Implementation of a collaborative care management program with buprenorphine in primary care: A comparison between opioid-dependent patients and patients with chronic pain using opioids nonmedically

Joji Suzuki, MD; Michele L. Matthews, PharmD; David Brick, BA; Minh-Thuy Nguyen; Robert N. N. Jamison, PhD; Andrew L. Ellner, MD, MSc; Lori W. Tishler, MD; Roger D. Weiss, MD

doi:10.5055/jom.2014.0204

Authors

Joji Suzuki, MD
Michele L. Matthews, PharmD
David Brick, BA
Minh-Thuy Nguyen
Robert N. N. Jamison, PhD
Andrew L. Ellner, MD, MSc
Lori W. Tishler, MD
Roger D. Weiss, MD

DOI:

https://doi.org/10.5055/jom.2014.0204

Keywords:

opioid dependence, collaborative care management, buprenorphine, nonmedical use of opioids, primary care

Abstract

Objective: To implement a collaborative care management program with buprenorphine in a primary care clinic.

Design: Prospective observational study.

Setting: A busy urban academic primary care clinic affiliated with a tertiary care hospital.

Participants: Opioid-dependent patients or patients with chronic pain using opioids nonmedically were recruited for the study. A total of 45 participants enrolled.

Interventions: Patients were treated with buprenorphine and managed by a supervising psychiatrist, pharmacist care manager, and health coaches. The care manager conducted buprenorphine inductions and all follow-up visits. Health coaches offered telephonic support. The psychiatrist supervised both the care manager and health coaches.

Main outcome measures: Primary outcomes were treatment retention at 6 months, and change in the proportion of aberrant toxicology results and opioid craving scores from baseline to 6 months. After data collection, clinical outcomes were compared between opioid-dependent patients and patients with chronic pain using opioids nonmedically. Overall, 55.0 percent of participants (25/45) remained in treatment at 6 months. Primary care physicians (PCPs)' attitudes about opioid dependence treatment were surveyed at baseline and at 18 months.

Results: Forty-three patients (95.6 percent) accepted treatment and 25 (55.0 percent) remained in treatment at 6 months. The proportion of aberrant urine toxicology results decreased significantly from baseline to 6 months (p < 0.01). Craving scores significantly decreased from baseline to 6 months (p < 0.01). Opioid-dependent patients, as opposed to patients with chronic pain using opioids nonmedically, were significantly more likely to complete 6 months of treatment (p < 0.05). PCPs' confidence in treating opioid dependence in primary care increased significantly from baseline to 18 months postimplementation (p < 0.01).

Conclusion: Collaborative care management for opioid dependence with buprenorphine may be feasible in a primary care clinic. More research is needed to understand the role of buprenorphine in managing patients with chronic pain using opioids nonmedically.

Author Biographies

Joji Suzuki, MD

Instructor in Psychiatry, Harvard Medical School, Boston, Massachusetts; Division of Addiction Psychiatry, Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts.

Michele L. Matthews, PharmD

Associate Professor of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences University, Boston, Massachusetts; Department of Anesthesia, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

David Brick, BA

Harvard Medical School Center for Primary Care, Boston, Massachusetts

Minh-Thuy Nguyen

Harvard Medical School Center for Primary Care, Boston, Massachusetts.

Robert N. N. Jamison, PhD

Professor of Anesthesia, Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Department of Anesthesia, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts

Andrew L. Ellner, MD, MSc

Instructor in Medicine, Harvard Medical School, Boston, Massachusetts; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts

Lori W. Tishler, MD

Assistant Professor of Medicine, Harvard Medical School, Boston, Massachusetts; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts

Roger D. Weiss, MD

Professor of Psychiatry, Harvard Medical School, Boston, Massachusetts; Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts

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