Recovery Centers of
King County
Buprenorphine Treatment Program
AAP Providers Conference, April 19, 2013, Lynnwood, WA
Patricia C. Knox, Ph.D.
Where do I sign up?
Program Design
• Pharmacological treatment in conjunction with behavioral CD
treatment
• Six month Suboxone taper (max 16mg) starting with induction
in detox, followed by 28 days of intensive inpatient and five
months of outpatient treatment
• Ultimate goal is Abstinence
Funding: DSHS
• Patients enrolled were Medicaid eligible: TANF, ADATSA, SSI,
Disability Lifeline, and Disability Lifeline – Extended.
• DSHS paid for medication in treatment and for physician
services.
• Detox Subutex and Suboxone were not billed to DSHS.
Funding: King County
• King County MHCADSD contracted with RCKC to provide
Buprenorphine services.
• Contract began in 2009 and has been annually. Fund source
was County MIDD funds.
• Funding was used for MD services: initial visit and med checks,
and for UA’s and bus tickets.
Funding: King County
• The contract objectives were:
• To evaluate the acceptability and feasibility of buprenorphine
detoxification with heroin dependent patients.
• To evaluate the impact of buprenorphine on outpatient treatment
retention following inpatient treatment by comparing retention of
the project sample to historical norms.
• To evaluate the impact of buprenorphine on repeat detoxification
admissions by comparing readmission rates of the project sample in
the 12 months prior to admission to the project.
Program Flow Overview
Patient screened over the phone and has Medicaid funding
Patient enters RCKC detox (4-5 days)
28-Day Intensive Inpatient Treatment
Build behavioral skills and taper suboxone
5-12 Months of Outpatient Treatment
Program Flow: Screening
During the screening call, we determine if the patient
has funding ( TANF, ADATSA, SSI,
Disability Lifeline, and Disability Lifeline – Extended)
The RCKC screening form guides our staff member
through appropriate criteria for admittance.
Recent methadone and fentanyl use are exclusions for
entering detox.
Program Flow: Detoxification
• Upon admission, patients are transported
to a nearby lab by RCKC and liver values
are tested.
• Detox stays for Suboxone patients are
funded by RCKC.
• After a health evaluation, patients are inducted unto Subutex
with a starting dose of 16mg and detoxed for any additional
substances.
• The typical length of detox is 4-5 days.
Program Flow: Detoxification (cont)
•
Suboxone DBHR authorization completed and faxed
• http://www.dshs.wa.gov/pdf/ms/forms/13_720.pdf
Program Flow: Intensive Inpatient
• After successful detoxification, patients enter 28 days of
intensive inpatient treatment.
• Funding for Inpatient is provided by State.
• For the duration of
Inpatient, patients are
maintained on a dose
of 16mg of Suboxone.
Program Flow: Outpatient
• After successful completion of IIP, patients
begin outpatient treatment at our Central
Seattle location.
• Outpatient treatment lasts 5-12 months for
Suboxone patients.
• Patients receive priority admission
• Assigned to Buprenorphine Group and additional
appropriate groups (e.g. RPG, CCG …)
• Rules for OP compliance include:
• Weekly UDS tests
• Mandatory Buprenorphine Group attendance
• Positive UDS test for Buprenorphine
Compliance Protocol
Noncompliance
• Relapse, missing group / individual session
• Failure to attend 3 SS meetings weekly
• Negative for Buprenorphine
• Refusing a UA
Verbal Warning
Further Noncompliance
Bupe. Group counselor and Program Coordinator
meet and patient signs Behavioral Contract. Director,
Physician and Research Coordinator notified via email
Contract Violation
Patient Discharged
Suboxone Tapering Schedule
• The Suboxone taper begins in the 10th week.
• Every two weeks thereafter, Suboxone dose is tapered by 2mg.
• At week 24, the final taper goes from 2mg to 1 mg.
Program Challenges
• Billing Issues
• ADATSA funding and Medicaid Coverage (patients need Medicaid
coverage for meds to be covered)
• Coordination Problems:
• Prescriptions only filled every two weeks
• Only 8mg pills are covered: problems with taper
• Population challenges:
• Housing issues
• Non-tapering Suboxone patients
• Fear of discomfort with the taper
Program Observations for Success
Readiness
• To actively engage in 12-step program
• To taper off the Suboxone
• To actively participate in the Buprenorphine Group
Future Plans
• Consider continuing the pilot and comparing a one year taper
to six months taper.
• Develop outpatient Relapse Prevention program specifically
for these patients.
• Work with State to streamline the prescription authorization
system.
• Incorporate alternative treatment methods for anxiety related
withdrawal symptoms (i.e. mindfulness)
Happy, Joyous
and
Suboxone Free!!