Offering Buprenorphine in Homeless Shelters in Massachusetts Projects Life- and Cost-saving Results
Statewide expansion of buprenorphine treatment in shelters is projected to reduce overdose deaths among people experiencing homelessness.
Overdose is the leading cause of death among people with opioid use disorder (OUD) who are experiencing homelessness. Innovative care models that meet this population outside of office-based settings can improve access to buprenorphine, a medication for treating OUD, and avert fatal overdoses. In this study, Avik Chatterjee, lead author and addiction specialist at Boston Medical Center, and colleagues used a simulation model to project the long-term health outcomes and healthcare costs of expanding buprenorphine to 100 homeless shelters in Massachusetts.
Expanding shelter-based buprenorphine access in Massachusetts could be an opportunity to address overdoses among a historically marginalized population.
Avik Chatterjee
The team used the Massachusetts Public Health Data Warehouse and the RESPOND Model to simulate a shelter-based opioid overdose prevention program for 13,800 people experiencing homelessness from 2013-2023. The model reflects the relapsing and remitting nature of OUD and simulates active versus nonactive and injection versus non-injection opioid use. The health economic analyses were conducted from the healthcare and societal perspectives.
Key Findings
- Offering shelter-based opioid treatment was associated with 9.2% fewer overdose deaths among people experiencing homelessness; 254 overdose deaths were projected to be averted over the 10-year period.
- Shelter-based buprenorphine was cost-saving, with a discounted lifetime cost-savings from the health sector perspective of $1,300 per person.
Distributing buprenorphine in shelters was expected to generate cost savings that exceed the cost of the program, largely through reduced health care expenses, and was associated with fewer overdose deaths.
Findings from this economic evaluation build on previous studies that demonstrate the effectiveness of tailoring buprenorphine programs to people experiencing homelessness. Implementing a statewide expansion of buprenorphine treatment in shelters is projected to be a fiscally responsible solution and an equity-promoting strategy to avert overdose deaths among a population that has historically faced barriers to care. The number of shelter- and street-based buprenorphine programs that have emerged nationwide further reinforces the potential for large-scale expansion of buprenorphine distribution and participation of organizations caring for people experiencing homelessness.
The article, “Health and Economic Outcomes of Offering Buprenorphine in Homeless Shelters in Massachusetts,” was published in JAMA Network Open, on October 16, 2024. Additional details can be found on Boston Medical Center and HealthCity.