What About Nights, Weekends, and Wait Times? Adding an On-Demand Facilitated Telemedicine Buprenorphine Component to a Community-Based Peer Support Outreach Program

Background: In 2020, loosened federal regulations allowed for buprenorphine for opioid use disorder to be initiated via telemedicine. In response to these regulatory changes and growing racial inequities in overdose in St. Louis, MO, a local, peer-led outreach program incorporated a new rapid access (RA) to buprenorphine program. RA facilitated same-day buprenorphine access by conducting peer-facilitated telemedicine visits in community settings. Methods: This study used logistic regression to compare 1- and 3-month treatment and buprenorphine retention between clients in the RA and Traditional (ie, linkage to brick-and-mortar prescribers within 1-3 days) programmatic arms of a peer-led outreach program between December 2020 and June 2022. Propensity score matching allowed participants across groups to be matched on key factors (eg, sex, race, homelessness). Racial differences in program receipt/enrollment were also assessed through Chi-squared tests. Results: Total program participation (N = 4139) included 1% (n = 52) in the RA program. Those in RA were more likely to be in treatment at 1 and 3 months and more likely to be on buprenorphine at 3 months compared to those in the Traditional group. The RA program included more White and fewer Black clients than expected. Four of the 8 reasons for non-enrollment differed by race, with Black individuals more likely to already have treatment secured but also more likely to decline the program or be unable to be contacted. Conclusions: This study is the first to demonstrate sustained benefits in treatment and medication engagement following same-day access to buprenorphine via community-based, peer-facilitated telemedicine. Lower-than-expected enrollment of Black individuals indicates a need for more culturally responsive implementation strategies for peer- and telemedicine-facilitated programs.