Improving Success of Field-based Buprenorphine Inductions for Opioid Use Disorder Treatment

Grantee: Downtown Emergency Service Center
Timeframe: July 2024 – June 2025 | Amount: $200,000

This project will allow DESC to hire a Full-Time Induction Specialist (RN) for its opioid treatment team to support clients transitioning from fentanyl to buprenorphine and to improve induction success rates.

The opioid epidemic continues to ravage communities nationwide, including Seattle/King County. In 2023, King County EMS responded to 8,390 opioid overdoses, with 1,113 being fatal—a 47% increase from the previous year. People experiencing homelessness comprised 20% of these cases, underscoring their heightened vulnerability due to isolation and inconsistent access to treatment.

DESC serves individuals who are unhoused, in emergency shelters, or in permanent supportive housing, many of whom have severe behavioral health conditions, medical issues, and disabilities. Approximately 15-20% of these clients regularly use opioids and meet the criteria for opioid use disorder.

Buprenorphine is a critical medication for treating opioid use disorder (MOUD) that can be administered in a physician’s office, thereby increasing treatment access. However, the induction process, which involves transitioning from fentanyl to buprenorphine, is complex and can last from 1 to 13 days. Fentanyl requires about 48 hours of withdrawal before induction, compared to the 12 hours needed for heroin or prescription opioids. Inadequate withdrawal time often results in severe discomfort, causing many clients to abandon the process.

Microdosing—starting with a small dose and gradually increasing over 5 to 14 days—can alleviate withdrawal symptoms and enhance induction success. DESC offers on-demand care, including walk-in intakes during business hours and telehealth support, leading to a high volume of new intakes each month.

Effective buprenorphine induction requires daily support, which was not originally part of DESC’s Opioid Treatment Network (OTN) design. To better address the current opioid crisis, DESC needs to adapt its staffing model.

Funding from PHPDA will enable DESC to hire a Full-Time RN dedicated to engaging clients in MOUD treatment. This specialist will guide clients through a personalized buprenorphine induction process, which typically spans 1 to 14 days. Daily contact with the RN will provide clients with continuous support and flexibility in their induction process, allowing adjustments based on their progress. The RN will also gather feedback throughout and after the induction to refine and enhance future interactions with OTN clients.

ABOUT OUR GRANTEE

Downtown Emergency Service Center

“Our vision is a community where no person is abandoned, ignored, or experiencing homelessness.

DESC helps people with the complex needs of homelessness, substance use disorders, and serious mental illness achieve their highest potential for health and well-being through comprehensive services, treatment, and housing.”