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Low Barrier Buprenorphine: A Street Medicine Approach – Leah Warner, NP, MPH

Low Barrier Buprenorphine: A Street Medicine Approach – Leah Warner, NP, MPH


Leah Warner, NP, MPH

Leah Warner, NP, MPH is with Lyon-Martin Health Services as a , full-time Primary Care Provider. Before coming to Lyon-Martin, Warner worked at Glide Health Services, providing primary care services to homeless adults and elderly clients living in San Francisco’s Tenderloin neighborhood. Warner began providing primary care to patients of all ages at Marin City Health and Wellness Center.

People experiencing homelessness with substance use disorders face multiple barriers accessing healthcare, including access to medication-assisted therapy to treat opiate dependence. The Street Medicine Team initiated a pilot in November 2017 to improve access to medication-assisted treatment for a vulnerable and marginalized population. Initial evaluation at 1 year found favorable results. The program has therefore been supported and expanded by the City and County of San Francisco. We will report on successes and challenges within this program and our evaluation at 2 years of operation.

The target population for this project is high risk/high vulnerability people experiencing homelessness who are not otherwise receiving effective healthcare services. We define high risk as unhoused opioid users who often inject drugs in public spaces, increasing the risk of overdose and other medical complications. An innovation critical to our effectiveness is a patient assessment and initiation of medication treatment at non-traditional sites, for example, syringe access programs, and encampments. Essential components for success include: collaboration with a local pharmacy with clinical expertise in treating this population; a harm reduction practice and philosophy; collaboration with skilled and trusted community-based organizations; and a multidisciplinary medical team that honors each members’ clinical expertise irrespective of degree or title. Our primary outcome to measure success is retention in care, and within retention, in care, we found several patterns beyond timed follow-up visits. We also found positive outcomes related to screening, prevention, and provision of care for chronic conditions, indicating an overall health improvement within a high-risk group.

Learning Objectives:

  • Define barriers specific to people experiencing homelessness to access medication assisted therapy for opiate use disorder
  • Identify different patterns in retention of care that predicted overall improvement to health for injection drug using people experiencing homelessness
  • Describe the successes and lessons learned of a Low Barrier Buprenorphine Clinic for people experiencing homelessness in San Francisco