Expanding buprenorphine treatment to people experiencing homelessness through a mobile, multidisciplinary program in an urban, underserved setting

• Published in: Journal of substance abuse treatment 2021-08, Vol.127, p.108342-108342, Article 108342
• Main Authors: O'Gurek, David T., Jatres, Jillian, Gibbs, Jonetta, Latham, Ian, Udegbe, Byron, Reeves, Kathleen
• Format: Article
• Language: English
• Subjects: Access; Addictions; Adverse childhood experiences; Buprenorphine; Case management; Childhood experiences; Childhood factors; Chronic illnesses; Counseling; Counseling services; Homeless people; Homelessness; Inequality; Medical records; Medicine; Opioid use disorder; Opioids; Patients; Substance abuse treatment; Trauma; Underserved populations; Urban areas
• ISSN: 0740-5472; 1873-6483
• DOI: 10.1016/j.jsat.2021.108342

Inequities in access to buprenorphine treatment remain despite measures to increase access to treatment. “Begin the Turn,” a low-barrier, multidisciplinary mobile care unit with access to outreach services, counseling, case management, and buprenorphine treatment addresses these disparities in an urban setting. Retrospective medical record review of patients during the initial 6 months of operation abstracted patient demographics and clinical data, including 10 categories of adverse childhood experiences (ACEs) using a total number of ACEs (ACE score) and measuring scores greater than or equal to 4 given higher risk of chronic disease states at this level. The study collected data in electronic data capture tools. The study assessed retention rates at 1, 3, and 5 months. Among the 147 individuals who received care, the mean age was 39.6 years and median onset of opioid use was 21 years of age. Among study participants, 67.3% (n = 99) reported IV use, 91.9% (n = 135) reported previous experiences with addiction treatment, and 49.7% (n = 73) had previously suffered an overdose. Adverse Childhood Experiences surveys demonstrated a mean score of 4.6 (n = 141), with 63.1% (n = 89) having a score of 4 or greater. The percentages of patients retained in care at 1, 3, and 5 months were 61.2%, 36.6%, and 27.6%, respectively. The program serves a population with high rates of trauma and overdose. The program can serve as a model for treatment for this population. •Higher rates of substance use disorders and substance-related mortality exists among individuals struggling with homelessness•Adverse childhood experiences are common among persons with opioid use disorder.•A mobile multidisciplinary unit is a feasible service model to provide buprenorphine to people experiencing homelessness.