TY - JOUR
T1 - Expanding low-threshold buprenorphine to justice-involved individuals through mobile treatment
T2 - Addressing a critical care gap
AU - Krawczyk, Noa
AU - Buresh, Megan
AU - Gordon, Michael S.
AU - Blue, Thomas R.
AU - Fingerhood, Michael I.
AU - Agus, Deborah
N1 - Funding Information:
PCARE van operations were supported by grants from The Jacob and Hilda Blaustein Foundation , The Krieger Fund , The Open Society Institute – Baltimore , The Leonard and Helen R. Stulman Foundation , and the Abell Foundation . Noa Krawczyk was also supported by the National Institute On Drug Abuse of the National Institutes of Health under Award Number F31DA047021 .
Funding Information:
The authors would like to thank all PCARE staff members as well as Commissioner Michael Resnick of the Baltimore Division of Pretrial Detention and Services for their continued dedication to the PCARE model and its mission. PCARE van operations were supported by grants from The Jacob and Hilda Blaustein Foundation, The Krieger Fund, The Open Society Institute – Baltimore, The Leonard and Helen R. Stulman Foundation, and the Abell Foundation. Noa Krawczyk was also supported by the National Institute On Drug Abuse of the National Institutes of Health under Award Number F31DA047021.
Publisher Copyright:
© 2019
PY - 2019/8
Y1 - 2019/8
N2 - Background: Opioid use disorder (OUD)is highly prevalent among justice-involved individuals. While risk for overdose and other adverse consequences of opioid use are heightened among this population, most justice-involved individuals and other high-risk groups experience multiple barriers to engagement in opioid agonist treatment. Methods: This paper describes the development of Project Connections at Re-Entry (PCARE), a low-threshold buprenorphine treatment program that engages vulnerable patients in care through a mobile van parked directly outside the Baltimore City Jail. Patients are referred by jail staff or can walk in from the street. The clinical team includes an experienced primary care physician who prescribes buprenorphine, a nurse, and a peer recovery coach. The team initiates treatment for those with OUD and refers those with other needs to appropriate providers. Once stabilized, patients are transitioned to longer-term treatment programs or primary care for buprenorphine maintenance. This paper describes the process of developing this program, patient characteristics and initial outcomes for the first year of the program, and implications for public health practice. Results: From November 15, 2017 through November 30, 2018, 220 people inquired about treatment services and completed an intake interview, and 190 began treatment with a buprenorphine/naloxone prescription. Those who initiated buprenorphine were primarily male (80.1%), African American (85.1%), had a mean age of 44.1 (SD = 12.2), and a mean of 24.0 (SD = 13.6)years of opioid use. The majority of patients (94.4%)had previous criminal justice involvement, were unemployed (72.9%)and were unstably housed (70.8%). Over a third (32.1%)of patients had previously overdosed. Of those who began treatment, 67.9% returned for a second visit or more, and 31.6% percent were still involved in treatment after 30 days. Of those who initiated care, 20.5% have been transferred to continue buprenorphine treatment at a partnering site. Conclusions: The PCARE program illustrates the potential for low-threshold buprenorphine treatment to engage populations who are justice-involved and largely disconnected from care. While more work is needed to improve treatment retention among vulnerable patients and engaging persons in care directly after release from detention, offering on-demand, flexible and de-stigmatizing treatment may serve as a first point to connect high-risk populations with the healthcare system and interventions that reduce risk for overdose and related harms.
AB - Background: Opioid use disorder (OUD)is highly prevalent among justice-involved individuals. While risk for overdose and other adverse consequences of opioid use are heightened among this population, most justice-involved individuals and other high-risk groups experience multiple barriers to engagement in opioid agonist treatment. Methods: This paper describes the development of Project Connections at Re-Entry (PCARE), a low-threshold buprenorphine treatment program that engages vulnerable patients in care through a mobile van parked directly outside the Baltimore City Jail. Patients are referred by jail staff or can walk in from the street. The clinical team includes an experienced primary care physician who prescribes buprenorphine, a nurse, and a peer recovery coach. The team initiates treatment for those with OUD and refers those with other needs to appropriate providers. Once stabilized, patients are transitioned to longer-term treatment programs or primary care for buprenorphine maintenance. This paper describes the process of developing this program, patient characteristics and initial outcomes for the first year of the program, and implications for public health practice. Results: From November 15, 2017 through November 30, 2018, 220 people inquired about treatment services and completed an intake interview, and 190 began treatment with a buprenorphine/naloxone prescription. Those who initiated buprenorphine were primarily male (80.1%), African American (85.1%), had a mean age of 44.1 (SD = 12.2), and a mean of 24.0 (SD = 13.6)years of opioid use. The majority of patients (94.4%)had previous criminal justice involvement, were unemployed (72.9%)and were unstably housed (70.8%). Over a third (32.1%)of patients had previously overdosed. Of those who began treatment, 67.9% returned for a second visit or more, and 31.6% percent were still involved in treatment after 30 days. Of those who initiated care, 20.5% have been transferred to continue buprenorphine treatment at a partnering site. Conclusions: The PCARE program illustrates the potential for low-threshold buprenorphine treatment to engage populations who are justice-involved and largely disconnected from care. While more work is needed to improve treatment retention among vulnerable patients and engaging persons in care directly after release from detention, offering on-demand, flexible and de-stigmatizing treatment may serve as a first point to connect high-risk populations with the healthcare system and interventions that reduce risk for overdose and related harms.
KW - Buprenorphine
KW - Criminal justice
KW - Harm reduction
KW - Low threshold
KW - Opioid use disorder
KW - Vulnerable populations
UR - http://www.scopus.com/inward/record.url?scp=85065549834&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85065549834&partnerID=8YFLogxK
U2 - 10.1016/j.jsat.2019.05.002
DO - 10.1016/j.jsat.2019.05.002
M3 - Article
C2 - 31229187
AN - SCOPUS:85065549834
SN - 0740-5472
VL - 103
SP - 1
EP - 8
JO - Journal of Substance Abuse Treatment
JF - Journal of Substance Abuse Treatment
ER -