Overcoming Policy and Financing Barriers to Integrated Buprenorphine and HIV Primary Care

• Published in: Clinical infectious diseases Vol. 43; no. Supplement-4; pp. S247 - S253
• Main Authors: Schackman, Bruce R., Merrill, Joseph O., McCarty, Dennis, Levi, Jeffrey, Lubinski, Christine
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Chicago, IL The University of Chicago Press 15.12.2006; University of Chicago Press; Oxford University Press
• Subjects: Addiction; Addictive behaviors; Adult and adolescent clinical studies; Antiretroviral Therapy, Highly Active - economics; Biological and medical sciences; Buprenorphine - economics; Buprenorphine - therapeutic use; Delivery of Health Care, Integrated - economics; Delivery of Health Care, Integrated - methods; Drug addiction; Drug addictions; Female; Financing; Financing, Government; Funding; Health Care Costs; Health care policy; Health outcomes; Health Policy; Health Resources; HIV; HIV Infections - diagnosis; HIV Infections - drug therapy; HIV Infections - economics; Human immunodeficiency virus; Human viral diseases; Humans; Infectious diseases; Insurance, Health, Reimbursement - economics; Investments; Male; Medicaid; Medical sciences; Methadone; Narcotic Antagonists - economics; Narcotic Antagonists - therapeutic use; Opioid analgesics; Opioid-Related Disorders - diagnosis; Opioid-Related Disorders - drug therapy; Opioid-Related Disorders - economics; Physicians; Primary care; Primary health care; Primary Health Care - economics; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Quality of Health Care; Substance abuse; Substance abuse treatment; Toxicology; United States; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; United States; Infection; Human; Policy; Immunopathology; Drug addiction; Buprenorphine; Viral disease; Financing; Opiates; AIDS; Narcotic analgesic; Immune deficiency
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/508192

Treatment for substance abuse and human immunodeficiency virus (HIV) infection historically have come from different providers, often in separate locations, and have been reimbursed through separate funding streams. We describe policy and financing challenges faced by health care providers seeking to integrate buprenorphine, a new treatment for opioid dependence, into HIV primary care. Regulatory challenges include licensing and training restrictions imposed by the Drug Addiction Treatment Act of 2000 and confidentiality regulations for alcohol and drug treatment records. Potential responses include the development of local training programs and electronic medical records. Addressing the complexity of funding sources for integrated care will require administrative support, up-front investments, and federal and state leadership. A policy and financing research agenda should address evidence gaps in the rationales for regulatory restrictions and should include cost-effectiveness studies that quantify the “value for money” of investments in integrated care to improve health outcomes for HIV-infected patients with opioid dependence.