title: Integrating Buprenorphine Into an Opioid Treatment Program: Tailoring Care for Patients With Opioid Use Disorders.
abstract: This report identifies the institutional barriers to, and benefits of, buprenorphine maintenance treatment (BMT) integration in an established hospital-based opioid treatment program (OTP).
  
  
  
  This case study presents the authors' experiences at the clinic, hospital, and corporation levels during efforts to integrate BMT into a hospital-based OTP in New York City and a descriptive quantitative analysis of the characteristics of hospital outpatients treated with buprenorphine from 2006 to 2013 (N=735).
  
  
  
  Integration of BMT into an OTP offered patients the flexibility to transition between intensive structured care and primary care or outpatient psychiatry according to need. Main barriers encountered were regulations, clinical logistics of dispensing medications, internal cost and reimbursement issues, and professional and cultural resistance.
  
  
  
  Buprenorphine integration offers a model for other OTPs to facilitate partnerships among primary care and mental health clinics to better serve diverse patients with varying clinical needs and with varying levels of social support.
authors.affiliation: Dr. Polydorou, Dr. Ross, Dr. Thomas, and Dr. Hansen are with the Department of Psychiatry, where Ms. Duncan was affiliated at the time of this study, Dr. Polydorou is also with the Department of Medicine, Dr. Hansen is also with the Nathan S. Kline Institute for Psychiatric Research, and Ms. Mendoza is with the Department of Psychiatry and Anthropology, where Ms. Roxas was affiliated at the time of this study, all at New York University, New York (e-mail: soteri.polydorou@nyumc.org ). Ms. Duncan is currently a medical student at the University of California San Francisco. Ms. Mendoza is currently a doctoral student at the Columbia University Mailman School of Public Health, New York. Ms. Roxas is currently a medical student at the University of Rochester School of Medicine and Dentistry, Rochester, New York. Mr. Coleman, who is retired, was with the Office of Behavioral Health, New York City Health and Hospitals, New York, at the time of this study.
authors.forename: Soteri
authors.initials: S
authors.lastname: Polydorou
authors.affiliation: Dr. Polydorou, Dr. Ross, Dr. Thomas, and Dr. Hansen are with the Department of Psychiatry, where Ms. Duncan was affiliated at the time of this study, Dr. Polydorou is also with the Department of Medicine, Dr. Hansen is also with the Nathan S. Kline Institute for Psychiatric Research, and Ms. Mendoza is with the Department of Psychiatry and Anthropology, where Ms. Roxas was affiliated at the time of this study, all at New York University, New York (e-mail: soteri.polydorou@nyumc.org ). Ms. Duncan is currently a medical student at the University of California San Francisco. Ms. Mendoza is currently a doctoral student at the Columbia University Mailman School of Public Health, New York. Ms. Roxas is currently a medical student at the University of Rochester School of Medicine and Dentistry, Rochester, New York. Mr. Coleman, who is retired, was with the Office of Behavioral Health, New York City Health and Hospitals, New York, at the time of this study.
authors.forename: Stephen
authors.initials: S
authors.lastname: Ross
authors.affiliation: Dr. Polydorou, Dr. Ross, Dr. Thomas, and Dr. Hansen are with the Department of Psychiatry, where Ms. Duncan was affiliated at the time of this study, Dr. Polydorou is also with the Department of Medicine, Dr. Hansen is also with the Nathan S. Kline Institute for Psychiatric Research, and Ms. Mendoza is with the Department of Psychiatry and Anthropology, where Ms. Roxas was affiliated at the time of this study, all at New York University, New York (e-mail: soteri.polydorou@nyumc.org ). Ms. Duncan is currently a medical student at the University of California San Francisco. Ms. Mendoza is currently a doctoral student at the Columbia University Mailman School of Public Health, New York. Ms. Roxas is currently a medical student at the University of Rochester School of Medicine and Dentistry, Rochester, New York. Mr. Coleman, who is retired, was with the Office of Behavioral Health, New York City Health and Hospitals, New York, at the time of this study.
authors.forename: Peter
authors.initials: P
authors.lastname: Coleman
authors.affiliation: Dr. Polydorou, Dr. Ross, Dr. Thomas, and Dr. Hansen are with the Department of Psychiatry, where Ms. Duncan was affiliated at the time of this study, Dr. Polydorou is also with the Department of Medicine, Dr. Hansen is also with the Nathan S. Kline Institute for Psychiatric Research, and Ms. Mendoza is with the Department of Psychiatry and Anthropology, where Ms. Roxas was affiliated at the time of this study, all at New York University, New York (e-mail: soteri.polydorou@nyumc.org ). Ms. Duncan is currently a medical student at the University of California San Francisco. Ms. Mendoza is currently a doctoral student at the Columbia University Mailman School of Public Health, New York. Ms. Roxas is currently a medical student at the University of Rochester School of Medicine and Dentistry, Rochester, New York. Mr. Coleman, who is retired, was with the Office of Behavioral Health, New York City Health and Hospitals, New York, at the time of this study.
