Science and Service Awards
2012 Office-Based Opioid Treatment Winners
Mountain Manor Treatment Center
Mountain Manor Treatment Center in Baltimore, MD developed the Youth Opioid Treatment Program in response to the severe and growing epidemic of prescription opioid and heroin addiction among adolescents and young adults. Since 2008 the program has been treating youth between the ages of 14 and 21, using relapse prevention medications, specifically buprenorphine and extended release naltrexone. Most of the patients step down from an episode of crisis-driven detoxification at Mountain Manor’s inpatient program. This innovative specialty model which integrates counseling and medication assistance has proven feasible, successful, and sustainable in a community treatment setting. Medication treatment is well tolerated and well accepted by patients and their families, along with the expectation of counseling participation. Although patients continue to move in and out of treatment, there are substantial rates of return to treatment following dropout, and re-establishment of abstinence following lapse/relapse. The program’s clinical service delivery model also corresponds to a sustainable business model that is supporting expansion. Preliminary data show that use of medications for relapse prevention is associated with increased retention and treatment utilization and decreased opioid and other drug use in this population. Our experience also suggests the benefits of a more longitudinal medical management model of care with an expectation of extended duration of treatment, a lapsing/remitting course, and open-ended return to treatment following relapse as compared to a more traditional model with time-limited, discrete episodes of care.
Boston Medical Center-Massachusetts Department of Public Health Treatment Expansion STATE OBOT B
Utilization of a State-funded Nurse Care Manager Model to Disseminate Buprenorphine Treatment into Community Settings, including Federally Qualified Community Health Centers (FQHC)
The MA Department of Public Health (DPH) Bureau of Substance Abuse Services (BSAS) partnered with Boston Medical Center (BMC) to expand OBOT treatment in Massachusetts with the goals to:
- Integrate buprenorphine treatment into community health centers, including (FQHC);
- Increase the amount of DEA waivered physicians;
- Provide an information and referral hotline for persons seeking treatment;
- Provide accessible buprenorphine treatment to indigent individuals;
- Develop expertise in the treatment of opiate addiction among health center providers.
The project components are twofold. BSAS funded 14 community health centers, to expand buprenorphine treatment. The funding is used to employ NCMs and medical assistants to support physicians in providing buprenorphine using a “Best Practice” model that combines the use of medication, counseling, drug screening and monitoring. Additionally BSAS funded BMC to provide technical assistance to the OBOT programs with the goal:
- Provide consultation to doctors and nurses in the 14 funded OBOT’s;
- Provide learning collaborative for nurse care managers via calls, site visits, email updates, Addiction Nurse Chapter, and quarterly meetings.
This model is unique in that it addressed a key barrier in community settings by providing structural clinical support to physicians utilizing a Nurse Care Manager Model to expand and integrate buprenorphine treatment into community settings, and sustainability in FQHC’s.
Dr. Joseph O. Merrill’s colleagues nominated him for outstanding work in expanding office-based opioid treatment (OBOT) to rural areas through Projects ECHO and ROAM. Project ROAM (Life Science Discovery Fund) seeks to increase access to treatment to decrease the epidemic of opioid related deaths while Project ECHO (Robert Woods Johnson Foundaton) ensures the quality of that expanded treatment for chronic pain, addiction and HCV patients by linking rural providers from five states in telemedicine learning communities. Dr. Merrill’s contribution is exemplary in its full complement of service, research and dissemination to rural communities. As an attending physician at Harborview Medical Center, he participates in care of low income patients on opioids, and teaches medical students and residents. Using his research funds, he investigates key clinical questions that arise during his practice. By co-directing five training buprenorphine courses, he developed 4290 potential buprenorphine treatment slots in rural Washington State. More than 200 persons were trained in OBOT including more than 100 physicians. Since 2010, more than 150 Washington providers joined the telemedicine clinic to discuss substance abuse patients, providing care to isolated rural communities and persons with major psychiatric co-morbidities. The quality of his work, his commitment to disseminate evidence based practices, and his skills as a collaborator and mentor burnish the merit of this recognition. We nominate him for his gifted practice with patients, paradigm changing research, and dissemination of what he has learned in practice and research to remote primary care providers in a five-state area.
Co-occurring Disorders Clinic
Albuquerque, New Mexico
The Co-occurring Disorders Clinic (CODC), embedded within the Ambulatory Care Service of the Raymond G. Murphy VA Medical Center in Albuquerque, New Mexico, was established in June 2009 to manage and treat patients with co-morbid chronic pain and addiction and psychiatric disorders. Between June 2009 and November 2011, CODC induced 142 patients with co-occurring chronic non-cancer pain and opioid dependence with buprenorphine/naloxone (BUP/NLX). To date, 93 of those patients (65%) continue to be maintained on the medication and 7 completed BUP/NLX treatment and are no longer taking any opioid (5%). The high retention rates and improved pain scores utilizing BUP/NLX may be attributed to simultaneously treating addiction and pain as well as integrating treatment within primary care. CODC providers also utilize adjunctive pharmaceutical and non-pharmaceutical measures to enhance the treatment of underlying pain issues and minimize the return to prescription or illicit opioid use.
To expand treatment services to the large cohort of patients with co-occurring pain and addiction who are enrolled in VA community-based clinics, CODC providers have implemented and direct a telemedicine program using case-based training and didactic session. Based on the internationally acclaimed ECHO (Extension for Community Health Outcomes) program, the Veterans Administration’s project SCAN (Specialty Care Access Network) program allows the CODC providers to transfer skill and knowledge to a statewide network of primary care providers.
CleanSlate Centers are a consortium of medical offices created to provide outpatient opioid addiction medicine services to patients previously denied access to adequate treatment. Located throughout Massachusetts, CleanSlate offices are placed in areas that are identified by the State as having an unusually high incidence of opioid substance abuse. Each office can care for approximately 1000 patients. The CleanSlate model has many innovative practices, including the employment of multiple part-time physicians who provide oversight for the addiction treatment of their assigned patients in collaboration with nurse practitioners and physician assistants. Clear medical guidelines are in place to ensure consistency, quality, and continuity in patient care among a large number of providers. Participation in counseling is a requirement of the CleanSlate office-based opioid therapy program, and an extensive collaborative network of counselors, detox centers, IOPs, community physicians and other providers has been essential in the provision of superior care. This integration of behavioral health and medication-assisted treatment in a very closely supervised outpatient setting allows patients to develop the trusting relationship with their medical provider and behavioral health team necessary to support and sustain sobriety. CleanSlate currently provides treatment for approximately 2000 patients, of whom nearly 85 percent are dependent on Medicaid and Medicare. CleanSlate’s innovative approach removes treatment from busy, over-stretched primary care settings, and provides the infrastructure necessary for primary care physicians and psychiatrists to collaborate with behavioral health providers and experienced full-time clinicians so that patients are able to receive the comprehensive care necessary to achieve recovery.
Last updated: 02/17/2012