2023
Buprenorphine use and courses of care for opioid use disorder treatment within the Veterans Health Administration
Gordon A, Saxon A, Kertesz S, Wyse J, Manhapra A, Lin L, Chen W, Hansen J, Pinnell D, Huynh T, Baylis J, Cunningham F, Ghitza U, Bart G, Yu H, Sauer B. Buprenorphine use and courses of care for opioid use disorder treatment within the Veterans Health Administration. Drug And Alcohol Dependence 2023, 248: 109902. PMID: 37196572, PMCID: PMC10875624, DOI: 10.1016/j.drugalcdep.2023.109902.Peer-Reviewed Original ResearchMeSH KeywordsBuprenorphineCohort StudiesHumansOpioid-Related DisordersRetrospective StudiesVeterans HealthConceptsOpioid use disorderVeterans Health AdministrationUse disordersHealth AdministrationOpioid use disorder treatmentHalf of patientsOpen cohort studyRetention of patientsCourse of careUse disorder treatmentLarge healthcare systemCohort studyMedian durationPatient characteristicsPatient demographicsDaily doseMedication treatmentBuprenorphine useClinical dataWhite racePatientsProportion daysDisorder treatmentMultiple coursesHealthcare system
2022
Complex Persistent Opioid Dependence—an Opioid-induced Chronic Pain Syndrome
Manhapra A. Complex Persistent Opioid Dependence—an Opioid-induced Chronic Pain Syndrome. Current Treatment Options In Oncology 2022, 23: 921-935. PMID: 35435616, DOI: 10.1007/s11864-022-00985-x.Peer-Reviewed Original ResearchConceptsChronic pain syndromeOpioid dependenceOpioid taperingPain syndromeClinical conundrumLong-term opioid useWorse pain controlNon-cancer painOpioid use disorderPoor patient acceptanceSeparate clinical entityAnti-reward systemsOpioid doseOpioid therapyPain providersPain controlOpioid usePain mechanismsClinical entityMore painIatrogenic problemsPatient acceptanceTreatment choiceChronic cancerPain experience
2021
Twelve-Month Retention in Opioid Agonist Treatment for Opioid Use Disorder Among Patients With and Without HIV
Wyse JJ, McGinnis KA, Edelman EJ, Gordon AJ, Manhapra A, Fiellin DA, Moore BA, Korthuis PT, Kennedy AJ, Oldfield BJ, Gaither JR, Gordon KS, Skanderson M, Barry DT, Bryant K, Crystal S, Justice AC, Kraemer KL. Twelve-Month Retention in Opioid Agonist Treatment for Opioid Use Disorder Among Patients With and Without HIV. AIDS And Behavior 2021, 26: 975-985. PMID: 34495424, PMCID: PMC8840957, DOI: 10.1007/s10461-021-03452-0.Peer-Reviewed Original ResearchMeSH KeywordsAnalgesics, OpioidCohort StudiesHIV InfectionsHumansMethadoneOpiate Substitution TreatmentOpioid-Related DisordersConceptsOpioid agonist therapyOpioid use disorderVeterans Aging Cohort StudyHIV statusUse disordersOpioid agonist treatmentAging Cohort StudyDiagnosis of HCVTwelve-month retentionPositive health outcomesOAT retentionAgonist therapyCohort studyHIV managementAgonist treatmentPredictors of retentionPatientsHealth outcomesHistory of homelessnessHIVLower likelihoodImproved likelihoodLikelihood of initiationBuprenorphineDisordersThe association of opioid use disorder and homelessness nationally in the veterans health administration
Manhapra A, Stefanovics E, Rosenheck R. The association of opioid use disorder and homelessness nationally in the veterans health administration. Drug And Alcohol Dependence 2021, 223: 108714. PMID: 33865213, DOI: 10.1016/j.drugalcdep.2021.108714.Peer-Reviewed Original ResearchMeSH KeywordsCross-Sectional StudiesHumansIll-Housed PersonsOpioid-Related DisordersUnited StatesUnited States Department of Veterans AffairsVeteransVeterans HealthConceptsOpioid use disorderSubstance use disordersVeterans Health AdministrationRisk factorsUse disordersHealth AdministrationUnited States Veterans Health AdministrationCo-morbid risk factorsPrevalence of OUDMajor risk factorMultivariate logistic regressionHomeless veteransHigher unadjusted oddsCross-sectional analysisClinical factorsVHA patientsNon-homeless veteransUnadjusted oddsVHA careFiscal year 2012US veteransOdds ratioHigh prevalenceHigher oddsPsychiatric diagnosis
2020
Complex Persistent Opioid Dependence with Long-term Opioids: a Gray Area That Needs Definition, Better Understanding, Treatment Guidance, and Policy Changes
Manhapra A, Sullivan MD, Ballantyne JC, MacLean RR, Becker WC. Complex Persistent Opioid Dependence with Long-term Opioids: a Gray Area That Needs Definition, Better Understanding, Treatment Guidance, and Policy Changes. Journal Of General Internal Medicine 2020, 35: 964-971. PMID: 33159241, PMCID: PMC7728942, DOI: 10.1007/s11606-020-06251-w.Peer-Reviewed Original ResearchConceptsLong-term opioid therapyOpioid taperingOpioid dependenceChronic pain refractoryUtilization of buprenorphineLong-term opioidsSevere chronic painOpioid use disorderMultitude of treatmentsLimited supportive evidenceOpioid therapyPain refractoryBuprenorphine treatmentChronic painClinical instabilityRecent guidelinesClinical definitionUS adultsUse disordersDiagnosis/Treatment guidancePainComplicationsTreatmentSupportive evidenceEnsuring Patient Protections When Tapering Opioids: Consensus Panel Recommendations
