People with substance use disorders are often overlooked in the design of treatment programs, even as the street opioid supply continues to change. Pathways to Housing PA is committed to ensuring that its programs reflect direct input from those most affected.
Our Center of Excellence (COE) staff support people with opioid use disorder (OUD) in accessing treatment and medications for opioid use disorder (MOUD), while helping them overcome barriers along the way. We were thrilled to partner with the Scattergood Foundation to expand these services.
Several years ago, we piloted an incentive program for long-acting injectable MOUD. Our team had observed that participants often struggled to take medication every day, yet showed little interest in a once-monthly injectable option. When we asked why, participants identified concerns about losing income as a significant barrier. In response, we developed an incentive-based program that provides stipends to help offset that loss. One of the program’s greatest accomplishments is that it was designed with input from people with OUD and directly addresses the barrier they identified.
With Scattergood’s support, we are expanding the program to serve significantly more participants. We are also partnering with Thomas Jefferson University to collect data and evaluate the program’s effectiveness. By building an evidence base for this approach, we hope to share the model with other providers and ultimately reach more people.
Our greatest hurdle has been obtaining approval from the City’s Institutional Review Board (IRB). The process is lengthy, in part because the board meets only once a month to review submissions. It took time to secure a research partner at Jefferson, develop the proposal, and move through several months of IRB review. Although we expected the project to take time to launch, we did not anticipate that nearly a year would pass between receiving the grant and beginning the program.
We knew that conducting rigorous research would require a significant investment of time, and we are thrilled to finally be on track to launch the project with full IRB approval. If we had a magic wand, we would use it to make the process of building evidence-based research more efficient.
The longer this process takes, the longer participants must wait for the opportunity to try long-acting MOUD—and that delay can mean the difference between life and death.
James participated in our initial incentive program and shared his experience with Suboxone and Sublocade, a long-acting form of MOUD:
“An issue I had with the street drugs was the volatility and the unpredictability. So I was always up and down with the withdrawal. Suboxone created a situation where that wasn’t an issue. It gave me this baseline of, you know, a legal drug that could keep me from having these real high highs and low lows. And it was effortless. It was one shot, and it was done [once] for a month, and then it worked. It worked so well that I was unaware of how well it was working until I stopped. When I stopped, I was just in awe of how much of the load that the Sublocade was carrying. It’s a wonderful thing.”
James’s experience highlights several important aspects of this project. First, long-acting MOUD can help people with OUD find greater stability by easing the cycles of intoxication and withdrawal. Second, his story reflects the reality that recovery is rarely linear. People may start and stop MOUD or move through periods of increased and decreased substance use. MOUD is not a guarantee, but it is an important tool that can help people begin and continue their recovery. Removing barriers and encouraging someone to try treatment can make the difference between taking that first step and remaining in active addiction.
As we launch the project with full IRB approval, our greatest opportunity lies in its potential impact beyond the individual participants. The incentive program will directly support people with OUD, while the accompanying research will produce evidence about the model’s effectiveness. These findings could encourage other organizations that provide MOUD to adopt incentive-based approaches, potentially supporting thousands more people in their recovery.
We are proud to lead this work in our community and look forward to sharing updates as the program moves forward.