N.Y. youth agency incorporates buprenorphine into harm reduction strategy

A New York City drop-in center serving homeless young people is finding that the medication buprenorphine can be integrated successfully into a broad-based harm reduction strategy targeting injection drug users.

The Lower East Side location of the Streetwork Project has been working with the Suboxone formulation of buprenorphine for the past three years. Counseling and case management are the core services of the Streetwork Project, explains program director John Welch, and the site also houses a syringe exchange program.
Because the Streetwork Project is not governed by an abstinence model but by a broader effort to improve social functioning and quality of life for a group of street-involved young people, treatment of opioid addiction is highly individualized to each client’s condition. Welch reports that he often hears very positive comments about buprenorphine from the clients who are taking it.
“Some say, ‘It’s like it was before I did heroin. I feel normal now,’” says Welch.
The Streetwork Project, a program of the New York-based agency Safe Horizon, works with individuals from the teen years to age 24; the agency is funded by a combination of government and private sources. Welch says he became interested in a medication intervention for the injection drug users who are targeted in the Lower East Side drop-in program because he noticed that many people would tend not to pursue treatment voluntarily until their late 20s to 30s. In the meantime, they would be susceptible to contracting illnesses such as HIV and hepatitis C.
Welch saw buprenorphine as representing a possibly effective introduction to treatment for a group of individuals who likely would not respond to the strict clinic structure of methadone maintenance treatment.
“We found a psychiatrist who was authorized to prescribe buprenorphine and was already using it in his private practice,” Welch says. “This was someone with a good philosophical understanding of what we do.”
Welch says he has found that individuals with more stable mental health profiles and those with less polydrug use appear to be the best candidates for buprenorphine in his program. In addition, he says clients taking buprenorphine appear to engage in less abuse of other substances while they are on the medication.
The overall population identified through the Streetwork Project’s street outreach has multiple problems ranging from homelessness to victimization. Some have been in the foster care system, but many have never received human services prior to their being identified through the project’s outreach.