Marilyn Ann DeLuca, PhD, RN, Department of Psychiatry, New York University, School of Medicine, 335 East 18th Street, New York, NY 10003, 212-228-6714, marilyn.deluca@mcihispeed.net and Andrew J. Kolodny, MD, Office of the Executive Deputy Commissioner, NYC Department of Health & Mental Hygiene, 93 Worth St, New York, NY 10013.

I. Heroin use in New York City (NYC) surpasses other cities in the US and perhaps the world. Estimates indicate 400,000 persons abuse illicit opioids and opioid prescription drugs; another 200,000 are daily or near daily users. Of those addicted, a small percent (19%) are on methadone or in treatment. While methadone is established as effective, many are unwilling to accommodate to the requirements and stigma associated with methadone. II. Results from clinical trials in the US and elsewhere, fewer administrative requirements, mainstream access, and diminished stigma hold promise for office-based buprenorphine treatment. The Federal Drug Addiction Treatment Act of 2000 allows authorized physicians to prescribe, administer or dispense specially approved narcotic medications and licensed registered pharmacists to dispense controlled substances to patients. Physicians who prescribe buprenorphine for addiction must have special training or qualifications and register with regulatory agencies. The FDA approved buprenorphine in October 2002; in November 2002, Authorization for Physicians to Use Controlled Substances for Treatment of Chemical Dependence covered NYS practice. In July 2003, the NYC Department of Health and Mental Hygiene (DOHMH) began an initiative to: (1) promote buprenorphine treatment; (2) gather pertinent data and (3) seek adequate reimbursement and appropriate regulations. III. This case study examines buprenorphine treatment in NYC: (1) implementation of buprenorphine in office-based practice; (2) training; (3) availability; (4) regulatory issues and reimbursement, and (5) DOHMH activities. Implications include: (a) mechanisms to monitor training and practice; (b) importance of inter-agency and inter-organizational collaboration, and (c) actions for NYC and other settings.

Learning Objectives: At the completion of this session, participants will be able to

(
• Describe the federal requirements for prescription and administration of buprenorphine for opiate dependency in office-based practice settings. (
• Articulate the trends in New York City of the number of physicians trained to provide buprenorphine treatment for opiate dependency in office-based practice,as well as the number of individuals treated with buprenorphine in office-based practice. (
• Asses access of buprenorphine treatment across patient groups and settings. (
• List three challenges to the implementation of buprenorphine treatment for opiate dependency in office-based practice. (
• Recognize two current obstacles to provider reimbursement for buprenorphine induction and treatment. (
• Discuss the implications for other settings implementing buprenorphine treatment. (
• Recognize the benefits of inter-agency and inter-organizational collaboration in the implementation of new substance abuse treatment modalities.

Keywords: Substance Abuse Treatment, Urban Health Care

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.