In Colorado, some opioid treatment programs (OTPs) governed by federal methadone regulations are combining the office-based opioid treatment (OBOT) protocol with OTP. This means that the patients in the OBOT program in the OTP can get a prescription for buprenorphine right away—just as if they went to a prescribing provider in the community.
In Colorado, some opioid treatment programs (OTPs) governed by federal methadone regulations are combining the office-based opioid treatment (OBOT) protocol with OTP. This means that the patients in the OBOT program in the OTP can get a prescription for buprenorphine right away—just as if they went to a prescribing provider in the community.
In a recent interview with AT Forum, Tina Beckley, director of clinical services for Dallas-based Behavioral Health Group (BHG), explained how this works.
There are three programs: OBOT, OTP buprenorphine, and OTP methadone (for those who don’t respond to either OBOT or OTP buprenorphine).
“It’s a combination of OBOT and OTP,” she said. “Within our programs, we have DATA-waived physicians who are able to write a prescription for buprenorphine.” Patients are monitored more closely than they would be in a typical physician’s office, because BHG wants to make sure that they receive best-practice psychosocial services. If the patient doesn’t achieve stability, the provider can transfer the patient into the OTP buprenorphine program. In the OTP buprenorphine program, the patient can still receive buprenorphine, but it is dispensed, not prescribed, and is more closely regulated.
Many physicians in the community do not provide that level of psychosocial and clinical services, said Ms. Beckley. Patients who go to BHG’s OBOT program are required to have regular counseling and drug screens, as well as regular meetings with the provider, she added.
Ms. Beckley has great respect for community-based providers, some of whom may feel that treating OUD is “outside their comfort level.” This is a complex population, and many of the patients have co-occurring physical and mental health issues, she said. “I’ve been in state meetings in Colorado with physicians who have talked about working with the opioid use disorder population, and several of them expressed being uncomfortable with it and had not yet begun to prescribe buprenorphine.”
Medication Does Not Equal Treatment
“I remember a couple years ago, when I was regional director, we knew there were practices in the community that were not providing psychosocial services,” recalled Ms. Beckley. “We reached out to them to try to partner, so that we could provide the clinical services, and they would provide the medical services.” Some of the physicians wondered “how they could sell that to their patients” who had not previously had the expectation to attend counseling, and basically wanted as few “services” as possible, and just wanted the medication. However, treating addiction requires more than a prescription. “Medication does not equal treatment,” said Ms. Beckley.
Closer Monitoring; Better Retention
“What we have found at BHG—and it’s my role to enhance clinical services throughout the organization—is that patients who take advantage of a higher level of clinical services have better retention and outcomes,” said Ms. Beckley.
And Ms. Beckley doesn’t think the regulations at BHG treatment centers present further barriers to treatment. “We have doctors available every day in several of our Colorado programs,” she said. There is not usually a wait to be admitted.
Buprenorphine or Methadone? A Doctor/Patient Decision
“In our programs, we do a lot of training about why it’s up to the provider and patient, not the nurse or counselor, to choose between buprenorphine and methadone,” she said. “We had to shift the thinking that a certain type of patient is appropriate for only buprenorphine or only methadone.”
“Patients who don’t stabilize can be moved into the OTP buprenorphine program—and if that doesn’t work, we can move them into the methadone program,” said Ms. Beckley. But how do you know what is working? There are many factors that can be indicators of treatment efficacy, including urine drug screens, adherence, and patient report, she added. If patients continue to test positive, they are not discharged from treatment, but are moved into a higher level of care. “It’s an acuity model,” said Ms. Beckley.
In Colorado, some opioid treatment programs (OTPs) governed by federal methadone regulations are combining the office-based opioid treatment (OBOT) protocol with OTP. This means that the patients in the OBOT program in the OTP can get a prescription for buprenorphine right away—just as if they went to a prescribing provider in the community.
In a recent interview with AT Forum, Tina Beckley, director of clinical services for Dallas-based Behavioral Health Group (BHG), explained how this works.
There are three programs: OBOT, OTP buprenorphine, and OTP methadone (for those who don’t respond to either OBOT or OTP buprenorphine).
“It’s a combination of OBOT and OTP,” she said. “Within our programs, we have DATA-waived physicians who are able to write a prescription for buprenorphine.” Patients are monitored more closely than they would be in a typical physician’s office, because BHG wants to make sure that they receive best-practice psychosocial services. If the patient doesn’t achieve stability, the provider can transfer the patient into the OTP buprenorphine program. In the OTP buprenorphine program, the patient can still receive buprenorphine, but it is dispensed, not prescribed, and is more closely regulated.
Many physicians in the community do not provide that level of psychosocial and clinical services, said Ms. Beckley. Patients who go to BHG’s OBOT program are required to have regular counseling and drug screens, as well as regular meetings with the provider, she added.
Ms. Beckley has great respect for community-based providers, some of whom may feel that treating OUD is “outside their comfort level.” This is a complex population, and many of the patients have co-occurring physical and mental health issues, she said. “I’ve been in state meetings in Colorado with physicians who have talked about working with the opioid use disorder population, and several of them expressed being uncomfortable with it and had not yet begun to prescribe buprenorphine.”
Medication Does Not Equal Treatment
“I remember a couple years ago, when I was regional director, we knew there were practices in the community that were not providing psychosocial services,” recalled Ms. Beckley. “We reached out to them to try to partner, so that we could provide the clinical services, and they would provide the medical services.” Some of the physicians wondered “how they could sell that to their patients” who had not previously had the expectation to attend counseling, and basically wanted as few “services” as possible, and just wanted the medication. However, treating addiction requires more than a prescription. “Medication does not equal treatment,” said Ms. Beckley.
Closer Monitoring; Better Retention
“What we have found at BHG—and it’s my role to enhance clinical services throughout the organization—is that patients who take advantage of a higher level of clinical services have better retention and outcomes,” said Ms. Beckley.
And Ms. Beckley doesn’t think the regulations at BHG treatment centers present further barriers to treatment. “We have doctors available every day in several of our Colorado programs,” she said. There is not usually a wait to be admitted.
Buprenorphine or Methadone? A Doctor/Patient Decision
“In our programs, we do a lot of training about why it’s up to the provider and patient, not the nurse or counselor, to choose between buprenorphine and methadone,” she said. “We had to shift the thinking that a certain type of patient is appropriate for only buprenorphine or only methadone.”
“Patients who don’t stabilize can be moved into the OTP buprenorphine program—and if that doesn’t work, we can move them into the methadone program,” said Ms. Beckley. But how do you know what is working? There are many factors that can be indicators of treatment efficacy, including urine drug screens, adherence, and patient report, she added. If patients continue to test positive, they are not discharged from treatment, but are moved into a higher level of care. “It’s an acuity model,” said Ms. Beckley.
