title: Collaborative care of opioid-addicted patients in primary care using buprenorphine: five-year experience.
abstract: BACKGROUND
  Opioid addiction is a chronic disease treatable in primary care settings with buprenorphine hydrochloride, but this treatment remains underused. We describe a collaborative care model for managing opioid addiction with buprenorphine hydrochloride-naloxone hydrochloride dihydrate sublingual tablets.
  
  
  METHODS
  Ours is a cohort study of patients treated for opioid addiction using collaborative care between nurse care managers and generalist physicians in an urban academic primary care practice during a 5-year period. We examine patient characteristics, 12-month treatment success (ie, retention or taper after 6 months), and predictors of successful outcomes.
  
  
  RESULTS
  From September 1, 2003, through September 30, 2008, 408 patients with opioid addiction were treated with buprenorphine. Twenty-six patients were excluded from analysis because they left treatment owing to preexisting legal or medical conditions or a need to transfer to another buprenorphine program. At 1 year, 196 of 382 patients (51.3%) underwent successful treatment. Of patients remaining in treatment at 12 months, 154 of 169 (91.1%) were no longer using illicit opioids or cocaine based on urine drug test results. On admission, patients who were older, were employed, and used illicit buprenorphine had significantly higher odds of treatment success; those of African American or Hispanic/Latino race had significantly lower odds of treatment success. These outcomes were achieved with a model that facilitated physician involvement.
  
  
  CONCLUSIONS
  Collaborative care with nurse care managers in an urban primary care practice is an alternative and successful treatment method for most patients with opioid addiction that makes effective use of time for physicians who prescribe buprenorphine.
authors.affiliation: Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, 801 Massachusetts Ave, Second Floor, Boston, MA 02118, USA. dan.alford@bmc.org
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Alford
authors.forename: Colleen T
authors.initials: CT
authors.lastname: LaBelle
authors.forename: Natalie
authors.initials: N
authors.lastname: Kretsch
authors.forename: Alexis
authors.initials: A
authors.lastname: Bergeron
authors.forename: Michael
authors.initials: M
authors.lastname: Winter
authors.forename: Michael
authors.initials: M
authors.lastname: Botticelli
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D016739:Behavior, Addictive / Q000188:drug therapy*; D002047:Buprenorphine / Q000627:therapeutic use*; D015331:Cohort Studies; D055030:Drug Users; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000451:nursing*; D011320:Primary Health Care; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data
chemical_list: D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine