Suboxone Program Evaluation in a Private Psychiatric Office-Based Practice

Opioid use disorder continues to be a major concern for public well being in the Unites States today with many different treatment options. A more accessible treatment option called, Buprenorphine Management Treatment (BMT) is a harm reduction technique which offers a significant benefit to those living with opioid use disorders (OUD) is is considered under the umbrella of treatments called medication assisted treatment (MAT). As with any clinical treatment program, an evaluation of outcomes is an important activity to not only to justify the treatment being offered, but also to identify gaps in services or clients who need additional support which increases the overall effectiveness of the treatment being offered.

Purpose. The purpose of this project is to evaluate a Buprenorphine Maintenance Treatment (BMT) program to examine the client outcome of the percentage of opioid negative urines and the relationship between client characteristics and the client outcome for the individual clinic in order to identify individuals who would benefit from additional supports to increase treatment successes. The specific aims of this evaluation are:

1. To assess the percentage of opioid negative urines retrospectively through open and closed chart review through collected clinic data by the buprenorphine clinic to determine the effectiveness of the clinic compared to benchmarks found in literature.
2. To explore the relationship between the clinic’s client outcome and client characteristics (e.g., age, sex, initial urine screens/drug preferences, employment status, co-occurring treatments [counseling], and housing status) for comparison to the literature of individuals who are successful in adhering to the buprenorphine treatment utilizing open and closed charting.
3. To make recommendations to guide future directions of the buprenorphine clinics

Design. This program evaluation project will use a retrospective cohort design with open and closed charts.

Setting. The buprenorphine clinic program to be evaluated is housed in a private psychiatric clinic in the Greater Pittsburgh Area. This BMT clinic itself regularly sees people who live with OUDs and other substance use disorder (SUDs).

Sample. Adults (≥ 18 years) who have received buprenorphine-naloxone for OUD who have successfully completed the 6-month induction period. Sample size for analysis will be 40 individuals with data from 20 open charts i.e. people still receiving treatment and 20 closed charts i.e. individuals who had been discharged.

Procedures. Following the Substance Abuse and Mental Health Services Administration (SAMHSA) guidelines for program evaluation (Substance Abuse and Mental Health Services Administration, 2015), a retrospective chart review of adults (≥ 18 years) who have received buprenorphine-naloxone (Suboxone) for OUD in the clinic will be conducted. The 40 individuals included have completed their initial 6-month treatment induction.

Data collection. Prior to data collection, current BUP patients were approached and informed of the current project, purpose, information reviewed and asked to agree to consent to allow their chart to be reviewed via consent form signature. Data for the chart review process was collected through the medical records for paper and electronic which is maintained by the clinic’s buprenorphine program and saved on a Microsoft Access Database file for data management.

Outcomes. Support by statistical experts was used after data collection to analyze and interpret the effectiveness of the program (Aim 1) as well as the relationship between client outcome and client characteristics (Aim 2). The primary client outcome is overall percentage of illicit opioid use or non-use in patients served by the clinic and completing the 6 months induction phase. Illicit opioid use or non-use was operationally defined as percentage of opioid positive or negative urine screens or tampered urine outcomes such as Elevated BUP levels (>20,000) with decreased Norbuprenorphine (metabolized). General frequency of urine sampling is taken depending on the length of participation in the program. Generally, this frequency was monthly. The secondary outcomes are characteristics of individuals who complete, continue, or drop-out of treatment, which were assessed by the following: age, sex, initial urine screens/drug preferences, employment status, co-occurring treatments (counseling), and housing status.

Evaluation Plan. Evaluation of the program was completed using descriptive statistics to summarize the primary outcome for comparison to past literature consistent with the SAMHSA program evaluation guide. The benchmark for comparison with the primary outcome based on the literature is an average ONU of 17.8-36.6% of ONU. The secondary client characteristic outcomes listed above will be summarized using descriptive statistics. The results of Aim 1 and Aim 2 and their interrelationships will support recommendations for the achievement of Aim 3. Individual client characteristics that are found to increase success or those that identify vulnerable individuals in the sample will be recommended for future quality improvement initiatives, such as increasing services or supports. Additionally, creation of a flagging system to identify what modifiable client characteristics increased or decreased sobriety to use during assessment as an prophylactic management strategy to support individuals before relapse occurs.