Treatment of Opioid Use Disorder in Primary Care: Integrating Behavioral Health and MAT.

“Traveller, there is no way. The way is made by walking.”
Antonio Machado

The treatment model at Seaport Community Health Center combines group behavioral therapy and medication assisted treatment (MAT) with a commitment to taper to zero over 2 years. These documents describe a philosophy and practice that has evolved over 12 years of treating opioid use disorder with buprenorphine in a primary care setting. We provide standardized forms, workflow guidelines, and general insight into the recovery process, but emphasize that the journey to sobriety follows an individual and varied course.

For any specific questions or concerns, please call or email us directly:

Mary Beth Leone LCSW 207-338-6900, mleone@pchc.com
David Loxterkamp MD 207-338-6900, dloxterkamp@pchc.com
Tim Hughes MD 207-338-6900, timhughes@pchc.com

We believe that:

  • People with substance use disorder have a primary care problem that responds to treatment within their community.
  • Relationships are the fulcrum for change.
  • Group therapy is a laboratory for exploring honesty, self-knowledge, and caring about the wellbeing of others.
  • Program success is measured in terms of progress toward life goals that ultimately can lead to and sustain abstinence from all addictive drugs.
  • Social stability comes before medication taper. Stability involves meaningful employment, safe housing, sober friends, honest relationships, and the practice of self-care.

In addition we believe that there is a serious lack of long term outcome data for what works in addiction treatment, or even how to define “what works.” The difficulties in doing long term outcome studies in this population are legion. Here in Maine, (a) substance use is rampant, and (b) intact communities and families are the norm; therefore there is a great opportunity to do this work, here, now. We are attempting to establish a common ongoing patient information database among those treating opioid use disorder, with the plan of collaborating on future outcome studies to learn more.

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This website provides an ordered plan of a primary care opioid use disorder (OUD) treatment program in a small rural clinic setting. It is based on our experience, starting around 2008 with one group of a dozen patients in a group setting, guided by one therapist and one provider. We have slowly grown to five providers and four therapists running seven groups with about eighty patients in 2016, and have learned much along the way.

Each group meets for an hour and a half weekly, and each group is attended by a therapist and a provider. Individual buprenorphine refill visits are done outside of group time, and all patients are also offered individual psychotherapy visits. We see most of our patients steadily progressing in their own life goals, the least measurable but perhaps most important part of recovery.

“Steps” provides a step-by-step walk through our program, from the point of view of an entering patient. “Issues” lists discussions of certain problems we have encountered along the way. Other questions inevitably arise which we try to cover in the “FAQ” section.

Any feedback on this information is welcome.