2024
Cost-Effectiveness of Implementation Facilitation to Promote Emergency Department-Initiated Buprenorphine for Opioid Use Disorder
Lu T, Ryan D, Cadet T, Chawarski M, Coupet E, Edelman E, Hawk K, Huntley K, Jalali A, O'Connor P, Owens P, Martel S, Fiellin D, D'Onofrio G, Murphy S. Cost-Effectiveness of Implementation Facilitation to Promote Emergency Department-Initiated Buprenorphine for Opioid Use Disorder. Annals Of Emergency Medicine 2024 PMID: 39570250, DOI: 10.1016/j.annemergmed.2024.10.001.Peer-Reviewed Original ResearchHealth care sector perspectiveImplementation facilitatorsOpioid use disorder careIncremental cost-effectiveness ratioCost-effectiveness ratioHealth care sector costsEducational strategiesImplementation facilitation strategyCost-effectiveness acceptability curvesLikelihood of cost-effectivenessCost-effectiveOpioid use disorderQuality-adjusted life yearsUse disorderPatient engagementAcademic EDED visitsAcceptability curvesStandard educationEmergency departmentLife yearsFacilitation strategiesMeasures of effectivenessHealthBuprenorphine
2023
Perspectives on and experiences of emergency department–initiated buprenorphine among clinical pharmacists: A multi-site qualitative study
Justen M, Edelman E, Chawarski M, Coupet E, Cowan E, Lyons M, Owens P, Martel S, Richardson L, Rothman R, Whiteside L, O'Connor P, Zahn E, D'Onofrio G, Fiellin D, Hawk K. Perspectives on and experiences of emergency department–initiated buprenorphine among clinical pharmacists: A multi-site qualitative study. Journal Of Substance Use And Addiction Treatment 2023, 155: 209058. PMID: 37149149, DOI: 10.1016/j.josat.2023.209058.Peer-Reviewed Original ResearchConceptsOpioid use disorderClinical pharmacistsED careEmergency department-initiated buprenorphineEffective OUD treatmentEffectiveness-implementation studyHealth Services frameworkFocus groups/interviewsMulti-site qualitative studyFuture implementation effortsOUD treatmentUrban EDGroups/interviewsEmergency departmentPromoting ActionUnique pharmacologyED staffBuprenorphinePharmacist participantsUse disordersED contextPharmacistsPractice changePharmacy resourcesSuccessful program implementationPerspectives of Clinicians and Staff at Community-Based Opioid Use Disorder Treatment Settings on Linkages With Emergency Department–Initiated Buprenorphine Programs
Sue K, Chawarski M, Curry L, McNeil R, Coupet E, Schwartz R, Wilder C, Tsui J, Hawk K, D’Onofrio G, O’Connor P, Fiellin D, Edelman E. Perspectives of Clinicians and Staff at Community-Based Opioid Use Disorder Treatment Settings on Linkages With Emergency Department–Initiated Buprenorphine Programs. JAMA Network Open 2023, 6: e2312718. PMID: 37163263, PMCID: PMC10173026, DOI: 10.1001/jamanetworkopen.2023.12718.Peer-Reviewed Original ResearchConceptsCommunity-based cliniciansOpioid use disorderEmergency departmentOUD treatmentMedication treatmentSubstance use disorders trainingUrban academic emergency departmentEffectiveness-implementation studyAcademic emergency departmentDisorder treatment settingsPerspectives of cliniciansCommunity-based treatmentCommunity-based treatment programsStaff perspectivesImplementation science frameworkBuprenorphine programTreatment cliniciansPeer navigatorsReferral sitesPromoting ActionMAIN OUTCOMEED staffBuprenorphineFocus groupsUse disorders
2022
Models for Implementing Emergency Department–Initiated Buprenorphine With Referral for Ongoing Medication Treatment at Emergency Department Discharge in Diverse Academic Centers
