Office-Based Addiction Treatment Retention and Mortality Among People Experiencing Homelessness

Fine, Danielle R.; Lewis, Elizabeth; Weinstock, Karen; Wright, J. D.; Gaeta, Jessie M.; Baggett, Travis P.

doi:10.1001/jamanetworkopen.2021.0477

Cited by 23 publications

(24 citation statements)

References 28 publications

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“…During the years under study, BHCHP provided substance use disorder treatment primarily in office-based settings. 39 To better reach this population, addiction and harm-reduction services may need to be provided in nontraditional settings, such as mobile addiction vans, shelters, supportive housing, and other places where homeless-experienced individuals with substance use disorders congregate. 39 , 40 Furthermore, given the high burden of comorbid mental health disease in this population, 41 expanding access to behavioral health services may improve outcomes.…”

Section: Discussionmentioning

confidence: 99%

Drug Overdose Mortality Among People Experiencing Homelessness, 2003 to 2018

et al. 2022

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IMPORTANCEDespite high rates of drug overdose death among people experiencing homelessness, patterns in drug overdose mortality, including the types of drugs implicated in overdose deaths, remain understudied in this population. OBJECTIVE To describe the patterns in drug overdose mortality among a large cohort of people experiencing homelessness in Boston vs the general adult population of Massachusetts and to evaluate the types of drugs implicated in overdose deaths over a continuous 16-year period of observation.

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Section: Discussionmentioning

confidence: 99%

Drug Overdose Mortality Among People Experiencing Homelessness, 2003 to 2018

et al. 2022

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“…Greater supports are urgently needed for individuals experiencing homelessness given substantially higher rates and larger increases in ED visits for drug overdoses among this population before and during the re‐opening period of the COVID‐19 pandemic. Programs and services such as supervised consumption facilities, low‐barrier opioid agonist therapies, and tailored office‐based addiction treatments have been shown to reduce drug‐related morbidity and mortality in the homeless population [ 22 , 41 , 42 ]. The high dual burden of substance use and mental health disorders in this population also necessitates more comprehensive interventions including on‐site and trauma‐informed case management and psychiatric services [ 21 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

Drug Overdoses During the COVID‐19 Pandemic Among Recently Homeless Individuals

Liu

Richard²,

Campitelli³

et al. 2022

Addiction

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Aims To examine how weekly rates of emergency department (ED) visits for drug overdoses changed among individuals with a recent history of homelessness (IRHH) and their housed counterparts during the pre‐pandemic, peak, and re‐opening periods of the first wave of the COVID‐19 pandemic, using corresponding weeks in 2019 as a historical control. Design Population‐based retrospective cohort study conducted between September 30, 2018 and September 26, 2020. Setting Ontario, Canada. Participants A total of 38 617 IRHH, 15 022 369 housed individuals, and 186 858 low‐income housed individuals matched on age, sex, rurality, and comorbidity burden. Measurements ED visits for drug overdoses of accidental and undetermined intent. Findings Average rates of ED visits for drug overdoses between January and September 2020 were higher among IRHH compared with housed individuals (rate ratio [RR], 148.0; 95% CI, 142.7–153.5) and matched housed individuals (RR, 22.3; 95% CI, 20.7–24.0). ED visits for drug overdoses decreased across all groups by ~20% during the peak period (March 17 to June 16, 2020) compared with corresponding weeks in 2019. During the re‐opening period (June 17 to September 26, 2020), rates of ED visits for drug overdoses were significantly higher among IRHH (RR, 1.56; 95% CI, 1.44–1.69), matched housed individuals (RR, 1.25; 95% CI, 1.08–1.46), and housed individuals relative to equivalent weeks in 2019 (RR, 1.07; 95% CI, 1.02–1.11). The relative increase in drug overdose ED visits among IRHH was larger compared with both matched housed individuals (P = 0.01 for interaction between group and year) and housed individuals (P < 0.001) during this period. Conclusions Recently homeless individuals in Ontario, Canada experienced disproportionate increases in ED visits for drug overdoses during the re‐opening period of the COVID‐19 pandemic compared with housed people.

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“…(18,19) Similarly, other programs in low-threshold settings have used nurse care managers, in which nurses play central roles in completing initial assessments, counseling participants about initiation procedures, conducting follow-up visits, obtaining and discussing urine toxicology results, and discussing dose changes. (20,21) Maximizing collaboration between providers and other SSP staff members is particularly important for low-threshold settings.…”

Section: Discussionmentioning

confidence: 99%

Implementation of Buprenorphine Services in NYC Syringe Services Programs: a qualitative process evaluation

Jakubowski

Rath

Harocopos

et al. 2021

Preprint

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Background Syringe services programs (SSPs) hold promise for providing buprenorphine treatment access to people with opioid use disorder (OUD) who are reluctant to seek care elsewhere. In 2017, the New York City Department of Health and Mental Hygiene (DOHMH) provided funding and technical assistance to nine SSPs to develop “low-threshold” buprenorphine services as part of a multipronged initiative to lower opioid-related overdose rates. The aims of this study were to 1) Describe characteristics of SSP-based buprenorphine services; and 2) Identify barriers to and facilitators of implementing SSP-based buprenorphine services. Methods We conducted 26 semi-structured qualitative interviews from April 2019 - November 2019 at eight SSPs in NYC that received funding and technical assistance from DOHMH. Interviews were conducted with three categories of staff: leadership (8 interviews); staff (11), and providers (6). We used thematic analysis to identify themes within pre-identified domains: program characteristics and barriers and facilitators to program implementation. We make recommendations for implementation based on our findings. Results Programs differed in their stage of development, location of services provided, and provider type, availability, and practices. Barriers to providing buprenorphine services at SSPs included gaps in staff knowledge and comfort communicating with participants about buprenorphine, difficulty hiring providers, managing tension between harm reduction and traditional OUD treatment philosophies, and financial constraints. Challenges also arose from serving a population with unmet psychosocial needs. Implementation facilitators included technical assistance from DOHMH, designated buprenorphine coordinators, offering other supportive services to participants, and telehealth to bridge gaps in provider availability. Key recommendations include: 1) health departments should provide support for SSPs in training staff, building health service infrastructure and developing policies and procedures, 2) SSPs should designate a buprenorphine coordinator and ensure regular training on buprenorphine for their frontline staff, and 3) providers should be selected or supported to use a harm reduction approach to buprenorphine treatment. Conclusions Despite encountering challenges, eight SSPs implemented buprenorphine services outside of conventional OUD treatment settings. Our findings have implications for health departments, SSPs, and other community organizations implementing buprenorphine services. Expansion of low-threshold buprenorphine services is a promising strategy to address the opioid overdose epidemic.

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Office-Based Addiction Treatment Retention and Mortality Among People Experiencing Homelessness

Cited by 23 publications

References 28 publications

Drug Overdose Mortality Among People Experiencing Homelessness, 2003 to 2018

Drug Overdose Mortality Among People Experiencing Homelessness, 2003 to 2018

Drug Overdoses During the COVID‐19 Pandemic Among Recently Homeless Individuals

Implementation of Buprenorphine Services in NYC Syringe Services Programs: a qualitative process evaluation

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