Addressing the Opioid Crisis: Medication-Assisted Treatment at Health Care for the Homeless Programs

Health Care for the Homeless (HCH) programs, a subset of community health centers that receive special populations funding to address the specific needs of vulnerable and medically complex patients, play a significant role in addressing the opioid epidemic by providing medication-assisted treatment (MAT). MAT, which combines one of three medications (methadone, buprenorphine, or naltrexone) with behavioral therapies, is the standard of care for opioid use disorder (OUD). This brief presents findings from an analysis of health center data on the provision of buprenorphine-based MAT, as well as interviews with providers and administrators from 12 HCH programs about strategies they adopted to implement MAT programs. Key findings include:

• Among health centers, HCH programs provide a disproportionately large share of buprenorphine-based MAT, although there was wide variation across states. HCH programs accounted for over one-third of both providers who can prescribe buprenorphine and of all patients receiving buprenorphine in 2017, despite serving only 4% of all health center patients. Additionally, the number of providers able to prescribe buprenorphine and the number of patients receiving the medications both more than doubled at HCH programs from 2016 to 2017.
• Building support with leadership and clinical staff was a key strategy to implementing MAT at HCH programs. Some approaches to achieving this goal included identifying “champions” within HCH programs to advocate for establishing MAT services, consulting with more experienced HCH programs, and addressing concerns about medication diversion.
• HCH programs also reported the need to invest in staff training and support. Providing training to primary care providers who lacked expertise in treating opioid use disorder (OUD), fostering coordination between primary care and behavioral health staff, dedicating administrative staff for MAT programs, and recruiting waivered providers can help build MAT programs.
• Another important strategy respondents discussed was the need to create more flexible systems and programs. For example, adjusting schedules to block out dedicated time for MAT patients and adopting a more flexible approach to the therapy component of MAT services improved access to treatment.
• Fostering community partnerships and accessing available resources helped build MAT programs. HCH programs were able to establish and grow MAT programs by working with community partners, such as local hospitals and social services organizations, and by maximizing available federal, state, and local grant funding for training and treatment. HCH programs also reported educating local homeless service providers on the importance of MAT to recovery to ensure patients could access shelter or housing while they were in treatment.

Looking ahead, HCH programs will likely continue to make more investments in provider training and capacity, find additional strategies to grow programs to meet patient need, and ensure that MAT services are provided as part of the standard of care for OUD.