Noa Krawczyk1, Megan Buresh2, Michael S Gordon3, Thomas R Blue3, Michael I Fingerhood4, Deborah Agus5. 1. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, USA; Behavioral Health Leadership Institute, 2200 Arden Road, Baltimore, MD, USA. 2. Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD, USA. 3. Friends Research Institute, 1040 Park Ave #103, Baltimore, MD, USA. 4. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, USA; Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD, USA. 5. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, USA; Behavioral Health Leadership Institute, 2200 Arden Road, Baltimore, MD, USA. Electronic address: deborahagus.bhli@gmail.com.
Abstract
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.
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.
Authors: Ingrid A Binswanger; Marc F Stern; Richard A Deyo; Patrick J Heagerty; Allen Cheadle; Joann G Elmore; Thomas D Koepsell Journal: N Engl J Med Date: 2007-01-11 Impact factor: 91.245
Authors: Lynn E Sullivan; Robert D Bruce; David Haltiwanger; Gregory M Lucas; Lois Eldred; Ruth Finkelstein; David A Fiellin Journal: Clin Infect Dis Date: 2006-12-15 Impact factor: 9.079
Authors: Declan T Barry; Brent A Moore; Michael V Pantalon; Marek C Chawarski; Lynn E Sullivan; Patrick G O'Connor; Richard S Schottenfeld; David A Fiellin Journal: J Gen Intern Med Date: 2007-02 Impact factor: 5.128
Authors: Noa Krawczyk; Ramin Mojtabai; Elizabeth A Stuart; Michael Fingerhood; Deborah Agus; B Casey Lyons; Jonathan P Weiner; Brendan Saloner Journal: Addiction Date: 2020-02-24 Impact factor: 6.526
Authors: Raminta Daniulaityte; Ramzi W Nahhas; Sydney Silverstein; Silvia Martins; Angela Zaragoza; Avery Moeller; Robert G Carlson Journal: Drug Alcohol Depend Date: 2019-09-22 Impact factor: 4.492
Authors: Ricky N Bluthenthal; Kelsey Simpson; Rachel Carmen Ceasar; Johnathan Zhao; Lynn Wenger; Alex H Kral Journal: Drug Alcohol Depend Date: 2020-03-18 Impact factor: 4.492
Authors: Sydney M Silverstein; Raminta Daniulaityte; Shannon C Miller; Silvia S Martins; Robert G Carlson Journal: Drug Alcohol Depend Date: 2020-03-16 Impact factor: 4.492
Authors: Christine M Gunn; Ariel Maschke; Miriam Harris; Samantha F Schoenberger; Spoorthi Sampath; Alexander Y Walley; Sarah M Bagley Journal: Addiction Date: 2020-11-26 Impact factor: 6.526
Authors: Sara C Warfield; Robert P Pack; Louisa Degenhardt; Sarah Larney; Chrianna Bharat; Lisham Ashrafioun; Brandon D L Marshall; Robert M Bossarte Journal: J Subst Abuse Treat Date: 2020-11-04
Authors: Amanda Rosecrans; Robert Harris; Ronald E Saxton; Margaret Cotterell; Meredith Zoltick; Catherine Willman; Ingrid Blackwell; Joy Bell; Darryl Hayes; Brian Weir; Susan Sherman; Gregory M Lucas; Adena Greenbaum; Kathleen R Page Journal: J Subst Abuse Treat Date: 2021-06-24