Medications for Opioid Use Disorder for People Experiencing Homelessness
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Background
Opioid use disorder (OUD) affects approximately 2.7 million individuals in the US. In 2021, nearly 110,000 drug overdose deaths occurred, 75% were opioid-related. These numbers have only increased in recent years, leading the Department of Health and Human Services to renew opioid use as a national public health emergency in 2023. In addition to fatalities, opioid use disorder can result in adverse physical, psychological, and social outcomes. Research has indicated that medications for opioid use disorder (MOUD), which include methadone, buprenorphine, and naltrexone, are an effective method to treat OUD. However, uptake remains low, with less than 10% of those with OUD utilizing these medications.
While OUD consequences have been studied extensively, a gap in research remains on how to promote OUD treatment, especially in people experiencing homelessness (PEH). PEH disproportionately experience opioid overdose fatalities, facing up to a 30 times higher risk compared to housed individuals. Understanding the factors contributing to the lack of MOUD uptake is critical when devising interventions to increase utilization. Semi-structured interviews conducted by Swartz et al. evaluated PEH with a history of opioid overdose on influences to seeking care. Researchers found that nonfatal overdoses deterred individuals from initiating treatment. Reasons included emotional distress, sickness from naloxone, and negative interactions with healthcare providers. On the other hand, the consequences of chronic opioid use, such as the stress of avoiding withdrawal symptoms, prompted a desire to start MOUD. Other studies found common barriers to treatment, including transportation, stigma, and withdrawal. For example, participants noted that experiencing homelessness made it difficult to endure withdrawal symptoms. When attempting to access resources to help them through this process, long waitlists, lack of insurance, and lack of transportation inhibited their progress.
Gaps and Opportunities
Although these studies provide valuable insight into factors influencing MOUD use among PEH, more research is needed to fully understand the issue’s scope. Journey mapping is one way to determine common barriers to care and touchpoints with the healthcare system. Following a patient’s experience can identify and address gaps in service. This data can be leveraged to tailor interventions based on unique community needs.
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Evidence to Practice holds the expertise to document and assess a patient’s journey. Highly experienced in data collection and analyses, clients can expect quality research and a professional, collaborative partnership. Please reach out for more information.