Buprenorphine

The costs and logistics of buprenorphine implementation can vary based on the specific strategy and context, but generally focus on conducting clinician education, building information technology infrastructure, and establishing procedures for linking individuals to regular care for continued buprenorphine prescribing.

Naloxone — Evidence Rating: High Quality

Evidence supporting opioid overdose education and naloxone distribution (OEND) programs is summarized in at least eight systematic reviews. These draw mostly from observational study designs, including case series, cohort studies, and quality improvement studies. There are very few randomized controlled trials evaluating OEND programs, largely due to the overwhelming body of real-world evidence supporting naloxone distribution; this is common for interventions with substantial face-value credibility, such as parachutes or epinephrine pens. The few existing randomized controlled trials of OEND programs tend to compare one OEND implementation strategy to another OEND implementation strategy

Evidence-based Scale

Programs that seek to implement buprenorphine tend to focus on supporting healthcare providers with the necessary knowledge and workflows to safely prescribe buprenorphine to individuals for the first time. The costs and logistics of supporting implementation of a buprenorphine program depend on the specific implementation strategy selected but, in general, require resources focused on clinician education for appropriate prescribing; building information technology infrastructure for clinical decision support; identifying space and staff to support treatment initiation (which may require direct patient observation) and follow up care if it is provided on site; and facilitating external partnerships to ensure regular follow-up and continued buprenorphine prescribing if it is not provided on site. Payers may have requirements related to medication coverage that will affect cost, including prior authorization, restricting coverage to specific medications, requiring a specified frequency of provider visits, and/or requiring additional services such as urine toxicology testing and counseling. Patient considerations that can affect logistics and cost include the ability to store medication safely, availability of medication at local pharmacies, availability and cost of transportation, and health insurance access and co-payment requirements.