Barriers and facilitators to buprenorphine delivery

Abstract

BACKGROUND: Access to medications for opioid use disorder (MOUD) is essential for the 6.1 million Americans with OUD. However, only one in five adults with past-year OUD received MOUD. Syringe services programs (SSPs) have existing and trusting relationships with people who use drugs and are an alternative service provider to traditional healthcare settings. SSPs are uniquely positioned to facilitate buprenorphine inductions and increase overall MOUD access. We aimed to understand models for implementing buprenorphine and barriers and facilitators SSPs encounter.

METHODS: We interviewed 23 SSP representatives across the U.S. Interviews sought to explore emerging issues, including whether and how SSPs facilitate access to buprenorphine. We used purposive sampling to include programs varying by region, organizational type, and legal status to understand a range of perspectives. We coded transcripts using a blended inductive and deductive, content analysis approach, met weekly to capture emerging themes, and developed analytic memos using the Health Equity Implementation Framework.

RESULTS: Of the 23 representatives interviewed, 20 reported that their SSP facilitated buprenorphine access. We identified four models for implementing buprenorphine. For all models, stigma, policy, and funding systems dictate SSPs' ability to be involved in buprenorphine induction. In turn, these determinants impact the patient-provider buprenorphine induction experience, which could perpetuate low service provision and participant uptake.

CONCLUSIONS: SSPs need various approaches to improve the patient-provider buprenorphine induction experience. SSPs can select the best fit buprenorphine model(s) by examining their inner and outer contexts. In doing so, SSPs leverage their position as trusted allies to improve care and outcomes for people with OUD.