Access challenges to opioid use disorder treatment among individuals experiencing homelessness: Voices from the streets

Michael Hsu; Olivia S Jung; Li Ting Kwan; Oluwole Jegede; Bianca Martin; Aniket Malhotra; Joji Suzuki

doi:10.1016/j.josat.2023.209216

Access challenges to opioid use disorder treatment among individuals experiencing homelessness: Voices from the streets

J Subst Use Addict Treat. 2024 Feb:157:209216. doi: 10.1016/j.josat.2023.209216. Epub 2023 Nov 18.

Authors

Michael Hsu¹, Olivia S Jung², Li Ting Kwan³, Oluwole Jegede⁴, Bianca Martin⁵, Aniket Malhotra⁶, Joji Suzuki⁵

Affiliations

¹ Department of Psychiatry, Greater Los Angeles VA Medical Center, Los Angeles, CA, USA. Electronic address: michael.hsu@va.gov.
² Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California, USA.
³ Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
⁴ Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
⁵ Division of Addiction Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.
⁶ Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA.

PMID: 37981243
DOI: 10.1016/j.josat.2023.209216

Abstract

Background: Achieving equitable access to medications for opioid use disorder (MOUD) such as buprenorphine is a pressing issue. Evidence suggests disparities in MOUD access based on race and socioeconomic status, further exacerbated by the COVID-19 pandemic. However, the drivers behind this access gap remain poorly understood. This study explores barriers to treatment access among individuals with opioid use disorder (OUD) experiencing homelessness.

Methods: We interviewed 28 individuals in and around the Boston Public Health Commission (BPHC) Engagement Center, an area known for its high density of active substance use and homelessness. We asked about people's experiences, perceptions, and attitudes toward OUD treatment. We conducted a thematic analysis of our interview data.

Results: Fifty-four percent of participants sampled were not prescribed MOUD. None of the participants reported having an active prescription of sublingual buprenorphine or buprenorphine/naloxone. White participants were more likely to have been prescribed buprenorphine in the past compared to participants of other races even in this socioeconomically homogeneous sample. Themes that emerged in our data included challenges to accessing MOUD due to reduced services during the COVID-19 pandemic, lost or stolen medications, fewer inpatient withdrawal management beds for women, transportation challenges, fear of adverse effects of MOUD, the perception that taking MOUD replaces one addiction for another, and community disapproval of MOUD. Participants also reported stigma and discrimination based on race, gender, and socioeconomic status.

Conclusion: Systems and individual-level factors contribute to the MOUD treatment gap across race and socioeconomic status. The COVID-19 pandemic posed additional access challenges. This study provides important, actionable insights about the barriers faced by a particularly vulnerable population of individuals with OUD experiencing homelessness.

Keywords: Buprenorphine; Health equity; Medications for opioid use disorder; Opioid use disorder; Treatment access.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Buprenorphine* / therapeutic use
COVID-19*
Female
Humans
Ill-Housed Persons*
Opioid-Related Disorders* / drug therapy
Pandemics

Substances

Buprenorphine