Low-Threshold Buprenorphine in Non-Traditional Settings: A Scoping Review.

Background: Despite the continuing opioid overdose crisis, the majority of those diagnosed with opioid use disorder (OUD) are not engaged in treatment due to various barriers. Low-threshold buprenorphine programs are designed to reduce treatment barriers. Key tenets of these programs are a harm reduction approach, same-day entry, flexibility, and accessibility. The development of novel programs has expanded low-threshold treatment into mobile units, syringe service programs, and community centers. Objective: This scoping review aims to describe approaches taken by programs in non-clinical settings by identifying key components of delivery models, implementation barriers and facilitators, and outcomes. Given the diverse nature of the literature on these programs, a scoping review was selected to review outcomes and to identify gaps. Methods: A protocol following the PRISMA-ScR guidelines was developed to systematically search 5 databases: Medline, Embase, CINAHL, PsycInfo, and Web of Science. Articles published prior to January 31, 2024 that described buprenorphine programs operating outside traditional healthcare settings were included. Results: The search identified 18 784 articles, including 147 in full-text review, with 41 meeting eligibility criteria. Common program types encompassed syringe service, mobile, community center, and street medicine. All programs emphasized community partnerships as key implementation facilitators and noted funding is urgently needed. Conclusion: Low-threshold buprenorphine programs are an innovative way to deliver OUD treatment to people who otherwise may not have access to and/or engage in treatment. Future efforts should determine which outcomes are most important to people who use drugs, standardize outcome measurements, and implement programs tailored to help communities meet those outcomes.