Whiteside LK, D'Onofrio G, Fiellin DA, Edelman EJ, Richardson L, O'Connor P, Rothman RE, Cowan E, Lyons MS, Fockele CE, Saheed M, Freiermuth C, Punches BE, Guo C, Martel S, Owens PH, Coupet E, Hawk KF. Models for Implementing Emergency Department–Initiated Buprenorphine With Referral for Ongoing Medication Treatment at Emergency Department Discharge in Diverse Academic Centers. Annals Of Emergency Medicine 2022, 80: 410-419. PMID: 35752520, PMCID: PMC9588652, DOI: 10.1016/j.annemergmed.2022.05.010.Peer-Reviewed Original ResearchConceptsOpioid use disorderUse disordersEmergency Department-Initiated BuprenorphineEmergency department dischargeEmergency department patientsElectronic medical record integrationAcademic medical centerBuprenorphine programDepartment patientsTreatment initiationMedication treatmentEmergency physiciansMedical CenterAmerican CollegeClinical practiceImplementation facilitationQuality improvement processBuprenorphineCommon facilitatorsRecord integrationPatientsReferralED cultureEducational disseminationDisordersThe Impact of Access to Addiction Specialist on Attitudes, Beliefs and Hospital-Based Opioid Use Disorder Related Care: A Survey of Hospitalist Physicians
Calcaterra SL, Binswanger IA, Edelman EJ, McNair BK, Wakeman SE, O'Connor P. The Impact of Access to Addiction Specialist on Attitudes, Beliefs and Hospital-Based Opioid Use Disorder Related Care: A Survey of Hospitalist Physicians. Substance Use & Addiction Journal 2022, 43: 143-151. PMID: 32267807, PMCID: PMC7541600, DOI: 10.1080/08897077.2020.1748169.Peer-Reviewed Original ResearchConceptsOpioid use disorderAddiction specialistsLocal treatment resourcesLife-saving treatmentBuprenorphine initiationMultivariable analysisOUD careScreening practicesHospitalist physiciansUse disordersClinical practicePatientsRelated careTreatment resourcesHospitalistsHarm reductionCareTreatmentUnited StatesSpecialistsOnline surveyHospitalizationBuprenorphineComplicationsPrescribing
2021
The design and conduct of a randomized clinical trial comparing emergency department initiation of sublingual versus a 7-day extended-release injection formulation of buprenorphine for opioid use disorder: Project ED Innovation
D'Onofrio G, Hawk KF, Herring AA, Perrone J, Cowan E, McCormack RP, Dziura J, Taylor RA, Coupet E, Edelman EJ, Pantalon MV, Owens PH, Martel SH, O'Connor PG, Van Veldhuisen P, DeVogel N, Huntley K, Murphy SM, Lofwall MR, Walsh SL, Fiellin DA. The design and conduct of a randomized clinical trial comparing emergency department initiation of sublingual versus a 7-day extended-release injection formulation of buprenorphine for opioid use disorder: Project ED Innovation. Contemporary Clinical Trials 2021, 104: 106359. PMID: 33737199, PMCID: PMC9153252, DOI: 10.1016/j.cct.2021.106359.Peer-Reviewed Original ResearchConceptsOpioid use disorderRandomized clinical trialsPrimary outcomeFormal addiction treatmentOpioid withdrawalClinical trialsAncillary studiesUse disordersSelf-reported opioid useAddiction treatmentEmergency department initiationIncremental cost-effectiveness ratioReceipt of medicationEmergency department studyHealth service utilizationCost-effectiveness ratioOpioid useSecondary outcomesService utilizationTreatment accessEligibility criteriaImplementation facilitationBuprenorphineOverdose eventsDepartment study
2017
Interpreting quantitative urine buprenorphine and norbuprenorphine levels in office-based clinical practice
Donroe JH, Holt SR, O’Connor P, Sukumar N, Tetrault JM. Interpreting quantitative urine buprenorphine and norbuprenorphine levels in office-based clinical practice. Drug And Alcohol Dependence 2017, 180: 46-51. PMID: 28866369, DOI: 10.1016/j.drugalcdep.2017.07.040.Peer-Reviewed Original ResearchConceptsOpioid use disorderUrine buprenorphineNorbuprenorphine levelsUrine adulterationAddiction treatment clinicsTreatment clinicsBuprenorphine medicationSublingual buprenorphineBuprenorphine treatmentTreatment cohortsRetrospective studyUrine specimenBuprenorphineUse disordersPatientsClinical practiceUrine samplesUrineClinicTreatmentMedicationsLevelsNorBUPCohortSuspicionCost‐effectiveness of emergency department‐initiated treatment for opioid dependence
Busch SH, Fiellin DA, Chawarski MC, Owens PH, Pantalon MV, Hawk K, Bernstein SL, O'Connor PG, D'Onofrio G. Cost‐effectiveness of emergency department‐initiated treatment for opioid dependence. Addiction 2017, 112: 2002-2010. PMID: 28815789, PMCID: PMC5657503, DOI: 10.1111/add.13900.Peer-Reviewed Original ResearchConceptsCost-effectiveness acceptability curvesOpioid dependenceCommunity-based treatmentBrief interventionAcceptability curvesPast weekHealth care system costsHealth care system perspectiveAddiction treatmentOpioid-dependent patientsPatient time costsHealth care useFormal addiction treatmentBuprenorphine treatmentUrban EDEmergency departmentPrimary carePatient engagementTreatment engagementPatientsReferralSecondary analysisBuprenorphineNumber of daysInterventionEmergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention
D’Onofrio G, Chawarski MC, O’Connor P, Pantalon MV, Busch SH, Owens PH, Hawk K, Bernstein SL, Fiellin DA. Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention. Journal Of General Internal Medicine 2017, 32: 660-666. PMID: 28194688, PMCID: PMC5442013, DOI: 10.1007/s11606-017-3993-2.Peer-Reviewed Original ResearchConceptsIllicit opioid useOpioid usePrimary careHIV riskBrief interventionAddiction treatmentBuprenorphine groupEmergency Department-Initiated BuprenorphineCohort of patientsLong-term followLong-term outcomesFormal addiction treatmentSignificant differencesMain MeasuresSelfStudy entryUrine toxicologyBuprenorphine/Opioid dependenceED interventionsUrine resultsBuprenorphineTreatment engagementDrug useReferralPatients
2012
Counseling and Directly Observed Medication for Primary Care Buprenorphine Maintenance
Moore BA, Barry DT, Sullivan LE, O'Connor PG, Cutter CJ, Schottenfeld RS, Fiellin DA. Counseling and Directly Observed Medication for Primary Care Buprenorphine Maintenance. Journal Of Addiction Medicine 2012, 6: 205-211. PMID: 22614936, PMCID: PMC3419276, DOI: 10.1097/adm.0b013e3182596492.Peer-Reviewed Original ResearchConceptsCognitive behavioral therapyPhysician managementObserved medicationBaseline characteristicsCBT sessionsOpioid-negative urinesIndividual CBT sessionsBuprenorphine maintenanceOpioid useMedication adherencePatient satisfactionPrimary careImproved outcomesTreatment outcomesSession attendanceNegative urineTreatment groupsGreater abstinenceCounseling intensityDrug useTherapist availabilityMedicationsBuprenorphinePatientsIndependent effects
2008
Cost analysis of clinic and office-based treatment of opioid dependence: Results with methadone and buprenorphine in clinically stable patients
Jones ES, Moore BA, Sindelar JL, O’Connor P, Schottenfeld RS, Fiellin DA. Cost analysis of clinic and office-based treatment of opioid dependence: Results with methadone and buprenorphine in clinically stable patients. Drug And Alcohol Dependence 2008, 99: 132-140. PMID: 18804923, PMCID: PMC2646001, DOI: 10.1016/j.drugalcdep.2008.07.013.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultBuprenorphineCohort StudiesCost of IllnessCosts and Cost AnalysisData Interpretation, StatisticalFemaleHealth PersonnelHumansMaleMethadoneMiddle AgedNarcoticsOpioid-Related DisordersPhysicians' OfficesSocioeconomic FactorsSubstance Abuse DetectionSubstance Abuse Treatment CentersTreatment OutcomeYoung AdultConceptsOffice-based treatmentOpioid dependencePatient costsClinical contactMonthly medication costsOffice-based buprenorphineOffice-based methadoneMonths of treatmentAnalysis of treatmentTotal monthly costsChi-square testMonths of maintenanceStable patientsMedication costsPatientsMethadoneMonthly costBuprenorphineTreatmentMonthsStatistical comparisonCost estimatesClinic
2005
The practice of office-based buprenorphine treatment of opioid dependence: is it associated with new patients entering into treatment?
