Opioid dependence is largely an undertreated medical condition in the United States. The introduction of buprenorphine has created the potential to expand access to and use of opioid agonist treatment in generalist settings. Physicians, however, often have limited training and experience providing this type of care. Some physicians believe having a mentoring relationship with an experienced provider during their initial introduction to the use of buprenorphine would ease implementation. Our goal was to describe the development, implementation, resources, and evaluation of the Physician Clinical Support System-Buprenorphine (PCSS-B), a federally funded program to improve access to and quality of treatment with buprenorphine. We provide a description of the PCSS-B, a national network of 88 trained physician mentors with expertise in buprenorphine treatment and skills in clinical education. We provide information regarding the use the PCSS-B core services including telephone, email and in-person support, a website, clinical guidances, a warmline and outreach to primary care and specialty organizations. Between July 2005 and July 2009, 67 mentors and 4 clinical experts reported providing mentoring services to 632 participants in 48 states, Washington DC and Puerto Rico. A total of 1,455 contacts were provided through email (45%), telephone (34%) and in-person visits (20%). Seventy-six percent of contacts addressed a clinical issue. Eighteen percent of contacts addressed a logistical issue. The number of contacts per participant ranged from 1–125. Between August 2005 and April 2009 there were 72,822 visits to the PCSS-B website with 179,678 pages viewed. Seven guidances were downloaded more than 1000 times. The warmline averaged more than 100 calls per month. The PCSS-B model provides support for a mentorship program to assist non-specialty physicians in the provision of buprenorphine and may serve as a model for dissemination of other types of care.

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The doctor-patient interaction in the methadone maintenance treatment clinic is qualitatively different from general medical settings. The patient presents with a specific request for treatment of opioid dependence, most often having already selected the methadone treatment modality, and the initial contact is centered around obtaining methadone. Addiction and needle use increase susceptibility to life-threatening illnesses, such as syphilis, endocarditis, tuberculosis, and AIDS. The physician is working with counselors, nurses, therapists and 12-Step programs, incorporating the best of the medical, psychodynamic, behavioral, and recovery models into treatment. Federal and state governments also control and regulate methadone treatment. Given this complex picture, the basic techniques of methadone maintenance treatment are reviewed, including the intake examination, the annual examination, dose adjustment, withdrawal from methadone maintenance, management of pregnant patients, dual diagnosis patients, and severely ill or medically disabled patients.

The Drug Addiction Treatment Act of 2000 (DATA-2000) allows qualified physicians to treat opioid-dependent patients with schedule III-V medications, such as buprenorphine, in practices separate from licensed, accredited opioid treatment programs. Physicians may attain this qualification by completing 8-hours of training in treating opioid dependence. This paper describes the evaluation of a faculty development workshop designed to enhance teaching skills of small-group facilitators involved with DATA-2000 training sessions. This workshop coached the facilitators on their teaching roles in the DATA-2000 session through experiential practice of patient-case discussions related to treatment of opioid-dependence. Descriptive questionnaires evaluated the value of the workshop. Twenty-six facilitators participated in the workshops. Paired mean score responses for specific teaching skill abilities demonstrated statistically significant improvement in all categories. Evaluation of the DATA-2000 training session small-group facilitators was uniformly positive. This faculty development workshop was successful in improving teaching skills for our small-group faculty facilitators.