Expedited referrals from community health center to opioid treatment program: innovative approaches to improving access to methadone treatment for patients who use opioids and experience homelessness

Abstract Background Methadone treatment (MT) is the “gold standard” treatment for opioid use disorder (OUD). However, patients face significant barriers to enrollment at opioid treatment programs (OTPs), e.g. need for proof of identity, lack of transportation, and limited intake hours. For patients experiencing homelessness or unstable housing, those barriers are magnified. Objective We created a multifactorial intervention to address the above-described barriers to facilitate prompt OTP admission for patients with OUD and housing instability. Methods Our target population was patients with OUD and unstable housing who utilize the Greater Lawrence Family Health Center mobile health unit (MHU) and syringe services program (SSP) in Lawrence, MA. As part of the HEALing Communities Study, we developed an expedited referral process whereby mobile health clinicians provided preliminary clearance for MT. SSP staff, recovery coaches, and OTP staff assisted with outreach, engagement, coordination, and intake. Patients who completed psychosocial intake could start dosing at the OTP within 1–3 days. Results Over six months, 87 individuals were linked to treatment and 64 were admitted and dosed at the OTP. Many patients who had previously assumed they could not seek treatment with methadone were eager to do so when barriers to access were reduced. Conclusions Efforts to reduce barriers to methadone initiation via partnerships between mobile health programs, SSPs, and OTPs can be a tool in combating the overdose crisis.