Effective implementation strategies for integrating evidenced-based opiate treatment with buprenorphine into public health medical and mental health settings


Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

4169.0: Tuesday, December 13, 2005 - Board 6

Abstract #116174

David Hersh, MD¹, Alice A. Gleghorn, PhD², Stephanie Marsan, MD³, Stephen Dominy, MD¹, Brad Shapiro, MD⁴, and Charles Simons, DRPH². (1) Department of Psychiatry, San Fransisco General Hospital, OBOT Buprenorphine Induction Clinic (OBIC), 3180 18th St, Suite 205, San Francisco, CA 94110, 415.206.4068, david.hersh@sfdph.org, (2) Community Behavioral Health Services, San Francisco Department of Public Health, 1380 Howard Street, 4th Floor, San Francisco, CA 94103, (3) Department of Family Medicine, San Fransisco General Hospital, OBOT Buprenorphine Induction Clinic (OBIC), 3180 18th St, Suite 205, San Francisco, CA 94110, (4) Methadone Induction Clinic, San Francisco General Hospital, 1001 Potrero Ave, Bldg. 93, San Francisco, CA 94110

Heroin addiction is responsible for tremendous morbidity in San Francisco and has produced a significant burden on the public health system. Injection heroin use results in multiple serious medical conditions, including soft tissue infections, HIV, and HVC. Untreated opiate addiction is responsible for high utilization of urgent, primary, psychiatric and emergency care, in addition to inpatient hospitalization. However, opiate addiction is seldom treated in primary care or outpatient mental health settings rather, referral to specialized drug treatment programs is the norm. With the approval of Buprenorphine in 2002 in the US, physicians with appropriate training can provide opiate agonist treatment to their heroin dependent patients in settings heretofore restricted exclusively to medical or psychiatric care. Despite evidence supporting the effectiveness of buprenorphine, concern has been raised that few non-addiction specialist physicians have initiated this service. To encourage the implementation of buprenorphine treatment throughout the San Francisco Public Health system (SFDPH), a deliberate strategy of trainings, induction support services, treatment guidelines and ongoing consultation was developed for physicians working in SFDPH-funded settings. A cohort of volunteer physicians was identified in primary care, specialty care, mental health case management, and outpatient psychiatric treatment facilities. The presentation will focus on the pragmatic process of integrating buprenorphine treatment services in various public health settings, and identify both barriers and effective implementation strategies. Outcome measures, including patient retention and the impact of buprenorphine treatment on medical service utilization will be examined. Sustainability of buprenorphine services in public health settings will be discussed.

Learning Objectives:

At the conclusion of the session, the participant (learner) in this session will be able to

1. Identify five strategies to engage physicians to begin treating opiate dependent patients with buprenorphine.
2. Describe the impact of untreated opiate addiction on the public health services system.
3. Articulate system barriers impeding adoption of the evidence-based practice of buprenorphine treatment in public health settings.
4. Identify the impact of buprenorphine treatment on patient retention and utilization of medical and other related health services.

Keywords: Drug Abuse Treatment, Medicine

Related Web page: dphnet/obot/

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Data Measurement and Substance Abuse Treatment Services Research Poster Session

The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA