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Medical Rounds

Opioid Use Disorder: Treatment Where It’s Needed

When addiction specialist Megan Buresh isn’t seeing patients at Johns Hopkins Bayview Medical Center, you can find her in an unassuming mobile van, which pulls up outside the Baltimore City Detention Center four mornings a week. The mission? To provide people newly released from prison with immediate treatment for their opioid use disorder.

“We know that release from prison is a highly vulnerable time for patients, particularly for overdose,” says Buresh. “Many who walk on the van to see us have been struggling with opioid use for years,” and most don’t have access to treatment while they are behind bars.

Buresh and her team, which includes a nurse—and a nurse practitioner on days when Buresh is not on-site—take a medical history, do a physical exam and assess whether it’s appropriate to prescribe buprenorphine, an under-the-tongue medication that blocks cravings for opioids. About half of those who walk onto the van get a prescription for buprenorphine and begin treatment for their opioid disorder that same day.

Even more encouraging: “We have found that about two-thirds of those who begin treatment return for at least a second visit, and about one-third have remained in care for 30 days and beyond,” she says, noting that care includes being connected to Johns Hopkins’ peer recovery coaches and programs such as Dee’s Place, an alcohol and drug addiction recovery support center near The Johns Hopkins Hospital that is run by Michael Fingerhood, an expert in addiction medicine.

Those treatment figures are impressive, considering the myriad challenges that many of these newly released citizens face: unemployment, homelessness, mental health issues, and a long history of substance use and involvement with the criminal justice system.

Buprenorphine is not a quick fix, as Buresh is fast to remind patients. “Opioid dependence is a chronic disease, just like diabetes or high blood pressure. We tell people to think of being in treatment for three to five years to truly stabilize. Some may need to remain on it for the rest of their lives,” she says. The aim of the mobile van program is to serve as a bridge. “We are transitional,” she says. “We work with people over the course of several weeks to months until we can get them into long-term treatment.”

The mobile van initiative was launched by Deborah Agus, executive director of the Behavioral Health Leadership Institute and an associate professor at the Johns Hopkins Bloomberg School of Public Health. The funding the project has received from foundations has been crucial to the pilot program’s success, says Buresh. “Funding from foundations covers my time and also makes it possible to provide buprenorphine to all, regardless of whether or not the patient has health insurance to cover it,” she says.

Buresh and Fingerhood would love to see the mobile van program expand, by increasing staffing to handle more patients and perhaps by adding an additional van to a different underserved area of the city, such as Dundalk. “Currently the demand for treatment is much higher than we can meet,” says Buresh. “We have to turn people away.”