(Management Case Study) On the Road to Recovery: Bringing Ambulatory Opioid Use Disorder (OUD) Care Into the Community

Purpose: Social determinants of health (SDH) play an integral role in creating access barriers to opioid use disorder (OUD) care amongst patients. These barriers affect many of the Chicagoland communities leading to profound reductions in health outcomes and high rates of preventable fatal drug overdose events. This session aims to showcase the model used to provide SDH-cognizant and harm reduction-focused approaches to OUD care in these Chicagoland communities, stimulate discussion on developing and expanding pharmacist-integrated street medicine services elsewhere, and identify areas in which pharmacists can contribute to patient-centered OUD care.

Methods: In 2021, the Drug Enforcement Administration (DEA) allowed opioid treatment programs (OTPs) to employ mobile units, expanding access to medication-assisted recovery (MAR) for patients outside traditional clinic settings. The Community Outreach Intervention Projects (COIP) developed a partnership with Family Guidance Centers, Inc., a network of OTPs, to implement a mobile medical unit integrating clinical pharmacists for the provision primary care, harm reduction, wound care, and MAR via low-threshold buprenorphine in Chicago. The interprofessional team consisted of an indigenous leader outreach worker, attending physician, clinical pharmacist, and health professional trainees. To reduce barriers faced by patients obtaining medications for OUD at the pharmacy, the clinical pharmacist provided pre-packaged buprenorphine/naloxone dose packs directly to patients through OTP licensure.
Protocols for the provision of the buprenorphine/naloxone dose packs were developed by pharmacy leadership and designed to reduce the risk of medication diversion and increase service consistency. Patients were surveyed to explore their satisfaction with the service as compared to previous experiences at a pharmacy. The results of service development were communicated to university and statewide administration and disseminated through peer-reviewed publications.

Results: This interdisciplinary mobile team met patients where they are and decreased the stigma patients experience in more traditional care models. The mobile unit provided critical same-day direct access to buprenorphine in an area where opioid-related overdose death rates are among the city’s highest, and where patients commonly experience difficulties coordinating their medical care due to SDH factors. Patients consistently rated greater satisfaction levels with receiving buprenorphine via the mobile unit compared to pharmacies. Additional funding was procured to increase the number of operational mobile units and expand access to additional underserved communities across Chicagoland and Illinois including non-urban and Spanish-speaking communities.

Conclusion: Collaborations across healthcare institutions, OTPs, and community-based organizations are uniquely positioned to reduce OUD stigma and provide access points through low-threshold models.