"I'm on the Right Path": Exploring 1-Month Retention in a Homeless-Tailored Outpatient-Based Opioid Treatment Program

Area of Science:

• Public Health
• Addiction Medicine
• Health Services Research

Background:

• Opioid overdose crisis disproportionately affects individuals experiencing homelessness.
• Office-based opioid treatment (OBOT) programs tailored for homeless populations are crucial.
• Understanding retention facilitators and barriers is vital for program success.

Purpose of the Study:

• To evaluate facilitators and barriers to retention in a homeless-tailored OBOT program.
• To identify factors influencing patient engagement and long-term treatment adherence.
• To inform interventions for improving OBOT program effectiveness in vulnerable populations.

Main Methods:

• Qualitative in-depth interviews with 24 homeless-experienced adults enrolled in an OBOT program.
• Purposive sampling based on 1-month retention status (retained vs. not retained).
• Abductive analytic process using a priori framework (Behavioral Model for Vulnerable Populations) and emergent codes.

Main Results:

• Common facilitators: positive clinic experience, low-threshold model, supportive staff, comprehensive care.
• Facilitators for retained participants: personal motivation, extended-release buprenorphine, perceived efficacy.
• Common barriers: challenging clinic environment, subsistence difficulties, transportation issues. Barriers for non-retained: opioid use severity, social network influence, perceived buprenorphine inefficacy.

Conclusions:

• Identified common and divergent determinants of OBOT retention among homeless-experienced individuals.
• Divergent factors by retention status offer potential intervention points.
• Findings can guide the development of targeted strategies to enhance retention in homeless-tailored OBOT programs.