title: Policy implications of integrating buprenorphine/naloxone treatment and HIV care.
abstract: Researchers, practitioners, and policymakers have long recognized the potential benefits of providing integrated substance abuse and medical care services, particularly for special populations such as people living with HIV/AIDS. Buprenorphine, an office-based pharmacological treatment for opioid dependence, offers new opportunities for integrating drug treatment into HIV care settings. However, the historical separation between the drug treatment and medical care systems has resulted in a host of policy barriers. The Buprenorphine and HIV Care Evaluation and Support initiative, a multisite demonstration project to assess the feasibility and effectiveness of integrating buprenorphine/naloxone into HIV care settings, provided an opportunity to evaluate if and how policy barriers affect efforts to integrate HIV care and addiction treatment. We found that financing issues, workforce and training issues, and the operational consequences of some conceptual differences between HIV care and addiction treatment are barriers to the full integration of buprenorphine into HIV care. We recommend changes to financing and reimbursement policies, programs to strengthen the addiction treatment skills of physicians, and cross training between the fields of addiction, medicine, drug treatment, and HIV medicine. By addressing some of the policy barriers to integration, this promising new treatment can help the thousands of people living with HIV/AIDS who are also opioid dependent.
authors.affiliation: The New York Academy of Medicine, Division of Health Policy, New York, NY 10029, USA. rfinkelstein@nyam.org
authors.forename: Ruth
authors.initials: R
authors.lastname: Finkelstein
authors.forename: Julie
authors.initials: J
authors.lastname: Netherland
authors.forename: Laurie
authors.initials: L
authors.lastname: Sylla
authors.forename: Marc N
authors.initials: MN
authors.lastname: Gourevitch
authors.forename: Adan
authors.initials: A
authors.lastname: Cajina
authors.forename: Laura
authors.initials: L
authors.lastname: Cheever
mesh_terms: D002047:Buprenorphine / Q000627:therapeutic use*; D000069479:Buprenorphine, Naloxone Drug Combination; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D015658:HIV Infections / Q000188:drug therapy*; D006291:Health Policy; D006801:Humans; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment; D014481:United States
chemical_list: D000069479:Buprenorphine, Naloxone Drug Combination; D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine