2017
Cost‐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
2014
Primary Care–Based Buprenorphine Taper vs Maintenance Therapy for Prescription Opioid Dependence: A Randomized Clinical Trial
Fiellin DA, Schottenfeld RS, Cutter CJ, Moore BA, Barry DT, O’Connor P. Primary Care–Based Buprenorphine Taper vs Maintenance Therapy for Prescription Opioid Dependence: A Randomized Clinical Trial. JAMA Internal Medicine 2014, 174: 1947-1954. PMID: 25330017, PMCID: PMC6167926, DOI: 10.1001/jamainternmed.2014.5302.Peer-Reviewed Original ResearchConceptsPrescription opioid dependenceOngoing maintenance therapyIllicit opioid useMaintenance therapyOpioid dependenceBuprenorphine taperBuprenorphine therapyTaper groupMaintenance groupOpioid usePrimary careClinical trialsPrimary care-based treatmentSignificant public health burdenBuprenorphine maintenance therapyOngoing maintenance treatmentPrimary care physiciansEvidence-based guidelinesPrimary care sitesPublic health burdenWeeks of stabilizationHydrochloride therapyOpioid withdrawalBuprenorphine treatmentNaltrexone treatment
2013
A Randomized Trial of Cognitive Behavioral Therapy in Primary Care-based Buprenorphine
Fiellin DA, Barry DT, Sullivan LE, Cutter CJ, Moore BA, O'Connor PG, Schottenfeld RS. A Randomized Trial of Cognitive Behavioral Therapy in Primary Care-based Buprenorphine. The American Journal Of Medicine 2013, 126: 74.e11-74.e17. PMID: 23260506, PMCID: PMC3621718, DOI: 10.1016/j.amjmed.2012.07.005.Peer-Reviewed Original ResearchConceptsCognitive behavioral therapyPhysician managementBehavioral therapyOpioid useOpioid dependencePrimary careSelf-reported frequencyBuprenorphine/naloxone treatmentConsecutive weeksOpioid-dependent patientsIllicit opioid usePrimary care clinicsPrimary outcome measureWeeks of treatmentNaloxone treatmentOpioid abstinenceBuprenorphine/Care clinicsIllicit opioidsRandomized trialsUrine toxicologyClinical trialsStudy completionOutcome measuresCocaine use
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
2011
Medications for unhealthy alcohol use: across the spectrum.
O'Malley SS, O'Connor PG. Medications for unhealthy alcohol use: across the spectrum. Alcohol Research 2011, 33: 300-12. PMID: 23580015, PMCID: PMC3860540.Peer-Reviewed Original ResearchConceptsUnhealthy alcohol useSpecialty careCare settingsAlcohol useAdvent of pharmacotherapyPrimary care providersPrimary care settingSpectrum of careHealth care settingsPrimary careCare providersHazardous drinkersEarly interventionExcessive drinkingCareAlcohol problemsTreatmentMedicationsPharmacotherapyPatientsCliniciansPrevalenceSettingDrinkers
2008
Integrating Buprenorphine Treatment into Office-based Practice: a Qualitative Study
Barry DT, Irwin KS, Jones ES, Becker WC, Tetrault JM, Sullivan LE, Hansen H, O’Connor P, Schottenfeld RS, Fiellin DA. Integrating Buprenorphine Treatment into Office-based Practice: a Qualitative Study. Journal Of General Internal Medicine 2008, 24: 218-225. PMID: 19089500, PMCID: PMC2628993, DOI: 10.1007/s11606-008-0881-9.Peer-Reviewed Original ResearchConceptsBuprenorphine maintenance treatmentOffice-based practicePhysicians' perceptionsPatient-related barriersOffice-based physiciansLack of remunerationBuprenorphine treatmentOpioid dependenceMaintenance treatmentPhysician barriersMethadone maintenancePrimary careResultsEighty percentLow prevalenceClinical practiceMedical providersMultidisciplinary teamPatient careInternal medicinePhysician facilitatorsInfectious diseasesAddiction medicinePhysiciansQualitative software programDesignQualitative studyLong‐Term Treatment with Buprenorphine/Naloxone in Primary Care: Results at 2–5 Years
