Improving equity and access to buprenorphine treatment through telemedicine at syringe services programs

Abstract

Background and aims In the United States, access to buprenorphine remains low and disparities regarding who receives treatment have emerged. Federal laws have regulated buprenorphine delivery, ultimately limiting its implementation more broadly. At the onset of the COVID-19 pandemic, federal agencies acted quickly to remove a legal barrier, effectively allowing people with opioid used disorder (OUD) to initiate buprenorphine treatment via telemedicine. Leveraging this policy shift, a low barrier buprenorphine treatment initiative via telemedicine was started at syringe service programs in California. We assessed early findings from participants reached by this model of treatment. Methods In May 2020, buprenorphine treatment was offered through a virtual platform to SSP participants in California. SSP staff connected interested participants to virtual appointments with medical providers in a private location. During these visits, clinicians conducted clinical assessments for diagnosing participants with OUD and developed an unsupervised home induction plan for individuals who were eligible. Participants were prescribed a 7-day supply of up to 16 mg daily buprenorphine or 16 mg buprenorphine-2 mg naloxone and asked to return the following week if interested in continuing treatment. Results From May 2020 to March 2021, the SSP-buprenorphine virtual care initiative inducted 115 participants onto treatment with 87% of participants inducted on the same day as their referral. Of those inducted, 58% were between the ages of 30 and 49 and 28% were cisgender female. Regarding participants’ method of payment to reimburse buprenorphine costs, 92% of participants were covered by Medicare/Medicaid. Overall, 64% of participants returned for a second buprenorphine prescription refill. Conclusions These early findings suggest that this could be a promising approach to improve equity and access to buprenorphine treatment. We encourage policymakers to continue allowing buprenorphine delivery via telemedicine and researchers to study whether this approach improves equity and access to treatment throughout the United States.

The Role of Context in Integrating Buprenorphine into a Drop-In Center in Kampala, Uganda, Using the Consolidated Framework for Implementation Research

“…Experiences from the US in providing buprenorphine in harm reduction drop-in-centers or mobile health centers show some similarities and differences due to the different contexts [ 53 , 54 , 55 , 56 , 57 ]. PWUD who use NSPs were enthusiastic about having buprenorphine provided in the drop-in centers and pilots of these have shown that providing buprenorphine in DICs is both acceptable and feasible.…”

“…Harm reduction agencies serve a diverse population of out-of-treatment opioid users with a variety of services, including the provision of sterile syringes and HIV/HCV testing. In spite of their large reach to out-of-treatment PWIDs and PWID’s stated preference for receiving buprenorphine in harm reduction agencies, only a few pilot studies have implemented buprenorphine in harm reduction agencies within the US [ 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ], and none, to our knowledge, in low- and middle-income countries (LMICs). Offering buprenorphine in harm reduction settings not only may be more acceptable to PWID, but it can be offered to both those who are living with HIV and those who are not yet infected.…”

Pandemic telehealth flexibilities for buprenorphine treatment: A synthesis of evidence and policy implications for expanding opioid use disorder care in the U.S

“…38 Multiple studies analyzed patient data from 'low-threshold' buprenorphine treatment programs, which aim to eliminate as many barriers as possible to accessing care. 43 Many such programs offered telehealth programs out of mobile vans, 37,44 SSPs, 40,42,45 and COVID-19 isolation sites 39 to provide continued access to buprenorphine initiation and continuation during the pandemic. 38,46 These programs reported high acceptability and feasibility of patient engagement exclusively via telehealth.…”

Adaptation of the Tele-Harm Reduction intervention to promote initiation and retention in buprenorphine treatment among people who inject drugs: a retrospective cohort study

“…Although only 20% of SSPs nationally provided one or more forms of MOUD treatment on-site in 2019 [ 29 ], there has been a significant increase in telehealth-based buprenorphine programs at SSPs in recent years [ 12 ]. However, there remains limited evidence on effective telehealth-based interventions to promote buprenorphine initiation and retention among PWID within an SSP setting [ 30 , 31 ].…”