Counteracting Structural Barriers to Increase Access to Medications for Opioid Use Disorder (MOUD) Among Unhoused Montanans

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The opioid epidemic has disproportionately impacted the unhoused population with an overdose death rate 20 times higher than that of the general population. Medications for opioid use disorder (MOUD) is highly effective in saving lives, but unhoused individuals experience many structural barriers to accessing treatment – stigmatization by healthcare providers, limited acceptance of Medicaid, and personal instability that precludes treatment co-requirements. Those barriers are compounded for unhoused individuals in Montana (MT) where the number of Montanans with opioid use disorder (OUD) outweigh treatment capacity by 10-fold with 92% of individuals with OUD (housed and unhoused) not receiving treatment. To combat these barriers, we will utilize three evidence-based interventions proven to increase engagement of underserved populations: 1) MOUD care based in syringe service programs (SSPs), 2) a nurse-led model of MOUD, and 3) peer navigator supported care. We will embed these interventions into the five SSPs that span the state of MT – sites located in both urban and rural areas with three sites adjacent to American Indian Reservations. Following the OUD cascade of care framework, we will assess the following measures among SSP clients: 1) engaged in care services at SSP, 2) OUD diagnosis by SSP prescriber, 3) MOUD initiations, 4) patient days on MOUD, and 5) MOUD for ≥ 60 days, 90 days, and 180 days. In each SSP, we aim to surpass the state average of Montanans utilizing MOUD. In whole, we intend to make these SSPs the state model for equitable OUD care.