New evidence shows that using a low-barrier, compassionate, tele-harm reduction approach to provide buprenorphine to people with substance use disorders, particularly when delivered through syringe services programs like the IDEA Exchange at the University of Miami Miller School of Medicine, can increase access to lifesaving treatment for communities at high risk of overdose.
The partial opioid agonist buprenorphine “is one of the tools toward ending the HIV epidemic,” says Hansel Tookes, M.D., M.P.H., associate professor of clinical medicine in the Division of Infectious Diseases, medical director of the IDEA Exchange, and senior author of the study published in Annals of Medicine.
The Miller School is a leader in this type of initiative, which is supported by a $2.5 million, four-year Avenir Award for HIV/AIDS research from the National Institute on Drug Abuse, part of the National Institutes of Health.
“We're one of these well-resourced programs that are pushing hard to make it very easy for people with substance use disorders to access this lifesaving medication,” Dr. Tookes says. “We are fortunate to have a health system that has a Syringe Services Program [SSP], a program that treats people kindly, with dignity and respect.”
Dr. Tookes, alongside lead author Edward Suarez, Jr., Psy.D., L.M.H.C., M.B.A., behavioral health director of the IDEA Exchange, and their colleagues, studied data from 109 patients seeking buprenorphine through the IDEA Exchange. When entering the study, 72% of participants either self-reported or tested positive on a urine drug screen for fentanyl, and 53% tested positive for a stimulant. About two thirds of providers prescribed a 30-day supply of 16 mg buprenorphine at the first physician visit.
At three months, the overall retention rate on buprenorphine was 59%. “That's extraordinarily high, particularly given the fact that our patients inject fentanyl and cocaine so frequently,” Dr. Tookes says. Driving the success of the BupRenorphine Initiation and Retention Experience (BRITE) is availability of physicians via telehealth or tele-harm reduction and the utilization of peers with lived experiences. “We want people who have lived the experience delivering the intervention,” Dr. Tookes says. They are “the true experts in harm reduction.”
Enhancing Education, Services, and Treatment of People with Substance Use Disorders
Medical students also play a crucial role through the Mitchell Wolfson Sr. Department of Community Service (DOCS). The Wolfson DOCS students help run the program, and multiple students rotate through IDEA Exchange. “Not only are they getting first-class, compassionate, harm reduction-based medical education, but we're training a new generation of physicians to treat this community kindly,” Dr. Tookes says. “And that's really something you get exclusively at our academic institution.”
In an opinion piece published in JAMA on Dec. 1, Dr. Tookes pointed out that this 2022 “World AIDS Day feels different.”
“Due to remarkable strides during the last four decades, we now have the tools we need to end the HIV epidemic. Yet barriers persist, which have fueled the HIV epidemic from the outset and continue to stoke an ever-growing hostility aimed at vulnerable, at-risk populations,” Dr. Tookes said.
“We must expand syringe services programs, provide treatment for mental health and substance use disorders rooted in harm reduction principles and create safe, respectful environments to build trust with these populations.”