Opioid use disorder (OUD) is a serious health condition that is effectively treated with buprenorphine. However, only a minority of people with OUD are able to access buprenorphine. Many access points for buprenorphine have high barriers for initiation and retention. Health care and drug treatment systems have not been able to provide services to all — let alone the majority — who need it, and many with OUD report extreme challenges starting and staying on buprenorphine in those care settings. The study’s investigators describe the design and protocol for a study of a rapid access buprenorphine program model in six Washington State communities at existing sites serving people who are unhoused and/or using syringe services programs. This study aimed to test the effectiveness of a Community-Based Medication-First Program model.
Methods
The study’s investigators are conducting a hybrid effectiveness-implementation study of a rapid access buprenorphine model of care staffed by prescribers, nurse care managers, and care navigators. The Community-Based Medication-First model of care was designed as a 6-month, induction-stabilization-transition model to be delivered between 2019 and 2022. Effectiveness outcomes will be tested by comparing the intervention group with a comparison group derived from state records of people who had OUD. Construction of the comparison group will align characteristics such as geography, demographics, historical rates of arrests, OUD medication, and health care utilization, using restriction and propensity score techniques. Outcomes will include arrests, emergency and inpatient health care utilization, and mortality rates. Descriptive statistics for buprenorphine utilization patterns during the intervention period will be documented with the prescription drug monitoring program.
Conclusion
Results of this study will help determine the effectiveness of the intervention. Given the serious population-level and individual-level impacts of OUD, it is essential that services be readily available to all people with OUD, including those who cannot readily access care due to their circumstances, capacity, preferences, and related systems barriers.
Existing gaps in receipt of MOUD and other treatments for OUD may be due in part to the numerous barriers individuals with OUD experience when seeking care in traditional healthcare settings, such as lack of prescribers in their community, lack of transportation, and costs. Individuals with OUD also experience stigma when presenting to hospitals and primary care. Stigma can make individuals less likely to seek care in the future. Thus, providing person-centered care in trusted settings should help to expand access to and retention in MOUD, allow for opportunities to treat OUD sooner and more consistently, and consequently reduce opioid overdose across the United States.
Population of Focus: Individuals with Opioid Use Disorder
Links to Resources:
- Read the full study
- Learn more about Opioid Use Disorder
- Read the 2021 National Survey of Drug Use and Health results
- Read the article, Therapeutic Approaches to Opioid Use Disorder: What is the Current Standard of Care?
Date: 2023