Buprenorphine Initiation by a Street Medicine Program is Associated with Reduced Opioid-Related Emergency Department Utilization Among People Experiencing Homelessness
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Objectives
People experiencing homelessness are at increased risk for addiction, with substance use both a cause and response to homelessness. Street Medicine (SM) programs provide decentralized, low-barrier care to people experiencing homelessness and have begun to offer medication for opioid use disorder (MOUD). Literature on MOUD initiation via SM is nascent. This study investigated the impact of SM-initiated MOUD on ED utilization among people experiencing homelessness in a mid-sized US city.
Methods
We completed a retrospective medical record review of patients initiated on buprenorphine in 2023 by the SM program. Age, gender, prescription refill status, and emergency department (ED) utilization were recorded. Outcome measures were the number of overdose-related, opioid use disorder (OUD)-related, and all-cause ED visits in the 12 months before versus 12 months after buprenorphine initiation.
Results
In the year prior to buprenorphine initiation, 115 patients had 221 cumulative ED visits, 79 of which were OUD-related. In the year following initiation, cumulative ED visits declined to 191, of which 44 were related to OUD (p<0.05). Overdose-related ED visits decreased from 26 to 13. In terms of prescription renewal, 44% of subjects renewed, 13% via SM and 31% via another provider.
Conclusions
Buprenorphine initiation by a SM program was associated with a significant decline in OUD-related ED visits and insignificant reductions in overdose-related and total ED visits. These conclusions support SM-initiated buprenorphine as a strategy for reducing opioid-related ED utilization while encouraging sustained engagement in care. SM programs represent promising avenues to initiate buprenorphine and reduce OUD-related morbidity in the unhoused population.
