番茄社区

ANAHEIM, Calif. -- People using opioids were significantly more satisfied with accessing buprenorphine from a mobile unit than from a pharmacy, a prospective cohort study in Chicago found.

Satisfaction on 5-point scale where higher scores were better came out at a median of 4 with pharmacy access versus a median of 5 with the mobile unit (P=0.004), according to findings presented at the American Society of Health-System Pharmacists (ASHP) midyear meeting.

Most mobile unit users surveyed said they would not have been able to access buprenorphine that day without the mobile unit.

"This critical access -- only 13% [of clients] would have been able to receive treatment had our bus not been there -- is kind of our biggest selling point, that we exist and people are like really happy to actually be able to get ahold of medications the second they need to," study presenter Alexander Infante, PharmD, of the University of Illinois Chicago, told 番茄社区.

Of 2.5 million people in the U.S. with opioid use disorder, less than a quarter in 2021. Lower income and segregated communities to medication-assisted recovery (MAR). Past research has shown that patients treated with buprenorphine and methadone are or need serious opioid-related acute care.

"This study, though very small, demonstrates that many people face barriers in accessing buprenorphine at their local pharmacy and interventions, like a mobile unit, may be able to address these barriers," commented Dima Qato, PharmD, MPH, PhD, of the University of Southern California in Los Angeles, who was not involved in the study.

"However, concerns about continuation of treatment and withdrawal and relapse among those with OUD remain," Qato told 番茄社区 in an email. "For example, is this unit always opened? [Does] it follow-up with patients?"

In 2021, the University of Chicago's Community Outreach Intervention Projects collaborated with a community based organization, Family Guidance Centers, to set up a mobile medical unit integrating clinical pharmacists that provided basic primary care, harm reduction, wound care, and buprenorphine prescriptions as part of MAR on Chicago's West Side.

In 2022, the mobile unit began dispensing buprenorphine/naloxone dose packs. Researchers saw clients at their mobile clinic from May to August 2023 and dispensed up to 24 mg daily of sublingual buprenorphine to 106 clients. Of these, 84 took the client satisfaction survey.

Clients were a mean of 45.4 years old, 70.8% male, and 59.4% Black race. Most were insured, 79.2% by Medicaid. Nearly all had documented polysubstance use, and the mean duration of use was 18.4 years. Slightly more than half of the clients seen had used the mobile clinic before, and many had accessed buprenorphine before without a prescription. According to Infante, there are plans to expand the program.

The survey also asked clients about barriers to getting buprenorphine at the pharmacy, and of the 30 who reported barriers, the most common were long wait times for buprenorphine (50%), lack of transportation to the pharmacy (43.3%), and experiencing illness or withdrawal symptoms (40%).

Limitations included a small sample size, short duration of follow-up with patients, and a lack of information related to continuation of treatment, withdrawal, relapse, or recovery.

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