The Use of Buprenorphine to Treat Co-occurring Pain and Opioid Dependence in a Primary Care Setting



March 22, 2013

The Use of Buprenorphine to Treat Co-occurring Pain and Opioid Dependence in a Primary Care Setting

Patricia Pade, M.D.
Assistant Professor - Department of Family Medicine
Center for Dependency, Addiction and Rehabilitation (CeDAR)
University of Colorado Hospital

The Co-occurring Disorders Clinic (CODC) is a unique treatment setting embedded within the Primary Care Clinics of the Veterans Administration Medical Center in Albuquerque, New Mexico. The clinic was established in 2009 to manage and treat patients with co-morbid pain and addiction. Patients include those with high risk opioid dependency, prescription and illicit drug and alcohol use disorders, and high dose or complex regimens. The clinic manages a large volume of patients utilizing monitoring methodology, including comprehensive assessment, contracting, frequent office visits, and urine toxicology screening. Buprenorphine/naloxone therapy is offered to patients with opioid dependency.

Between June 2009 and November 2011, 143 patients were induced with buprenorphine/naloxone and 93 of these patients are continuing treatment with buprenorphine. Furthermore, the pain scores pre- and post- induction with buprenorphine show a modest but statistically significant improvement. Co-morbid condition prevalence, concurrent treatment and monitoring, CODC operation, and buprenorphine induction and maintenance dosing will be discussed in this presentation.

Since the care provided by the CODC is not widely available to patients and providers in rural areas of New Mexico and surrounding states, the clinic provides tele-health to patients but more importantly to providers in remote areas. The clinic staff directs project Specialty Care Access Network (SCAN), modeled after the successful Project ECHO (Extension for Community Health Outcomes), a University of New Mexico effort and internationally recognized program that utilizes telemedicine to train rural primary care providers (PCP) to deliver specialty care. The program uses case-based training and didactic sessions to increase the skill level and confidence of the PCPs with the goal of gradually transferring the responsibility for providing complex care from specialist to PCPs. In March 2012, the first SCAN Veterans Administration 8 hour Buprenorphine training led to the training of 22 new providers. This technology and program has improved outreach and monitoring capability to remote and underserved areas.

Dr. Pade’s presentation slides.