TREATMENT OF IATROGENIC OPIOID DEPENDANCE USING BUPERNORPHINE IN PATIENTS WITH CHRONIC PAIN A TELE-BEHAVIORAL MEDICINE PROTOCOL   
Herbert A. Schwager, Ph.D.  Willow, Alaska, USA
100 Iatrogenic opioid dependent patients with persistent pain were selected for this study.  All patients were set up with a HIPAA compliant video conference link in their homes.  Provider 1 (the psychologist) completes a thorough history and makes a clinical determination of the patient’s appropriateness for the Tele behavioral protocol. If appropriate, Provider 2 (psychiatrist/primary care physician) interviews the patient and makes arrangements for the induction process, administration of the COWS questionnaire and sets a date for the actual induction process.  At this point the patient, provider 1 and provider 2 are all on the same real-time video conference together.  Withdrawal date is set, patient presents in moderate withdrawal, the COWS is administered, and provider 2 writes the initial induction prescription.  Provider 1 meets with the patient over the next 3 days to monitor effect and tolerance. Day 3 or 4 provider 2 then writes the one-month prescription for buprenorphine.  Provider 1 meets in cognitive therapy sessions with patient weekly, and provider 2 meets the patient monthly to monitor and or adjust the Buprenorphine prescription.

After 1 year 98 patients are still in treatment.  2 dropped out.  All patients in the study are and have been free of full Agonist opioids. 20 of the patients have gradually titrated completely off the Buprenorphine and secured pain relief from other non-opioid medications or interventions such as Spinal Cord Stimulation.  78 or the patients remain on Buprenorphine doses ranging from 16-32mg per day, taken in q 6-8-hour increments and report effective functional analgesia greater than that ever achieved from opioids alone.

1.	Use of Tele behavioral Medicine to effectively treat patients with persistent pain.
2. Cost effectiveness and accessibility of Tele behavioral Medicine in the treatment of Iatrogenic opioid dependence
3.  2 provider model, psychologist, psychiatrist in the delivery of medication assisted treatment of opioid dependence
4. Effectiveness of a tele behavioral medicine model for both disuse of full agonist opioids and the effectiveness of partial agonist opioids (buprenorphine) in treating patients with persistent pain.

Objectives:
1. Medication assisted use of Tele behavioral Medicine effectively treats patients with persistent pain.
2. Cost effectiveness and accessibility of Tele behavioral Medicine in the treatment of Iatrogenic opioid dependence
3. Effectiveness of a tele behavioral medicine model for both disuse of full agonist opioids and the effectiveness of partial agonist opioids (buprenorphine) in treating patients with persistent pain.
Background:
100 Iatrogenic opioid dependent patients with persistent pain were selected for this study.   Provider 1 (the psychologist) completes a thorough history and makes a clinical determination of the patient’s appropriateness for the Tele behavioral protocol. If appropriate, Provider 2 (psychiatrist/primary care physician) interviews the patient and makes arrangements for the induction process, administration of the COWS questionnaire and sets a date for the actual induction process. 
Materials and Methods:
All patients were set up with a HIPAA compliant video conference link in their homes.  Provider 1 (the psychologist) completes a thorough history and makes a clinical determination of the patient’s appropriateness for the Tele behavioral protocol.
Results and Conclusions:
After 1 year 98 patients are still in treatment.  2 dropped out.  All patients in the study are and have been free of full Agonist opioids.  78 of the patients remain on Buprenorphine doses ranging from 16-32mg per day, taken in q 6-8-hour increments and report effective functional analgesia greater than that ever achieved from opioids alone. 

The 2-provider model utilizing real-time video conferencing (Tele-Behavioral Medicine) is an effective, accessible and cost effective method of treating patients with persistent pain, as well as discontinuance of full agonist opioids.

09 - TREATMENT OF IATROGENIC OPIOID DEPENDANCE USING BUPERNORPHINE IN PATIENTS WITH CHRONIC PAIN A TELE-BEHAVIORAL MEDICINE PROTOCOL