CE25-149 - Rigorous Evaluation of Community-Delivered Short- and Long-Acting Buprenorphine to People who Experience Homelessness or Live at Permanent Supportive Housing Sites

Project Abstract The intersection of the overdose and housing crises has prompted unprecedented mortality among our nation’s most vulnerable residents – people who experience homelessness (PEH). Multilevel barriers to care often obstruct this population’s access to medications for opioid use disorder (MOUD) -- a secondary overdose prevention strategy that halves the risk of overdose and improves other health outcomes. To eliminate the barriers associated with traveling to healthcare facilities for MOUD appointments and prescription refills, Public Health – Seattle and King County (PHSKC) will pilot a new MOUD service delivery model. Starting in 2025, buprenorphine prescriptions ordered during street medicine or telemedicine encounters at participating encampments, shelters and permanent supportive housing (PSH) sites will be filled at the Downtown Public Health Pharmacy and transported by a nurse-led care team, who will disburse short-acting sublingual and administer long-acting injectable buprenorphine directly to patients in the field. This study will employ a Type 2 Implementation-Effectiveness Hybrid design to evaluate this pilot program. Using quasi-experimental methods, we will evaluate the effect of community-delivered buprenorphine on (i) the risk of overdose in a propensity score matched patient cohort and (ii) occurrence of overdose at PSH sites, assessed via interrupted time series. Guided by the RE-AIM Implementation Science Framework, we will measure patient-level and systems-level implementation outcomes. This rigorous evaluation will generate real-world evidence for a (i) community-based MOUD delivery model and (ii) long-acting injectable buprenorphine. Findings from this evaluation will inform how these innovations can be adapted and brought to scale both locally and in other jurisdictions that grapple with the syndemic overdose and housing crises.