Reaching in to reach out: Unique program locates Buprenorphine treatment in two Baltimore City grassroots recovery programs

Background: Opioid use dependence is a major public health concern highlighted by recent high profile heroin-related deaths. Barriers to care remain for individuals in impoverished urban areas due to lack of engagement, distrust in the traditional system and lack of insurance. The Behavioral Health Leadership Institute (BHLI) buprenorphine program employs a unique, flexible model that engages community members where they live. Methods: 305 clients from two Baltimore City sites were recruited in 2010-2013. Active clients (n=24) or incarcerated (n=11) were excluded; 7 were readmissions. Participants had a mean age of 46.7±0.5 years; 60.0% were men, 83.0% Black/African-American, 81.6% unemployed, 49.5% unstably housed, and 35.4% had no primary care provider. More than half (58.0%) had chronic illnesses, 8.9% HIV+, and 20.7% HCV+. T-tests and chi-squared tests assessed associations between client characteristics and treatment status: transitioned to ongoing care (transitioned) and lost to follow-up (LTF). Logistic regression calculated the odds of transition by client characteristics. Results: 41.6% of clients were transitioned to ongoing care. Mean treatment length was 70 days longer for transitioned (116.9 days) than LTF (46.7 days) (t=9.1, df=300, p<0.001). Odds of transition increased by 13% with each week of participation (OR=1.13, 95% CI=1.09-1.17, p<0.001). Individuals with chronic illnesses or HIV+ had higher odds of transition (p’s<0.05). Demographic variables were not associated with transition. Conclusions: Buprenorphine treatment can be incorporated into trusted grassroots recovery programs to reach individuals in their communities. Flexible programs that engage low-resource communities in impoverished neighborhoods can be used to address current gaps in services.