Meeting the Broader Health Needs of People Who Use Drugs

Meeting the broader health needs of people who use drugs means delivering primary care alongside substance use services, because the same people who need treatment for opioid use disorder also need care for chronic disease, infections, wounds, reproductive health, and vaccines. A low-barrier mobile model does this by bringing an integrated team to familiar locations on a predictable schedule, offering substance use treatment and general medical care in the same visit, and using each contact to build trust and close gaps. The model works because it treats a person as a whole patient rather than a single diagnosis, and because it reaches people who face travel, cost, and stigma at fixed clinics.

The unmet need is measurable in the infections that follow drug use. Concurrent hepatitis C and opioid use disorder treatment for people who inject drugs is feasible and effective, which shows that combining care is not only possible but works. Programs that build this way, through a primary care satellite clinic network connected to substance use services, meet people where they are.

Why do people who use drugs have unmet primary care needs?

People who use drugs have unmet primary care needs because the barriers that keep them from substance use treatment also keep them from routine medical care. Long travel, wait times, cost, and stigma add up, and many people avoid clinics until a problem becomes urgent. The result is care that arrives late, in emergency settings, for conditions that were manageable earlier.

The infection burden shows the cost of these gaps. Over 2,500 new HIV infections occur each year among people who inject drugs, and hepatitis C rises steeply with time injecting. HCV antibody prevalence climbs from 2.9% in the first year of injecting to 59.7% at eight years or more. Each year without accessible testing and care lets these conditions advance. A behavioral health satellite clinic network that includes medical services closes some of that distance.

What health needs go beyond substance use treatment?

The needs go well beyond substance use treatment and cover most of what any primary care patient requires. People who use drugs live with chronic conditions like diabetes and hypertension, they face infections including HIV and hepatitis C, they develop wounds and skin and soft-tissue infections, and they need reproductive health care and vaccines.

Wounds are a clear example. Among people who use drugs, wound infection is common due to poor living conditions, limited health-care access, and inadequate hygiene. Infections are another: hepatitis C prevalence reaches 59.7% among people who have injected for eight years or more. The range of need includes:

• Chronic disease management, such as diabetes and high blood pressure
• Infectious disease testing and treatment, including HIV and hepatitis C
• Wound and skin and soft-tissue infection care
• Reproductive and sexual health services
• Vaccines and preventive screening

A program that offers only substance use treatment leaves these needs to other systems that people often cannot reach.

Why deliver primary care alongside substance use services?

Deliver primary care alongside substance use services because doing so is both effective and efficient, and because it reflects how people actually experience their health. Combining care is feasible: concurrent hepatitis C and opioid use disorder treatment is feasible and effective for people who inject drugs. When someone is already engaged for one need, addressing another in the same visit removes a referral that might never be completed.

There is also a bridging effect worth building on. Syringe services programs bridge people to HIV and hepatitis C testing and treatment and to medications for opioid use disorder. The same logic applies to a mobile program that pairs medical care with substance use services: each service becomes a doorway to the others. Designing that flow well takes planning, which is where planning and staffing support helps a program integrate services rather than stack them.

How does a low-barrier mobile model work?

A low-barrier mobile model works by removing the obstacles that keep people from care and by bringing an integrated team to places people already are. Low-barrier means few requirements to walk in, care offered without judgment, and services combined so a person does not have to travel between them.

Core features

1. A predictable route and schedule, so people know when and where the unit returns.
2. Integrated staffing that can address substance use and general medical needs in one visit.
3. On-unit testing and treatment for common infections, plus wound care and preventive services.
4. Warm connections to specialty and hospital care, built before they are needed.
5. Care delivered without judgment, which is what earns the return visit.

Continuity holds the model together. Because trust and follow-up depend on the same team returning, staff the program with people hired for the mobile unit rather than rotating fixed-site clinicians onto it. Rotating breaks continuity and makes the mobile program the first thing cut when a fixed site loses a clinician. A primary care satellite clinic network built on dedicated staff keeps the schedule and the relationships intact.

How does a substance use program become a front door to health care?

A substance use program becomes a front door when it uses each contact to offer more than one kind of care. People who come for medications for opioid use disorder or harm reduction supplies are already engaged, and a program that also offers testing, wound care, chronic disease management, and vaccines turns that engagement into comprehensive care.

The evidence for this pattern comes from harm reduction. Syringe services programs bridge people to broader services, including HIV and HCV testing and treatment and MOUD, which shows that a trusted point of contact can carry someone into wider care. A mobile substance use program can do the same when it is staffed to handle broader needs and connected to a behavioral health satellite clinic network. The first visit answers one need; the relationship answers many.

Frequently asked questions

What primary care do people who use drugs need?

They need the same care as other patients, including chronic disease management, infectious disease testing and treatment, wound care, reproductive and sexual health services, and vaccines. Infections are a particular concern, with hepatitis C prevalence reaching 59.7% among people who have injected for eight years or more. A program that offers only substance use treatment leaves these needs to systems many people cannot reach.

Can you treat hepatitis C and opioid use disorder at the same time?

Yes. Concurrent hepatitis C and opioid use disorder treatment for people who inject drugs is feasible and effective. Treating both together removes a referral that might never be completed and addresses two needs in one engagement.

Why deliver primary care through a mobile program?

A mobile program reaches people who face travel, cost, and stigma at fixed clinics, and it combines services so a person does not have to move between them. Because syringe services programs already bridge people to HIV and HCV testing and to medications for opioid use disorder, a mobile model that adds primary care extends the same trusted point of contact into broader care.

How does a substance use program lead to broader health care?

It uses each visit to offer more than one kind of care. Someone engaged for medications for opioid use disorder or harm reduction can also receive testing, wound care, chronic disease management, and vaccines. Trust built over repeat contact turns a single service into a doorway to comprehensive care.

Who should staff an integrated mobile program?

Staff it with people hired for the mobile unit. Dedicated staff keep the schedule reliable and build the trust that makes integrated care work, and they protect the program from being cut when a fixed site loses a clinician. Rotating fixed-site clinicians onto the unit breaks the continuity the model depends on.

If you want to meet the broader health needs of people who use drugs by combining primary care with substance use services, MMM can help you plan and staff an integrated mobile program. Explore how a primary care satellite clinic network delivers whole-person care where people already are.