Low-threshold Buprenorphine Treatment at Syringe Services Programs: a Type I Hybrid Effectiveness-implementation Trial (NIH HEAL Initiative)

Funded by the NIH HEAL Initiative^®

CTN-0155, or Buprenorphine Implementation at Syringe Services Programs to Reduce Overdoses (BISTRO), is a Hybrid Type 1 Effectiveness-Implementation study that will examine low-threshold buprenorphine treatment at syringe service programs (SSPs). Using a cluster randomized stepped wedge design, 8 SSPs will be randomly and sequentially assigned to an intervention start date, and participants with opioid use disorder (OUD) will be recruited from these SSPs before and after intervention implementation. The intervention will be to train SSPs to implement buprenorphine treatment programs informed by low-threshold principles (i.e., same-day treatment entry; patient-centered practices; flexible policies and procedures; and availability in non-traditional settings). Before implementation, participants will be referred to community buprenorphine treatment providers (standard of care). After implementation, participants will receive low-threshold buprenorphine treatment onsite at the SSP. The study’s primary objective is to examine intervention effectiveness by comparing 3-month buprenorphine retention among participants receiving low-threshold buprenorphine treatment at SSPs and those receiving standard of care referral. Secondary objectives include: assessing participant-level OUD treatment outcomes; evaluating the cost-effectiveness of implementing low-threshold buprenorphine treatment at SSPs; and characterizing adoption, acceptability, appropriateness, feasibility, reach, fidelity, and sustainability of the intervention.