Integrating Buprenorphine into formerly "drug-free" programs
This article, while not based on NIDA Clinical Trials Network research, may be of interest to those following the CTN’s work related to buprenorphine for opiate use disorder treatment.
Integration of medical and behavioral health treatments is increasing in the United States.
- Blending staff to provide team-based health care can be accomplished in a variety of different ways, ranging from minimal coordination to fully integrated service provision.
Drug-free outpatient programs deliver treatment to the largest number of patients out of all treatment modalities in the U.S., providing a significant opportunity to expand access to medication treatments for substance use disorders. This analysis examined staff perceptions of organizational dynamics associated with the delivery of buprenorphine maintenance within 3 formerly drug-free outpatient treatment programs in Baltimore, Maryland.
Semi-structured interviews (N=15) were conducted with counseling and medical staff; respondents were predominantly African American (n=11) and female (n=12). Two different delivery models were involved:
Co-location: where physicians and counselors were located in the same clinic, but physicians were part-time and primarily only functioned as prescribers;
- Fully integrated: where physicians attend team meetings and are in regular communication with counselors.
Two of the treatment clinics that incorporated buprenorphine maintenance into their formerly drug-free programs used a co-located model of care. Their staff generally reported greater intra-organizational discord regarding the best ways to combine medication and counseling, compared to the clinic using a fully integrated model of care.
Co-located program staff also reported less communication between medical and counseling staff, which contributed to uncertainty about proper dosing and concerns about potential for medication diversion.
Conclusions: Clinics that shift from drug-free to incorporating buprenorphine maintenance should consider which model of care they wish to adapt and how best to train staff and structure communication. Team-based approaches being used in primary care settings offer models of integration that have the potential to translate into more specialty care settings, like previously drug-free treatment centers. Future research can build from these results and offer short- and long-term patient outcome data to support the effectiveness of various models and gradients of team-based integration in substance abuse treatment.