30

Appendix 1A. Beehive Program Recruitment Materials

San Francisco Department of Public Health Integrated Buprenorphine Intervention Services Brochure

Beehive Patient Brochure

Beehive Patient Flyer

Beehive Program Exam Room Laminate Card

31

SUM

MA

RY

And

so,

we

wou

ld li

ke to

wel

com

e yo

u to

IB

IS.

We

are

hope

ful t

hat p

artic

ipat

ion

in

IBIS

will

be a

n op

portu

nity

for y

ou to

wor

k on

yo

ur a

ddic

tion

and

help

you

to im

prov

e ot

her

area

s of

you

r life

as

wel

l. T

his

pam

phle

t was

cr

eate

d to

intro

duce

the

IBIS

pro

gram

. It

is

mea

nt to

giv

e an

ove

rvie

w a

nd b

asic

und

er-

stan

ding

of b

upre

norp

hine

and

the

prog

ram

’s

com

pone

nts.

For

mor

e in

form

atio

n, p

leas

e fe

el fr

ee to

con

tact

the

OB

IC c

linic

at t

he fo

l-lo

win

g nu

mbe

r:

OB

IC (4

15)

502-

7223

Inte

gra

ted

Bu

pre

no

rph

ine

Inte

rve

nti

on

Se

rvic

es

TR

EA

TM

EN

T A

T O

BIC

Fo

llow

ing

the

eval

uatio

n, p

atie

nts

appr

opria

te

for I

BIS

will

be

sche

dule

d fo

r an

initi

al in

duct

ion

appo

intm

ent.

Pat

ient

s m

ust b

e in

opi

ate

with

-dr

awal

to b

egin

rece

ivin

g bu

pren

orph

ine.

All

patie

nts

are

inst

ruct

ed to

NO

T us

e he

roin

or

othe

r opi

ates

for a

t lea

st 1

2 ho

urs

prio

r to

thei

r O

BIC

indu

ctio

n ap

poin

tmen

t. P

atie

nts

who

ha

ve re

cent

ly in

gest

ed a

ny o

piat

e an

d/or

do

not

appe

ar to

be

in w

ithdr

awal

will

be

aske

d to

re-

turn

at a

late

r dat

e.

Gen

eral

ly, O

BIC

pat

ient

s ar

e se

en d

aily

for t

he

first

wee

k, w

ith d

ecre

ased

freq

uenc

y th

erea

fter.

The

dose

of b

upre

norp

hine

is in

crea

sed

over

th

e fir

st w

eek

or tw

o un

til a

ther

apeu

tic d

ose

is

achi

eved

. E

arly

in tr

eatm

ent,

mos

t dos

es o

f bu

pren

orph

ine

will

be

take

n at

OB

IC.

Ove

r tim

e, p

atie

nts

will

mov

e to

a w

eekl

y, e

very

oth

er

wee

k, o

r mon

thly

dis

pens

ing

sche

dule

at O

BIC

. IB

IS p

atie

nts

typi

cally

sta

y at

OBI

C fo

r 30

to 6

0 da

ys, b

ut th

is c

an v

ary

quite

a b

it.

Whe

n th

e pa

tient

is c

linic

ally

sta

ble

and

has

an a

ppoi

ntm

ent s

ched

uled

at a

n IB

IS c

omm

u-ni

ty s

ite, t

he O

BIC

phy

sici

an w

ill tr

ansf

er m

edi-

catio

n do

sing

to a

com

mun

ity p

harm

acy.

In a

dditi

on to

bup

reno

rphi

ne, p

atie

nts

at O

BIC

re

ceiv

e su

ppor

tive

coun

selin

g du

ring

the

indu

c-tio

n an

d st

abiliz

atio

n pr

oces

s.

Bot

h in

divi

dual

an

d gr

oup

coun

selin

g ar

e av

aila

ble.

