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Project Connections at Re-Entry

A mobile van in Baltimore that parks in front of a jail to provide low-threshold buprenorphine treatment to individuals just released from incarceration

Individuals with opioid use disorder that are re-entering society after incarceration are at a very high risk of opioid overdose. Project Connections at Re-Entry (PCARE), a program started in 2017 by the Behavioral Health Leadership Institute, provides a low-threshold buprenorphine treatment program that engages vulnerable patients in care through a mobile van parked directly outside the Baltimore City Jail. This program is an extension of the Project Connections program, which aims to deliver low-threshold buprenorphine treatment in non-traditional settings. Notably, PCARE primarily serves vulnerable populations, such as Blacks, those experiencing homelessness, and those with criminal justice involvement. 

PCARE predominantly targets persons who are released from the jail or who have been recently incarcerated, although anyone is welcome to receive treatment. To make the target population aware of PCARE, corrections staff at different stages of the jail intake process from booking through discharge are asked to inform individuals about the program upon release. 

As a low-threshold option, PCARE does not require identification, health insurance, abstinence from any drugs, or attendance at group meetings. In addition to buprenorphine, patients are provided with naloxone kits, fentanyl-testing strips, and linkage to a primary care clinic for continued buprenorphine prescribing and other medical help, or to a more comprehensive outpatient substance use program. However, this transition is not required and patients can continue getting buprenorphine treatment from PCARE. 

A preliminary evaluation and description of PCARE can be found in the peer-reviewed paper here. An overview of the program can be found in the news article here and the video here. 

The program is documented in the peer-reviewed literature as successful adapting to the COVID-19 pandemic.

Baltimore also has a mobile van called Healthcare on the Spot, launched in 2018 by the Baltimore City Health Department, the provides low-threshold buprenorphine services integrated with health care services to meet the needs of people who use drugs and has shown promising results. 

Immediate access to evidence-based treatment for OUD upon release from jail...31.6% percent still involved in treatment after 30 days.

Continuum of Care
Treatment
Type of Evidence
Peer-reviewed
Response Approach
COVID / Coronavirus related
Medications for Opioid Use Disorder
Outreach
Peer-reviewed Article
Expanding low-threshold buprenorphine to justice-involved individuals through mobile treatment: Addressing a critical care gap
Adapting a Low-threshold Buprenorphine Program for Vulnerable Populations During the COVID-19 Pandemic
Higher buprenorphine dose associated with increased treatment retention at low threshold buprenorphine clinic: A retrospective cohort study
Related Resources
“Another Tool for the Tool Box? I'll Take It!”: Feasibility and Acceptability of Mobile Recovery Outreach Teams (MROT) for Opioid Overdose Patients in the Emergency Room
Kraft Center for Community Health Mobile Addiction Services Toolkit
Routes of Non-Traditional Entry into Buprenorphine Treatment Programs
How States and Counties Can Help Individuals With Opioid Use Disorder Re-Enter Communities
Partnering with Jails to Improve Reentry: A Guidebook for Community-Based Organizations
Reentry Matters: Strategies and Successes of Second Chance Act Grantees
Opioid Recovery Initiation: Pilot Test of a Peer Outreach and Modified Recovery Management Checkup Intervention for Out-of-Treatment Opioid Users
Medication-Assisted Treatment With Buprenorphine: Assessing the Evidence
Medication-Assisted Treatment for Opioid Use Disorder in Jails and Prisons: A Planning and Implementation Toolkit
Jail-based Medication-assisted Treatment: Promising Practices, Guidelines, and Resources for the Field
Opioid Use Disorder Treatment in Jails and Prisons

Evidence of Program Effectiveness

"Those who initiated buprenorphine were primarily male (80.1%), African American (85.1%), had a mean age of 44.1 (SD = 12.2), and a mean of 24.0 (SD = 13.6) years of opioid use. The majority of patients (94.4%) had previous criminal justice involvement, were unemployed (72.9%) and were unstably housed (70.8%). Over a third (32.1%) of patients had previously overdosed. Of those who began treatment, 67.9% returned for a second visit or more, and 31.6% percent were still involved in treatment after 30 days. Of those who initiated care, 20.5% have been transferred to continue buprenorphine treatment at a partnering site...The PCARE program illustrates the potential for low-threshold buprenorphine treatment to engage populations who are justice-involved and largely disconnected from care." (Krawczyk et al., 2019)

"A total of 143 patients completed an intake assessment between March and May 2020 and 140 began treatment with buprenorphine/naloxone. Those who completed an intake assessment were primarily male (68.5%), Black (83.2%), had a mean age of 43.2 years (SD = 11.7), and reported a mean of 17.0 years of opioid use (SD = 12.9). The majority of patients were unemployed (72.7%) and reported previous criminal justice involvement (69.2%). Of those who completed an intake assessment, 96.5% returned for a second visit. Among those for whom 30-day retention data was available (n = 113), 63.7% were engaged for 30 days or longer...The PC program illustrates that offering on-demand, flexible treatment is an opportunity to increase opioid use disorder treatment access, even during a public health emergency that disrupted access to services. Relaxation of buprenorphine telehealth regulations allowed for flexibility in treatment and benefits vulnerable populations." (Nordeck et al., 2020)

"In this study examining patients with OUD in a low-threshold buprenorphine clinic, we observed higher rates of treatment retention with buprenorphine doses >16 mg." (Selitsky et al., 2023)