The Physician Clinical Support System-Buprenorphine (PCSS-B): a Novel Project to Expand/Improve Buprenorphine Treatment

Abstract

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.

Unobserved “Home” Induction Onto Buprenorphine

“…However, these surveys examined buprenorphine prescribing generally and did not focus on unobserved versus observed induction differences or specifics. Similarly but not included in Table 2 as it was not a formal provider survey and instead a description of a mentoring program, the Egan et al report on PCSS-B reported buprenorphine induction dosing and timing issues as 2 of the 3 most frequent topics discussed between PCSS-B mentors and community providers (Egan et al, 2010). Based on a 2007 US state (Massachusetts) and a 2001 French regional sample, the practice of unobserved induction was common: the Massachusetts survey indicated that many physicians (43%) had adopted unobserved induction as regular practice (Walley et al, 2008); the French survey documented that 29% of pharmacy-based inductions were unobserved, and none were supervised by prescribing general practitioners or conducted in a medical office setting (Vignau et al, 2001).…”

“…Primary care and general psychiatry settings typically do not require consecutive observed induction or consecutive daily visits to begin other chronic care treatments or when prescribing other controlled substances, although few other prescription medications have the potential of causing a syndrome such as acute precipitated opioid withdrawal. Induction issues were among the top issue for contacts to the Physician Clinical Support System for Buprenorphine (PCSS-B), a Substance Abuse and Mental Health Service Administration (SAMHSA)-sponsored national mentoring network for buprenorphine prescribers (Egan et al, 2010).…”

Project ECHO (Extension for Community Healthcare Outcomes): A New Model for Educating Primary Care Providers about Treatment of Substance Use Disorders

“…6 Key differences include the small number of specialists who staff the teleECHO clinic and are able to offer guided practice and telementorship to numerous PCPs simultaneously. Also, the IAP ECHO program has thus far operated in NM and so has been implemented in one state rather than nationally.…”

From Education to Practice: Addressing Opioid Misuse through Health Care Provider Training: A Special Issue of Substance Abuse Journal

“…1 As the United States faces increasing opioid-related overdose deaths and diagnoses of addiction, educational and mentoring activities of the PCSS-O are needed to educate health care providers to address opioid misuse and the use of medication treatment for opioid use disorder. 2,3 AMERSA and Substance Abuse journal (SAj) have previously published scholarship involving medication treatment for addictions in a special issue titled "Expanding Treatment for Opioid Use Disorder: The Role of Pharmacotherapies" and the role of prevention and engagement titled "From Risk Reduction to Implementation: A Special Issue on Addressing the Opioid Epidemic." 4,5 These 2 special issues generated many submissions for consideration of publication.…”