Buprenorphine initiation by a street medicine program is associated with reduced opioid-related emergency department utilization among people experiencing homelessness.

Abstract

OBJECTIVES: People experiencing homelessness (PEH) 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 PEH 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 PEH. METHODS: We completed a retrospective, single-center, electronic 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 12 months following buprenorphine initiation, 115 patients had a non-significant decrease in collective, cumulative ED visits compared to the 12 months before (221 visits before versus 191 after). OUD-related visits declined significantly from 79 visits before to 44 visits after (p < 0.05). Overdose-related ED visits decreased non-significantly 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 non-significant reductions in overdose-related and total ED visits. These findings 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 PEH.