UVA SMART clinic brings low‑barrier opioid treatment and harm‑reduction services to The Haven in Charlottesville

Charlottesville — The University of Virginia Health System operates a walk‑in addiction and street‑medicine clinic at The Haven day shelter that offers medication for opioid use disorder, harm‑reduction supplies and case navigation, presenters said at a Virginia Opioid Abatement Authority Abatement Academy webinar on Oct. 24.

The clinic, known as the SMART (Street Medicine Access Reduction and Treatment) project, was described by Dr. Andrew Ligon, MD, an assistant professor of psychiatry at UVA Health, and Elena Baker, a licensed clinical social worker and addictions counselor with UVA Health. The Virginia Opioid Abatement Authority (OAA) funds the Abatement Academy webinars and has supported the clinic’s operations.

The SMART clinic provides Wednesday morning walk‑in addiction and psychiatry visits at The Haven and coordinates with a Wednesday afternoon primary care clinic at the same site. Services include initiation and continuation of buprenorphine‑naloxone (Suboxone), naloxone distribution, fentanyl and xylazine test strips, basic wound care and case management to connect people with housing and benefits, the presenters said. "We don't force anybody into treatment," Baker said, describing the program's outreach and engagement strategy.

UVA clinicians said the clinic aims to reduce access barriers faced by people who are unhoused or justice‑involved: transportation, lack of phones, medical mistrust and stigma. Dr. Ligon said the team can start opioid‑use‑disorder medications in the hospital and then continue treatment at The Haven’s walk‑in clinic. He also noted the program cannot provide methadone because UVA does not operate a methadone clinic.

Baker described the program’s intake and navigation work: a web‑based screening collects preferred name and pronouns, legal‑system involvement, pregnancy status and social‑drivers‑of‑health needs; a patient navigator helps with housing and Medicaid or disability applications. Since opening, the clinic reported 60 unique screenings, two people were pregnant at screening (two more discovered pregnancy later) and 15 people screened reported being on pretrial or probation, Baker said.

Clinical operations include on‑site urine drug screens transported to UVA labs, prescriptions sent to a nearby pharmacy, and coordination for longer‑acting injectable treatments (for example, SUBLOCADE) that require prior authorization and must be administered at a separate UVA clinic. Baker said prior authorization delays are sometimes bridged by clinic funding so patients can receive injections while paperwork is pending.

Planned expansions include hiring a peer recovery specialist, expanding outreach beyond The Haven, offering SMART Recovery meetings and creating a harm‑reduction vending machine at a city fire station on Ridge Avenue. The planned vending machine would dispense naloxone kits, safer‑use supplies, fentanyl/xylazine test kits, pregnancy tests and other hygiene items; city and state laws and community acceptance were cited as factors in how quickly syringe exchange services could be added. Baker said negotiations with the city on a memorandum of understanding were near completion.

Presenters also described an upcoming contingency‑management pilot with Dynamic Care for people with opioid or stimulant use disorder; participants who complete tasks through an app receive incentives loaded to a prepaid debit card, Baker said. The program team includes addiction medicine and psychiatry attendings and trainees, social workers, a patient navigator and volunteer students.

The presenters emphasized a harm‑reduction, person‑centered approach: meeting people where they are, avoiding stigmatizing language, following through on commitments and using flexible, non‑punitive care strategies. "Meeting the patients where they're at" was a repeated framing from the presentation.

Virginia Opioid Abatement Authority staff moderated and confirmed the webinar recording and slides will be posted on the OAA website for registrants.

The presenters did not report formal votes or regulatory approvals tied to the clinic during the webinar. Several operational limitations were specified on the record: the clinic cannot dispense methadone, cannot provide long‑acting injectable medications at The Haven (those must be administered at a UVA clinic), and syringe exchange expansion depends on city action and state regulations, which presenters described as more constrained in Virginia than in some other states.