Urin

e to

xi-

colo

gy s

cree

ning

is d

one

on

a re

gula

r bas

is to

get

a b

ette

r id

ea o

f how

eac

h pa

tient

is

doin

g in

trea

tmen

t. O

BIC

is

loca

ted

at:

3180

18t

h S

treet

#2

05, S

an F

ranc

isco

, CA

94

110

CA

RE

IN

TH

E C

OM

MU

NIT

Y

Upo

n gr

adua

tion

from

OB

IC, I

BIS

patie

nts

will

be

rece

ivin

g th

eir m

edic

atio

n, c

ouns

elin

g, a

nd o

ther

se

rvic

es th

roug

h th

eir c

omm

unity

-bas

ed c

linic

or

prog

ram

. P

atie

nts

will

nee

d to

com

e to

thei

r clin

ic

at le

ast o

ne ti

me

per m

onth

for p

hy-

sici

an v

isits

, cou

nsel

ing,

or o

ther

ap

poin

tmen

ts.

At le

ast 8

urin

e sa

m-

ples

will

be

colle

cted

ove

r the

yea

r fo

r tox

icol

ogy

scre

ens.

P

atie

nts

are

expe

cted

to c

ompl

y w

ith p

rogr

am

requ

irem

ents

and

with

the

rule

s of

th

e co

mm

unity

clin

ic.

Th

e S

an F

rancis

co

De

pa

rtm

en

t o

f P

ub

lic

He

alt

h

APPENDIX 1A. BEEHIVE PROGRAM RECRUITMENT MATERIALS

San Francisco Department of Public Health Integrated Buprenorphine Intervention

Services Brochure page 1

32

WH

AT

IS

IB

IS?

IBIS

is a

trea

tmen

t pro

gram

des

igne

d to

hel

p in

divi

dual

s w

ho a

re d

epen

dent

on

hero

in a

nd/o

r ot

her o

piat

es.

Whi

le th

e m

edic

atio

n bu

pren

or-

phin

e is

the

corn

erst

one

of th

e pr

ogra

m, t

reat

-m

ent t

hrou

gh IB

IS in

clud

es c

ouns

elin

g, s

uppo

rt gr

oups

, and

oth

er s

ervi

ces

prov

ided

by

heal

th

care

pro

fess

iona

ls tr

aine

d in

bup

reno

rphi

ne

treat

men

t.

Bec

ause

sta

rting

on

bupr

enor

phin

e m

ay re

quire

fre

quen

t vis

its a

nd c

lose

mon

itorin

g, a

ll IB

IS

patie

nts

will

be

stab

ilized

at t

he O

ffice

-bas

ed

Bup

renr

ophi

ne In

duct

ion

Clin

ic (O

BIC

) prio

r to

trans

ition

to c

omm

unity

trea

tmen

t site

s.

Ple

ase

be a

war

e th

at IB

IS is

a “m

aint

enan

ce”

prog

ram

. It

is n

ot in

tend

ed fo

r pat

ient

s in

ter-

este

d in

det

oxifi

catio

n.

AB

OU

T B

UP

RE

NO

RP

HIN

E

Bup

reno

rphi

ne h

as b

een

show

n to

be

very

ef-

fect

ive

in th

e tre

atm

ent o

f opi

ate

(e.g

., he

roin

) ad

dict

ion.

Lik

e m

etha

done

, bup

reno

rphi

ne

bloc

ks h

eroi

n/op

ioid

with

draw

al a

nd c

ravi

ng

with

out p

rodu

cing

a “h

igh”

. And

, lik

e m

etha

-do

ne, b

upre

norp

hine

pro

duce

s so

me

degr

ee o

f de

pend

ence

. U

nlik

e m

etha

done

, bup

reno

r-ph

ine

can

be p

resc

ribed

by

phys

icia

ns in

offi

ce-

base

d se

tting

s. C

omm

on s

ide

effe

cts

of b

upre

-no

rphi

ne a

re u

sual

ly m

ild a

nd c

an in

clud

e na

u-se

a, v

omiti

ng, a

nd c

onst

ipat

ion.

Ind

ivid

uals

w

ho re

gula

rly u

se h

eroi

n or

oth

er o

piat

es m

ay

expe

rienc

e so

me

with

draw

al if

they

take

bup

re-

norp

hine

soo

n af

ter u

sing

.

Bup

reno

rphi

ne, l

ike

met

hado

ne, c

an b

e a

dan-

gero

us d

rug

if m

isus

ed o

r com

bine

d w

ith o

ther

su

bsta

nces

. It

is e

spec

ially

dan

gero

us to

com

-bi

ne b

upre

norp

hine

with

alc

ohol

or b

enzo

di-

azep

ines

, suc

h as

Klo

nopi

n an

d V

aliu

m.

