Primary Care and Medication Assisted Treatment: A Powerful Combination

Published on March 15, 2016 by
kristen silvia

Kristen SIlvia, MD

More than 150 primary care providers gathered at Maine Quality Counts forums in five locations across the state last Thursday night to learn about Medication Assisted Treatment (MAT), a form of addiction therapy that combines counseling with medication, typically buprenorphine, to help reduce the craving for opioids. Just days earlier, Maine Attorney General Janet Mills announced that a record 267 Mainers had died from opioid or heroin overdoses in 2015, lending a heightened sense of urgency to the evening’s discussions.

At the Portland forum, presenters Eric Haram, LADC and Kristen Silvia, MD encouraged primary care providers to address Maine’s opioid crisis head-on by carefully and thoughtfully considering the launch of their own MAT programs in partnership with addiction treatment specialists in their communities. Currently, only 10 to 15 primary care practices in the state offer MAT.

Eric Haram, who heads up the outpatient behavioral health services of Mid Coast Health’s Addiction Resource Center, offered a few tips for those considering MAT:

  • A successful MAT program is all about teamwork, forging partnerships and coordinating care. Work with addiction specialists with whom you can develop agreements around support and referral.
  • Currently, buprenorphine prescribing is limited to physicians with a waiver to prescribe issued by SAMHSA. An eight-hour CME course is required to earn the waiver and waiver recipients are limited in the number of patients they prescribe for in the first and subsequent years. However, if passed, new federal legislation may allow non-physician providers to prescribe and may increase patient limits.

Kristen Silvia, a primary care provider at Scarborough Family Practice, added insights from her experience offering MAT:

  • To be effective, practices should have at least two providers prescribing buprenorphine in a coordinated manner.
  • A multi-disciplinary team approach is ideal, with team members including an addiction psychiatrist, licensed clinical social worker and a case manager. After a few years offering MAT, Scarborough Family Medicine is currently developing this “Integrated Medication Assisted Treatment” approach that also includes group therapy.
  • New MAT programs should start by “treating patients with the most likelihood for success” and limit themselves to around 30 patients per prescriber.

Both Eric Haram and Kristen Silvia acknowledged that considering a MAT program can be uncomfortable for primary care providers. It can, however, be a profoundly satisfying experience.

“In ten years of primary care practice treating many chronic diseases, there’s nothing I’ve done that’s had a more significant impact on a patient’s life,” said Dr. Silvia. “I’m able to offer them a medication that helps them get off the street, rebuild their families and have a stable life. That’s incredibly rewarding.”


To learn more about MAT, opioid addiction and chronic pain treatment, please access these resources on the Maine Quality Counts website:

Primary Care-Based Buprenorphine Treatment: How and Why, a QC Lunch & Learn Webinar with Marwan Haddad, MD, MPH. Slides, audio and video are available.

6 Things Clinicians Can Do to Help Solve Maine’s Opioid Crisis, a QC lunch & Learn Webinar with Lisa Letourneau, MD, MPH

The Controlled Medications and Chronic Management Playbook provides a step-by-step guide, recommendations and templates for working with patients with chronic pain or those patients who are prescribed controlled medications.


  1. Linnea Amara says:

    People who have never abused drugs or alcohol may have fears of addiction, but the addict and alcoholic have fears of treatment, and in general of living a sober life, that are so strong as to defy understanding.

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