{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:28:16Z","timestamp":1760236096019,"version":"build-2065373602"},"reference-count":36,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2021,10,21]],"date-time":"2021-10-21T00:00:00Z","timestamp":1634774400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The opioid epidemic is a public health crisis that disproportionately affects our unsheltered neighbors. Because medication-assisted treatment (MAT) is effective for preventing deaths from drug overdose and retention is associated with better health outcomes, there is a clear need for more research on factors impacting retention in care. This retrospective cohort analysis examines the relationship between attendance in counseling and retention on buprenorphine for three or more months for individuals experiencing homelessness being treated at a Federally Qualified Health Center (FQHC) and Public Health Service Act \u00a7330(h) Health Care for the Homeless Program grantee in San Diego County, California. The cohort included 306 adults experiencing homelessness who had at least one prescription for buprenorphine and participated in a MAT program between 2017 and 2019. The sample included 64.4% men, almost exclusively white, and 35% lived in a place not meant for human habitation. Of the sample, 97 patients were retained at 3 months and 209 were not. Results from a logistic regression model showed that counseling appointments were positively associated with retention at three months (OR = 1.57, p &lt; 0.001). Findings from this study inform future MAT program design components for people experiencing homelessness.<\/jats:p>","DOI":"10.3390\/ijerph182111072","type":"journal-article","created":{"date-parts":[[2021,10,22]],"date-time":"2021-10-22T00:22:02Z","timestamp":1634862122000},"page":"11072","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Association between Participation in Counseling and Retention in a Buprenorphine-Assisted Treatment Program for People Experiencing Homelessness with Opioid Use Disorder"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0733-1086","authenticated-orcid":false,"given":"Amanda R. W.","family":"Berry","sequence":"first","affiliation":[{"name":"School of Social Work, San Diego State University, San Diego, CA 92182, USA"},{"name":"School of Public Health, San Diego State University, San Diego, CA 92182, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tracy L.","family":"Finlayson","sequence":"additional","affiliation":[{"name":"School of Public Health, San Diego State University, San Diego, CA 92182, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luke M.","family":"Mellis","sequence":"additional","affiliation":[{"name":"Saint Vincent de Paul Village, Inc., San Diego, CA 92102, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lianne A.","family":"Urada","sequence":"additional","affiliation":[{"name":"School of Social Work, San Diego State University, San Diego, CA 92182, USA"},{"name":"Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,21]]},"reference":[{"key":"ref_1","unstructured":"(2021, October 18). Substance Abuse and Mental Health Services Administration (SAMHSA), Available online: https:\/\/www.samhsa.gov\/data\/sites\/default\/files\/cbhsq-reports\/NSDUHNationalFindingsReport2018\/NSDUHNationalFindingsReport2018.pdf."},{"key":"ref_2","first-page":"1419","article-title":"Morbidity and mortality weekly report drug and opioid-involved overdose deaths-United States, 2013\u20132017","volume":"67","author":"Scholl","year":"2017","journal-title":"Morb. Mortal. Wkl. Rep."},{"key":"ref_3","unstructured":"(2021, October 18). The 2019 Annual Homeless Assessment Report (AHAR) to Congress, Available online: https:\/\/www.huduser.gov\/portal\/sites\/default\/files\/pdf\/2019-AHAR-Part-1.pdf."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1001\/jamainternmed.2013.1604","article-title":"Mortality among homeless adults in Boston: Shifts in causes of death over a 15-year period","volume":"173","author":"Baggett","year":"2013","journal-title":"JAMA Intern. Med."},{"key":"ref_5","unstructured":"(2020, August 17). Addressing the Opioid Crisis in the United States|IHI\u2014Institute for Healthcare Improvement. Available online: http:\/\/www.ihi.org\/resources\/Pages\/Publications\/Addressing-Opioid-Crisis-US.aspx."