Engaging an unstably housed population with low-barrier buprenorphine treatment at a syringe services program: Lessons learned from Seattle, Washington

Abstract

Background: Clinic-imposed barriers can impede access to medication for opioid use disorder (MOUD). We evaluated a low-barrier buprenorphine program that is co-located with a syringe services program (SSP) in Seattle, Washington, USA. Methods: We analyzed medical record data corresponding to patients who enrolled into the buprenorphine program in its first year of operation. We used descriptive statistics and tests of association to longitudinally evaluate retention, cumulative number of days buprenorphine was prescribed, and toxicology results. Results: Demand for buprenorphine among SSP clients initially surpassed programmatic capacity. Of the 146 enrolled patients, the majority (82%) were unstably housed. Patients were prescribed buprenorphine for a median of 47 days (interquartile range [IQR] = 8–147) in the 180 days following enrollment. Between the first and sixth visits, the percentage of toxicology tests that was positive for buprenorphine significantly increased (33% to 96%, P < .0001) and other opioids significantly decreased (90% to 41%, P < .0001) and plateaued thereafter. Toxicology test results for stimulants, benzodiazepines, and barbiturates did not significantly change. Conclusions: SSP served as an effective point of entry for a low-barrier MOUD program. A large proportion of enrolled patients demonstrated sustained retention and reductions in opioid use, despite housing instability and polysubstance use.

Keywords:

• Buprenorphine
• harm reduction
• syringe services programs
• polysubstance use
• unstable housing

Acknowledgments

Cindy Lee, Glenn McWilson, Bhavna Narsai, and Jodi Warren were instrumental in generating the data sets utilized for this evaluation. SPP staff (Angelina Benson, Trevor Evans, Ronnie Holt, Kevin Kogin, Mel LaBelle, and Joe Tinsley) documented their conversations with SSP clients about Bupe Pathways, which allowed for trends in demand to be assessed.

Author contributions

The authors of the manuscript are a mix of frontline staff (J.B., W.D., D.M., M.H., T.O.), program managers (S.H., B.F.), and researchers (J.H., C.B., J.D., S.G., M.S.). The frontline staff created the data that formed the basis of the evaluation. Frontline staff and program managers contributed to sections of the manuscript relating to programmatic design, philosophy, and implementation. The researchers designed the evaluation strategy. The first author (J.H.) implemented the analysis. All authors contributed to the interpretation of results, drafting and revision of the manuscript text, and final review.

Notes

i Unpublished. These estimates were prepared by the Washington State Health Care Authority for Washington State Accountable Communities of Health in March 2017.

ii The one death that occurred within 180 days of enrollment was not attributed to drug overdose.

iii Unpublished.