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Recovery Centers of King County
Buprenorphine Treatment Program
AAP Providers Conference, April 19, 2013, Lynnwood, WA
Patricia C. Knox, Ph.D.
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Where do I sign up?
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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
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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.
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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.
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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.
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Program Flow Overview
28-Day Intensive Inpatient Treatment
5-12 Months of Outpatient Treatment
Build behavioral skills and taper suboxone
Patient screened over the phone and has Medicaid funding
Patient enters RCKC detox (4-5 days)
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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.
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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.
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Program Flow: Detoxification (cont)• Suboxone DBHR authorization completed and
faxed
• http://www.dshs.wa.gov/pdf/ms/forms/13_720.pdf
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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.
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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
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Compliance ProtocolNoncompliance •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
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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.
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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
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Program Observations for Success
Readiness• To actively engage in 12-step program
• To taper off the Suboxone
• To actively participate in the Buprenorphine Group
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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)
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Happy, Joyousand
Suboxone Free!!