Sullivan LE, Chawarski M, O’Connor P, Schottenfeld RS, Fiellin DA. The practice of office-based buprenorphine treatment of opioid dependence: is it associated with new patients entering into treatment? Drug And Alcohol Dependence 2005, 79: 113-116. PMID: 15943950, DOI: 10.1016/j.drugalcdep.2004.12.008.Peer-Reviewed Original ResearchConceptsPrimary care clinicsInjection drug useOpioid treatment programsMethadone treatmentOpioid dependenceClinical trialsTreatment outcomesHistory of IDUOffice-based buprenorphine treatmentOffice-based buprenorphineBuprenorphine/naloxoneOffice-based treatmentLower ratesHepatitis CClinical characteristicsBuprenorphine treatmentCare clinicsMethadone maintenancePCC patientsNew patientsTreatment retentionPatientsDrug useTreatment programBuprenorphine
2004
Processes of Care During a Randomized Trial of Office‐based Treatment of Opioid Dependence in Primary Care
Fiellin DA, O'Connor PG, Chawarski M, Schottenfeld RS. Processes of Care During a Randomized Trial of Office‐based Treatment of Opioid Dependence in Primary Care. American Journal On Addictions 2004, 13: s67-s78. PMID: 15204676, DOI: 10.1080/10550490490440843.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultFemaleFocus GroupsHumansMaleMedical AuditMethadoneMiddle AgedMulticenter Studies as TopicNarcoticsOffice VisitsOpioid-Related DisordersOutcome and Process Assessment, Health CarePrimary Health CareProcess Assessment, Health CareQuality Assurance, Health CareRandomized Controlled Trials as TopicReferral and ConsultationSubstance Abuse DetectionTreatment RefusalUnited StatesConceptsUrine toxicology resultsProcess of careOpioid dependenceChart auditToxicology resultsOpioid treatment programsOffice-based careOffice-based treatmentDependent patientsMethadone maintenancePrimary carePsychiatric servicesFocus groupsQuality careTreatment programCareTreatmentTrialsAuditMedicationsBuprenorphinePatientsMethadoneGroupEvaluation of processes
2002
Treatment of heroin dependence with buprenorphine in primary care
Fiellin DA, Pantalon MV, Pakes JP, O'Connor PG, Chawarski M, Schottenfeld RS. Treatment of heroin dependence with buprenorphine in primary care. The American Journal Of Drug And Alcohol Abuse 2002, 28: 231-241. PMID: 12014814, DOI: 10.1081/ada-120002972.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, SublingualAdultAmbulatory CareBuprenorphineCombined Modality TherapyConnecticutCounselingDose-Response Relationship, DrugDrug Administration ScheduleFeasibility StudiesFemaleHeroin DependenceHumansMaleMiddle AgedPrimary Health CareSocial SupportTreatment OutcomeUrban PopulationConceptsUrine toxicologyHeroin dependencePrimary careBrief counselingUrine toxicology testsHeroin-dependent patientsPrimary care settingPrimary care centersUrban medical centerBuprenorphine maintenancePrimary outcomeDependent patientsCare centerClinical trialsCare settingsMedical CenterEffective treatmentTreatment retentionBuprenorphinePatientsPotential efficacyToxicology testsMaintenance phaseWeeksCare
2000
Pharmacologic treatment of heroin-dependent patients.
