Opiate Dependence Treatment with Buprenorphine

Abstract

Buprenorphine became available for office-based treatment of opiate dependence in January 2003, at which time the Underwood-Memorial Hospital Family Practice Residency Program began offering buprenorphine treatment at its family practice center. This article describes the patient selection process, outcomes, and obstacles to treatment. Patients who had a pharmaceutical benefit were much more likely to remain in treatment than those who had to pay for the medication. The authors are not aware of other residency programs currently providing buprenorphine training, and postulate reasons why family physicians in the United States have not readily adopted the office-based opiate treatment model.

Primary care models for treating opioid use disorders: What actually works? A systematic review

“…Most included studies (n = 32) had coordinated care models with 32 studies falling into two or more care models (e.g. coordinated care and multi-disciplinary care) [ 8 , 10 – 12 , 28 – 30 , 32 , 33 , 38 , 43 , 45 , 48 – 51 , 56 – 58 , 60 , 61 , 63 , 64 , 66 , 67 , 69 – 75 ]. Only three physician-centric studies existed, predominantly in community health centers, where physicians independently provided MAT [ 34 , 68 , 76 ].…”

“…nurses, pharmacists, counselors) to carry out tasks. [ 8 , 10 , 11 , 27 – 30 , 32 , 33 , 38 , 45 , 49 – 51 , 56 – 60 , 62 – 67 , 69 – 73 , 75 , 77 ] The level of training and specific tasks managed by each non-physician provider varied across interventions. First, multiple studies used nurses as liaisons in coordinating care between PCPs and behavioral specialists.…”

“…Following the intake visit, studies varied on how they handled medication induction. Twenty-nine studies supervised patient induction with frequent appointments and supervised medication dosing [ 8 , 10 , 11 , 27 – 30 , 32 – 34 , 38 , 49 – 51 , 56 – 58 , 60 , 62 , 63 , 65 , 67 , 69 – 72 , 75 – 77 ]. In contrast, four studies evaluated “home” inductions, which increased patient autonomy via a specific plan for how to first begin self-treatment with the chosen medication [ 55 , 57 , 68 , 71 ].…”

A Buprenorphine Education and Training Program for Primary Care Residents: Implementation and Evaluation

“…Previous work has described and evaluated the incorporation of substance abuse teaching into residency curricula (19;20), or targeted chief residents to promote downstream dissemination (25). We are aware of two studies that examined buprenorphine treatment outcomes in clinics which included resident physicians (26;27). However, neither study described how residents were trained to provide buprenorphine treatment or the extent of residents' experiences providing buprenorphine treatment during and after their residency programs.…”

Geographic variability in HIV and injection drug use in Ukraine: Implications for integration and expansion of drug treatment and HIV care

“…Buprenorphine has a longer duration of action than methadone (24–72 h), stable serum levels, and allows for the option of either daily or thrice weekly dosing. Buprenorphine has been used in a diverse array of clinical settings (Alford et al, 2007; Colameco, Armando, & Trotz, 2005; Fiellin et al, 2008; Mintzer et al, 2007). Given the emphasis on specialized clinics to provide treatment for specific illnesses in Ukraine, an opportunity exists to provide collaborative care with different types of clinical specialists.…”