prevention technologies and techniques for people who inject drugs
- Compare and contrast different medications used for opioid use disorder
- Differentiate clinical policies which prioritize readiness to change vs prioritizing risk for death
- Prepare for the impact of methamphetamine use in New England among people who currently use opioids
A variety of the listed populations will be discussed at this event.
- Gay, lesbian, bisexual or transgender
- Incarcerated or recently released
A variety of the listed topics will be discussed at this event.
- Behavioral Prevention
- HIV Transmission Risk Assessment
- Pre-exposure prophylaxis (PrEP)
- Acute HIV
- Linkage to Care
- Medication-assisted therapy for substance use disorders (i.e. buprenorphine, methadone, and/or naltrexone)
- Mental health disorders
- Pain management
- Substance use disorders
- Case management
- Community linkages
- Coordination of care
- Funding or resource allocation