A mobile addiction service for community-based overdose prevention

Abstract

Mainstays of opioid overdose prevention include medications for opioid use disorder (e.g., methadone or buprenorphine) and naloxone distribution. Inadequate access to buprenorphine limits its uptake, especially in communities of color, and people with opioid use disorders encounter multiple barriers to obtaining necessary medications including insurance, transportation, and consistent availability of telephones. UMass Memorial Medical Center and our community partners sought to alleviate these barriers to treatment through the deployment of a mobile addiction service, called the Road to Care. Using this approach, multidisciplinary and interprofessional providers deliver holistic addiction care by centering our patients’ needs with respect to scheduling, location, and convenience. This program also extends access to buprenorphine and naloxone among people experiencing homelessness. Additional systemic and individualized barriers encountered are identified, as well as potential solutions for future mobile addiction service utilization. Over a two-year period, we have cared for 1,121 individuals who have accessed our mobile addiction service in over 4,567 encounters. We prescribed buprenorphine/naloxone (Suboxone®) to 330 individuals (29.4% of all patients). We have distributed nearly 250 naloxone kits directly on-site or and more than 300 kits via prescriptions to local pharmacies. To date, 74 naloxone rescue attempts have been reported back to us. We have demonstrated that a community-based mobile addiction service, anchored within a major medical center, can provide high-volume and high-quality overdose prevention services that facilitate engagement with additional treatment. Our experience is described as a case study below.

The Role of Street Medicine and Mobile Clinics for Persons Experiencing Homelessness: A Scoping Review

“…In California, 25 street medicine programs provided behavioral health services, serving 9682 unique patients in 2021 alone [ 30 ]. An individual mobile clinic in Massachusetts (UMass Memorial Medical Center) has cared for 1121 individuals, with over 4567 encounters [ 31 ]. Programs such as these play a role in the diagnosis of mental health disorders, continuing treatment for conditions, the distribution of psychiatric medications, substance use disorder treatment, medication management for assisted treatment (MAT) with buprenorphine, naloxone distribution, and counseling services [ 30 , 31 , 32 , 33 , 34 , 35 ].…”

“…Several programs provided substance use disorder treatment, including MAT [ 31 , 32 , 36 ]. Notably, buprenorphine prescription was reported by programs [ 31 , 32 , 36 ].…”

“…Several programs provided substance use disorder treatment, including MAT [ 31 , 32 , 36 ]. Notably, buprenorphine prescription was reported by programs [ 31 , 32 , 36 ]. In a retrospective chart review, a buprenorphine program administered by a street medicine team successfully engaged patients and decreased the barriers to access [ 32 ].…”

“…In a retrospective chart review, a buprenorphine program administered by a street medicine team successfully engaged patients and decreased the barriers to access [ 32 ]. The UMass Memorial Medical Center mobile clinic reported prescribing buprenorphine to 330 individuals, and their naloxone distribution reported 74 rescue attempts [ 31 ]. In fact, naloxone distribution was reported by multiple organizations [ 31 , 37 ].…”

“…The UMass Memorial Medical Center mobile clinic reported prescribing buprenorphine to 330 individuals, and their naloxone distribution reported 74 rescue attempts [ 31 ]. In fact, naloxone distribution was reported by multiple organizations [ 31 , 37 ]. One street medicine team also reported providing and evaluating education on how to use naloxone [ 37 ].…”