Triple Threat: Response to the Crises of COVID-19, Homelessness, and Opioid Use Disorder With a Novel Approach to Buprenorphine Delivery: A Case Series

Samuel, Lysa; Caygill-Walsh, Rory; Suen, Leslie W.; Mohebbi, Sheila; Geier, Michelle

doi:10.1097/adm.0000000000000989

Cited by 3 publications

(5 citation statements)

References 15 publications

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“…While previous studies have detailed the successes of low-barrier BUP treatment models in engaging PEH, there is no literature on the effects of such models in PSH. 6,16 Given the high rate of overdose deaths occurring in those with fixed addresses and the increased risk for overdose associated with residential relocation, it is imperative that we explore methods to support individuals transitioning to living in PSH. 9,10 In this pre-and-post interventional pilot study, we found that a pharmacist-led intervention was effective in increasing BUP treatment adherence for individuals living in PSH with OUD.…”

Section: Discussionmentioning

confidence: 99%

“…This is the first study to evaluate the impact of a pharmacist‐led outreach service in increasing BUP access for individuals residing in PSH. While previous studies have detailed the successes of low‐barrier BUP treatment models in engaging PEH, there is no literature on the effects of such models in PSH 6,16 . Given the high rate of overdose deaths occurring in those with fixed addresses and the increased risk for overdose associated with residential relocation, it is imperative that we explore methods to support individuals transitioning to living in PSH 9,10 .…”

Section: Discussionmentioning

confidence: 99%

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Evaluating a novel pharmacist‐led buprenorphine outreach service for treatment of opioid use disorder in individuals residing in supportive housing

Ly,

Peterson,

Geier

2024

J Am Coll Clin Pharm

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IntroductionIn San Francisco, there were 638 accidental overdose deaths involving opioids in 2022 alone, with opioid overdoses occurring at a disproportionate rate in the Black population and in those with fixed housing. Past studies attempting to address such disparities suggest that low‐barrier buprenorphine (BUP) treatment models may improve patient engagement and retention in care for marginalized populations. While such models have been studied among persons experiencing houselessness (PEH), less is known about the effects of such treatment models among individuals residing in permanent supportive housing (PSH).ObjectivesTo evaluate the impact of an innovative pharmacist‐led pilot service in providing more equitable and accessible BUP treatment to individuals residing in PSH.MethodsThis was a 3‐month pre‐and‐post interventional pilot study to evaluate the impact of a novel pharmacist‐led outreach service on patient engagement in treatment with BUP for Opioid Use Disorder (OUD). The primary endpoint was treatment adherence, defined as 80% prescription days covered (PDC) in a 3‐month period. Secondary endpoints included change in PDC, linkage to office‐based care, incidence of overdose, emergency department (ED) presentations, and hospital admissions, as well as successful BUP initiation.ResultsThirty‐eight patients were enrolled in the pharmacist‐led BUP outreach service. Among the 38 patients, the mean age was 46 years and 16 (42%) were Black. Engagement with the service was associated with increased treatment adherence, with 14 patients (37%) achieving ≥80% PDC post‐intervention compared to 1 patient (3%) pre‐intervention (p = 0.0009).ConclusionA pharmacist‐led BUP outreach service was found to increase treatment adherence in individuals residing in PSH over 3 months. Low‐barrier BUP treatment models, such as that evaluated in this study, may help provide more equitable and accessible care that is critical in addressing the socioeconomic and racial disparities in opioid overdose deaths.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluating a novel pharmacist‐led buprenorphine outreach service for treatment of opioid use disorder in individuals residing in supportive housing

Ly,

Peterson,

Geier

2024

J Am Coll Clin Pharm

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“…OBIC began conducting virtual visits and SIP and SMSH clinicians engaged patients directly at the hotels and shelters to increase access to buprenorphine and curb morbidity and mortality from fentanyl-related overdoses. Buprenorphine was also delivered to some patients residing in the SIP hotels 29 . Directly observed dosing and/or urine drug screening (UDS) was less emphasized during our study period to reduce COVID-19 exposure.…”

Section: Methodsmentioning

confidence: 99%

“…Buprenorphine was also delivered to some patients residing in the SIP hotels. 29 Directly observed dosing and/or urine drug screening (UDS) was less emphasized during our study period to reduce COVID-19 exposure.…”

Section: Covid-19 Impactmentioning

confidence: 99%

The Howard Street Method: A Community Pharmacy-led Low Dose Overlap Buprenorphine Initiation Protocol for Individuals Using Fentanyl

Noel

Abbs²,

Suen³

et al. 2023

J Addict Med

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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.

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“…The pandemic changed patterns of substance use, disrupting the drug supply and access to medications for opiate use disorder (MOUD) in many states and hindering practices of harm reduction (such as not using alone) [24,25]. The SIP initiative similarly altered the settings in which substance use occurs but quickly fostered an innovative approach to MOUD via buprenorphine delivery [26]. Further, many of SF's methadone clinics were able to provide more take-home doses than prior to COVID.…”

Section: Substance Use Patternsmentioning

confidence: 99%

Care and Complexity in Emergency Housing: an Examination of the COVID-19 Shelter-in-Place (SIP) Hotel Program to House People Experiencing Homelessness in San Francisco

et al. 2023

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In this study, we consider the patient, provider, and public health repercussions of San Francisco’s (SF) COVID-related response to homelessness using tourist hotels to house people experiencing homelessness (PEH). We describe the demographics, medical comorbidities, and healthcare utilization patterns of a subset of PEH who accessed the shelter-in-place (SIP) hotel sites during the 2020–2021 pandemic. We focus on how SIP hotels impacted connection to outpatient care and higher-cost emergency utilization. Our mixed methods study integrates qualitative and quantitative data to consider the impact of this temporary housing initiative among a medically complex cohort in a time of increased morbidity and mortality related to substance use. We found that temporary SIP housing increased outpatient care and reduced higher-cost hospital utilization. Our results can inform the future design and implementation of integrated supportive housing models to reduce mortality and promote wellness for PEH.

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Triple Threat: Response to the Crises of COVID-19, Homelessness, and Opioid Use Disorder With a Novel Approach to Buprenorphine Delivery: A Case Series

Cited by 3 publications

References 15 publications

Evaluating a novel pharmacist‐led buprenorphine outreach service for treatment of opioid use disorder in individuals residing in supportive housing

Evaluating a novel pharmacist‐led buprenorphine outreach service for treatment of opioid use disorder in individuals residing in supportive housing

The Howard Street Method: A Community Pharmacy-led Low Dose Overlap Buprenorphine Initiation Protocol for Individuals Using Fentanyl

Care and Complexity in Emergency Housing: an Examination of the COVID-19 Shelter-in-Place (SIP) Hotel Program to House People Experiencing Homelessness in San Francisco

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