2024
Guideline concordant opioid therapy in Veterans receiving VA and community care
Ma P, Cheng Y, Goulet J, Sandbrink F, Brandt C, Spevak C, Kean J, Becker W, Libin A, Shara N, Sheriff H, Houston J, Butler J, Workman E, Agrawal R, Kupersmith J, Zeng-Treitler Q. Guideline concordant opioid therapy in Veterans receiving VA and community care. BMC Health Services Research 2024, 24: 1284. PMID: 39456008, PMCID: PMC11515256, DOI: 10.1186/s12913-024-11742-1.Peer-Reviewed Original ResearchConceptsDual-system usersGuideline concordant careConcordant careVA servicesCommunity careElectronic health record dataHealth record dataRates of guideline concordanceVA Medical CenterOpioid therapyAdherence to specific guidelinesBaltimore VA Medical CenterGuideline adherenceGuideline concordanceAdherence ratesGuideline recommendationsRecord dataCareDemographic factorsMedical CenterVeteransComorbid conditionsOpioid crisisUrine drug screensSpecific guidelinesLong-Term Use of Muscle Relaxant Medications for Chronic Pain
Oldfield B, Gleeson B, Morford K, Adams Z, Funaro M, Becker W, Merlin J. Long-Term Use of Muscle Relaxant Medications for Chronic Pain. JAMA Network Open 2024, 7: e2434835. PMID: 39298168, PMCID: PMC11413720, DOI: 10.1001/jamanetworkopen.2024.34835.Peer-Reviewed Original ResearchConceptsLow back painBack painSkeletal muscle relaxantsChronic painRandomized clinical trialsNeck painCohort studyEfficacy of long-term useLong-term useSystematically searched Ovid MEDLINEMuscle relaxant medicationsModerate risk of biasOpioid prescribing guidelinesRisk of biasQuality of cohort studiesWeb of SciencePainful crampsRelaxant medicationsChronic pain syndromesPainful spasmsOvid MEDLINEPrescribing guidelinesSystematic reviewIncreased prescriptionModerate riskIdentifying provider, patient and practice factors that shape long-term opioid prescribing for cancer pain: a qualitative study of American and Australian providers
Fereydooni S, Lorenz K, Azarfar A, Luckett T, Phillips J, Becker W, Giannitrapani K. Identifying provider, patient and practice factors that shape long-term opioid prescribing for cancer pain: a qualitative study of American and Australian providers. BMJ Open 2024, 14: e082033. PMID: 38514141, PMCID: PMC10961503, DOI: 10.1136/bmjopen-2023-082033.Peer-Reviewed Original ResearchConceptsPractice-related factorsLong-term opioid prescribingPrescribed long-term opioid therapyQualitative studyOpioid prescribingQuality of careProvider-related factorsLong-term prescribingPatient’s social contextLong-term opioid therapyAlternative pain therapiesCancer-related painConcurrent qualitative studyDisadvantaged patientsHealthcare interventionsExacerbate disparitiesIdentified providersAustralian providersOpioid practicesSocioeconomic statusSecondary analysisPrescribed opioidsCancer painProvidersPrescribing
2023
A Tool to Identify and Engage Patients on Risky Opioid Regimens
Griffin A, Perez T, Avoundjian T, Becker W, Midboe A. A Tool to Identify and Engage Patients on Risky Opioid Regimens. Applied Clinical Informatics 2023, 14: 1018-1026. PMID: 38151042, PMCID: PMC10752654, DOI: 10.1055/s-0043-1777126.Peer-Reviewed Original ResearchConceptsMedication regimensHigh-risk patient populationHigh-dose opioidsHigh-risk opioidPrimary care clinicsPrimary care appointmentsPrimary care staffPatient-centered careHealth care systemClinical informatics toolsOutreach letterOpioid regimensCare appointmentsCare clinicsChronic painOpioid safetyPatient populationCase reportClinic staffPatientsRegimensClinical initiativesCare staffCare initiativesOpioidsNIH HEAL Common Data Elements (CDE) implementation: NIH HEAL Initiative IDEA-CC
Adams M, Hurley R, Siddons A, Topaloglu U, Wandner L, Adams M, Arnsten J, Bao Y, Barry D, Becker W, Fiellin D, Fox A, Ghiroli M, Hanmer J, Horn B, Hurlocker M, Jalal H, Joseph V, Merlin J, Murray-Krezan C, Pearson M, Rogal S, Starrels J, Bachrach R, Witkiewitz K, Vasquez A. NIH HEAL Common Data Elements (CDE) implementation: NIH HEAL Initiative IDEA-CC. Pain Medicine 2023, 24: 743-749. PMID: 36799548, PMCID: PMC10321760, DOI: 10.1093/pm/pnad018.Peer-Reviewed Original ResearchConceptsClinical trialsClinical Trials NetworkCDE programsChronic painSecondary data analysisPainTrials NetworkDisease statesOpioidData standardsGeographical codingClinical researchHealing initiationData elementsNational InstituteTrialsDisordersFederal investmentInterventionStandard processDisorder researchSurveyed librariesCDELeveraging toolsNetwork alignment
2017
Group Visits for Overdose Education and Naloxone Distribution in Primary Care: A Pilot Quality Improvement Initiative
Spelman JF, Peglow S, Schwartz AR, Burgo-Black L, McNamara K, Becker WC. Group Visits for Overdose Education and Naloxone Distribution in Primary Care: A Pilot Quality Improvement Initiative. Pain Medicine 2017, 18: 2325-2330. PMID: 29045696, DOI: 10.1093/pm/pnx243.Peer-Reviewed Original ResearchConceptsHigh-risk patientsGroup visitsUsual carePrimary careNaloxone distributionOverdose educationLong-term opioid therapyMorphine equivalent daily dosePilot quality improvement initiativeQuality improvement pilot studyPrimary care clinicsChronic pain populationsPatient satisfaction scoresVeterans Health AdministrationQuality improvement interventionsQuality improvement initiativesPrescription of naloxoneOpioid therapyDaily doseCare clinicsChronic painPain populationNaloxone prescriptionsOpioid overdoseOverdose deathsMultiple Sources of Prescription Payment and Risky Opioid Therapy Among Veterans
Becker WC, Fenton BT, Brandt CA, Doyle EL, Francis J, Goulet JL, Moore BA, Torrise V, Kerns RD, Kreiner PW. Multiple Sources of Prescription Payment and Risky Opioid Therapy Among Veterans. Medical Care 2017, 55: s33-s36. PMID: 28410338, DOI: 10.1097/mlr.0000000000000722.Peer-Reviewed Original ResearchConceptsOpioid therapySource of paymentHigher oddsHigh-dose opioid therapyHigh-risk opioid prescribingMorphine equivalent daily dosePayment sourceOpioid analgesic prescriptionsPrescription monitoring programsEquivalent daily doseCross-sectional studyAnalgesic prescriptionOpioid prescribingBenzodiazepine therapyDaily doseUS veteransFiscal year 2014TherapyPrivate insuranceLogistic regressionRelated harmsPrescription paymentAnalytic sampleOpioidsOddsAbuse-Deterrent Opioid Formulations — Putting the Potential Benefits into Perspective
Becker WC, Fiellin DA. Abuse-Deterrent Opioid Formulations — Putting the Potential Benefits into Perspective. New England Journal Of Medicine 2017, 376: 2103-2105. PMID: 28564568, DOI: 10.1056/nejmp1701553.Peer-Reviewed Educational MaterialsEvaluation of an Integrated, Multidisciplinary Program to Address Unsafe Use of Opioids Prescribed for Pain
Becker WC, Edmond SN, Cervone DJ, Manhapra A, Sellinger JJ, Moore BA, Edens EL. Evaluation of an Integrated, Multidisciplinary Program to Address Unsafe Use of Opioids Prescribed for Pain. Pain Medicine 2017, 19: 1419-1424. PMID: 28371816, DOI: 10.1093/pm/pnx041.Peer-Reviewed Original ResearchConceptsPreliminary efficacyUnsafe useSubstance abuse/dependenceMultidisciplinary care teamSubstance use disorder diagnosisPrimary care physiciansAdvanced practice nursesUrine drug testingLength of treatmentStructured clinical assessmentNurse case managersAbuse/dependenceHealth system levelHigh-complexity patientsElectronic progress notesOpioid prescribedOpioid receiptCare physiciansPractice nursesPrimary careCare coordinationCare teamClinical assessmentCare modelClinic processesBarriers and facilitators to use of non-pharmacological treatments in chronic pain
Becker WC, Dorflinger L, Edmond SN, Islam L, Heapy AA, Fraenkel L. Barriers and facilitators to use of non-pharmacological treatments in chronic pain. BMC Primary Care 2017, 18: 41. PMID: 28320337, PMCID: PMC5359906, DOI: 10.1186/s12875-017-0608-2.Peer-Reviewed Original ResearchConceptsPrimary care providersNominal group techniqueChronic painMean agePain treatment modalitiesProvider-reported barriersNon-pharmacological treatmentPatient-reported barriersChronic pain treatmentPatient-provider interactionsPerspectives of patientsTeam-based approachOpioid therapyPatients' skepticismPain treatmentPatient knowledgeTreatment modalitiesTreatment beliefsModifiable barriersCare providersHealthcare professionalsTreatment philosophyStaff consensusPainPatientsUltra–High-Dose Opioids With Low Efficacy and Significant Harm—Time to Make a Change: A Teachable Moment
Guillod P, Edens EL, Becker WC. Ultra–High-Dose Opioids With Low Efficacy and Significant Harm—Time to Make a Change: A Teachable Moment. JAMA Internal Medicine 2017, 177: 17-18. PMID: 27893881, DOI: 10.1001/jamainternmed.2016.7344.Peer-Reviewed Original Research
2016
Prescribing opioids in primary care: Safely starting, monitoring, and stopping
Tobin DG, Andrews R, Becker WC. Prescribing opioids in primary care: Safely starting, monitoring, and stopping. Cleveland Clinic Journal Of Medicine 2016, 83: 207-215. PMID: 26974992, DOI: 10.3949/ccjm.83a.15034.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsChronic opioid therapyChronic noncancer painPrimary care providersPrescription drug abuseNoncancer painOpioid therapyOpioid misusePrimary careCare teamCare providersEpidemic proportionsMeaningful benefitPatient communicationOpioidsDrug abuseAdverse effectsAbusePainOutpatientsPatientsTherapyCareInitial development of patient-reported instrument assessing harm, efficacy, and misuse of long-term opioid therapy
Becker WC, Fiellin DA, Black AC, Kostovich CT, Kerns RD, Fraenkel L. Initial development of patient-reported instrument assessing harm, efficacy, and misuse of long-term opioid therapy. The Journal Of Rehabilitation Research And Development 2016, 53: 127-136. PMID: 27006339, PMCID: PMC4806533, DOI: 10.1682/jrrd.2014.11.0285.Peer-Reviewed Original ResearchConceptsLong-term opioid therapyPatient-reported instrumentOpioid therapyFurther item reductionIneffective medicationsClinical outcomesPrimary careFrequent reassessmentPatient comprehensionItem reductionGold standardEfficacyTherapyInterdisciplinary teamLevel checksCognitive interviewsMisuseHarmMedicationsPatients
2015
Trends in Any and High-Dose Opioid Analgesic Receipt Among Aging Patients With and Without HIV
Becker WC, Gordon K, Jennifer Edelman E, Kerns RD, Crystal S, Dziura JD, Fiellin LE, Gordon AJ, Goulet JL, Justice AC, Fiellin DA. Trends in Any and High-Dose Opioid Analgesic Receipt Among Aging Patients With and Without HIV. AIDS And Behavior 2015, 20: 679-686. PMID: 26384973, PMCID: PMC5006945, DOI: 10.1007/s10461-015-1197-5.Peer-Reviewed Original Research
2014
Buprenorphine/Naloxone Dose and Pain Intensity Among Individuals Initiating Treatment for Opioid Use Disorder
Becker WC, Ganoczy D, Fiellin DA, Bohnert AS. Buprenorphine/Naloxone Dose and Pain Intensity Among Individuals Initiating Treatment for Opioid Use Disorder. Journal Of Substance Use And Addiction Treatment 2014, 48: 128-131. PMID: 25312475, DOI: 10.1016/j.jsat.2014.09.007.Peer-Reviewed Original ResearchConceptsOpioid use disorderNumerical rating scoreBUP/NXPain intensityUse disordersPrimary outcomeBuprenorphine/naloxone doseDecreased pain intensityFull agonist opioidsImproved pain intensityBuprenorphine/naloxoneSubset of patientsSubstance use comorbiditiesChronic pain diagnosesPartial agonist propertiesEligible patientsNX treatmentAgonist opioidsPain levelsNaloxone doseComorbid painMultivariable analysisMaintenance treatmentMean ageClinical correlates
2012
Federal plan for prescriber education on opioids misses opportunities.
