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Description
Background: Homelessness and opioid use disorder are at the forefront of public health issues in Maine. Substance use accounts for a higher proportion of deaths among those experiencing homelessness than it does in the overall population. In 2022, Maine ranked third in the U.S. for fatal overdoses involving opioids. The clinic at the center of this evaluation is a low-barrier buprenorphine bridge program serving people experiencing homelessness that provides same-day prescriptions and other supports, while connecting patients to ongoing care for substance use disorder. Methods: This was a qualitative program evaluation that used semi-structured key informant interviews. The evaluation focused on assessing internal processes, attitudes and beliefs of employees, and relationships with partner organizations. Participants were included if they are curren employees at the clinic or a partner organization. Interviews were conducted via Zoom and recorded. Interviews were coded in Excel using in-vivo coding. Codes were categorized using a color-coding system. Themes were assessed based on codes and categories. Results: Six interviews were conducted. A total of six participants were interviewed. Four of these participants currently work at the clinic, and two work at partner organizations. After analysis and coding, a total of 26 distinct categories of codes were identified. Among the codes and categories, five unifying themes emerged. The five themes include: Providers/Staff at the clinic build trusting, respectful relationships with patients & partners which is key to success; the clinic is the lowest barrier in the community, which promotes harm-reduction; Many systemic challenges impact the clinic and its patients; Respondents are excited to expand the clinic to include more outreach 3 via van; Respondents overwhelmingly support low-barrier buprenorphine and acknowledge limitations/drawbacks. Discussion: The findings support low-barrier, harm-reduction approaches to treating substance use disorder, especially in a population that is experiencing homelessness. The findings highlight human connection, harm reduction approaches, and trusting, respectful relationships as strengths of the clinic. The findings also highlight the need to include patient voices in future study. At the community level, the findings could spark further discussion about harm reduction and promote its adoption in more medical settings. Conclusions: The clinic is a local leader in harm reduction, and would benefit from more social work support. Further evaluation is needed that includes patient voices. These findings can help garner support for the clinic and for low-barrier buprenorphine in the community.
Faculty Advisor(s)
Courtni Jeffers, MS, MPH, Ed.D.
Publication Date
Summer 7-11-2024