Fiellin DA, Moore BA, Sullivan LE, Becker WC, Pantalon MV, Chawarski MC, Barry DT, O'Connor PG, Schottenfeld RS. Long‐Term Treatment with Buprenorphine/Naloxone in Primary Care: Results at 2–5 Years. American Journal On Addictions 2008, 17: 116-120. PMID: 18393054, DOI: 10.1080/10550490701860971.Peer-Reviewed Original ResearchMeSH KeywordsAdultBuprenorphineCombined Modality TherapyCounselingCross-Sectional StudiesDose-Response Relationship, DrugDrug Administration ScheduleDrug Therapy, CombinationFemaleFollow-Up StudiesHeroin DependenceHumansLong-Term CareMaleMiddle AgedNaloxoneNarcotic AntagonistsOpioid-Related DisordersPatient DropoutsPrimary Health CareSubstance Abuse DetectionTreatment OutcomeConceptsOpioid-dependent patientsAdverse eventsSerum transaminasesBuprenorphine/naloxone treatmentSerious adverse eventsBuprenorphine/naloxoneLong-term outcomesOffice-based treatmentIllicit drug useOpioid useClinical stabilityNaloxone treatmentPrimary outcomePatient satisfactionPrimary careTerm treatmentDrug useUrine samplesPatientsTreatmentTransaminaseOutcomesYearsModerate levelsPercent
2007
Buprenorphine/naloxone treatment in primary care is associated with decreased human immunodeficiency virus risk behaviors
Sullivan LE, Moore BA, Chawarski MC, Pantalon MV, Barry D, O'Connor PG, Schottenfeld RS, Fiellin DA. Buprenorphine/naloxone treatment in primary care is associated with decreased human immunodeficiency virus risk behaviors. Journal Of Substance Use And Addiction Treatment 2007, 35: 87-92. PMID: 17933486, PMCID: PMC2587397, DOI: 10.1016/j.jsat.2007.08.004.Peer-Reviewed Original ResearchConceptsBuprenorphine/naloxone treatmentNaloxone treatmentHIV risk behaviorsHIV riskRisk behaviorsHuman immunodeficiency virus (HIV) risk behaviorsDrug-related HIV riskHuman immunodeficiency virus (HIV) riskSex-related HIV risk behaviorsBuprenorphine/naloxoneIntravenous drug useOpioid-dependent personsPrimary care clinicsInconsistent condom useBuprenorphine/Care clinicsMethadone treatmentPrimary careDrug useSteady partnerCondom useBaselineWeeksTreatmentPatientsSmoking Status as a Clinical Indicator for Alcohol Misuse in US Adults
McKee SA, Falba T, O’Malley S, Sindelar J, O’Connor P. Smoking Status as a Clinical Indicator for Alcohol Misuse in US Adults. JAMA Internal Medicine 2007, 167: 716-721. PMID: 17420431, PMCID: PMC2869385, DOI: 10.1001/archinte.167.7.716.Peer-Reviewed Original ResearchConceptsClinical care guidelinesSmoking statusPositive predictive valueClinical indicatorsAlcohol misuseUS adultsPositive likelihood ratioCurrent smokingCare guidelinesOdds ratioAlcohol diagnosisAssociated Disabilities Interview Schedule-IVPredictive valueHazardous drinkingPrimary care settingAlcohol-related diagnosesConfidence intervalsAlcohol use disorderNational Epidemiological SurveyAlcohol use diagnosisHazardous drinking behaviorLikelihood ratioOccasional smokersPrimary careDaily smokers
2006
Counseling plus Buprenorphine–Naloxone Maintenance Therapy for Opioid Dependence
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 2006, 355: 365-374. PMID: 16870915, DOI: 10.1056/nejmoa055255.Peer-Reviewed Original ResearchConceptsStandard medical managementBuprenorphine-naloxone treatmentIllicit opioid useMedical managementOpioid dependenceWeekly medicationOpioid useIllicit opioidsWeekly counselingPrimary careUrine specimensConsecutive weeksProportion of patientsImproved treatment outcomesMaintenance therapyPrimary outcomeClinical trialsMedication distributionSimilar efficacyTreatment outcomesMedicationsSelf-reported frequencyPatientsFrequency of attendanceMean percentageAre Commonly Ordered Lab Tests Useful Screens for Alcohol Disorders in Older Male Veterans Receiving Primary Care?
Reid MC, Guo Z, Van Ness PH, O'Connor PG, Concato J. Are Commonly Ordered Lab Tests Useful Screens for Alcohol Disorders in Older Male Veterans Receiving Primary Care? Substance Abuse 2006, 26: 25-32. PMID: 16687367, DOI: 10.1300/j465v26n02_04.Peer-Reviewed Original ResearchConceptsAST/ALT ratioAlcohol abuse/dependenceMean corpuscular volumeOlder male veteransAbuse/dependenceAlcohol Use Disorders Identification TestCAGE positivityRisk drinkingAlanine aminotransferaseALT ratioAspartate aminotransferaseAlcohol disordersMale veteransPrimary careMedical recordsParticipants' medical recordsAbnormal test resultsTest performance characteristicsDisorders Identification TestPositive likelihood ratioNegative likelihood ratioLikelihood ratioRoutine careVA databasesCAGE questionnaire
2005
The prevalence and impact of alcohol problems in major depression: A systematic review
Sullivan LE, Fiellin DA, O’Connor P. The prevalence and impact of alcohol problems in major depression: A systematic review. The American Journal Of Medicine 2005, 118: 330-341. PMID: 15808128, DOI: 10.1016/j.amjmed.2005.01.007.Peer-Reviewed Original ResearchConceptsHealth care utilizationLifetime alcohol problemsCare utilizationDepression outcomesAlcohol problemsMajor depressionGeneral populationAlcohol abuseAlcohol dependenceHealth care utilization outcomesPrimary care outpatient settingCochrane Controlled Trials RegistryControlled Trials RegistrySocial functioningPsychiatric inpatient settingsCourse of depressionEnglish-language studiesSevere alcohol problemsTrials RegistryUtilization outcomesDepression courseOutpatient settingPrimary careDeath riskWorse outcomes
2004
Counseling Requirements for Buprenorphine Maintenance in Primary Care
Pantalon M, Fiellin D, O’Connor P, Chawarski M, Pakes J, Schottenfeld R. Counseling Requirements for Buprenorphine Maintenance in Primary Care. Addictive Disorders & Their Treatment 2004, 3: 71-76. DOI: 10.1097/00132576-200406000-00003.Peer-Reviewed Original ResearchUrine toxicology testsMedical managementPrimary care settingBuprenorphine maintenanceCare settingsDrug counselingCounseling requirementsToxicology testsBuprenorphine-maintained patientsOpioid-dependent patientsMethadone maintenance programIndividual drug counselingBuprenorphine treatmentOpioid dependenceDependent patientsPrimary carePatientsConsecutive weeksDrug counselorsStatistical significanceWeeksPreliminary feasibilityPreliminary findingsEfficacyCounselingProcesses 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
2003
Initial and Maintenance Naltrexone Treatment for Alcohol Dependence Using Primary Care vs Specialty Care: A Nested Sequence of 3 Randomized Trials
O'Malley SS, Rounsaville BJ, Farren C, Namkoong K, Wu R, Robinson J, O'Connor PG. Initial and Maintenance Naltrexone Treatment for Alcohol Dependence Using Primary Care vs Specialty Care: A Nested Sequence of 3 Randomized Trials. JAMA Internal Medicine 2003, 163: 1695-1704. PMID: 12885685, DOI: 10.1001/archinte.163.14.1695.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAlanine TransaminaseAlcoholismAspartate AminotransferasesCognitive Behavioral TherapyCombined Modality TherapyConnecticutFemaleGamma-GlutamyltransferaseHumansMaleMedicineMiddle AgedNaltrexoneNarcotic AntagonistsPatient CompliancePatient ParticipationPrimary Health CareSpecializationTimeTreatment OutcomeConceptsPrimary care managementCognitive behavior therapyPlacebo-controlled studyAlcohol dependenceNaltrexone treatmentPersistent heavy drinkingPrimary care treatmentWeeks of treatmentMaintenance of responseMaintenance of improvementCBT armCBT patientsPlacebo groupNaltrexone maintenanceRandomized trialsCare treatmentPrimary careSpecialty carePCM patientsDays abstinentNaltrexoneInitial courseCare managementCBT respondersPatients
2002
Increasing drug users’ adherence to HIV treatment: results of a peer-driven intervention feasibility study
Broadhead RS, Heckathorn DD, Altice FL, van Hulst Y, Carbone M, Friedland GH, O’Connor P, Selwyn PA. Increasing drug users’ adherence to HIV treatment: results of a peer-driven intervention feasibility study. Social Science & Medicine 2002, 55: 235-246. PMID: 12144138, DOI: 10.1016/s0277-9536(01)00167-8.Peer-Reviewed Original ResearchConceptsActive drug usersDrug users' adherenceDrug usersDrug treatmentMedical carePrimary careIntervention feasibility studySocial support structuresHealth advocatesUser adherenceTreatment program staffPeer-driven interventionHIV diseaseHIV infectionPatient adherenceSix-month studyHIV treatmentPhysician referralClinical appointmentsHIV therapeuticsCarePositive behavioral changesAdherencePeer pressureTreatmentUse of Opioid Medications for Chronic Noncancer Pain Syndromes in Primary Care
Reid MC, Engles‐Horton L, Weber MB, Kerns RD, Rogers EL, O'Connor PG. Use of Opioid Medications for Chronic Noncancer Pain Syndromes in Primary Care. Journal Of General Internal Medicine 2002, 17: 173-179. PMID: 11929502, PMCID: PMC1495018, DOI: 10.1046/j.1525-1497.2002.10435.x.Peer-Reviewed Original ResearchConceptsChronic noncancer painChronic pain disordersPrimary care centersPrimary care settingNoncancer painOpioid medicationsAbuse/dependenceSubstance use disordersPain disordersPsychiatric comorbidityPCC patientsPrimary careCare settingsUse disordersLifetime historyVA primary care clinicsAlcohol abuse/dependenceRetrospective cohort studyProportion of patientsMedical record reviewPrimary care clinicsChronic pain diagnosesAbuse behaviorsDegenerative joint diseaseLifetime prevalence ratesTreatment 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
Screening for Alcohol Problems in Primary Care: A Systematic Review
Fiellin DA, Reid MC, O'Connor PG. Screening for Alcohol Problems in Primary Care: A Systematic Review. JAMA Internal Medicine 2000, 160: 1977-1989. PMID: 10888972, DOI: 10.1001/archinte.160.13.1977.Peer-Reviewed Original ResearchConceptsAlcohol Use Disorders Identification TestPrimary careAlcohol problemsFormal screening instrumentsAlcohol abuseHarmful drinkingScreening instrumentQuantity-frequency questionsPrimary care physiciansSearch of MEDLINEDisorders Identification TestCAGE questionsCare physiciansClinical subgroupsClinical measuresCriterion standardDiagnostic test researchSystematic reviewPatient spectrumDiagnostic testsMethodological standardsCareIdentification TestWorkup biasMethodological limitations