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.