Buprenorphine Treatment of Opioid Use Disorder Improves Primary Care-Based Addiction Treatment Engagement Among People With and At Risk for HIV

Some agencies recognize the need for integrated chronic disease, behavioral health, and addiction management within a medical home model, which may be particularly useful for people with HIV. The FAST PATH program was developed to increase capacity to provide addiction treatment to patients with HIV, or at high risk of HIV infection, at an urban medical center. Researchers assessed whether certain predisposing characteristics (depression, housing status, and polysubstance use) and an enabling resource (provision of on-site buprenorphine treatment for those with opioid use disorder) were associated with engagement in an integrated primary care-based addiction treatment program and persistent DSM-IV substance dependence at 6 months.

• At enrollment, 61% of participants were HIV-infected, 71% had depression, 19% were homeless, and 53% had polysubstance use. At 6 months, 60% were receiving treatment with buprenorphine.
• 64% of patients were engaged in care (defined as 2 visits within the first 2 weeks and 2 additional visits within 30 days). Patients receiving buprenorphine for opioid use disorder (OUD) were 8 times more likely to be engaged in care.
• Baseline depression was associated with polysubstance use at 6 months (adjusted odds ratio, 3.32). Neither baseline housing status nor polysubstance use were associated with either outcome.

Comments:

This cohort study confirms prior reports that buprenorphine treatment for OUD delivered within an integrated primary care setting is associated with improved treatment engagement among a cohort of patients with SUD who are infected with or at high risk for HIV infection. However, these data suggest that integrated care models should also address patients’ mental health needs.

Jeanette M. Tetrault, MD

Reference:

Walley AY, Palmisano J, Sorensen-Alawad A, et al. Engagement and substance dependence in a primary care-based addiction treatment program for people infected with HIV and people at high-risk for HIV infection. J Subst Abuse Treat. 2015 [Epub ahead of print]. doi: 10.1016/j.jsat.2015.07.007.