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 ResearchMeSH KeywordsBuprenorphineEmergency Service, HospitalHumansOpiate Substitution TreatmentOpioid-Related DisordersPharmacistsConceptsOpioid 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 ResearchMeSH KeywordsBuprenorphineEmergency Service, HospitalFemaleHealth ServicesHumansMiddle AgedOpiate Substitution TreatmentOpioid-Related DisordersConceptsCommunity-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 disordersImplementation Facilitation to Promote Emergency Department–Initiated Buprenorphine for Opioid Use Disorder
D’Onofrio G, Edelman E, Hawk K, Chawarski M, Pantalon M, Owens P, Martel S, Rothman R, Saheed M, Schwartz R, Cowan E, Richardson L, Salsitz E, Lyons M, Freiermuth C, Wilder C, Whiteside L, Tsui J, Klein J, Coupet E, O’Connor P, Matthews A, Murphy S, Huntley K, Fiellin D. Implementation Facilitation to Promote Emergency Department–Initiated Buprenorphine for Opioid Use Disorder. JAMA Network Open 2023, 6: e235439. PMID: 37017967, PMCID: PMC10077107, DOI: 10.1001/jamanetworkopen.2023.5439.Peer-Reviewed Original ResearchMeSH KeywordsAdultBuprenorphineEmergency Service, HospitalFemaleHumansMaleNaloxoneNarcotic AntagonistsOpiate Substitution TreatmentOpioid-Related DisordersConceptsOpioid use disorderRate of patientsOUD treatmentImplementation facilitationED visitsObservational cohortED cliniciansX-waiverUse disordersEmergency Department-Initiated BuprenorphineUntreated opioid use disorderEvaluation periodHybrid type 3Provision of buprenorphineBaseline periodGrand roundsRates of EDPrimary outcomeWhite patientsAcademic EDBlack patientsED patientsEmergency departmentCommunity cliniciansMAIN OUTCOME
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 ResearchMeSH KeywordsBuprenorphineEmergency Service, HospitalHumansNarcotic AntagonistsOpiate Substitution TreatmentOpioid-Related DisordersPatient DischargeReferral and ConsultationConceptsOpioid 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 Abuse 2022, 43: 143-151. PMID: 32267807, PMCID: PMC7541600, DOI: 10.1080/08897077.2020.1748169.Peer-Reviewed Original ResearchMeSH KeywordsAttitudeBuprenorphineHospitalistsHospitalsHumansNaloxoneOpiate Substitution TreatmentOpioid-Related DisordersSurveys and QuestionnairesUnited StatesConceptsOpioid use disorderAddiction specialistsLocal treatment resourcesLife-saving treatmentBuprenorphine initiationMultivariable analysisOUD careScreening practicesHospitalist physiciansUse disordersClinical practicePatientsRelated careTreatment resourcesHospitalistsHarm reductionCareTreatmentUnited StatesSpecialistsOnline surveyHospitalizationBuprenorphineComplicationsPrescribing
2020
Barriers and Facilitators to Clinician Readiness to Provide Emergency Department–Initiated Buprenorphine
Hawk KF, D’Onofrio G, Chawarski MC, O’Connor P, Cowan E, Lyons MS, Richardson L, Rothman RE, Whiteside LK, Owens PH, Martel SH, Coupet E, Pantalon M, Curry L, Fiellin DA, Edelman EJ. Barriers and Facilitators to Clinician Readiness to Provide Emergency Department–Initiated Buprenorphine. JAMA Network Open 2020, 3: e204561. PMID: 32391893, PMCID: PMC7215257, DOI: 10.1001/jamanetworkopen.2020.4561.Peer-Reviewed Original ResearchConceptsOpioid use disorderEmergency departmentAdvanced practice cliniciansED cliniciansClinicians' readinessOngoing treatmentTreatment of OUDEmergency Department-Initiated BuprenorphineUntreated opioid use disorderDrug Addiction Treatment ActDecrease opioid useVisual analog scaleHealth Services frameworkAcademic emergency departmentMixed-methods formative evaluationQuality of careSubset of participantsBuprenorphine initiationClinician typeOpioid useED patientsAnalog scaleOngoing careDepartmental protocolPractice clinicians