authors.forename: Laura
authors.initials: L
authors.lastname: Duncan
authors.affiliation: Dr. Polydorou, Dr. Ross, Dr. Thomas, and Dr. Hansen are with the Department of Psychiatry, where Ms. Duncan was affiliated at the time of this study, Dr. Polydorou is also with the Department of Medicine, Dr. Hansen is also with the Nathan S. Kline Institute for Psychiatric Research, and Ms. Mendoza is with the Department of Psychiatry and Anthropology, where Ms. Roxas was affiliated at the time of this study, all at New York University, New York (e-mail: soteri.polydorou@nyumc.org ). Ms. Duncan is currently a medical student at the University of California San Francisco. Ms. Mendoza is currently a doctoral student at the Columbia University Mailman School of Public Health, New York. Ms. Roxas is currently a medical student at the University of Rochester School of Medicine and Dentistry, Rochester, New York. Mr. Coleman, who is retired, was with the Office of Behavioral Health, New York City Health and Hospitals, New York, at the time of this study.
authors.forename: Nichole
authors.initials: N
authors.lastname: Roxas
authors.affiliation: Dr. Polydorou, Dr. Ross, Dr. Thomas, and Dr. Hansen are with the Department of Psychiatry, where Ms. Duncan was affiliated at the time of this study, Dr. Polydorou is also with the Department of Medicine, Dr. Hansen is also with the Nathan S. Kline Institute for Psychiatric Research, and Ms. Mendoza is with the Department of Psychiatry and Anthropology, where Ms. Roxas was affiliated at the time of this study, all at New York University, New York (e-mail: soteri.polydorou@nyumc.org ). Ms. Duncan is currently a medical student at the University of California San Francisco. Ms. Mendoza is currently a doctoral student at the Columbia University Mailman School of Public Health, New York. Ms. Roxas is currently a medical student at the University of Rochester School of Medicine and Dentistry, Rochester, New York. Mr. Coleman, who is retired, was with the Office of Behavioral Health, New York City Health and Hospitals, New York, at the time of this study.
authors.forename: Anil
authors.initials: A
authors.lastname: Thomas
authors.affiliation: Dr. Polydorou, Dr. Ross, Dr. Thomas, and Dr. Hansen are with the Department of Psychiatry, where Ms. Duncan was affiliated at the time of this study, Dr. Polydorou is also with the Department of Medicine, Dr. Hansen is also with the Nathan S. Kline Institute for Psychiatric Research, and Ms. Mendoza is with the Department of Psychiatry and Anthropology, where Ms. Roxas was affiliated at the time of this study, all at New York University, New York (e-mail: soteri.polydorou@nyumc.org ). Ms. Duncan is currently a medical student at the University of California San Francisco. Ms. Mendoza is currently a doctoral student at the Columbia University Mailman School of Public Health, New York. Ms. Roxas is currently a medical student at the University of Rochester School of Medicine and Dentistry, Rochester, New York. Mr. Coleman, who is retired, was with the Office of Behavioral Health, New York City Health and Hospitals, New York, at the time of this study.
authors.forename: Sonia
authors.initials: S
authors.lastname: Mendoza
authors.affiliation: Dr. Polydorou, Dr. Ross, Dr. Thomas, and Dr. Hansen are with the Department of Psychiatry, where Ms. Duncan was affiliated at the time of this study, Dr. Polydorou is also with the Department of Medicine, Dr. Hansen is also with the Nathan S. Kline Institute for Psychiatric Research, and Ms. Mendoza is with the Department of Psychiatry and Anthropology, where Ms. Roxas was affiliated at the time of this study, all at New York University, New York (e-mail: soteri.polydorou@nyumc.org ). Ms. Duncan is currently a medical student at the University of California San Francisco. Ms. Mendoza is currently a doctoral student at the Columbia University Mailman School of Public Health, New York. Ms. Roxas is currently a medical student at the University of Rochester School of Medicine and Dentistry, Rochester, New York. Mr. Coleman, who is retired, was with the Office of Behavioral Health, New York City Health and Hospitals, New York, at the time of this study.
authors.forename: Helena
authors.initials: H
authors.lastname: Hansen
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002047:Buprenorphine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D011320:Primary Health Care / Q000379:methods*
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine
keywords: Buprenorphine treatment; Drug abuse; Opioid treatment program; methadone treatment