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Community-Based Medications First for Opioid Use Disorder - Care Utilization and Mortality Outcomes.

Caleb J Banta-Green1,2,3, Mandy D Owens1,4, Jason R Williams1

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Summary
This summary is machine-generated.

A community-based medications first model significantly increased medication for opioid use disorder (MOUD) access and retention. This low-barrier approach also substantially reduced mortality rates among individuals with opioid use disorder (OUD).

Keywords:
harm reductionlow-barrier caremedications for opioid use disordermulti-site studyopioid use disorder

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Area of Science:

  • Public Health
  • Substance Use Disorders
  • Health Services Research

Background:

  • A significant treatment gap persists for medications for opioid use disorder (MOUD).
  • Individuals with opioid use disorder (OUD) face challenges accessing MOUD in traditional healthcare and opioid treatment programs.
  • Harm reduction and community-based organizations serve a population with high MOUD needs but limited access points.

Purpose of the Study:

  • To evaluate the impact of a community-based, "medications first" model of care for MOUD.
  • To assess MOUD and healthcare utilization among individuals newly prescribed MOUD through a drop-in access model.
  • To determine the effect of this intervention on mortality rates in Washington State.

Main Methods:

  • Prospective cohort analysis of individuals newly prescribed MOUD in six Washington State communities.
  • Intervention involved drop-in access to MOUD within harm reduction and homeless services settings.
  • Mortality impact assessed using a synthetic comparison group analysis with state administrative data.

Main Results:

  • Significant increases observed in buprenorphine supply, and months with any MOUD and any buprenorphine.
  • No change in emergency department visits for overdose; inpatient hospital stays increased.
  • First-year annual death rate was 0.45% in the intervention group versus 2.2% in the comparison group (Relative Risk: 0.323).

Conclusions:

  • The community-based "medications first" model effectively increased MOUD engagement and significantly reduced mortality.
  • Findings support the expansion of low-barrier MOUD care models as a complement to existing services.
  • Potential impact may have been moderated by the COVID-19 pandemic and fentanyl prevalence.