Office-Based Opioid Treatment with Buprenorphine (OBOT-B): Statewide Implementation of the Massachusetts Collaborative Care Model in Community Health Centers

Abstract

We describe a Massachusetts Bureau of Substance Abuse Services' (BSAS) initiative to disseminate the office-based opioid treatment with buprenorphine (OBOT-B) Massachusetts Model from its development at Boston Medical Center (BMC) to its implementation at fourteen community health centers (CHCs) beginning in 2007. The Massachusetts Collaborative Care Model for the delivery of opioid agonist therapy with buprenorphine, in which nurses working with physicians play a central role in the evaluation and monitoring of patients, holds promise for the effective expansion of treatment for opioid use disorders. The training of and technical assistance for the OBOT nurses as well as a limited program assessment are described. Data spanning 6years (2007-2013) report patient demographics, prior treatment for opioid use disorders, history of overdose, housing, and employment. The expansion of OBOT to the fourteen CHCs increased the number of physicians who were "waivered" (i.e., enabling their prescribing of buprenorphine) by 375%, from 24 to 114, within 3years. During this period the annual admissions of OBOT patients to CHCs markedly increased. Dissemination of the Massachusetts Model of the Office-Based Opioid Treatment with Buprenorphine employing a collaborative care model with a central role for nursing enabled implementation of effective treatment for patients with an opioid use disorder at community health centers throughout Massachusetts while effectively engaging primary care physicians in this endeavor.

Keywords: Access to treatment; Buprenorphine; Nurse care manager; Opioid agonist therapy; Opioid use disorder; Waivered physicians.

Figure 1

Patient flow in the OBOT-B Collaborative Care Model.

Figure 2

Role of the nurse care manager (NCM) in the OBOT-B Collaborative Care Model. * Treatment agreements and consents are often employed in the treatment of addiction to make explicit expectations of the patients and their involvement in the treatment process, which is consistent with the Clinical Guidelines in the Use of Buprenorphine Treatment Improvement Protocol 40 SAMHSA. ^ Lab tests done for the purposes of primary care of a patient with an opioid use disorder ** Drug screening is used to assess the patient’s ongoing treatment needs and allows the provider to have a conversation with the patient addressing the findings and assisting with appropriate treatment planning.

Figure 3

Topics covered in the OBOT NCM core training program.