Survey Identifies Barriers to Office-Based Opioid Treatment
A Magellan project team, partially supported by a grant from Reckitt Benckiser, recently concluded a year-long project to identify barriers to the use of office-based opioid treatment (OBOT) by Magellan-credentialed providers. The ultimate goal of the project is to develop interventions to expand the use of OBOT.
Opiate addiction is a significant problem – second only to alcohol abuse in prevalence. Studies indicate that, even after the introduction of maintenance therapies with methadone, the mortality rate of opiate-dependent persons is still 20 times higher than that of the non-drug using population.1
“In most cases, treatment of opioid dependence can be safely administered with detoxification or inducement onto a maintenance medication on an outpatient basis,” says Robert Ciaverelli, MD, vice president of medical services, who leads the Magellan project team. Several studies have demonstrated excellent retention rates and positive outcomes with OBOT. 2, 3, 4, 5
“There is a potential for significant improvement in quality of care, not to mention a reduction in health care costs, if we are able to understand the barriers to OBOT and establish a strong network of certified OBOT providers,” says Ciaverelli.
Magellan’s survey targeted 621 providers, 47 percent of whom completed the survey. Results indicated that the following four barriers negatively influenced providers against treating opioid-dependent patients in the office setting:
- Burden of lab testing
- Concern about attracting more drug users to the practice than can comfortably be managed
- Concern about needing to be available 24 hours a day, seven days a week to meet the needs of patients
- Concerns about places to refer difficult patients.
Based on the survey findings and input from a focus group of physicians, Magellan implemented its Referral to OBOT (ROBOT) program in January 2008, which inaugurated a new network of more than 160 Magellan-credentialed OBOT providers. The program includes access to a Magellan OBOT expert, and a quarterly newsletter with helpful hints on how to provide this unique form of care, and how best to navigate the Magellan system.
“Magellan extends thanks to those providers involved in the ROBOT program and encourages others to join,” says Ciaverelli. Inquiries and comments may be directed to Ciaverelli at RCiaverelli@MagellanHealth.com.
You may also visit www.ncsl.org/programs/health/forum/mat.htm for information on medication-assisted treatment for opiate addiction and OBOT.
- Effective Medical Treatment of Opiate Addiction. NIH Consensus Statement Online 1997 Nov 17-19; [cited 2006 May 05]; 15(6):1-38.
- Johnson, R.E. and Fudala, P.J. (1992) Development of Buprenorphine for the treatment of opioid dependence. National Institute on Drug Abuse, Research Monograph 121, Buprenorphine: An Alternative Treatment for Opioid Dependence, pp. 120-141.
- Johnson, R E. Pharm.D., Chutuape, Mary Ann, Ph.D., Strain, Eric C., M.D., Walsh, Sharon L., Ph.D., Stitzer, Maxine L., Ph.D., and Bigelow, George E., Ph.D. A comparison of Levomethadyl Acetate, Buprenorphine, and Methadone for opioid dependence. The New England Journal of Medicine, Volume 343:1290-1297.
- Kakko J, Svanborg KD, Kreek MJ, Heilig M. (2003). 1-year retention and social function after Buprenorphine-associated relapse prevention treatment for heroin dependence in Sweden: a randomised, placebo-controlled trial. Lancet, 361:662-668
- O'Connor PG, Oliveto AH, Shi JM, et al. (1996). A pilot study of primary-care-based Buprenorphine maintenance for heroin dependence. Am J Drug Alcohol Abuse; 22:523-531.