Development and implementation of buprenorphine maintenance program in a primary care setting

Drug overdose is an epidemic in our country. While overdose affects all communities, it is of particular concern for people in the Health Care for the Homeless community, as drug overdose death disproportionately impacts people who are homeless, recently released from incarceration, and living with chronic illnesses such as HIV/AIDS, lung disease, or kidney disease. This issue has gained national prominence in recent years and is fueling a search for answers. Medication Assisted Treatment (MAT) involves the use of medication, in combination with behavioral therapy, to treat substance use disorders. Methadone and buprenorphine are drugs that are used to provide MAT for people with an opioid use disorder. Unlike methadone, buprenorphine can be prescribed in primary care settings for the treatment of opioid use disorder. Despite the fact that buprenorphine maintenance is an evidence-based practice and an effective treatment option for individuals with opioid use disorder, it has not been widely implemented into primary care settings. The severity of the overdose epidemic in recent years has led to an increased focus at the national level on improving access to substance use treatment and specifically medication assisted treatment. HRSA recently called for proposals for technical assistance grants to assist health centers in expanding MAT into their practices. This session will review the national trends around opioid use and overdose in the United States and the increasing demand for opioid use disorder treatment. We will briefly review opioid use disorder treatment options and will have a specific focus on buprenorphine maintenance treatment. We will describe how we have developed our buprenorphine maintenance program, the partnership we have created with a local addiction treatment program, and areas of continued challenges. Knowing that many health centers have recently applied for the HRSA technical assistance MAT grant, we will outline the key elements that any new program will want to consider when developing and implementing buprenorphine into their practices, as well as areas where programs may take different approaches. The last portion of the session will be reserved for discussion and questions.