Al-

WH

O C

AN

RE

CE

IVE

CA

RE

T

HR

OU

GH

IB

IS?

• A

dults

(age

18

and

olde

r) w

ith a

dia

gno-

sis

of o

piat

e de

pend

ence

•

San

Fra

ncis

co re

side

nts

elig

ible

for

treat

men

t in

the

Com

mun

ity H

ealth

Net

-w

ork

way

s in

form

any

med

ical

sta

ff yo

u en

coun

ter t

hat

you

are

on b

upre

norp

hine

, sin

ce it

can

blo

ck th

e ef

fect

iven

ess

of o

ther

opi

ates

suc

h as

nar

cotic

pa

in m

edic

atio

ns. B

upre

norp

hine

can

be

very

da

nger

ous

or e

ven

fata

l if t

aken

by

a ch

ild, o

r by

any

adul

t for

who

m it

is n

ot p

resc

ribed

.

Bup

reno

rphi

ne c

omes

in ta

blet

form

and

is ta

ken

by le

tting

it d

isso

lve

unde

r the

tong

ue.

Pat

ient

s w

ill ta

ke s

ome

of th

e do

ses

in th

e pr

esen

ce o

f a

doct

or, n

urse

, or p

harm

acis

t, es

pe-

cial

ly e

arly

in tr

eatm

ent.

How

ever

, th

e go

al is

to h

ave

patie

nts

even

tu-

ally

take

mos

t dos

es a

t hom

e, a

s th

ey w

ould

any

oth

er m

edic

atio

n.

WH

O I

S N

OT

EL

IGIB

LE

F

OR

CA

RE

TH

RO

UG

H I

BIS

?

• In

divi

dual

s w

ho a

re a

busi

ng o

r de-

pend

ent o

n b

enzo

diaz

epin

es

• In

divi

dual

s w

ho a

re d

epen

dent

on

alco

hol

• In

divi

dual

s w

ith u

ncon

trolle

d m

edic

al

or p

sych

iatri

c co

nditi

ons

• W

omen

who

are

pre

gnan

t or p

lann

ing/

tryin

g to

bec

ome

preg

nant

•

In a

dditi

on, p

atie

nts

with

pai

n sy

n-dr

omes

requ

iring

regu

lar n

arco

tic a

n-al

gesi

cs s

houl

d be

car

eful

ly s

cree

ned,

as

bup

reno

rphi

ne m

ay m

ake

pain

tre

atm

ent l

ess

effe

ctiv

e.

FIR

ST

ST

EP

S

Pat

ient

s m

ay b

e id

entif

ied

by IB

IS-a

ffilia

ted

pri-

mar

y ca

re a

nd m

enta

l hea

lth p

rovi

ders

and

re-

ferr

ed to

OB

IC fo

r eva

luat

ion.

Pat

ient

s m

ay a

lso

self-

refe

r or b

e re

ferr

ed b

y no

n-IB

IS p

rovi

ders

di-

rect

ly to

OBI

C o

r to

the

Cen

traliz

ed O

piat

e Pr

o-gr

am E

valu

atio

n (C

OPE

). T

he O

BIC

sta

ff w

ill de

-te

rmin

e w

heth

er a

pat

ient

is a

ppro

pria

te fo

r car

e th

roug

h IB

IS.

Dur

ing

the

eval

uatio

n vi

sit a

t OB

IC, t

he p

rogr

am w

ill b

e di

scus

sed,

the

patie

nt w

ill re

view

an

d si

gn c

onse

nt fo

rms,

com

plet

e a

phys

ical

exa

m a

nd m

edic

al h

isto

ry,

and

if ne

cess

ary,

hav

e la

bora

tory

te

sts

orde

red.

APPENDIX 1A. BEEHIVE PROGRAM RECRUITMENT MATERIALS

San Francisco Department of Public Health Integrated Buprenorphine Intervention

Services Brochure page 2

33

Wh

at is

Bu

pre

no

rph

ine?

Bup

reno

rphi

ne is

a p

resc

ript

ion

med

icin

e us

ed t

o tr

eat

adul

ts a

ddic

ted

to d

rugs

suc

h as

her

oin,

Vic

odin

, Pe

rcoc

et,

Oxy

cont

in,

mor

phin

e an

d ot

her

narc

otic

pai

nkill

ers.

