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

阿片类药物的流行对无住房人口造成了不成比例的影响，导致过量死亡。 这一比例是普通人口的20倍。治疗阿片使用障碍的药物(Moud)是 在拯救生命方面非常有效，但没有住房的人遇到了许多结构性障碍 获得治疗--医疗保健提供者的污名化，对医疗补助的接受程度有限，以及 个人不稳定，排除了共同治疗的要求。这些障碍是复杂的 蒙大拿州的无住房个人(MT)，蒙大拿州有阿片类药物使用障碍的人数(OUD) 超过治疗能力10倍，92%的OUD(有住房和无住房)患者没有 正在接受治疗。为了克服这些障碍，我们将利用三种已证实的循证干预措施 增加服务不足人群的参与度：1)以注射器服务方案为基础的穆德护理 (SSP)，2)护士主导的Moud模式，3)同行导航员支持的护理。我们将把这些嵌入 对横跨MT州的五个SSP的干预--位于城市和农村地区的站点 有三个地点毗邻美洲印第安人保留地。在一连串的关怀之后 我们将在SSP客户中评估以下措施：1)在SSP从事护理服务， 2)SSP处方者的BUD诊断，3)MUD启动，4)MUD患者日，5)MUD用于≥ 60天、90天和180天。在每个SSP中，我们的目标是超过蒙大拿州的平均使用率 穆德。总体而言，我们打算使这些SSP成为公平医疗的国家典范。

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.