Persisting Gaps in M-OUD Coverage at Post-Discharge Recovery Houses Necessitate our Continued Advocacy

Abstract

Effective treatment of opioid use disorder (OUD) must target both the medical and psychosocial aspects of a patient's condition. This, in turn, requires a collaboration between medical providers and social supports. We would like to illustrate a key difficulty in this collaboration for some patients in our country: many post-discharge recovery houses continue to refuse to allow patients to remain on medication treatment for OUD (M-OUD). This barrier to M-OUD access in recovery houses is a significant obstacle to effective OUD treatment.

Opioid use disorder treatment for people experiencing homelessness: A scoping review

“… Nyamathi et al (2004) Los Angeles, CA Cohort study Women experiencing homelessness Recent substance use treatment was not significantly associated with a motivation to quit for people who used heroin. Patel et al (2020) Nashville, TN Descriptive report Discharged patients with SUDs Of the recovery houses that accepted discharged patients from Vanderbilt Medical Center in 2018, 12.5 % allowed patients to remain on buprenorphine/naloxone, 0 % allowed patients to remain on MMT, and 19 % completely allowed naltrexone maintenance therapy. Reynoso-Vallejo et al (2008) Massachusetts, USA Cohort study Latino men who inject drugs Homelessness was associated with a decreased likelihood of entering methadone maintenance (OR = 0.41, 95 % CI 0.36, 0.47).…”

“…Of the sixty included studies, twenty-seven reported on opioid use treatment access and engagement among PEH ( Amodeo et al, 2004 ; Bachhuber et al, 2015 ; Bauer et al, 2016 ; Corsi et al, 2007 ; Daniulaityte et al, 2019 ; Deck and Carlson, 2004 ; Dunn et al, 2019 ; Englander et al, 2020 ; Eyrich-Garg et al, 2008 ; Hoffman et al, 2019 ; Kelly et al, 2018 ; Krawczyk et al, 2020 ; Krull et al, 2011 ; Lundgren et al, 2003 ; Masson et al, 2002 ; Midboe et al, 2019 ; Nyamathi et al, 2004 ; Patel et al, 2020 ; Reynoso-Vallejo et al, 2008 ; Rivers et al, 2006 ; Robbins et al, 2010 ; Royse et al, 2000 ; Shah et al, 2000 ; Simon et al, 2017 ; Timko et al, 2016 ; Upshur et al, 2018 ; Van Ness et al, 2004 ). While most were conducted among general populations of people who use opioids, five evaluated characteristics of treatment engagement exclusively among homeless-experienced populations ( Bauer et al, 2016 ; Midboe et al, 2019 ; Nyamathi et al, 2004 ; Robbins et al, 2010 ; Upshur et al, 2018 ).…”

“…Several articles specifically analyzed access to and engagement with MOUD treatment among PEH. Four reported potential barriers to MOUD uptake for PEH ( Hoffman et al, 2019 ; Krull et al, 2011 ; Patel et al, 2020 ; Simon et al, 2017 ). Krull et al (2011) found that substance use program directors serving higher percentages of PEH held more negative attitudes towards buprenorphine treatment.…”

“… Krull et al (2011) found that substance use program directors serving higher percentages of PEH held more negative attitudes towards buprenorphine treatment. Relatedly, a significant majority of recovery homes near Nashville were found to bar discharged inpatients from remaining on any MOUD in 2018 ( Patel et al, 2020 ). Moreover, not only were turbulent living conditions described as a significant barrier to recruitment for an XR-NTX clinical trial ( Hoffman et al, 2019 ), but PEH in Seattle were also disproportionately lost to follow-up for buprenorphine treatment after initial engagement but prior to induction ( Simon et al, 2017 ).…”

“…In addition, while buprenorphine and methadone are comparably effective at treating OUD, addressing PEH-related limitations unique to each treatment modality is urgently needed to offset this disparity in accessibility. For example, a buprenorphine prescription requires a secure storage space and may not be permitted in some shelters or recovery residences ( Patel et al, 2020 ), and MMT entails physically burdensome daily dosing at stationary program sites ( Chang, 2017 ). Extended-release (i.e.…”