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

Abstract

Introduction

In 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).

Objectives

To evaluate the impact of an innovative pharmacist-led pilot service in providing more equitable and accessible BUP treatment to individuals residing in PSH.

Methods

This 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.

Results

Thirty-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).

Conclusion

A 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.