Evaluation of Connections Clinic: The Bridge Program located within the Preble Street Learning Collaborative

Problem: The opioid epidemic continues, and overdose rates throughout the United States remain high. Only 22% of people diagnosed with opioid use disorder (OUD) access medications for OUD (MOUD). Bridge clinics may improve access to MOUD, specifically buprenorphine. Individuals experiencing homelessness (IEH) face additional barriers to accessing care, though little is known about bridge clinics specifically focused on IEH. The bridge clinic embedded within the MaineHealth–Preble Street Learning Collaborative, called Connections Clinic (CC), aims to address unmet health care needs of IEH in Portland, Maine, by providing low-barrier health care and access to buprenorphine. Approach: We analyzed demographics, health access, health outcomes and mortality, and MOUD use among a cohort of 471 patients who received buprenorphine at CC from January 1, 2018, through December 31, 2023, using data from the electronic health record. Outcomes: The median age of patients was 37 years. A total of 67% identified as male, and 89% were White. There were 309 (66%) patients who were insured at their first visit and 419 (89%) who were insured at their most recent visit. A total of 248 (53%) patients received hepatitis C virus screening with 195 (78.6%) screens returning positive. The all-cause mortality rate was 4%. Regarding MOUD use, patients received a mean of 2.5 prescriptions for buprenorphine per month. Of the 2666 urine drug screens performed during the study, 2148 (81%) returned positive for buprenorphine. Next Steps: We found strong treatment adherence and a low all-cause mortality rate among IEH at CC where patients had flexible and low-barrier access to comprehensive services, including buprenorphine treatment, infectious disease screening, and health insurance. These findings suggest that CC is an effective care model for IEH in Portland, Maine. Future areas of focus include analyzing outcomes after transfer to long-term MOUD management and improving screening for infectious diseases.