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"182","DOI":"10.2105\/AJPH.2017.304187","article-title":"Opioid crisis: No easy fix to its social and economic determinants","volume":"108","author":"Dasgupta","year":"2018","journal-title":"Am. J. Public Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.drugalcdep.2016.12.011","article-title":"Bowling alone, dying together: The role of social capital in mitigating the drug overdose epidemic in the United States","volume":"173","author":"Zoorob","year":"2017","journal-title":"Drug Alcohol Depend."},{"key":"ref_8","unstructured":"(2021, October 18). California Health Care Foundation. Available online: https:\/\/www.chcf.org\/publication\/why-health-plans-should-go-to-the-mat-in-the-fight-against-opioid-addiction\/."},{"key":"ref_9","unstructured":"Clemans-Cope, L., Epstein, M., and Wissoker, D. (2018, January 25). County-Level Estimates of Opioid Use Disorder and Treatment Needs in California. e Urban. Instit., Available online: https:\/\/www.urban.org\/sites\/default\/files\/publication\/93421\/county-level_estimates_of_opioid_use_disorder_and_treatment_needs_in_california.pdf."},{"key":"ref_10","unstructured":"Centers for Medicare and Medicaid Services (2021, October 18). CMS Roadmap: Strategy to Fight the Opioid Crisis, CMS, Available online: https:\/\/www.cms.gov\/About-CMS\/Agency-Information\/Emergency\/Downloads\/Opioid-epidemic-roadmap.pdf."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1176\/appi.ps.201300256","article-title":"Medication-assisted treatment with buprenorphine: Assessing the evidence","volume":"65","author":"Thomas","year":"2014","journal-title":"Psychiatr. Serv."},{"key":"ref_12","unstructured":"(2021, October 18). Factors That Influence Access to Medication-Assisted Treatment Project Team. Available online: https:\/\/www.behavioralhealthworkforce.org\/project\/factors-that-influence-access-to-medication-assisted-treatment-and-substance-use-disorder-treatment-services\/."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1080\/10550887.2016.1100960","article-title":"Retention in medication-assisted treatment for opiate dependence: A systematic review","volume":"35","author":"Timko","year":"2016","journal-title":"J. Addict. Dis."},{"key":"ref_14","unstructured":"(2021, October 18). Models for Medication-Assisted Treatment for Opioid Use Disorder, Retention, and Continuity of Care, Available online: https:\/\/aspe.hhs.gov\/reports\/models-medication-assisted-treatment-opioid-use-disorder-retention-continuity-care-0."},{"key":"ref_15","unstructured":"(2020, December 09). Glossary|Bureau of Primary Health Care, Available online: https:\/\/bphc.hrsa.gov\/programrequirements\/compliancemanual\/glossary.html."},{"key":"ref_16","first-page":"1273","article-title":"The behavioral model for vulnerable populations: Application to medical care use and outcomes for homeless people","volume":"34","author":"Gelberg","year":"2000","journal-title":"Health Serv. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s13722-019-0149-1","article-title":"Low barrier buprenorphine treatment for persons experiencing homelessness and injecting heroin in San Francisco","volume":"14","author":"Carter","year":"2019","journal-title":"Addict. Sci. Clin. Pract."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1080\/10550887.2012.694603","article-title":"Opioid maintenance treatment as a harm reduction tool for opioid-dependent individuals in New York City: The need to expand access to Buprenorphine\/Naloxone in marginalized Populations","volume":"31","author":"Stancliff","year":"2012","journal-title":"J. Addict. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.jsat.2016.12.010","article-title":"Long-term retention in Office based Opioid treatment with buprenorphine","volume":"74","author":"Weinstein","year":"2017","journal-title":"J. Subst. Abuse Treat."},{"key":"ref_20","first-page":"65","article-title":"Research report unsheltered homelessness trends, characteristics, and homeless histories","volume":"74","author":"Batko","year":"2020","journal-title":"J. Subst. Abuse Treat."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/s11606-006-0023-1","article-title":"Treating homeless opioid dependent patients with buprenorphine in an office-based setting","volume":"22","author":"Alford","year":"2007","journal-title":"J. Gen. Intern. