title: Overcoming policy and financing barriers to integrated buprenorphine and HIV primary care.
abstract: Treatment for substance abuse and human immunodeficiency virus (HIV) infection historically have come from different providers, often in separate locations, and have been reimbursed through separate funding streams. We describe policy and financing challenges faced by health care providers seeking to integrate buprenorphine, a new treatment for opioid dependence, into HIV primary care. Regulatory challenges include licensing and training restrictions imposed by the Drug Addiction Treatment Act of 2000 and confidentiality regulations for alcohol and drug treatment records. Potential responses include the development of local training programs and electronic medical records. Addressing the complexity of funding sources for integrated care will require administrative support, up-front investments, and federal and state leadership. A policy and financing research agenda should address evidence gaps in the rationales for regulatory restrictions and should include cost-effectiveness studies that quantify the "value for money" of investments in integrated care to improve health outcomes for HIV-infected patients with opioid dependence.
authors.affiliation: Department of Public Health, Weill Medical College of Cornell University, New York, NY 10021, USA. brs2006@med.cornell.edu
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Schackman
authors.forename: Joseph O
authors.initials: JO
authors.lastname: Merrill
authors.forename: Dennis
authors.initials: D
authors.lastname: McCarty
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Levi
authors.forename: Christine
authors.initials: C
authors.lastname: Lubinski
mesh_terms: D023241:Antiretroviral Therapy, Highly Active / Q000191:economics; D002047:Buprenorphine / Q000191:economics / Q000627:therapeutic use*; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000379:methods; D005260:Female; D005380:Financing, Government; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D017048:Health Care Costs; D006291:Health Policy; D006295:Health Resources; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D008297:Male; D009292:Narcotic Antagonists / Q000191:economics / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D011320:Primary Health Care / Q000191:economics; D011787:Quality of Health Care; D014481:United States
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine