Testimonies from the Trenches Series - Low-Barrier Buprenorphine Treatment (On-Demand)-Slides - Testimonies from the Trenches- Low-Barrier Buprenorphine Treatment

Slides - Testimonies from the Trenches- Low-Barrier Buprenorphine Treatment

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Dr. Shoshana Aronowitz discusses the importance of low-barrier approaches in expanding access to care for opioid use disorder (OUD). The COVID-19 pandemic has exacerbated the existing opioid crisis, leading to the closure of treatment providers and decreased capacity in harm reduction services. Additionally, the instability in the drug supply and financial hardship have further hindered access to care for individuals with OUD.<br /><br />Treatment with buprenorphine or methadone has been proven effective in reducing overdose risk. However, less than 20% of people with OUD receive these medications. Traditional treatment settings often have high-threshold expectations, frequent follow-up visits, and counseling and group requirements, which can be barriers to care. Geographic and transportation factors, lack of knowledge about available options, cost, stigma, and fear of precipitated withdrawal also contribute to limited access to treatment.<br /><br />Low-barrier treatment models aim to address these barriers by providing same-day access to medication, flexible scheduling, and no abstinence requirements. They meet patients where they are, both figuratively and literally, through telehealth and mobile models. Co-location with syringe access/harm reduction services and HIV and hepatitis C care can also improve access to OUD treatment.<br /><br />It is important to note that low-barrier treatment models do not expect complete abstinence and can accommodate patients who use substances other than opioids. Naloxone should always be co-prescribed with buprenorphine. Urine drug screens should be used as a tool and not punitively, as observed screening can be traumatic for patients and interfere with the clinician-patient relationship.<br /><br />Telehealth has become essential during the COVID-19 pandemic, and clinicians can now prescribe controlled substances through telehealth visits. However, eligibility for telehealth treatment should consider factors such as stable phone/internet connection, co-occurring untreated illnesses, benzodiazepine and/or alcohol use disorders, pregnancy, and access to in-person care.<br /><br />In cases where patients are using fentanyl, microdosing or the Bernese Method can be used for buprenorphine induction to minimize withdrawal symptoms. Pharmacists may present barriers to dispensing buprenorphine prescriptions, with some pharmacies not carrying the medication or being selective about co-occurring substance use and dosages.<br /><br />In conclusion, low-barrier approaches are crucial in expanding access to OUD treatment, particularly for marginalized individuals who have struggled with traditional approaches. By removing barriers and meeting patients where they are, healthcare providers can improve access and provide effective care to those with OUD.

Keywords

low-barrier approaches

expanding access to care

opioid use disorder

COVID-19 pandemic

treatment providers

harm reduction services

buprenorphine

methadone

barriers to care

telehealth