2013 Office-Based Opioid Treatment Winners
Barre Family Health Center & Worcester Family Medicine Residency
151 Worcester Road, Barre, MA 01005
Improving access to effective opiate dependence treatment is crucial, especially for those who live in isolated rural areas. However, few models exist in the literature to guide this improvement. In the absence of such models, Barre Family Health Center (BFHC) sought to integrate treatment for opiate dependence into their health center’s broader mission of providing high-quality primary care. In so doing, they were able to deliver effective opiate addiction treatment in a rural setting and train family medicine residents to deliver such care. The BFHC provides more than 30,000 visits a year to 8,000 patients from rural communities. They are also a family medicine residency site for the University of Massachusetts Medical School and host 12 residents as part of its three-year program. For over a year, residents have been formally trained in buprenorphine treatment and have treated patients with direct supervision from faculty experienced in opiate addiction. Combined with their existing behavioral health services and their development of on-site evaluation and treatment for Hepatitis C infection, they have been able to offer comprehensive primary care in addition to buprenorphine management. This model provides a force-multiplier effect, as each class of residents will now graduate with the skills and experience to care for opiate dependence in rural areas.
Peter Rostenberg, MD, FASAM, ABAM
71 Route 39, New Fairfield, CT 06812
Almost 10 years ago, in an effort to treat opioid dependency in a holistic manner, Dr. Peter Rostenberg began using buprenorphine in his primary care office. This clinical fusion of internal medicine and addiction services resulted in a successful model of integrated, community-based, healthcare. When patients who report opiate use present at Dr. Rostenberg’s office, they are placed on a treatment protocol consisting of buprenorphine and attendance of at least one group counseling weekly. Initially, Dr. Rostenberg partnered with a community-based provider for counseling services, but he soon determined that having a counselor on-site in his primary care office improved communication with the patient and improved the overall quality of the services. Additional challenges in improving patient attendance at group counseling were successfully addressed by flexible meeting options (four in-office group meetings are offered weekly), an innovative pricing policy, and a competent, skillful counselor. Besides meetings, the counselor is also available to patients by mobile phone to address small issues that may arise between sessions. Dr. Rostenberg’s addiction treatment program lasts approximately one year. By four weeks, most patients are abstinent and attending self-help meetings. The use of buprenorphine, together with counseling, has made it possible for his patients to make better choices and learn new life skills. Some patients volunteer to sponsor new comers in the community while others, who have completed his buprenorphine program, return to discuss their successes and challenges with current patients.
The Project Renewal Primary Care Medical Program
200 Varick Street, 9th Floor, New York, NY 10014
Homeless men and women are disenfranchised, with no housing security, limited financial resources, no regular source of health care, and a poor understanding of how to access care. When they do choose to detoxify from their drugs of choice, they often either end up in an emergency room with long waits that cause them to walk out in frustration, or they are admitted to a 3-5 day inpatient detox and receive little discharge planning. Project Renewal offers an accessible option for the treatment of opioid dependence. Project Renewal’s Primary Care Medical Program serves over 9000 homeless adults each year through shelter-based clinics and mobile medical vans, and offers buprenorphine maintenance therapy as an accessible option for the treatment of opioid dependence. The primary care physicians, who prescribe buprenorphine therapy, work within a continuum of care for substance use treatment that includes two detox units and an outpatient substance use treatment clinic located at the same site as their primary care clinic. Individuals receiving buprenorphine maintenance therapy receive comprehensive primary care that includes psychiatric care and prevention and management of chronic illnesses. The program has experienced remarkable growth since it began, from serving 37 individuals in 2008 to serving 179 individuals in 2012. A review of records confirms co-morbidity rates for serious mental illness, hepatitis C and HIV infection similar to that seen in national studies of similar populations. For 2012, the average stay has been 361 days, an impressive retention rate for this otherwise unstable population.
John M. Thorp, Jr., MD
3027 Old Clinic Bldg, CB 7570, Chapel Hill, NC 27514
University of North Carolina (UNC) Horizons is a gender-specific substance abuse treatment program within the Department of OB/GYN in the UNC School of Medicine. Founded in 1993 by John Thorp, MD, Horizons provides outpatient and long-term residential treatment to women who are pregnant and/or parenting young children. Horizons serves roughly 225 clients each year, about 70 of whom are pregnant. Women who are pregnant are provided services through an innovative high-risk prenatal program at UNC Women’s Hospital. This program includes weekly prenatal visits, regular urine drug screens, and individual counseling and case management with a substance abuse counselor at each visit. The clinic is staffed by a team which includes a Perinatologist (Dr. Thorp, the Medical Director), a Nurse-Midwife, and a Substance Abuse Counselor. Horizons has seen a dramatic increase in the number of clients whose primary drug of choice is opiates, now roughly one-third of clients. To address the needs of these clients during pregnancy, Horizons has developed an exemplary Medication Assisted Treatment Program (MATP) that is fully integrated into the prenatal program. Clients receive: buprenorphine treatment throughout pregnancy from Dr. Thorp; the weekly prenatal/substance abuse counseling visits; a consultation with staff from the newborn nursery prior to birth to discuss potential care needs for the infant and to set expectations; an anesthesia consult to discuss pain management options; and, support for rooming-in and breastfeeding postpartum – even for infants with neonatal abstinence syndrome. This program has achieved positive birth outcomes and high client satisfaction.
Washington County Health Department, Division of Behavioral Health Services
1302 Pennsylvania Avenue, Hagerstown, MD 21742
The Washington County Health Department, Division of Behavioral Health Services, in collaboration with the local detention center and its private medical provider, expanded office-based opioid treatment services by offering extended-release injectable naltrexone (Vivitrol) to incarcerated individuals. Candidates for this treatment protocol had a diagnosis of alcohol or opiate dependence and were receiving pre and post release reentry services. Those individuals who were returning to the local community and who had a history of providing support to their child(ren), received reentry case management and family reunification services including: behavioral health treatment, pharmacotherapy, criminogenic assessments, family needs assessments, the Strengthening Families Program, structured video family visitation, telemedicine, various program incentives, and linkages to community resources, i.e., employment, housing, transportation, child care, vocational, educational and mutual support programs. While in treatment, incarcerated individuals and their family members participated in weekly structured video family visitation, using Skype to enhance parental attachment. In addition, Skype was used to conduct medical evaluations between the inmate and the prescribing physician prior to the inmate receiving Vivitrol. Inducting the incarcerated individual on to Vivitrol prior to his release from detention offers him additional support in recovery as he seeks to develop a drug free support system. In Washington County, the use of Vivitrol in conjunction with behavioral therapies reduced the rates of recidivism, re-arrest and relapse, and increased substance abuse treatment retention rates. Offering Vivitrol to individuals eligible for pre-release provided the community with a cost savings of half of a million dollars within a consecutive two year period.
Last updated: 05/20/2013