PROVIDING LOW-BARRIER MEDICATIONS FOR ADDICTION TREATMENT VIA A TELEMEDICINE CALL LINE TO PEOPLE EXPERIENCING HOMELESSNESS IN LOS ANGELES, COUNTY

ABSTRACT

BACKGROUND: Los Angeles County Department of Health Services (LAC DHS) provides medical care for the safety net population of Los Angeles County, including a large population of people experiencing homelessness (PEH). To enhance patients' access to medications for addiction treatment during the COVID19 pandemic, LAC DHS established a telemedicine call line in March 2020 to support patients' access low-barrier medications for addiction treatment. To operationalize the call line, LAC DHS partnered with community organizations already working with PEH to facilitate timely access to medications for addiction treatment on demand. One of the largest community partners partnered with LAC DHS during this time was Community Health Project Los Angeles (CHPLA). Little was previously published regarding the patients who accessed care via CHPLA and how many of these patients remained engaged in medical treatment. We aimed to quantify and characterize the cohort of PEH treated and retained in care during the first 20 months of the operation of the telemedicine call line. METHODS: The telemedicine addiction medications call line was established in March 2020 and was accessible by any DHS affiliated outreach providers to call when they identified a patient interested in receiving a medication for addiction treatment. After each telemedicine visit was completed, CHPLA social workers logged patient information into a secure registry. Registry information was collected from March 2020 to August 2021 including patient demographics and the reason for visit. Information on addiction medications prescribed by the call line providers was also collected. Descriptive statistics were obtained and resulted below. RESULTS: During our study period, 111 of CHPLA's clients experiencing homelessness were served by the LAC DHS telemedicine call line (mean age 39 years, 74% male (N=82), 23% Latinx (N=26), 11% Black (N=10, 60% White (N=67). All PEH were prescribed buprenorphine-naloxone (bup-nx) for opioid use disorder. Insurance covered 87% (N=97) of prescriptions for bupnx. Of the 111 PEH who were prescribed bup-nx, 78% (N=87) obtained their initial prescription. Additional services provided to PEH by CHPLA included referral for case management (N=4), specialty addiction treatment (N=8), and women's health services (N=2). Of the 87 patients that received their initial prescription for bup-nx, 21% (N=18) were interested in and referred to and 6% (N=5) established care with a continuity clinic offering maintenance medications for addiction treatment. CONCLUSIONS: A telemedicine call line can be feasible and effective way to initiate low-barrier medications for addiction treatment to PEH during the COVID-19 pandemic, but low threshold initiation of medications for addiction treatment is itself insufficient to address the patient readiness, the many social determinates of health, and the systemic barriers to continuity clinical services for PEH with substance use disorders.