Collaborative Care of Opioid-Addicted Patients in Primary Care Using Buprenorphine

Abstract

Opioid addiction is a chronic, relapsing brain disease that affects millions of Americans and produces tremendous burden on the health care system.^1,2 Recent epidemiologic studies³ have revealed alarming increases in opioid addiction and overdoses, particularly with regard to prescription opioids. Less than 25% of individuals addicted to opioids receive addiction treatment.³ For more than 45 years, research has confirmed that opioid agonist therapy (ie, methadone hydrochloride) is a highly effective treatment for opioid addiction provided outside primary care.^4-6 In 2002, US physicians gained the opportunity to treat opioid-addicted patients with buprenorphine hydrochloride in primary care settings, commonly referred to as office-based opioid treatment (OBOT).⁷ This treatment has been shown to be effective in primary care settings^8-15; however, it remains underused in traditional care models.¹⁶ One consistently cited barrier preventing OBOT expansion is lack of adequate clinical support given the additional needs for patient monitoring.^16-18 Although collaborative care improves management of other chronic diseases (eg, hypertension¹⁹ and diabetes mellitus²⁰), experience with this model for the treatment of opioid addiction in primary care has not been described.²¹