2019
Implementation facilitation to promote emergency department-initiated buprenorphine for opioid use disorder: protocol for a hybrid type III effectiveness-implementation study (Project ED HEALTH)
D’Onofrio G, Edelman EJ, Hawk KF, Pantalon MV, Chawarski MC, Owens PH, Martel SH, VanVeldhuisen P, Oden N, Murphy SM, Huntley K, O’Connor P, Fiellin DA. Implementation facilitation to promote emergency department-initiated buprenorphine for opioid use disorder: protocol for a hybrid type III effectiveness-implementation study (Project ED HEALTH). Implementation Science 2019, 14: 48. PMID: 31064390, PMCID: PMC6505286, DOI: 10.1186/s13012-019-0891-5.Peer-Reviewed Original ResearchConceptsOpioid use disorderEmergency departmentImplementation facilitationCost-effectiveness analysisUse disordersPatient engagementEmergency department-initiated buprenorphineEffectiveness-implementation studyEvaluation periodOpioid agonist treatmentSoft tissue infectionsInjection drug useGeneral medical conditionsHealth Services frameworkClinical Trials NetworkAcademic emergency departmentRate of provisionIF interventionOngoing medicationED visitsTissue infectionsED patientsFacilitated referralAgonist treatmentED providers
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
2016
Cognitive Behavioral Therapy Improves Treatment Outcomes for Prescription Opioid Users in Primary Care Buprenorphine Treatment
Moore BA, Fiellin DA, Cutter CJ, Buono FD, Barry DT, Fiellin LE, O'Connor PG, Schottenfeld RS. Cognitive Behavioral Therapy Improves Treatment Outcomes for Prescription Opioid Users in Primary Care Buprenorphine Treatment. Journal Of Substance Use And Addiction Treatment 2016, 71: 54-57. PMID: 27776678, PMCID: PMC5119533, DOI: 10.1016/j.jsat.2016.08.016.Peer-Reviewed Original ResearchConceptsOpioid-using patientsCognitive behavioral therapyUse patientsPhysician managementOpioid useTreatment outcomesBuprenorphine/naloxone treatmentHeroin use disorder patientsSelf-reported opioid useBehavioral therapyOpioid use groupPrevious drug treatmentUrine toxicology analysisEffects of CBTInjection drug useBaseline demographic differencesPrescription opioid usersBuprenorphine treatmentNaloxone treatmentOpioid abstinencePrescription opioidsOpioid usersOpioid categoryTreatment responseDrug treatment
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 treatmentThe impact of buprenorphine/naloxone treatment on HIV risk behaviors among HIV-infected, opioid-dependent patients
Edelman EJ, Chantarat T, Caffrey S, Chaudhry A, O’Connor P, Weiss L, Fiellin DA, Fiellin LE. The impact of buprenorphine/naloxone treatment on HIV risk behaviors among HIV-infected, opioid-dependent patients. Drug And Alcohol Dependence 2014, 139: 79-85. PMID: 24726429, PMCID: PMC4029496, DOI: 10.1016/j.drugalcdep.2014.03.006.Peer-Reviewed Original ResearchMeSH KeywordsBuprenorphineFemaleHIV InfectionsHumansLongitudinal StudiesMaleMiddle AgedNaloxoneNarcotic AntagonistsNeedle SharingOpiate Substitution TreatmentOpioid-Related DisordersRisk-TakingUnsafe SexConceptsBuprenorphine/naloxone treatmentOpioid-dependent patientsHIV risk behaviorsBuprenorphine/naloxoneNon-condom useNaloxone treatmentRisk behaviorsTreatment initiationViral loadHIV-1 RNA viral loadCocaine/amphetaminesTime-updated variablesRNA viral loadMajor risk factorOpioid-dependent populationsCochran-Armitage trend testSexual risk behaviorsOlder patientsHIV infectionOpioid dependenceRisk factorsHeroin useHIVPatientsTargeted interventions