Becker WC, Fiellin DA. Federal plan for prescriber education on opioids misses opportunities. Annals Of Internal Medicine 2012, 157: 205-6. PMID: 22868838, DOI: 10.7326/0003-4819-157-3-201208070-00448.Peer-Reviewed Educational Materials
2011
Nonmedical Use of Opioid Analgesics Obtained Directly From Physicians: Prevalence and Correlates
Becker WC, Tobin DG, Fiellin DA. Nonmedical Use of Opioid Analgesics Obtained Directly From Physicians: Prevalence and Correlates. JAMA Internal Medicine 2011, 171: 1034-1036. PMID: 21670373, DOI: 10.1001/archinternmed.2011.217.Peer-Reviewed Original ResearchRacial Differences in Primary Care Opioid Risk Reduction Strategies
Becker WC, Starrels JL, Heo M, Li X, Weiner MG, Turner BJ. Racial Differences in Primary Care Opioid Risk Reduction Strategies. The Annals Of Family Medicine 2011, 9: 219-225. PMID: 21555749, PMCID: PMC3090430, DOI: 10.1370/afm.1242.Peer-Reviewed Original ResearchConceptsRegular office visitsUrine drug testingOpioid risk-reduction strategiesWhite patientsBlack patientsOffice visitsRisk reduction strategiesOpioid analgesicsEarly refillsDrug testingGuideline-recommended strategiesOpioids long termChronic noncancer painPrimary care patientsHealth care factorsMixed effects regression modelsRace/ethnicityNoncancer painOpioid refillsMedical comorbiditiesRetrospective cohortCare patientsOpioid misuseCare factorsHigher odds
2010
The Safety of Opioid Analgesics in the Elderly: New Data Raise New Concerns: Comment on “The Comparative Safety of Opioids for Nonmalignant Pain in Older Adults”
Becker WC, O'Connor PG. The Safety of Opioid Analgesics in the Elderly: New Data Raise New Concerns: Comment on “The Comparative Safety of Opioids for Nonmalignant Pain in Older Adults”. JAMA Internal Medicine 2010, 170: 1986-1988. PMID: 21149755, DOI: 10.1001/archinternmed.2010.443.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAnalgesics, OpioidAnti-Inflammatory Agents, Non-SteroidalCardiovascular DiseasesComorbidityContraindicationsCyclooxygenase 2 InhibitorsDrug UtilizationFemaleFractures, BoneGastrointestinal HemorrhageHumansMaleMedicareObservationPainPain MeasurementResearch DesignTherapeutic EquivalencyUnited StatesSystematic review: treatment agreements and urine drug testing to reduce opioid misuse in patients with chronic pain.
Starrels JL, Becker WC, Alford DP, Kapoor A, Williams AR, Turner BJ. Systematic review: treatment agreements and urine drug testing to reduce opioid misuse in patients with chronic pain. Annals Of Internal Medicine 2010, 152: 712-20. PMID: 20513829, DOI: 10.7326/0003-4819-152-11-201006010-00004.Peer-Reviewed Original ResearchConceptsUrine drug testingOpioid treatment agreementsPrimary care settingOpioid misuseTreatment agreementsChronic painDrug testingEligible studiesCare settingsAberrant drug-related behaviorsDrug abuseMental Health Services AdministrationOpioid misuse outcomesChronic noncancer painCochrane Central RegisterProportion of patientsPrimary care studyControlled Clinical TrialsHealth Services AdministrationDrug-related behaviorsCombination of interventionsNoncancer painDiversity of interventionsOpioid medicationsCentral Register