A surprising number of Americans suffering from Opioid Use Disorder (OUD) do not receive any treatment for their use disorder and even fewer receive medication as a part of their treatment. There are many reasons why some people who want to receive treatment do not receive it including an inability or unwillingness to abstain from substance use; insurance and financial constraints; and difficulties in finding, and consistently reaching, quality care. Fortunately, the “Bupe Bus” in Philadelphia has found a way to overcome these obstacles by bringing accessible, low barrier, medication assisted treatment (MAT) directly to communities most affected by the opioid epidemic.
Although the opioid epidemic has been raging in the U.S. for years, a disappointingly low percentage of people suffering from Opioid Use Disorder (OUD) receive treatment. Even fewer receive medication assisted treatment (MAT), a form of therapy that has been found to substantially reduce overdose related mortality. The CDC, using data captured from the 2022 National Survey on Drug Use and Health, estimates that 3.7% of U.S. adults needed OUD treatment in 2022 but only 55.2% of this group received any treatment and only 25% of the group received MAT for OUD. 1
There are racial disparities within the groups that receive treatment as well. In 2022, 4.5% of Black Americans were in need of OUD treatment compared to 3.7% of White Americans and 3.0% of Hispanic Americans. However, only 43.8% of Black Americans with OUD received treatment (one of the lowest rates among the calculated characteristics which included race, income, age, and others) compared to 45.7% of Hispanic Americans and 60.3% of White Americans. 2
There are a variety of reasons why people don’t seek out, or may even avoid, treatment and the Substance Abuse and Mental Health Services Administration (SAMHSA) collects survey data from those with a substance use disorder (SUD) to try and identify these specific reasons. One of the top reasons (60% of respondents) that people cited for not seeking treatment was “not being ready to stop or cut back on using alcohol or drugs”3. This is significant because treatment programs for SUD with abstinence as a long term goal comprise most of the treatment programs in the U.S.4 Treatment options that do not have abstinence as a requirement can help those 60% of people who are unwilling or unable to stop substance use, manage their use disorder, and improve their lives.
Others with a SUD may be ready and willing to enter into treatment but are unable to consistently reach treatment. It could be overly burdensome for some to seek treatment if they have to travel far distances, miss work, or find childcare during times when clinics and hospitals are operating (41% of people surveyed cited not having enough time as a barrier to seeking treatment). Additionally, many individuals suffering from a SUD including OUD are underinsured and lack a primary care physician (PCP). This could mean that people suffering from a use disorder may be unable to afford care (31.9% of respondents) or perceive they cannot afford care (42%) and those without a PCP may be unsure how or where to find appropriate care (39%).5
Fortunately, providers have become creative in how to best serve populations in need. Outreach programs including mobile treatment programs that offer syringe exchange, STD testing, wound care, and other important services have become prominent across the U.S. In Philadelphia, there are several organizations, including Courage Medicine, the Savage Sisters, and Prevention Point Philadelphia that are heavily invested in outreach efforts and are seeing real success. One example of a successful mobile outreach program is Prevention Point Philadelphia’s “Bupe Bus”.
This mobile treatment center is routinely parked in six different locations around Philadelphia with particularly high rates of fatal and non-fatal overdoses offering residents an easily identifiable medication assisted treatment (MAT) option close to where they live or work. The Bus crew aims to get patients same-day buprenorphine (this is the “Bupe” in “Bupe Bus”) prescriptions. Buprenorphine is an opioid partial antagonist which means it acts as both an opioid agonist (producing similar, but weaker, sensations to common opioids) and an opioid antagonist (blocking some harmful effects of common opioids). These unique qualities of a partial antagonist make buprenorphine an effective medication to treat OUD because it can prevent withdrawal symptoms, manage cravings for opioids, and lower the risk of overdose if someone is also concurrently using other opiods.6,7
The goal of the Bupe Bus initiative is to provide same day buprenorphine prescriptions to those in need without imposing additional red tape such as mandatory abstinence from other substances. The strategy is to make it quick and easy for people to access care in order to increase the likelihood that individuals with OUD receive and then sustain treatment. So far, the results have been quite promising. 86% of patients who completed an initial visit to the bus completed at least one follow up visit and 69% of patients completed four or more visits. These rates were higher than those for traditional “brick and mortar” clinics with an estimated 50% of patients returning for a follow up appointment and only 30% returning for two or more visits. Furthermore, the Bupe Bus successfully served marginalized groups with a composition of roughly 60% Black and 15% Hispanic patients. Finally, most of the patients visiting the bus did not have a primary care doctor or a mental health provider, meaning that the bus is reaching patients who may otherwise have no means of receiving this form of care.8
Outreach programs like the Bupe Bus will hopefully increase the likelihood that those in need receive and sustain effective medication assisted treatment (MAT) for OUD. Unfortunately, there are many reasons why those suffering from OUD do not receive treatment and even those who do pursue treatment are not necessarily going to maintain a lifetime of abstinence. A study conducted at Johns Hopkins Bloomberg School of Public Health estimates that 43% of patients who received buprenorphine filled an opioid prescription during treatment and 67% filled an opioid prescription during the 12 months following buprenorphine treatment.9 The study did not include any measure of individuals who consumed illegal opioids during this time which likely means the real numbers are much higher.
Despite these figures, health care providers should not stop prescribing medication to treat OUD. However, it is important to understand that although buprenorphine can help improve people’s lives as they recover from an OUD, these individuals are still at risk of overdosing on their long path of recovery. The Resilient monitoring system can serve a crucial role with this population by monitoring for signs of accidental overdose and reversing any opioid induced overdose with naloxone. Using the monitoring system could protect individuals with OUD as they pursue recovery by ensuring that no missteps result in tragedy.
