Overcoming policy and financing barriers to integrated buprenorphine and HIV primary care

Clin Infect Dis. 2006 Dec 15:43 Suppl 4:S247-53. doi: 10.1086/508190.

Abstract

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Antiretroviral Therapy, Highly Active / economics
  • Buprenorphine / economics
  • Buprenorphine / therapeutic use*
  • Delivery of Health Care, Integrated / economics*
  • Delivery of Health Care, Integrated / methods
  • Female
  • Financing, Government
  • HIV Infections / diagnosis
  • HIV Infections / drug therapy*
  • HIV Infections / economics
  • Health Care Costs
  • Health Policy
  • Health Resources*
  • Humans
  • Insurance, Health, Reimbursement / economics
  • Male
  • Narcotic Antagonists / economics
  • Narcotic Antagonists / therapeutic use*
  • Opioid-Related Disorders / diagnosis
  • Opioid-Related Disorders / drug therapy*
  • Opioid-Related Disorders / economics
  • Primary Health Care / economics
  • Quality of Health Care
  • United States

Substances

  • Narcotic Antagonists
  • Buprenorphine