Examining Low-Barrier Buprenorphine Treatment during COVID-19 for Individuals Experiencing Housing Insecurity and Homelessness

Abstract

People experiencing homelessness and housing insecurity are disproportionately affected by the current opioid crisis, but there is little research that focuses on obstacles to continuity of care for members of these communities receiving medication-assisted treatment. While the COVID-19 pandemic has added to the risk environment experienced by these individuals, it has also ushered in a wave of regulatory changes aimed at improving access to care during the pandemic. Given the recency of these changes, their impact has not yet been assessed. In an effort to fill in these gaps, this study analyzes retrospective data from a prominent harm reduction agency serving a Philadelphia community with a high prevalence of opioid use disorder and homelessness. I find that housing insecurity and homelessness are significantly associated with lower retention in treatment, lower medication adherence, and higher logistical barriers to care. I also demonstrate that access to remote telemedicine during the pandemic was extremely limited in this community, but that retention still significantly improved during the COVID-19 era, both for people who did and did not access telemedicine remotely. These findings indicate that regulatory changes during the pandemic were beneficial to participants in medication-assisted treatment, and I argue that they should remain in place after the resolution of COVID-19. Finally, I suggest that further supports are necessary for people in medication-assisted treatment who experience homelessness, especially as technology is incorporated into addiction management.