Description:

Buprenorphine Treatment for Opioid Use Disorders in HIV Primary Care (BUPE-HIV) is an evidence-informed, team-based primary care intervention that allows patients to readily access comprehensive HIV and addiction services in a single setting. Opioid use disorders interfere with antiretroviral treatment (ART) adherence and impede HIV viral suppression, making buprenorphine treatment an excellent option for PLWH. Compared to methadone, buprenorphine has lower likelihood of side effects, lower overdose potential, and more predictable drug–drug interactions with antiretroviral medications.

Literature & Resources:

Links to Literature

HIV/AIDS Bureau, Special Projects of National Significance Program. Integrating Buprenorphine Therapy into HIV Primary Care Settings. Rockville, MD: U.S. Department of Health and Human Services, Health Resources and Services Administration; 2011.

HIV/AIDS Bureau, Special Projects of National Significance Program. Training Manual: Integration of Buprenorphine into HIV Primary Care Settings. Rockville, MD: U.S. Department of Health and Human Services, Health Resources and Services Administration; 2012.

• Lucas GM, Chaudrhy A, Hsu J, Woodson T, Lau B, Yngvild O, Moore RD. (2010). Clinic-Based Treatment of Opioid-Dependent HIV-Infected Patients versus Referral to an Opioid Treatment Program: A Randomized Trial. Annals of Internal Medicine, 2010, 152, 704-711
• SAMHSA. Tip 63: Medications for opioid use disorder. Rockville, MD. U.S. Department of Health and Human Services; 2018.

Links to Websites

• American Society for Addiction Medicine
• Buprenorphine Waiver Management
  • Qualify for a Physician Waiver to Prescribe Buprenorphine
  • Clinic-Based Buprenorphine Treatment: Evidence-Based for Retention in HIV Care

• DEA Office Inspection Tips
• FDA Approved Risk Evaluation and Mitigation Strategies
• Harm Reduction Coalition
• Integrating Buprenorphine Treatment for Opioid Use Disorder in HIV Primary Care
• Medication-Assisted Treatment for Opioid Addiction: Fast Facts for Family and Friends
• National Alliance of Advocates for Buprenorphine Treatment (NAABT)
  • NAABT: What is Buprenorphine Like?
  • NAABT: Collection of Literature
• Providers Clinical Support System – About Mentoring
• SAMHSA Resources
  • SAMHSA: Confidentiality of Alcohol and Drug Abuse Patient Records
  • SAMHSA: Medication Assisted Treatment: Buprenorphine
  • SAMHSA: Substance Use Disorder Training

• Target Center Resources
  • TARGET Center: Buprenorphine
  • TARGET Center: Sample Recruitment Materials

Description:

Psychiatric Collaborative Care Management (CoCM) is more than just bringing a mental health provider to a primary care setting. In CoCM, a team of providers, including the patient’s medical provider, a behavioral health provider, and a psychiatric consultant, work together to provide evidence-informed mental health care to populations of patients. Primary care teams see their patients improve much more quickly in a successful CoCM program than in usual care.

To provide CoCM, a group of providers must function as a team and share a workflow to provide evidence-informed mental health or substance use disorder treatment. Strategies, staffing arrangements, and clinic work flows in implementing CoCM may be different among HIV service organizations, but the core principles to operationalize a successful and evidence-informed CoCM program are the same. For information about readiness requirements and other factors for successful implementation of CoCM, see the nine factors identified for effective implementation.

Literature & Resources:

Links to Literature

• Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P. Collaborative Care for People With Depression and Anxiety. Cochrane Database of Systematic Reviews. 2012.

• Unutzer J, Katon W, Callahan CM, Williams JW, Jr., Hunkeler E, Harpole L, Hoffing M, Della Penna RD, Noel PH, Lin EH, Arean PA, Hegel MT, Tang L, Belin TR, Oishi S, Langston C. Collaborative Care Management of Late-Life Depression in the Primary Care Setting: A Randomized Controlled Trial. Journal of the American Medical Association 2002;288: 2836-45.

• Whitebird RR, Solberg LI, Jaeckels NA, Pietruszewski PB, Hadzic S, Unutzer J, Ohnsorg KA, Rossom RC, Beck A, Joslyn KE, Rubenstein LV. Effective Implementation of Collaborative Care for Depression: What is Needed? American Journal of Managed Care. 2014; 20(9): 699-707.

Link to Websites

• Advancing Integrated Mental Health Solutions Center (AIMS) Main Website
  • Additional Information on CoCM Team Structure
  • Additional Information on Stepped Model of BHI
  • Caseload Tracker
  • Collaborative Care Financing Strategies
  • Collaborative Care Model: Integrating Physical and Mental Health Care in Medicaid Health Homes
  • More on PHQ-9 Depression Scale
  • More on Behavioral Interventions
  • More on the Evidence-Base for CoCM
  • More on Problem Solving Treatment (PST)
  • Patient Tracking Spreadsheet
  • Summary of Commonly Prescribed Psychotropic Medications

• The Plan Do Study Act Cycle

• Validated Screening and Treatment Monitoring Measures
  • IBHC Quality Measures
  • Patient Health Questionnaire Screeners
  • SAMHSA Screening Tools

Description:

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-informed intervention in which a health care provider screens clients for substance use (alcohol and other drugs), provides brief motivational counseling, and refers to treatment if needed. When integrated into the standard delivery of HIV health care and social services, each part of the SBIRT process provides information and assistance tailored to individual clients and their needs. Just as checking a client’s blood pressure can reveal potential health problems and guide recommendations for a healthier lifestyle, SBIRT for substance use provides early insight into potential health problems and a chance to address problems before they worsen.

