A behind the scenes look at buprenorphine ‘treatment on demand’

The Heroin and Prescription Opiate Addiction Taskforce recently published a 2017 Year End Report alongside highlights of actions taken to address the growing opiate epidemic in our region. The highlights show that in the past year, 40 new access points for buprenorphine–one of the best treatments available for opiate use disorder–became available. Buprenorphine supports recovery and reduces the chances of a fatal overdose by 50%. 40 sites

The goal is for people with opiate use disorder to be able to meet with a provider and start medication at their first appointment, when medically appropriate. This past year, community and public health clinics, hospitals, behavioral health agencies and other service providers worked to expand services to do just that.

But, retaining patients in medication-assisted treatment for substance use disorder, a highly stigmatized disease, can be challenging.  Some patients have a history of trauma or have mental health challenges. Others have dealt with discrimination or have had negative  experiences with the health care system.  To be successful, we must increase the number of community healthcare providers trained in trauma-informed care and connected to multi-disciplinary teams that can provide access to additional social and behavioral health services.

We caught up with several partners to hear more about what it takes.

Meeting vulnerable people where they already access services
A survey at the Public Health Needle Exchange found that 78% of clients reported interest in reducing or stopping opioid use. To meet that need, the Downtown Public Health Needle Exchange and Swedish Family Medicine Clinic launched a unique pilot project to provide rapid access to buprenorphine.  A substantial majority (83%) of clients who the program reaches are homeless. As Pat Kennedy, Program Manager for Buprenorphine Pathways describes, the program is clearly filling a need.

Buprenorphine Pathways provides services under one roof to meet the most vulnerable. Demand has been very high, reaching capacity within 13 weeks of when we launched.   But what this pilot has shown us is that you we can lower barriers to treatment safely and successfully.

There’s still more work to be done to look at the best practices for helping to retain clients and ensure they are connected to providers in the community for long-term care.”

Providing services in culturally appropriate settings
Seattle Indian Health Board has expanded provider hours for medication-assisted treatment. As Dr. Sapienza, Addiction Medicine Director at Seattle Indian Health Board points out, providing services by a trusted organization can make all the difference.

“The Seattle Indian Health Board is providing access to medications for opioid use disorder in a culturally appropriate setting, which is critical to reducing the harm of the opioid epidemic in the American Indian/Alaska Native community. The increased resources dedicated to new treatment models allows the Seattle Indian Health Board to do more.

Though we are moving in the right direction, we must make on-demand opioid treatment more of a reality. We know that services are most effective when they can be offered on the same day a person reaches out for help. We need to honor that courageous act by immediately providing them that help because, all too often, it comes too late and an opportunity to provide the necessary treatment is lost.”

Connecting with mental health services
In the U-District, the Community Psychiatric Clinic (CPC) recently began a low-barrier buprenorphine program with direct connections to mental health services. As David Newman, Program Manager for substance use disorder services at Community Psychiatric Clinic describes, mental health can be the missing link.

“We organized a team of mental health and substance use clinicians, embedding them in the People’s Harm Reduction Alliance syringe exchange. One client told us that he had been a heroin user for many years. He had given up most of his social life for his drug use.

He had heard about the low barrier program and decided to check it out. He has been opioid free for over a month on buprenorphine.  The provider also conducted a co-occurring assessment and was able to start the client on mental health medications and case management services.”

Learning from one another
As one provider noted, “Our low barrier program vision drew upon the experience and structure of King County Public Health’s low barrier buprenorphine program.” Clearly, providers across the region are learning from one another and are extremely committed to doing what they can to increase access to treatment when they need it, where they need it.

These are just some of the many local efforts that have launched in King County. To learn more about treatment options available for you or people you know, you can contact the Washington Recovery Hotline. 

Originally published May 8, 2018

One thought on “A behind the scenes look at buprenorphine ‘treatment on demand’

  1. A family doc friend of mine told me there aren’t enough physicians willing to take bupe patients bec. They don’t want to help people with substance e abuse disorders. True for KC?

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