"Bupe by the Book:" Developing and Testing a Tele-Buprenorphine Intervention in Public Libraries with Unstably Housed Persons with Opioid Use Disorder

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Bupe by the Book: Developing and Testing a Tele-buprenorphine Intervention in Public Libraries with Unstably Housed Persons with Opioid Use Disorder Abstract Public libraries nationwide are experiencing an on-premise opioid overdose crisis. Buprenorphine “bupe” is a highly effective medical treatment for OUD, but many unstably housed persons at libraries lack access to bupe due to structural barriers. “Bupe by the Book” (BBB), in collaboration with our established local partners, San Diego Public Libraries and Father Joe's Village Health Center (FJV), would innovatively adapt FJV's already successful same-day, free low barrier tele-bupe treatment to library settings. By testing tele-bupe uptake and retention in libraries, this study will inform how individuals can receive bupe care in innovative low-barrier ways, potentially changing the landscape radically for implementing bupe. Our three aims are: 1) Develop and refine “Bupe by the Book” (BBB) within the Technology Acceptance Model (TAM): Through focus groups and intervention mapping techniques, we will: a) assess the perceptions of stakeholders such as local residents with children who use the library, library staff, tele-bupe providers, and persons with OUD about BBB's potential, b) develop a plan with stakeholder input, and c) identify modifiable barriers to implementation. 2) Determine the feasibility of BBB and measure treatment uptake and adherence: We will conduct a 12-week pilot 2-arm randomized controlled trial (RCT) (n=40). Study staff will recruit library patrons and randomize them to weekly tele-bupe at the library or in-person clinic control arms. A health provider will then screen participants for eligibility for same-day bupe induction. BBB's effects on bupe induction and adherence to prescribed doses will be based on self-reported measures at 1-,2-,4-,8-,12- week follow-ups with study staff, and weekly urinary drug screenings and prescription pickups. We hypothesize that tele-bupe in the library vs. the control group will have higher uptake and longer adherence to treatment. This pilot will provide estimates of uptake and adherence for the design of a larger trial of the intervention's efficacy. 3) Evaluate the acceptability of BBB and identify program components that could be improved to enhance adherence and patient satisfaction. We will conduct structured interviews with BBB patients, health providers, and library staff to gain insight into the patients' experiences with BBB compared to in-person clinic-based bupe treatment. By utilizing multiple library sites, we will render tele-bupe reproducible for other libraries nationwide facing opioid overdoses and pave the foundation for a larger RCT in a subsequent R01 to evaluate the efficacy of utilizing public settings to treat substance use disorders and reduce opioid-related deaths.