1. Medication Assisted Treatment of Opioid Use Disorder
Fulfilling our dual mission of patient care and medical education

2. The Problem – a deadly epidemic

3. The Solution – a proven, life-saving treatment
Medication-assisted treatment (MAT) combines medication and psychosocial support to treat opioid addiction.
MAT is effective
Increases employment rates
Decreases relapse rates
Reduce rates of relapse
Prevents overdose related deaths
50% reduction in all-cause mortality.

4. The Problem – inadequate training and supply of physicians

5. The Opportunity
We have an opportunity to respond to this crisis by providing needed care to our patients and preparing our graduates to meet the healthcare needs of their communities.

6. Suboxone - How it works Suboxone = Buprenorphine + naloxone
Buprenorphine is a partial mu-opioid agonist
Naloxone is an opioid antagonist
Buprenorphine binds with high affinity to opioid receptor and significantly reduces the affects of other opioids
Buprenorphine only partially activates the opioid receptor
This prevents withdrawal symptoms and diminishes cravings
Naloxone
Inactive in oral form; poorly absorbed in GI tract
Active if injected
Reduces risk of diversion and abuse of injected buprenorphine

7. Suboxone – Induction and Continuation
Induction Process
Patient must be in mild opioid withdrawal
Initial dose given and patient observed for two hours
If withdrawal symptoms persist and second dose is administered
This can be done both at clinic or at home
Once stable daily dose is identified patient may continue indefinitely as long as they are benefiting

8. Regulatory Climate Drug Addiction Treatment Act of 2002
Allows for qualifying physician to prescribe narcotic drugs for maintenance or detoxification treatment
Requires physicians to affirm their capacity to provide or refer patients for appropriate counseling.
Comprehensive Addiction and Recovery Act of 2016
Allows nurse practitioners and physicians assistants with additional training to provide buprenorphine
21st Century Cures Act
Colorado will receive $7.8 million for two years to combat opioid epidemic and support expanding access to MAT

9. Reimbursement – Office-based services
There are few specific codes for billing for Suboxone treatment and standard E&M codes can be used:
Assessment visit: 99205/99215
Induction visit: (with potential add-on codes 99354, 99355)
Maintenance visit: 99214
Psychotherapy associated with MAT and prescription of Suboxone can also be billed as standard codes
For example: (psychotherapy services 30 minutes with patient)

10. Reimbursement - Suboxone
Colorado Medicaid: covered as a preferred drug provided patient meets criteria
SUD counseling and/or behavior therapy not required
Uninsured/undocumented: ~$100 for 1-month supply on GoodRx
Medicare: typically not covered unless provided in inpatient setting. In some instances may be covered by Part D.
Private insurance: covered by most major insurance companies though typically as an off-formulary medication with higher co-pays.

11. GME – patient volume
We would decide and set limits on number of patients receiving MAT with Suboxone
Potential initial patient volumes of 10 – 20
Bruner Family Medicine
Initial focus on providing care to chronic pain patients with opioid dependence
Caritas / FIT Service
Initial focus on uninsured inpatients with IV drug addiction
4 – 6 patients per month may be potential candidates (primarily Medicaid or Medicaid-eligible)

12. Capacity at SJH GME High level of engagement from faculty champions
Multiple providers in both IM and FM clinics already trained and possess prescription waivers. Several other providers interested.
Existing internal behavioral health expertise
Significant resident interest
External support
IT Matters
Denver Health
Colorado Access

13. The provision of medical-assisted treatment that includes Suboxone fulfills our dual missions of patient care for the underserved and medical education.