Integration of Buprenorphine into HIV Primary Care Settings

Tool for HIV/AIDS clinical programs who are considering integrating opioid addiction treatment using buprenorphine. Chapters cover background and rationale, lessons learned from the HRSA SPNS Initiative, and information for prescribers and clinic managers.

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The purpose of this curriculum is to provide physicians with the information they need to educate their clinic staff and other stakeholders about integrating medication-assisted treatment (MAT) with buprenorphine into HIV primary care.

It provides a detailed overview of buprenorphine within clinical settings, from the legal requirements for implementation to step-by-step procedures for prescribing and administering buprenorphine.

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In this webinar, clinicians from two Ryan White clinics with successful buprenorphine programs describe what buprenorphine is and how it works. Also addressed:

• What opioids do to the brain
• How Buprenorphine differs from Methadone
• Important drug-drug interactions
• The concept of precipitated withdrawal and how to recognize it
• How to determine patient eligibility
• Clinical aspects of working with opioid-addicted people living with HIV

Presenters

• Pamela Vergara-Rodriguez, MD, (CORE Center in Chicago)
• Jacqueline Tulsky, MD (University of California at San Francisco and San Francisco General Hospital)

This report highlights projects found to offer highly effective (and replicable) approaches to integrating buprenorphine-based medication-assisted treatment into HIV/AIDS primary care as part of a HRSA HAB SPNS initiative. Chapters outline the processes programs need to put in place, including meeting DATA 2000 regulatory requirements, achieving institutional buy-in, implementing staff training requirements, and evaluating processes and outcomes. 

Four demonstration sites are highlighted:

• University of California, San Francisco, Beehive Program
• CORE Buprenorphine Project
• Portland Integrates Care for Opioid-Dependent HIV/AIDS  Patients Demonstration Model 
• Miriam Hospital Buprenorphine Program 

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

• Beehive Program Treatment Forms 
• Beehive Program Recruitment Materials 
• Beehive Program Protocols

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

Protocols

• 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