Background and Objectives
Adults experiencing homelessness with opioid use disorder (OUD) utilize buprenorphine (BUP), a first‐line medication for OUD, at very low rates. Innovative and tailored approaches are needed to reduce barriers to treatment and increase utilization of BUP in this population. This study describes a pilot Mobile Community‐based Access Team (M‐CAT) that used mobile technology and FaceTime in addition to existing community‐based case management programs to provide BUP treatment for veterans with OUD experiencing homelessness who had difficulties engaging in the regular BUP clinic.
Methods
We conducted a retrospective chart review of veterans enrolled in M‐CAT or the usual BUP clinic between January 2015 and December 2017 (N = 36). We abstracted demographic, medical, substance use, prescription, health care utilization, and drug use data from medical records.
Results
Twelve veterans were enrolled in M‐CAT and 24 were enrolled in BUP clinic. Mean retention in treatment was 19.2 months (standard deviation [SD] = 10.2) in M‐CAT and 36 months (SD = 27.6) in BUP clinic. At the endpoint, 66.7% (n = 8) in M‐CAT and 100% (n = 24) in BUP clinic remained on BUP.
Discussion and Conclusion
M‐CAT is an innovative and tailored pilot project that successfully integrated specific OUD medication treatment into existing case management programs for veterans experiencing homelessness using mobile technology and Facetime. M‐CAT can potentially increase utilization of BUP for OUD among high‐risk population of veterans experiencing homelessness who are otherwise not engaged in treatment.
Scientific Significance
Integrating telemedicine, BUP treatment, and community‐based case management to treat OUD among veterans experiencing homelessness is feasible with high treatment retention. (Am J Addict 2020;29:485–491)
Training peer specialists in MI is feasible and may lead to some change in practices, but comprehensive training and ongoing supervision is needed to incur and sustain changes. Guidance and assessment of how peer specialists share their lived experiences with fellow veterans may be needed to capitalize on their unique experiences and skill sets. (PsycINFO Database Record
Research evidence suggests that a large number of individuals with substance misuse problems also have accompanying psychopathology. Some of those individuals diagnosed with schizophrenia may warrant a dual-diagnosis. The clinical area of psychiatric 'dual diagnosis' -that is, serious mental illness associated with substance misuse -is often linked to the 'revolving door' admissions of individuals with this complex comorbidity picture. Often, there is limited sharing of information and cooperation between statutory agencies with reference to this highly vulnerable client group. The shortfall in appropriate clinical response to this client group has been highlighted by previous researchers. This article looks at the role of the specialist dual-diagnosis worker in North Wales and how the appointee to this role has been able to facilitate the seamless transition of these individuals through the 'system' of mental health care.
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