Alice A. Gleghorn, PhD¹, Richard Fine, MD², David Hersh, MD³, Brigitte Lank, PhD⁴, Stephanie Marsan, MD⁵, and Jim Westphal, MD³. (1) Community Behavioral Health Services, San Francisco Department of Public Health, 1380 Howard Street, 4th Floor, San Francisco, CA 94103, (415) 255-3722, Alice_A_Gleghorn@dph.sf.ca.us, (2) Community Health Network of San Francisco, San Francisco General Hospital, 1001 Potrero Ave., 1M3, San Francisco, CA 94110, (3) Department of Psychiatry, San Fransisco General Hospital, OBOT Buprenorphine Induction Clinic (OBIC), 3180 18th St, Suite 205, San Francisco, CA 94110, (4) Langley Porter Psychiatric Institute, University of California at San Francisco, Division of Substance Abuse and Addiction Medicine, 1001 Portrero Ave. #7E12, San Francisco, CA 94110, (5) Department of Family Medicine, San Fransisco General Hospital, OBOT Buprenorphine Induction Clinic (OBIC), 3180 18th St, Suite 205, San Francisco, CA 94110

Research suggests that Office-Based Opiate Treatment (OBOT) may be an efficacious alternative to methadone clinics for people dependent on heroin. OBOT advantages include increased access to treatment, removal of stigma associated with entering a Narcotic Treatment Program (NTP), and greater coordination of medical care.

Federal OBOT guidelines focus on medical maintenance: the transfer of patients who have been highly successful in traditional NTPs, into a physician office setting. The majority of heroin-dependant persons however, do not meet stringent medical maintenance criteria. The San Francisco Department of Public Health has implemented a unique OBOT pilot program with 5 community providers, including 2 primary care clinics, 2 addiction specialty clinics, and the jail. SFOBOT is a federal and state-approved pilot, and is designed to provide both medical maintenance and direct access to office based treatment for patients who have been unable to access or achieve long-term success in a traditional NTP. The program requires a stabilization period that is only as long as clinically necessary. For example, indigent patients with long-standing relationships in public health clinics may enroll in OBOT and have their heroin addiction treatment managed by the physician who oversees all of their other medical needs.

Preliminary results suggest that less traditional patients benefit from OBOT, and more flexible inclusion and exclusion criteria are justified. Project implementation issues, including provider training and compliance, are discussed. Baseline characteristics are described, with comparisons made between OBOT and standard NTP patients, as well as between methadone and buprenorphine. Such information is useful for service planning by departments of public health in cities with a similarly large heroin-dependant population.

Learning Objectives:

• 1. Discuss the advantages and disadvantages of opiate agonist therapy.
• 2. Articulate the difference between Office-Based Opiate Treatment and traditional narcotic treatment programs.
• 3. Develop an action plan for implementing OBOT in their community.

Keywords: Methadone Maintenance, Access and Services

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.