Alcoholism; Behavioral Medicine; Buprenorphine; Methadone; Opioid-Related Disorders; Substance-Related Disorders; Chronic Pain
My research is aimed at improving the efficacy, accessibility and availability of addictions treatment (primarily focusing on heroin or other opioid dependence, stimulant abuse, and chronic pain) in the United States and internationally. We generally develop and investigate new treatments through clinical trials.
Specialized Terms: Addictions; Behavioral Treatments; Buprenorphine; Methadone; Opioid Dependence; Alcohol Dependence; Stimulant Abuse; Chronic Pain
Extensive Research Description
My research is aimed at: 1. improving the efficacy of opioid agonist maintenance treatment through investigations of alternatives to methadone for maintenance treatment (e.g., buprenorphine), investigations of adjunctive behavioral (e.g., behavioral drug and HIV risk reduction counseling, BDRC) and pharmacological (e.g., disulfiram) treatments, and developing integrated treatments for co-occurring disorders (co-occurring stimulant abuse or co-occurring chronic pain) for opioid dependent individuals; 2. improving the accessibility and effectiveness of opioid dependence treatment by integrating it in office-based and primary care settings; and 3. expanding opioid dependence treatment and clinical research in international settings (with current projects in Malaysia, Iran, and China). My work on buprenorphine maintenance treatment illustrates the progression of my research. My initial work focused on comparing the efficacy of buprenorphine and methadone for patients with co-occurring cocaine and opioid dependence. Subsequent studies evaluated adjunctive behavioral and pharmacological treatments to improve the effectiveness of buprenorphine maintenance treatment for patients with co-occurring cocaine and opioid dependence and also investigated the effectiveness of buprenorphine maintenance treatment in office-based and primary care settings and strategies for improving its effectiveness in those settings. The studies in office-based and primary care settings, the high prevalence and adverse consequences of chronic pain among opioid dependent patients treated in primary care settings, and the potential advantages of using buprenorphine to treat co-occurring chronic pain and opioid dependence (POD) in these settings led to our current studies aimed at evaluating buprenorphine for POD and at evaluating integrated behavioral treatments for POD. Our studies in primary care settings and physician offices also led to our research aimed at interventions for and treatment of cocaine dependent women identified in prenatal clinics and to our current studies of buprenorphine maintenance treatment in Iran, Malaysia, and China.
- Combining Behavioral Treatments with Opioid Agonist Maintenance Treatment: In studies in Malaysia, Iran and China, we are evaluating the efficacy and cost-effectiveness of behavioral drug and HIV risk reduction counseling when provided along with methadone or buprenorphine maintenance treatment.
- Pain and Opioid Dependence: We are evaluating buprenorphine treatment and integrated pain and opioid dependence behavioral therapy for patients with co-occurring chronic pain and opioid dependence.
- Schottenfeld, RS, Chawarski, MC, Mazlan, M. Maintenance treatment with buprenorphine and naltrexone for heroin dependence in Malaysia: a randomized double-blind placebo-controlled trial. The Lancet, 371, 2192-2200, 2008.
- Fiellin, DA, Pantalon MV, Chawarski MC, Moore BA, Sullivan LE, O’Connor PG, Schottenfeld RS. Counseling plus buprenorphine-naloxone maintenance therapy for opioid dependence. New England Journal of Medicine, 355(4): 365-374, 2006.
- Schottenfeld RS, Chawarski MC, Pakes J, Pantalon MV, Carroll KM, Kosten TR. Methadone vs. buprenorphine with contingency management or performance feedback for cocaine and opioid dependence. American Journal of Psychiatry 162: 340-349, 2005.