Assessing Perceptions of MOUD during COVID-19 in a Black and Homeless population

Introduction:
The focus of opioid-related deaths and opiate use disorder (OUD) has shifted to White and rural communities. However, black communities have seen the highest rates of increase in opioid-related overdose deaths and comprise the second largest group of deaths. While suboxone is a proven safe, effective and patient-centered medication for opiate use disorder (MOUD) option, uptake in the black community has been lagging. Furthermore, COVID-19 has disproportionately impacted the black community and disrupted routine access. To inform the direction of a newly established MOUD program emphasizing primary care-based suboxone induction during the COVID-19 pandemic, we characterized the perceptions of this program through survey of patients of a community health center serving a largely urban black population.

Methods:
Participants were patients of Roots Community Health Center (Roots), a 501c3 organization providing clinical services to a predominantly black population on public insurance and a provider of suboxone as of one year prior. Patients were chosen through purposeful sampling using a patient registry of those with a diagnostic code for OUD (F11) or with a prescription for opioids in their chart. The Roots outreach team of community health workers also recruited participants from homeless encampments and needle exchanges in Oakland, CA. Surveys were conducted from May to August 2020 over the phone after consent by community health workers. Participants were given a $25 gift card for participation. The governing institutional review board determined this project to be non-research.

Results:
Forty-seven individuals completed a phone survey administered by clinic community health workers. The majority of our patients identified as African-American or Black (74.5%), and about half (51.1%) were female. The study sampled a large portion of those experiencing homelessness (49.0%) as well people on public insurance 46 (97.9%). There were 16 (36.4%) participants aged 60-80 and 23 (52.3%) aged 39-59. Thirty-one (66.0%) participants reported using some type of opioid. Of those who tried to cut down opioid use (n=24), most participants attempted to quit cold turkey 18 (75.0%), followed by counseling 8 (33.3%), inpatient and outpatient rehabilitation 6 (25.0%), group therapy 3 (12.5%). Only one respondent noted having tried suboxone. Strikingly, only 26 (55.3%) participants recognized suboxone as a treatment and only 2 (4.35%) participants knew about naloxone/Narcan as a medication to treat overdose. However, 18 (38.30%) of participants reported witnessing someone overdose. Lastly, COVID-19 was cited by 15 (36%) of respondents as the largest barrier to treatment currently and 36 (76%) stated they would be able to call in for a provider visit related to treatment.

Conclusion:
Despite a standing MOUD program that offers suboxone and naloxone/Narcan, awareness of these drugs was low among this urban black patient population. Access to counseling was cited as a source of need to cut back on opiate use. Furthermore, COVID-19 is a significant barrier for the black community in accessing MOUD programs; however, telephone access for treatment was common. Future programmatic improvements should focus on increased education of suboxone as MOUD, behavioral health integration and additional access points like telehealth during the ongoing COVID pandemic.

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