Ho

w D

oes

Bu

pre

no

rph

ine

Wo

rk?

Whe

n ta

ken

by a

per

son

addi

cted

to

hero

in o

r ot

her

opia

tes,

bup

reno

rphi

ne

redu

ces

crav

ings

and

hel

ps t

he p

erso

n re

mai

n dr

ug-f

ree,

mak

ing

prod

uctiv

e liv

ing

poss

ible

. B

upre

norp

hine

can

be

used

to

with

draw

fro

m h

eroi

n or

pa

inki

llers

. It

can

als

o be

use

d to

hel

p ke

ep a

per

son

from

rel

apsi

ng b

ack

into

a h

eroi

n or

pai

nkill

er a

ddic

tion

.

Bup

reno

rphi

ne is

ava

ilabl

e in

tw

o fo

rms:

Sub

utex

, w

hich

con

tain

s on

ly

bupr

enor

phin

e, a

nd S

ubox

one,

whi

ch

is b

upre

norp

hine

com

bine

d w

ith a

m

edic

ine

calle

d na

loxo

ne.

Bot

h fo

rms

of b

upre

norp

hine

are

tab

lets

tha

t ar

e di

ssol

ved

unde

r th

e to

ngue

.

The

Ben

efit

s of

Bu

pre

nor

ph

ine

Trea

tmen

tBup

reno

rphi

ne h

as a

low

ris

k of

be

ing

abus

ed a

nd is

unl

ikel

y to

ca

use

an o

verd

ose.

Bup

reno

rphi

ne c

an p

reve

nt p

ain,

ch

ills,

nau

sea,

and

oth

er f

eelin

gs

that

com

e w

ith a

ddic

tion

with

draw

al.

Bup

reno

rphi

ne c

an b

lock

the

ef

fect

s of

add

ictiv

e dr

ugs.

For

ex

ampl

e, h

eroi

n ta

ken

by a

per

son

unde

r bu

pren

orph

ine

trea

tmen

t w

ill

not

caus

e a

‘hig

h.’

The

addi

tion

of n

alo x

one

in t

he

Sub

oxon

efo

rm o

f bu

pren

orph

ine

prev

ents

the

med

icin

e fr

om b

eing

ab

used

, be

caus

e it

will

cau

se

with

draw

al if

inje

cted

.

How

Can

You

Get

B

up

ren

orp

hin

e Tr

eatm

ent?

Bup

reno

rphi

ne t

reat

men

t ca

n be

pr

escr

ibed

by

phys

icia

ns w

ho h

ave

been

spe

cial

ly t

rain

ed a

nd h

ave

rece

ived

cer

tific

atio

n fr

om F

eder

al a

nd

Sta

te a

genc

ies.

Ask

you

r do

ctor

if h

e or

she

can

pre

scribe

bup

reno

rphi

ne o

r re

fer

you

to s

omeo

ne w

ho c

an.

The

Bee

hive

Pro

gram

fo

r H

IV-P

ositi

ve P

atie

nts

at

the

Posi

tive

Hea

lth P

rogr

am

If y

ou a

re H

IV-p

ositi

ve a

nd h

ave

a dr

ug a

ddic

tion,

you

may

qua

lify

to

part

icip

ate

in a

res

earc

h st

udy

eval

uatin

g bu

pren

orph

ine

trea

tmen

t at

th

e U

CSF

Posi

tive

Hea

lth P

rogr

am.

Can

dida

tes

for

this

stu

dy m

ust

be a

t le

ast

18 y

ears

old

and

not

pre

gnan

t.

If y

ou o

r so

meo

ne

you

kn

ow

wou

ld li

ke t

o ta

ke a

dva

nta

ge

of

this

sp

ecia

l pro

gra

m,

ask

you

r p

rovi

der

or

call

the

Bee

hiv

e cl

inic

al n

urs

e co

ord

inat

or a

t:

(415

) 20

6-24

52fo

r m

ore

info

rmat

ion

.