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1038\/s41380-020-00949-3","article-title":"Polysubstance use in the U.S. opioid crisis","volume":"26","author":"Compton","year":"2021","journal-title":"Molec. Psychiatry"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1080\/08897077.2016.1145616","article-title":"Substance use among persons with homeless experience in primary care","volume":"37","author":"Stringfellow","year":"2016","journal-title":"Subst. Abus."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2250","DOI":"10.1111\/add.14398","article-title":"High-intensity cannabis use is associated with retention in opioid agonist treatment: A longitudinal analysis","volume":"113","author":"Wood","year":"2018","journal-title":"Addiction"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1668","DOI":"10.1001\/jamainternmed.2014.4005","article-title":"Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999\u20132010","volume":"174","author":"Bachhuber","year":"2014","journal-title":"JAMA Intern. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e2010001","DOI":"10.1001\/jamanetworkopen.2020.10001","article-title":"Association of State policies allowing medical cannabis for Opioid use disorder with dispensary marketing for this indication","volume":"3","author":"Shover","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/j.neuroscience.2013.04.034","article-title":"Cannabinoid and opioid interactions: Implications for opiate dependence and withdrawal","volume":"248","author":"Scavone","year":"2013","journal-title":"Neuroscience"},{"key":"ref_28","unstructured":"(2021, March 03). Rising Stimulant Deaths Show that We Face More than Just an Opioid Crisis|National Institute on Drug Abuse (NIDA), Available online: https:\/\/www.drugabuse.gov\/about-nida\/noras-blog\/2020\/11\/rising-stimulant-deaths-show-we-face-more-than-just-opioid-crisis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.drugalcdep.2018.08.029","article-title":"Twin epidemics: The surging rise of methamphetamine use in chronic opioid users","volume":"193","author":"Ellis","year":"2018","journal-title":"Drug Alcohol Depend."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.jsat.2019.10.005","article-title":"Association between methamphetamine use and retention among patients with opioid use disorders treated with buprenorphine","volume":"109","author":"Tsui","year":"2020","journal-title":"J. Subst. Abuse Treat."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"102722","DOI":"10.1016\/j.drugpo.2020.102722","article-title":"Unintentional drug overdose: Is more frequent use of non-prescribed buprenorphine associated with lower risk of overdose?","volume":"79","author":"Carlson","year":"2020","journal-title":"Int. J. Drug Policy"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.addbeh.2012.01.019","article-title":"Incidence and risk factors for non-fatal overdose among a cohort of recently incarcerated illicit drug users","volume":"37","author":"Kinner","year":"2012","journal-title":"Addict. Behav."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.drugalcdep.2018.07.035","article-title":"Regular MDMA use is associated with decreased risk of drug injection among street-involved youth who use illicit drugs","volume":"192","author":"Gaddis","year":"2018","journal-title":"Drug Alcohol Depend."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1056\/NEJMoa055255","article-title":"Counseling plus buprenorphine\u2013naloxone maintenance therapy for opioid dependence","volume":"355","author":"Fiellin","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1097\/ADM.0000000000000193","article-title":"A systematic review on the use of psychosocial interventions in conjunction with medications for the treatment of opioid addiction","volume":"10","author":"Dugosh","year":"2016","journal-title":"J. Addict. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1001\/archgenpsychiatry.2011.121","article-title":"Adjunctive counseling during brief and extended buprenorphine-naloxone treatment for prescription opioid dependence: A 2-phase randomized controlled trial","volume":"68","author":"Weiss","year":"2011","journal-title":"Arch. Gen. Psychiatry"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/21\/11072\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:20:11Z","timestamp":1760167211000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/21\/11072"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,21]]},"references-count":36,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["ijerph182111072"],"URL":"https:\/\/doi.org\/10.3390\/ijerph182111072","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2021,10,21]]}}}