Show me the Evidence
Buprenorphine and methadone, the 2 medications approved to treat opioid use disorder, are associated with __________ % reduction in mortality.
50%
To access buprenorphine for opioid use disorder, without an appointment, what clinics can patients go to in San Francisco? (excluding OTPs, where they can also go)
MXM, Bridge/HAP, OBIC
Which opioid treatment program (aka, OTP, aka "methadone clinic") is currently doing new intakes SF county jail?
Ward 93 (aka, OTOP)
Bonus points: which NP is working there?
You are doing outreach in the TL and happen upon a patient who has overdosed. Someone comments to you, "when will these people learn." You respond with:
"I can't imagine how scared they feel.", or
"It's great to see people here trying to help.", or
"We're working on programs to help people after accidental overdose. Street fentanyl is unpredictable in strength."
National trends in homeless death rates over the past decade indicate that deaths are _____________ (rising/falling/steady) and the most common cause of death is ________________.
Homeless death rates are increasing (by 238%). The most common cause of death is OD by drugs or alcohol (29%), then heart disease (24%), then unintentional injury (7%), traffic injury (7%), then homicide and suicide (each 5%). Average age of dying was 51yo.
Buprenorphine, aka Suboxone, aka Subutex, only comes as a sublingual film or tab? T or F
F. Buprenorphine is also available as weekly or monthly injections.
BEAM provides access to ___________ during __________ hours?
buprenorphine, nighttime
BAART Turk, Westside, Bayview Hunters Point Foundation are all offering incentives for patients that are newly enrolled in methadone programs.
You are doing outreach when a patient remarks to you, "I'm not taking methadone. That rots your bones." How do you respond?
"Tell me more about what kind of stories you've heard?", or
"All opiates can lower testosterone levels, which can weaken bones over time.", or
"That sounds scary. Any interest in talking to a cool health provider that I know more about this? One thing that is sad is that for people with opioid use disorder, only 1/3 of them get treatment"
Buprenorphine and methadone are not safe during pregnancy. T or F
F. Both are safe in pregnancy.
F. Xylazine has not been detected in significant amounts among patients with opioid use disorder presenting for treatment.
Mayor Lurie has submitted a proposal for what to address the homelessness crisis?
Up-zoning or family zoning plan to accommodate 36K new units of housing. Next it goes to Planning Commission and then BOS (estimated Sept).
Which safety-net clinic is providing contingency management for OUD treatment?
Tom Waddell Urban Health Clinic: SOAR is the program for incentives for OUD treatment.
They also have a Come As You Are Group (CAYA) that provides Safeway cards for attendance.
You are speaking with a client who notes, "that suboxone made me crazy sick." You respond...
"That sounds rough. I've heard that they are getting better at avoiding the sickness when you start.", or
"Can you tell me more about that?", or
"The medication itself doesn't have that side effect. It's due to the interaction with fentanyl."
Where can clients be sent to receive free naloxone and training on its use?
BHS Pharmacy
1st floor at 1380 Howard St
San Francisco, CA 94103
The risk of precipitated withdrawal from buprenorphine is estimated at what:
10%
In surveys of patients with opioid use disorder and non-healing wounds, what percentage recommend cleaning of the wound with alcohol?
50%. 93% of respondents reported at least 1 negative experience with accessing health care for their wound.
CODE TL navigators are currently working where/when?
Currently in the TL. Nighttime mobile navigation teams from 8pm to 2am! Some daytime navigation at 55 Taylor.
Coming to the Bayview! 9a to 5pm starting in Aug 2025.
You overhear someone say, "Meds aren't real recovery." How do you respond...
"I've known some people that did really good on meds.", or
"Everyone's gotta do what works for them. No shame.", or
"Where have you been hearing that?"
Can you name 5 celebrities that have struggled with opioid use disorder?
Eminem, Bradley Cooper, Robert Downey Jr., Tiger Woods, Brett Farve
Among patients who come to OBIC to start buprenorphine, what percentage of them are retained at 28days: 21%, 43%, 57%, or 82%?
21%. Regardless of whether its a 4-d or 7d protocol.
Providers are now offering direct-to-inject protocols for buprenorphine. What does this mean?
Instead of doing a gradual induction (overlap protocol), clients can start on buprenorphine via injection on day 1. That injection lasts for one week.
Early data shows 77% 30-day retention in care.
Can you name all of the methadone clinics in San Francisco for people with public or no insurance? And the neighborhoods they are in.
You overhear a doctor remark, "this guy is always here." What do you say?
"He's going through something really, really hard.", or
"Thanks for your understanding. I'm really worried about him."
or, grumble to yourself. :)
Adverse childhood experiences (ACEs) include various forms of abuse, neglect, or household dysfunction. Exposure to ACEs increases a person's risk of a substance use disorder how many fold: 2-fold, 5-fold, or 100-fold.
5-fold increased risk of SUD with ACE(s)