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
Opioid Detoxification and Naltrexone Induction Strategies: Recommendations for Clinical Practice
Sigmon SC, Bisaga A, Nunes EV, O'Connor PG, Kosten T, Woody G. Opioid Detoxification and Naltrexone Induction Strategies: Recommendations for Clinical Practice. The American Journal Of Drug And Alcohol Abuse 2012, 38: 187-199. PMID: 22404717, PMCID: PMC4331107, DOI: 10.3109/00952990.2011.653426.Peer-Reviewed Original ResearchConceptsΜ-opioid receptor antagonist naltrexoneSignificant public health problemDose of buprenorphinePublic health problemLevel of careOral naltrexoneOpioid detoxificationAntagonist naltrexoneOpioid dependencePatient selectionOpioid agonistsAgonist maintenanceAncillary medicationsFavorable outcomeHigh riskTarget doseClinical practiceHealth problemsNaltrexoneExpert cliniciansTreatmentDoseMore researchUseful alternativeBest approach
2011
The Impact of Cocaine Use on Outcomes in HIV-Infected Patients Receiving Buprenorphine/Naloxone
Sullivan LE, Botsko M, Cunningham CO, O'Connor PG, Hersh D, Mitty J, Lum PJ, Schottenfeld RS, Fiellin DA. The Impact of Cocaine Use on Outcomes in HIV-Infected Patients Receiving Buprenorphine/Naloxone. JAIDS Journal Of Acquired Immune Deficiency Syndromes 2011, 56: s54-s61. PMID: 21317595, PMCID: PMC3065971, DOI: 10.1097/qai.0b013e3182097576.Peer-Reviewed Original ResearchMeSH KeywordsAdultAnti-HIV AgentsBuprenorphineBuprenorphine, Naloxone Drug CombinationCocaine-Related DisordersFemaleHIV InfectionsHumansMaleMiddle AgedNaloxoneNarcotic AntagonistsNeedle SharingOpiate Substitution TreatmentOpioid-Related DisordersProspective StudiesRisk FactorsTreatment OutcomeUnsafe SexConceptsBuprenorphine/naloxoneTimes greater likelihoodBaseline cocaine useOpioid useCocaine useHIV RNAAntiretroviral adherenceTreatment outcomesBuprenorphine/naloxone treatmentGreater likelihoodRisk behaviorsConcurrent opioid useLog10 HIV RNAOpioid-dependent HIVSubsequent opioid useHIV treatment outcomesPercent of patientsIllicit opioid useHIV risk behaviorsSubsequent cocaine useCD4 lymphocytesNaloxone treatmentProspective studyPatientsNaloxoneDrug Treatment Outcomes Among HIV-Infected Opioid-Dependent Patients Receiving Buprenorphine/Naloxone
Fiellin DA, Weiss L, Botsko M, Egan JE, Altice FL, Bazerman LB, Chaudhry A, Cunningham CO, Gourevitch MN, Lum PJ, Sullivan LE, Schottenfeld RS, O'Connor PG. Drug Treatment Outcomes Among HIV-Infected Opioid-Dependent Patients Receiving Buprenorphine/Naloxone. JAIDS Journal Of Acquired Immune Deficiency Syndromes 2011, 56: s33-s38. PMID: 21317592, PMCID: PMC3863630, DOI: 10.1097/qai.0b013e3182097537.Peer-Reviewed Original ResearchConceptsBuprenorphine/naloxoneBuprenorphine/naloxone treatmentOpioid-dependent patientsDrug useOpioid useNaloxone treatmentHIV treatment settingsIllicit opioid useOngoing drug useDrug treatment outcomesNaloxone dosesIllicit opioidsOpioid dependenceOffice visitsProspective studyHIV treatmentRetained patientsTreatment outcomesTreatment retentionPatientsTreatment settingsAddiction treatment processNaloxoneTreatment populationHIV