Covington E, Argoff C, Ballantyne J, Cowan P, Gazelka H, Hooten W, Kertesz S, Manhapra A, Murphy J, Stanos S, Sullivan M. Ensuring Patient Protections When Tapering Opioids: Consensus Panel Recommendations. Mayo Clinic Proceedings 2020, 95: 2155-2171. PMID: 33012347, DOI: 10.1016/j.mayocp.2020.04.025.Peer-Reviewed Original ResearchMeSH KeywordsAnalgesics, OpioidHumansOpioid-Related DisordersPractice Guidelines as TopicRisk FactorsConceptsLong-term opioid therapyOpioid therapyConsensus panel recommendationsOngoing pain managementSerious withdrawal symptomsSerious adverse outcomesDifferent patient populationsHealth care professionalsLong-term useOpioid reductionOpioid taperTapering opioidsUncontrolled painPain cliniciansPain managementAdverse outcomesCertain patientsPatient populationWithdrawal symptomsPrimary careCare professionalsPatient advocatesOpioidsIllicit substancesBeneficial effectsNonconsensual Dose Reduction Mandates are Not Justified Clinically or Ethically: An Analysis
Kertesz S, Manhapra A, Gordon A. Nonconsensual Dose Reduction Mandates are Not Justified Clinically or Ethically: An Analysis. The Journal Of Law, Medicine & Ethics 2020, 48: 259-267. PMID: 32631183, PMCID: PMC7938366, DOI: 10.1177/1073110520935337.Peer-Reviewed Original ResearchMeSH KeywordsAnalgesics, OpioidChronic PainDrug TaperingHealth PolicyHumansMandatory ProgramsOpioid-Related DisordersQuality of Health CareUnited States
2019
Systematic Review of Pain Severity and Opioid Craving in Chronic Pain and Opioid Use Disorder
MacLean RR, Spinola S, Manhapra A, Sofuoglu M. Systematic Review of Pain Severity and Opioid Craving in Chronic Pain and Opioid Use Disorder. Pain Medicine 2019, 21: e146-e163. PMID: 32034413, DOI: 10.1093/pm/pnz228.Peer-Reviewed Original ResearchConceptsLong-term opioid therapyOpioid use disorderChronic painPain severityOpioid therapyOpioid cravingUse disordersEligible studiesSystematic reviewOpioid use disorder patientsChronic pain populationsRisk of biasInclusion/exclusion criteriaPain populationObservational studyExclusion criteriaPainDisorder patientsPsycINFO databasesTherapyMean levelsDisordersSeverityStudy of individualsCraving
2018
The Conundrum of Opioid Tapering in Long-Term Opioid Therapy for Chronic Pain: A Commentary
Manhapra A, Arias A, Ballantyne J. The Conundrum of Opioid Tapering in Long-Term Opioid Therapy for Chronic Pain: A Commentary. Substance Abuse 2018, 39: 152-161. PMID: 28929914, PMCID: PMC6129223, DOI: 10.1080/08897077.2017.1381663.Peer-Reviewed Original ResearchMeSH KeywordsAnalgesics, OpioidChronic PainDrug Administration ScheduleHumansOpioid-Related DisordersPain ManagementWithholding TreatmentConceptsLong-term opioid therapyOpioid taperingChronic painOpioid therapyOpioid dependencePsychiatric symptomsHigher-dose long-term opioid therapyClinical scenariosPoor pain controlTerm opioid therapyUse of opioidsDifficult clinical scenariosUnique clinical challengesOpioid needsPain controlNeuroplasticity effectsAbstinence syndromeFunctional statusOpioid epidemicClinical challengeFunctional declinePainAffective symptomsPsychiatric instabilityAvailable evidence
2017
Three‐year retention in buprenorphine treatment for opioid use disorder nationally in the Veterans Health Administration
Manhapra A, Petrakis I, Rosenheck R. Three‐year retention in buprenorphine treatment for opioid use disorder nationally in the Veterans Health Administration. American Journal On Addictions 2017, 26: 572-580. PMID: 28472543, DOI: 10.1111/ajad.12553.Peer-Reviewed Original ResearchConceptsOpioid use disorderBuprenorphine treatmentLast prescriptionHazards modelUse disordersVeterans Health Administration facilitiesCox proportional hazards modelThree-year retentionProportion hazard modelKaplan-Meier curvesEmergency room visitsPsychotropic drug useVeterans Health AdministrationProportional hazards modelOnly black raceBuprenorphine discontinuationBuprenorphine retentionCharlson indexFirst prescriptionTreatment continuationRoom visitsBlack raceFY 2012Mean durationFiscal year 2012Opioid substitution treatment is linked to reduced risk of death in opioid use disorder
Manhapra A, Rosenheck R, Fiellin DA. Opioid substitution treatment is linked to reduced risk of death in opioid use disorder. The BMJ 2017, 357: j1947. PMID: 28446438, PMCID: PMC5412085, DOI: 10.1136/bmj.j1947.Peer-Reviewed Original ResearchMeSH KeywordsAnalgesics, OpioidHumansMethadoneOpiate Substitution TreatmentOpioid-Related DisordersRiskEvaluation 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 processes