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BEEHIVE Buprenorphine Program Tools

January 1, 2009

University of California, San Francisco

Resources for integrating buprenorphine treatment within HIV/AIDS programs, as developed by the HRSA SPNS Buprenorphine project.

Treatment Materials

  • Authorization to Exchange Health Information
  • Consent to Treatment with Buprenorphine
  • Take-Home Dose Agreement
  • Documentation of Clinical Eligibility 
  • Worksheet for DSM–IV Criteria for Diagnosis of Opioid Dependence
  • Prescribers’ Direct Dispensing Log Information

Recruitment Materials

  • San Francisco DPH’s Integrated Buprenorphine Intervention Services Brochure
  • Patient Brochure
  • Patient Flyer
  • Program Exam Room Laminate Card


  • Program Description
  • Provider–Patient Expectations
  • Referral Procedures for HIV/AIDS Patients
  • Clinical Guidelines for Prescribing Buprenorphine in the Office-Based Treatment of Opioid Dependence
  • Jail Health Services Buprenorphine Inventory
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