Implementation of Buprenorphine Within Aetna Behavioral Health

Investigator: Laura Schmidt, PhD
Sponsor: Oregon Health Sciences University

Location(s): United States


The buprenorphine and methadone model implemented by San Francisco County required significant Federal (CSAT, DEA) and State involvement related to regulatory changes and exceptions. OBIC not only trainspracticing physicians but has focused as well on MD residents to create a new wave of physicians knowledgeable about substance use and dependence. In this model, the pharmacy plays a critical role in client care. All buprenorphine patients receive their medication at the County Behavioral Health Pharmacy; the only limitation on number of patients that can receive medications is financing of the medications themselves and reimbursement for the procedures. Having the pharmacy play a key role in client care has led to increased compliance for multiple medications that patients may be taking for complex chronic diseases. 
A monthly meeting of an oversight committee composed of representatives of all provider disciplines and focusing on a few important programmatic outcomes supports San Francisco’s efforts to continually improve medication-assisted treatment. Outcomes include the number of clients referred, enrolled, transitioned to primary care, and retained in treatment; the number of clinics with eligible providers and the number of providers who actively provide medication-assisted treatment; the volume of non-methadone prescriptions; and direct provider feedback on “comfort” of primary care physicians with providing opiate treatment services and working with opiate-addicted patients.