O'Connor P, Fiellin D. Pharmacologic treatment of heroin-dependent patients. Annals Of Internal Medicine 2000, 133: 40-54. PMID: 10877739, DOI: 10.7326/0003-4819-133-1-200007040-00008.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsHeroin dependenceHeroin-dependent patientsDrug treatment settingsBehavioral health problemsOpioid withdrawalPharmacologic treatmentMethadone maintenanceHeroin usePhysician's officeTreatment approachesTreatment settingsHealth problemsPatientsRelapse preventionTreatmentPhysiciansAcetylmethadolBuprenorphineInternistsReferralDiagnosisAlternative sitesPreventionThrice-weekly versus daily buprenorphine maintenance
Schottenfeld R, Pakes J, O’Connor P, Chawarski M, Oliveto A, Kosten T. Thrice-weekly versus daily buprenorphine maintenance. Biological Psychiatry 2000, 47: 1072-1079. PMID: 10862807, DOI: 10.1016/s0006-3223(99)00270-x.Peer-Reviewed Original ResearchConceptsSublingual buprenorphineMaintenance treatmentSelf-reported illicit drug useDrug useOpioid agonist maintenance treatmentOpioid-positive urine testsAgonist maintenance treatmentDaily clinic attendanceDaily sublingual buprenorphineThrice-weekly dosingOpioid-dependent patientsUrine toxicology testsSignificant differencesIllicit drug useSelf-reported numberBuprenorphine maintenanceClinic attendanceWeekly doseIllicit opioidsMedication complianceThrice weeklyUrine testsOutcome measuresBuprenorphineCounseling attendance
1997
Three methods of opioid detoxification in a primary care setting. A randomized trial.
O'Connor PG, Carroll KM, Shi JM, Schottenfeld RS, Kosten TR, Rounsaville BJ. Three methods of opioid detoxification in a primary care setting. A randomized trial. Annals Of Internal Medicine 1997, 127: 526-30. PMID: 9313020, DOI: 10.7326/0003-4819-127-7-199710010-00004.Peer-Reviewed Original ResearchConceptsPrimary care settingOpioid detoxificationCare settingsBuprenorphine groupWithdrawal symptomsDouble-blind clinical trialOpioid-dependent patientsHeroin-dependent patientsPrimary care clinicsWithdrawal symptom scoresSevere withdrawal symptomsDrug treatment programsSubstance abuse treatmentNaltrexone groupCare clinicsSymptom scoresPharmacologic protocolClinical trialsTreatment protocolClonidineTreatment retentionBuprenorphineNaltrexoneTreatment programAbuse treatment
1996
A Pilot Study of Primary-Care—Based Buprenorphine Maintenance for Heroin Dependence
O'Connor P, Oliveto A, Shi J, Triffleman E, Carroll K, Kosten T, Rounsaville B. A Pilot Study of Primary-Care—Based Buprenorphine Maintenance for Heroin Dependence. The American Journal Of Drug And Alcohol Abuse 1996, 22: 523-531. PMID: 8911590, DOI: 10.3109/00952999609001678.Peer-Reviewed Original ResearchConceptsPrimary care providersHeroin dependenceBuprenorphine maintenancePilot studyOpioid maintenanceOpen-label pilot studyUrine toxicology dataPrimary care settingDrug treatment settingsSelf-help meetingsPrimary careMajority of urinesTreatment settingsPatientsToxicology dataBuprenorphineTreatmentOpioidsMethadoneProvidersStudySettingDosesMonthsUrine
1994
SPECT regional cerebral blood flow alterations in naltrexone-precipitated withdrawal from buprenorphine
van Dyck C, Rosen M, Thomas H, McMahon T, Wallace E, O'Connor P, Sullivan M, Krystal J, Hoffer P, Woods S, Kosten T. SPECT regional cerebral blood flow alterations in naltrexone-precipitated withdrawal from buprenorphine. Psychiatry Research 1994, 55: 181-191. PMID: 7701033, DOI: 10.1016/0925-4927(94)90013-2.Peer-Reviewed Original ResearchConceptsRegional cerebral blood flowRegional cerebral blood flow alterationsCerebral blood flow alterationsHexamethyl propylene amine oximeOpiate-induced analgesiaBlood flow alterationsSeverity of withdrawalCerebral blood flowOpiate-dependent patientsAnterior cingulate regionsAnterior cingulate cortexSingle photon emissionPlacebo administrationAmine oximeOpiate withdrawalRCBF ratiosWithdrawal severityBlood flowCingulate cortexCingulate regionsSignificant negative correlationBuprenorphineNaltrexonePlaceboPatients