Objectives: Buprenorphine treatment significantly reduces morbidity and mortality for people with opioid use disorder. Fear of precipitated withdrawal remains a barrier to starting buprenorphine for patients who use synthetic opioids, particularly fentanyl. We aim to evaluate the development and implementation of a buprenorphine low dose overlap initiation (LDOI) protocol in an urban public health community pharmacy. Methods: We performed a retrospective chart review of patients with nonprescribed fentanyl use (N = 27) to examine clinical outcomes of a buprenorphine LDOI schedule, named the Howard Street Method, dispensed from a community pharmacy in San Francisco from January to December 2020. Results: Twenty-seven patients were prescribed the Howard Street Method. Twenty-six patients picked up the prescription and 14 completed the protocol. Of those who completed the protocol, 11 (79%) reported no symptoms of withdrawal and 3 (21%) reported mild symptoms. Four patients (29%) reported cessation of full opioid agonist use and 10 (71%) reported reduction in their use by the end of the protocol. At 30 days, 12 patients (86%) were retained in care and 10 (71%) continued buprenorphine. At 180 days, 6 patients (43%) were retained in care and 2 (14%) were still receiving buprenorphine treatment. Conclusions: We found that a LDOI blister-pack protocol based at a community pharmacy was a viable intervention for starting buprenorphine treatment and a promising alternative method for buprenorphine initiation in an underresourced, safety-net population of people using fentanyl.
Objectives: In the setting of a 50% increase in opioid overdose deaths, the coronavirus disease 2019 crisis opened housing opportunities in the form of Shelter in Place (SIP) hotels to homeless San Francisco residents. Many who entered SIP hotels had opioid use disorder. In fall 2020, Community Behavioral Health Services Pharmacy partnered with SIP hotel medical staff to launch a pilot project, where on-site SIP medical providers prescribed buprenorphine (BUP) and clinical pharmacists hand-delivered BUP to SIP residents to increase BUP initiation and engagement. Methods: A retrospective chart review of 3 patients living in SIP hotels starting BUP to demonstrate the feasibility of a SIP hotel BUP delivery program.Results: In all 3 cases, patients were able to start and continue BUP with on-site medical staff visits and delivery of medications by pharmacists. Each case highlights different barriers that were overcome by this system. Conclusions: Our findings suggest that this system of onsite medical care with pharmacist delivery is possible and has the potential to allow for greater outreach and increased ease of obtaining medications for patients.
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