Redefining low-threshold buprenorphine access in an integrated mobile clinic program: Factors associated with treatment retention
Harris, Robert; Stracker, Norberth; Rice, Molly; St Clair, Anne; Page, Kathleen; Rosecrans, Amanda
Why this matters
Programs running low-threshold buprenorphine face pressure to cap doses and test frequently, and this study bears on both. Among 341 Baltimore patients, 90-day retention was 60 percent, and patients prescribed 28 to 32 mg daily were 80 percent less likely to discontinue than those on 16 mg or less.
Abstract
The Spot mobile clinic provides low-threshold buprenorphine integrated with clinical and social services in Baltimore City, MD. The 2021 practice modifications included extended prescriptions, reduced toxicology testing frequency, extended stabilization timelines, higher maximum doses (up to 32 mg daily), and telemedicine access. The retrospective cohort study examined 341 patients from September 2021 through October 2023. Retention in care at 90 days was 60%. Patients prescribed 28-32 mg daily buprenorphine were 80% less likely to discontinue treatment compared to those receiving 16 mg or less. Engagement in wound care or hepatitis C treatment correlated with improved retention. Individuals experiencing homelessness remained engaged at rates comparable to stably housed patients.