Open Society Institute’s work to create the Baltimore Buprenorphine Initiative (BBI), identifying and encouraging the use of the medication as a best practice to treat addiction, is a good example of several aspects of its work.
1. OSI takes risks.
Soon after OSI was founded in 1998, our Addiction and Health Equity program recognized the potential of buprenorphine to vastly increase access to medication-assisted drug treatment. Unlike methadone, which is geared toward heavy users and requires patients to come to a physical clinic every day, buprenorphine could be prescribed by a doctor and taken from home—offering better access to treatment for people with a history of substance use who often struggle with transportation, housing, employment, and other issues. Knowing that the Food and Drug Administration would soon approve buprenorphine to treat addiction, OSI spearheaded outreach to healthcare providers to familiarize them with the drug as an option for treatment of opioid dependence.
2. OSI sees things through.
OSI works at all points on the “arc of change,” from conceiving solutions to implementing them, and making successful ones permanent. Once the FDA approved buprenorphine, OSI helped community health centers—whose patients included many people with untreated addiction—prescribe the drug along with offering counseling services. Building on this, OSI worked with the Baltimore Substance Abuse System to develop the BBI, a model that provided primary care doctors with the support they needed to feel comfortable prescribing buprenorphine to patients struggling with opioid dependence. After helping patients enroll in health insurance, publicly-funded treatment centers transferred them to primary care doctors for ongoing buprenorphine treatment, continuing to offer counseling when needed. These physicians have reached thousands of patients and saved countless lives. In 2014 alone, 995 patients were admitted to locations where BBI operated, 48% of patients stayed in treatment for 90 days or more, and 275 were transferred to continuing care. Of those, 83% reached the important six-month milestone of treatment. We also helped lower the threshold to treatment by having medical teams trained to prescribe buprenorphine meet patients at non-traditional venues, like drop in centers and a mobile van outside the exit of the city’s detention center.
3. OSI creates solutions that can be replicated.
Open Society Foundations (OSF) opened OSI-Baltimore—OSF’s only US field office—in 1998 with the idea that work on difficult local problems could identify solutions that not only would improve the quality of life for Baltimoreans, but could also be replicated in other cities. That’s exactly what happened with BBI. By 2015, BBI had established 10 treatment locations throughout Maryland with nearly 400 treatment slots, and almost 800 doctors across Maryland were licensed to prescribe buprenorphine. Public health officials from Kentucky, Ohio, Tennessee, New Mexico, Washington, DC, and Ottawa, Canada have since visited Baltimore to learn about BBI and several cities have replicated elements of it.
“Our efforts are always focused on generating and promoting innovative ideas that improve health equity and lower the threshold to high-quality treatment, reduce stigma, and support community engagement,” says Addiction and Health Equity Director Scott Nolen. “BBI was successful across each of these goals, and it has been a blueprint for how our program drives promising policy ideas ever since.”