COVID-19 innovations in medication for addiction treatment at a Skid Row syringe exchange

J Subst Abuse Treat. 2021 Feb;121:108181. doi: 10.1016/j.jsat.2020.108181. Epub 2020 Oct 21.


Syringe exchange patients in Los Angeles' Skid Row endure conditions such as deep poverty, polysubstance use, underlying health problems, and living on the streets or in homeless encampments/shelters that make them uniquely vulnerable to acquiring and dying from COVID-19. In this commentary, we discuss two essential changes that Homeless Health Care Los Angeles (HHCLA) made to modify existing medication for addiction treatment (MAT) services to address the specific treatment needs of this high-risk population during COVID-19. First, HHCLA implemented a novel "telephone booth" model that allowed socially distanced on-site "face-to-face" treatment of syringe exchange patients; this model helped us to overcome the inherent challenges of using traditional telemedicine approaches (e.g., video, mobile telephone) with this disadvantaged patient population. Second, HHCLA transitioned from on-site direct dispensing of MAT medications in our providers' offices to a less contact- and time-intensive "coordinated pharmacy" model that allowed patients the freedom to obtain MAT medications off-site from participating pharmacies. Our data indicate that implementing these COVID-19-related changes effectively maintained patient enrollment and engagement in MAT-illuminating new, potentially effective models for delivering MAT that meet the critical health and safety needs of syringe exchange patients following COVID-19.

Keywords: COVID-19; Homelessness; Medication-assisted treatment; Syringe exchange.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • COVID-19*
  • Homeless Persons*
  • Humans
  • Los Angeles
  • Needle-Exchange Programs*
  • Pharmacies*
  • Substance-Related Disorders / drug therapy*
  • Telemedicine*
  • Vulnerable Populations