Transforming opioid treatment: Sublocade's impact at Indwell's Railway City Lofts

Two years ago, we celebrated the opening of an innovative 15-bed program in partnership with the City of St. Thomas: Railway City Lofts. This program provides more intensive supports to residents than other Indwell programs.

The city had identified the fifteen most at-risk individuals, mostly from encampments, based on factors such as length of time experiencing homelessness, vulnerability, and frequency in accessing support services.

Our Railway City Lofts team had several months to prepare for the launch of our program. Before we opened, we were able to meet regularly with our residents to build relationships and get to know each person more. Most of these individuals were experiencing co-occurring mental health and substance use disorders, and most indicated that they wanted support with their substance use.

We knew the best chance we had with helping our residents achieve their goals was through strong community partnerships with other service providers in St. Thomas. We met with several providers that were dedicated to helping the community and keeping it safe, including the addiction support team at Central Community Health Centre (CCHC), which proved to be an invaluable connection. CCHC provides direct support to the transient community in St. Thomas.

One of the staff members at CCHC is a strong advocate for Sublocade monthly injections and has developed a unique treatment method that avoids the usual extended symptoms of withdrawal. As Sublocade is a treatment for individuals suffering from moderate to severe opioid use disorder, this individual began to visit Railway City Lofts multiple times per month to support the residents in their health care and to educate staff so they could have conversations with residents about treatment. These visits on-site are unique to the Railway City Lofts program and part of why this intensive program has yielded such wonderful results. For treatment plans to be effective, we knew we had to cultivate open dialogue with our residents surrounding their treatment options—in other words, “meet people where they’re at.”

Sublocade is a proven Opioid Agonist Therapy (OAT) that is offered at most RAAM (Rapid Access Addiction Medicine) clinics. It’s an extended-release monthly injection that, once in the body, turns into a solid gel—called depot—which then gradually releases buprenorphine at a controlled rate over the course of the month. The buprenorphine attaches itself to the opioid receptors in the brain making it more difficult for other opioids to attach to those receptors. In essence, it blocks the gratifying effects of the other opioids, controlling the addictive cravings while also preventing overdose by blocking the receptors.

Other effective addiction treatments include Methadone and Suboxone; however, we find Sublocade is a preferable treatment as patients only get their injection every 28 days as opposed to taking daily doses. This makes it ideal for transient folks or for those who frequently miss doses because of mental health disorders or other factors. It’s also well-suited for those who are at high risk for drug poisoning, unable to safely store medication at home, and those that are not feeling full relief of symptoms at maximum Suboxone dosing.

We opened our doors in St. Thomas in October 2021 and by January 2022 each resident who was an opioid user was on Sublocade. We went from multiple drug poisoning incidents a week to zero drug poisonings, all with the implementation of Sublocade injections.

We’ve had some movement in our program and not all the original residents still live at Railway City Lofts—in fact, we’re thrilled that 6 residents from Railway City Lofts are now tenants at The Station, Indwell’s new St. Thomas program—but the advocacy for Sublocade continues as we work with new residents who are not yet receiving treatment.

There are a variety of reasons why a tenant may need supportive, affordable housing, and while many Indwell tenants do not use substances, for some, addiction is an ongoing struggle. Our continued hope is that 100% of residents who use opioids will have access to the addiction treatments that work best for them. While we believe Sublocade to be the most effective when it comes to the unpredictability of street drugs, we are dedicated to working with each resident to determine what is best for their individual needs. We are so grateful to the multitude of community support services who educate and come alongside Indwell staff and tenants in our mission to promote the health, wellness, and belonging of all tenants who live at our programs.