Office-Based Buprenorphine in Washington State

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Project Summary:

The treatment of opiate addiction has been limited by strict regulatory policies, budgetary constraints and social stigmatization. New options are sorely needed to expand access to care and to underscore the legitimacy of addiction treatment as a medical intervention. The development of buprenorphine, a new medication effective for opiate addiction, has great potential to expand treatment capacity and increase the involvement of physicians in the care of addiction. However, making buprenorphine accessible to patients who rely on public funding for addiction treatment will require substantial effort to develop financial and regulatory structures, establish clinical protocols, and train and support physicians. The purpose of this project is to facilitate and evaluate the development and implementation of a pilot office-based buprenorphine program within the Washington State Medicaid program. Phase I of this project will study the policy and protocol development process after FDA approval of buprenorphine. This process will involve a wide range of regulatory organizations, as well as state agencies and providers of medical and addiction treatment services. The resulting delineation of specific policies and protocols guiding a pilot Medicaid buprenorphine program, and a description of key stakeholder interests and interactions may assist others attempting similar programs. Phase II of this project will design, deliver and evaluate an initial physician training and ongoing clinical support program for office-based buprenorphine treatment. This program will go beyond the federal requirements for physician training in order to enhance physician satisfaction with this new area of practice, and to provide the clinical oversight necessary to assure quality care. Phase III will implement and evaluate the feasibility of the pilot Medicaid office-based buprenorphine program defined in the policy and training phases. Patients will receive buprenorphine with comprehensive psychosocial support and integrated medical services. Data for an immediate treatment group and waiting list control group will document health care utilization patterns and costs, societal costs, and individual patient outcomes and satisfaction, providing preliminary descriptive information for policy makers as well as key parameters for future effectiveness studies of buprenorphine in this population. A Medicaid buprenorphine program may enable the expansion and improvement of opiate addiction treatment in Washington State. It will increase physicians’ knowledge and experience of opiate addiction care and substance abuse issues more broadly. Finally, it begins to address the isolation and stigma that have kept these effective therapies from reaching their full potential.