Association between Participation in Counseling and Retention in a Buprenorphine-Assisted Treatment Program for People Experiencing Homelessness with Opioid Use Disorder

"Bupe by the Book": A study protocol for a pilot randomized controlled trial of library-facilitated telehealth to increase buprenorphine treatment among unstably housed individuals

Background

Accessing opioid use disorder (OUD) treatment is difficult for individuals in unstable housing. This population often uses public libraries for computer and internet access, which could provide telehealth access to OUD treatment. Therefore, we developed a novel 12-week library-facilitated telehealth intervention study called "Bupe by the Book" (BBB), which uses library resources to facilitate the initiation and retention of OUD treatment with buprenorphine.

Methods

This study involved a partnership between the San Diego Public Library and a federally qualified healthcare center attached to a homeless shelter (Father Joe's Villages (FJV) Village Health Center). We codesigned a pilot randomized controlled trial to evaluate a library-facilitated telehealth intervention in San Diego, California. We evaluated the intervention for its feasibility and acceptability and to obtain an estimate of the effect of the intervention on buprenorphine treatment outcomes. Individuals reporting homelessness and OUD (with or without other substance use) were eligible. Forty library patrons were recruited via flyers, screened for eligibility, and referred to the FJV Health Center for initial buprenorphine treatment intake visits. Participants who completed intake were enrolled and randomized to the library-facilitated telehealth condition, which involved the use of library internet and computer resources for follow-up visits to the clinic for buprenorphine treatment. The participants completed treatment follow-up in person or by phone in the control condition. Planned analyses (not powered to assess efficacy) will provide effect size estimates of the library-facilitated telehealth intervention on 1) buprenorphine use (measured in weekly urine drug screenings), 2) use of illicitly manufactured fentanyl (IMF) and other opioids (measured in weekly urine drug screens), 3) number of buprenorphine prescription pick-ups, 4) number and frequency of clinic visits, and 5) self-reported substance use, mental health, and quality of life measures at 1, 2, 4, 8, and 12 weeks.

Discussion

The findings from this pilot study may support the adoption of library-facilitated telehealth treatment as a feasible and acceptable strategy to engage and retain unstably housed people with OUD in buprenorphine treatment. The lessons from this pilot study include the importance of community-academic partnerships in sustainably adapting interventions in community-based settings.

Trial registration

This trial was registered prospectively at ClinicalTrials.gov (registration number NCT05872386) on May 24, 2023.

Endogenous opiates and behavior: 2021

This paper is the forty-fourth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2021 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonizts and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).

Homelessness at the San Diego Central Library: Assessing the Potential Role of Social Workers

Nationwide, public libraries are experiencing an increase in “on-premise” opioid overdoses and other issues (e.g., suicide attempts) affecting unstably housed library users. The public library presents a unique opportunity to access an otherwise hidden population. In partnership with the San Diego Central Library, researchers led focus groups, in-depth interviews, and surveys with 63 library patrons experiencing homelessness or housing instability (n = 49) and library staff (n = 14) (January–June 2019). Using a consensus organizing framework and mixed methods approach, the researchers conducted in-depth interviews exploring the library’s strengths and opportunities for patrons experiencing homelessness, the barriers to meeting their aspirations, and whether having a social worker at the library or other policy changes in government or the library could help. Specifically, participants answered inquiries about the opportunities for the library to address substance use and human trafficking. In brief surveys, library patrons and staff provided views on the patrons’ educational needs, library staff’s training needs, and changes needed in government or library policies. Results revealed the desire of the library patrons (69%) and staff (93%) to have a library social worker who could link patrons to housing services, substance use harm reduction or treatment, and address food-insecure youth/families and human trafficking/sexual exploitation. Participants also valued peer advocates with lived homelessness experiences. Over 70% of the unstably housed patrons said they would like library patrons to participate in peer leadership training. Other significant themes were the need for crisis prevention and intervention, connecting patrons to resources and each other, and creating consistent assistance. Libraries urgently need more on-premise support to address patrons’ pressing housing, health, and mental health needs.