Meeting Summary – October 2023: Mobile low-threshold buprenorphine integrated with infectious disease services

Nov 20, 2023 | Meeting Summary

Article

Rosecrans A, Harris R, Saxton RE, Cotterell M, Zoltick M, Willman C, Blackwell I, Bell J, Hayes D, Weir B, Sherman S, Lucas GM, Greenbaum A, Page KR. Mobile low-threshold buprenorphine integrated with infectious disease services. J Subst Abuse Treat. 2022 Feb;133:108553. doi: 10.1016/j.jsat.2021.108553. Epub 2021 Jun 24. PMID: 34238629; PMCID: PMC8702567.

Article Summary

In 2018, the Baltimore City Health Department launched a mobile health clinic called Healthcare on The Spot, which offers low-threshold buprenorphine services alongside health care services to meet the needs of people who use drugs, like testing and treatment for hepatitis C, HIV, and STIs, wound care, vaccinations, PrEP, naloxone, and case management. In this case, “low threshold” means that this program is meant to be easy to access and flexible for its users. The program offers individualized treatment plans, brings medication to people (instead of making people come to a clinic), requires less frequent patient visits, and allows for relapses. This study looks at clinical service data from the first 15 months of The Spot’s mobile clinic (September 2018-November 2019). During this time, the mobile program was co-located with syringe services at five locations across Baltimore. During the study period, the mobile clinic served 569 people—of these, about 74% received prescriptions for buprenorphine and 70% were tested for at least one infectious disease. Of the people who started buprenorphine at the mobile clinic, 56% remained in treatment one month after starting and 26% at three months. These data show that if we make it easier for people to access to medical services and drug treatment through low-threshold, community-based models of care, it can be an effective tool for helping counteract the harmful effects of substance use and to help people who wish to pursue recovery.

Mobile low-threshold buprenorphine integrated with infectious disease services

Key Themes

Mobile health units are a novel approach to bringing substance use treatment to people who need it.

Patients can access a variety of services through mobile health units, including: testing, treatment, prevention, harm reduction, and basic needs.

The use of mobile health units can improve treatment engagement by removing barriers around treatment access (transportation, scheduling, stigma) and offering patients a flexible and alternative approach to receiving care.

Challenges experienced by mobile health units include: adding serviced based on clinical demand (i.e. wound care for people who use xylazine), supporting people who are pregnant and actively using substance, choosing strategic locations for the mobile unit based on need and demand, and meeting patient needs during cold weather.

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