APPENDIX 1A. BEEHIVE PROGRAM RECRUITMENT MATERIALS

Beehive Patient Brochure page 1

34

UC

SF

Pos

itiv

e H

ealt

h P

rog

ram

Th

e Po

sitiv

e H

ealth

Pra

ctic

e at

San

Fr

anci

sco

Gen

eral

Hos

pita

l Med

ical

Cen

ter

is o

ne o

f th

e ol

dest

and

larg

est

HIV

/AID

S c

linic

s in

the

Uni

ted

Sta

tes.

Pa

rt o

f th

e U

CSF

Posi

tive

Hea

lth

Prog

ram

, th

e Po

sitiv

e H

ealth

Pra

ctic

e is

a

colla

bora

tive

effo

rt o

f th

e San

Fr

anci

sco

Dep

artm

ent

of P

ublic

Hea

lth's

Com

mun

ity H

ealth

Net

wor

k an

d th

e U

nive

rsity

of Cal

iforn

ia,

San

Fra

ncis

co

Dep

artm

ent

of M

edic

ine

at S

FGH

MC.

The

PHP

trea

tmen

t m

odel

incl

udes

an

emph

asis

on

outp

atie

nt p

rim

ary

and

spec

ialty

HIV

car

e, r

apid

ava

ilabi

lity

of

rout

ine

and

urge

nt c

are

to t

he p

atie

nt,

psyc

hoso

cial

sup

port

fro

m a

spe

ctru

m

of s

ocia

l ser

vice

s, in

tegr

atio

n of

pat

ient

ca

re w

ith c

linic

al r

esea

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APPENDIX 1A. BEEHIVE PROGRAM RECRUITMENT MATERIALS

Beehive Patient Brochure page 2

35

APPENDIX 1A. BEEHIVE PROGRAM RECRUITMENT MATERIALS

Beehive Patient Flyer

36

Buprenorphine HIVIntegrated Care

Patient Eligibility

Schedule for “86BUP” or call 206-2452

Patient Referral Process

BeeHIVe• Living with HIV/AIDS• Seeking office-based treatment for opioid

dependence, e.g., heroin, morphine, hydrocodone, oxycodone, methadone or other prescription opioids

• Receiving or willing to receive primary care at the UCSF Positive Health Program at SFGH

Clinical contraindications:• Non-prescribed or chaotic benzodiazepine use• Heavy alcohol use or dependence• AST/ALT > 5x ULN• If female, pregnant or planning pregnancy

Patients on methadone maintenance or prescription opioids for chronic pain syndromes may still be eligible for program services and will be carefully screened.

• Consultation appointment with Beehive Nurse; schedule at Front Desk or call 206-2452

• Findings discussed with HIV primary care provider• If clinically appropriate, first buprenorphine

treatment visit is scheduled within one week• Optional enrollment in UCSF-sponsored evaluation

study: Patient will be randomized to office-based buprenorphine treatment at Ward 86 or the Outpatient Buprenorphine Induction Clinic (18th/Folsom)

APPENDIX 1A. BEEHIVE PROGRAM RECRUITMENT MATERIALS

Beehive Program Exam Room Laminate Card page 1

37

Buprenorphine HIV Integrated Care

BeeHIVe Clinic ProceduresInitial Consultation

Schedule for “86BUP” or call 206-2452

Treatment Stages

Integrated Care

• Buprenorphine education and counseling• Medical & substance use history, exam, and labs• Program requirements and preparation, including

pre-induction management of opiate withdrawal symptoms

• Induction: Patient receives first buprenorphine dose in an opioid-free state (12 hrs since last heroin, 48 hrs since last methadone). Pt observed for relief of opioid craving and/or withdrawal. Additional doses may be given that day and to take at home.

• Stabilization: Titration to stable dose achieved via frequent but brief follow-up visits over 1-2 weeks. A stable dose achieves no symptoms of opioid craving, withdrawal, or excess.

• Maintenance: Stable patients are seen monthly; LFTs and urine toxicology monitored regularly. All patients receive substance use counseling and support.

• Frequent communication between Beehive staff and HIV primary care provider

• All Beehive visits and labs charted on HERO• Expert consultation for acute / chronic pain issues• Hands-on buprenorphine training available to all

Positive Health Program providers

APPENDIX 1A. BEEHIVE PROGRAM RECRUITMENT MATERIALS

Beehive Program Exam Room Laminate Card page 2