Literature & Resources:

Link to Literature

• Adamson SJ, Kay-Lambkin FJ, Baker AL, Lewin TJ. An Improved Brief Measure of Cannabis Misuse: The Cannabis Use Disorders Identification Test – Revised (CUDIT-R). Drug and Alcohol Dependence. 2010;110:137-143.
• Agerwala SM, McCance-Katz EF. Integrating Screening, Brief Intervention, and Referral to Treatment (SBIRT) into Clinical Practice Settings: A Brief Review. Journal of Psychoactive Drugs. 2012; 44(4), 307-317.
• Centers for Disease Control and Prevention. Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use: A Step-by-Step Guide for Primary Care Practices. Atlanta, Georgia: Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, 2014.

• Dawson-Rose C, Draughon JE, Zepf R, Cuca YP, Huang E, Freeborn K, Lum PJ. Prevalence of Substance Use in an HIV Primary Care Safety Net Clinic: A Call for Screening. Journal of the Association of Nurses in AIDS Care. 2017;28(2):238-249.

• D’Onofrio G, Pantalon MV, Degutis LC, Fiellin DA, O’Connor PG. Development and Implementation of an Emergency Practitioner-Performed Brief Intervention for Hazardous and Harmful Drinkers in the Emergency Department. Academy of Emergency Medicine. 2005; 12(3):249-56.
• Humeniuk RE, Ali R, Babor TF, Farrell M, Formigoni ML, Jittiwutikarn J, Boerngen de Larcerda R, Ling W, Marsden J, Monteiro M, Nhiwhatiwa S, Pal H, Poznyak V and Simon S. Validation of the Alcohol, Smoking And Substance Involvement Screening Test (ASSIST): Manual for Use in Primary Care. World Health Organization, Geneva, Switzerland 2010.

• Kalichman S, Grebler T, Amaral C, McNerey M, White D, Kalichman MO, Cherry C, Eaton L. Intentional Non-Adherence to Medications Among HIV Positive Alcohol Drinkers: Prospective Study of Interactive Toxicity Beliefs. Journal of General Internal Medicine. 2013: 28(3):399- 405.

• Knight JR, Sherritt L, Shrier LA, Harris SK, Chang G. Validity of the CRAFFT Substance Abuse Screening Test Among Adolescent Clinic Patients. Archives of Pediatric Adolescent Medicine. 2002;156(6):607– 614.
• Madras BK, Compton WM, Avula D, Steqbauer T, Stein JB, Clark HW. Screening, Brief Interventions, Referral to Treatment (SBIRT) for Illicit Drug and Alcohol Use at Multiple Healthcare Sites: Comparison at Intake and Six Months. Drug Alcohol Depend. 2009;99(1-3):280-295.

• Marx M, Corwin MA. Screening, Brief Intervention, and Referral to Treatment: Addressing Substance Abuse in HIV Care Settings. Mountain Plains AIDS Education and Training Center; June 2014.
• Skinner HA. Drug Use Questionnaire (DAST-20). Department of Public Health Sciences, University of Toronto, 1982.
• Strauss SM, Rindskopf DM. Screening Patients in Busy Hospital-Based HIV Care Centers for Hazardous and Harmful Drinking Patterns: The Identification of an Optimal Screening Tool. Journal of the International Association of Providers of AIDS Care (Chic). 2009;8(6):347-353.
• Volkow ND, Montaner J. The Urgency of Providing Comprehensive and Integrated Treatment for Substance Abusers with HIV. Health Affairs (Millwood). 2011;30(8):1411-1419.

Books

• Rollnick S, Miller WR, Butler C. Motivational Interviewing in Healthcare: Helping Patients Change Behaviour. London: Guilford Press; 2008.
• Rollnick S, Miller WR. Motivational Interviewing in Healthcare: Helping People Change: 3^rd Edition. London: Guilford Press; 2012.

Link to Websites

• A Pocket Guide for Alcohol Screening and Brief Intervention
• Center for Disease Control and Prevention: Alcohol Screening and Brief Intervention
• Cutting Back: Managed Care Screening and Brief Intervention for Risky Drinking
• Rankings of Preventive Services for the US Population

• SAMHSA Resources
  • SAMHSA: Behavioral Health Treatment Services Locator
  • SAMHSA: Reimbursement for SBIRT
  • SAMHSA: Training and Other Resources for SBIRT

• Substance Use Screening and Brief Intervention
• USAUDIT: The Alcohol Use Disorders Identification Test, Adapted for Use in the United States
• World Health Organization: Management of Substance Abuse