title: Implementation of a collaborative care management program with buprenorphine in primary care: a comparison between opioid-dependent patients and patients with chronic pain using opioids nonmedically.
abstract: OBJECTIVE
  To implement a collaborative care management program with buprenorphine in a primary care clinic.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  A busy urban academic primary care clinic affiliated with a tertiary care hospital.
  
  
  METHODS
  Opioid-dependent patients or patients with chronic pain using opioids nonmedically were recruited for the study. A total of 45 participants enrolled.
  
  
  METHODS
  Patients were treated with buprenorphine and managed by a supervising psychiatrist, pharmacist care manager, and health coaches. The care manager conducted buprenorphine inductions and all follow-up visits. Health coaches offered telephonic support. The psychiatrist supervised both the care manager and health coaches.
  
  
  METHODS
  Primary outcomes were treatment retention at 6 months, and change in the proportion of aberrant toxicology results and opioid craving scores from baseline to 6 months. After data collection, clinical outcomes were compared between opioid-dependent patients and patients with chronic pain using opioids nonmedically. Overall, 55.0 percent of participants (25/45) remained in treatment at 6 months. Primary care physicians (PCPs)' attitudes about opioid dependence treatment were surveyed at baseline and at 18 months.
  
  
  RESULTS
  Forty-three patients (95.6 percent) accepted treatment and 25 (55.0 percent) remained in treatment at 6 months. The proportion of aberrant urine toxicology results decreased significantly from baseline to 6 months (p < 0.01). Craving scores significantly decreased from baseline to 6 months (p < 0.01). Opioid-dependent patients, as opposed to patients with chronic pain using opioids nonmedically, were significantly more likely to complete 6 months of treatment (p < 0.05). PCPs' confidence in treating opioid dependence in primary care increased significantly from baseline to 18 months postimplementation (p < 0.01).
  
  
  CONCLUSIONS
  Collaborative care management for opioid dependence with buprenorphine may be feasible in a primary care clinic. More research is needed to understand the role of buprenorphine in managing patients with chronic pain using opioids nonmedically.
authors.affiliation: Instructor in Psychiatry, Harvard Medical School, Boston, Massachusetts; Division of Addiction Psychiatry, Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Joji
authors.initials: J
authors.lastname: Suzuki
authors.affiliation: Associate Professor of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences University, Boston, Massachusetts; Department of Anesthesia, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Michele L
authors.initials: ML
authors.lastname: Matthews
authors.affiliation: Harvard Medical School Center for Primary Care, Boston, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: Brick
authors.affiliation: Harvard Medical School Center for Primary Care, Boston, Massachusetts.
authors.forename: Minh-Thuy
authors.initials: MT
authors.lastname: Nguyen
authors.affiliation: Departments of  Anesthesiology and Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Anesthesiology, Bringham and Women's Hospital, Boston, Massachusetts.
authors.forename: Ajay D
authors.initials: AD
authors.lastname: Wasan
authors.affiliation: Professor of Anesthesia, Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Department of Anesthesia, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Jamison
authors.affiliation: Instructor in Medicine, Harvard Medical School, Boston, Massachusetts; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Ellner
authors.affiliation: Assistant Professor of Medicine, Harvard Medical School, Boston, Massachusetts; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Lori W
authors.initials: LW
authors.lastname: Tishler
authors.affiliation: Professor of Psychiatry, Harvard Medical School, Boston, Massachusetts; Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts.
authors.forename: Roger D
authors.initials: RD
authors.lastname: Weiss
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002047:Buprenorphine / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy*; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D010346:Patient Care Management; D011320:Primary Health Care
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine