For those who experience homelessness, treatment for an opioid abuse disorder is more difficult to obtain.
For people who are homeless, getting help for a substance use disorder can be difficult. Many are isolated from the health care system, often with no way to get to a point of care or pay for treatment. This is why, in Chicago, the providers come to them.
“We often just start with a bagged lunch and a bottle of water… and we’ll see what happens from there,” said Stephan Koruba, senior nurse practitioner at Night Ministry, a street medicine clinic based in Chicago, Illinois. “What happens from there” could include helping someone get housing or legal ID, or providing wound care and treatment for a use-related disorder. of substances, all in a van.
When providing care to the homeless, Koruba and her team of medical providers and social workers focus on relationship building first. “We are trying to offer a human connection without judgment,” he said. For many, distrust of health care providers can be a barrier to treatment. “Other humans are often the biggest threat to people on the streets,” Koruba said.
The vehicle allows providers to “search every nook and cranny” for those living in tent camps, under bridges and on street corners. In addition, the team operates a bus that it uses to provide overnight care to homeless people in six Chicago communities.
For people addicted to opioids, Koruba is able to provide medication assisted treatment. A typical treatment is to prescribe Suboxone, an opioid-based drug that prevents overdoses and withdrawal, and behavioral health support.
Although Koruba can write the prescription, it can be difficult to obtain the medications for the patients.
Many do not have insurance and cannot afford to buy Suboxone at a pharmacy, according to Koruba. Others do not have a vehicle or money for public transport, which makes it difficult to access a pharmacy. To close the gap, The Night Ministry is working with a local community health center to provide patients with free transportation to and from their appointment. At the health center, they can get free treatment for their substance abuse disorder.
But treating a substance use disorder requires more than a visit to the doctor. Patients must follow a strict drug regimen, which involves multiple trips to a pharmacy and consistent follow-up appointments. For people living on the streets, this type of high contact care is not always possible. “We plan to meet people at a certain time, in a certain place, and sometimes they are there and sometimes they are not,” Koruba explained.
Since the success of drug treatment depends on a certain degree of stability, the homeless face an uphill battle. If an opioid drug is not taken consistently, people may fall back on stronger, more addictive drugs.
This can lead to an overdose, especially after a period of detox, and ultimately land a person in the emergency room. From there, a dangerous cycle begins: “We have seen a lot of people get very dear, get really good care for a week or two in the hospital, but get kicked out on the streets, then they all miss their follow-up and get sicker and sicker and they end up in the emergency room a few weeks later, ”Koruba said.
According to Koruba, “breaking this cycle” begins by changing the culture of emergency rooms: “The institutional inertia is to ignore drug addicts when they come to the emergency room for visits,” he said. Often, providers assume that they are “just looking for more drugs.”
But taking into account an individual’s personal situation can have profound effects on their long-term results. For example, Koruba said, most emergencies don’t ask about a patient’s accommodation. “It’s not part of the internal culture,” he explained. Instead, they treat patients for the acute problem they were admitted to, such as an overdose. But because housing status can have “a great impact on [a patient’s] medical care and its monitoring capacity ”, this is essential information. For some, this can mean the difference between recovery and the need for additional emergency care.
To encourage better coordination among providers, The Night Ministry took emergency doctors on outreach trips to provide medical care on the streets. Doctors “can see the realities our people are facing” and “change the resources they have at the hospital,” Koruba said.
While this type of coordination does not happen on a large scale, there has been improvement. Recently, an emergency room doctor recognized a patient he treated while volunteering with The Night Ministry, who had been admitted with an overdose. The doctor informed Koruba and he was able to “help them with their follow-up regimen first,” thus avoiding the need for emergency care down the line.
As “the ball drops a lot,” Koruba said, “we are trying to change the culture little by little.”
Through the Fund for Health Equity, Direct Relief has granted the Night Ministry $ 250,000 to support its mobile outreach program, including funding to provide medical care and social services to those sleeping on urban trains, in tent camps and the streets of Chicago.