2024
Screening, brief intervention, and referral to treatment for pain management for veterans separating from military service: study protocol of a hybrid type 2 study testing implementation facilitation versus training-as-usual
Sellinger J, Rosen M, Lazar C, Gilstad-Hayden K, Dziura J, Li F, Mattocks K, Weede A, Sullivan-Tibbs M, Rose L, Vassallo G, Manhapra A, Turner A, Vogt D, Woodward E, Hartmann C, Haskell S, Mohammad A, Martino S. Screening, brief intervention, and referral to treatment for pain management for veterans separating from military service: study protocol of a hybrid type 2 study testing implementation facilitation versus training-as-usual. Pain Medicine 2024, 25: s99-s106. PMID: 39514877, DOI: 10.1093/pm/pnae062.Peer-Reviewed Original ResearchConceptsTraining-as-usualImplementation facilitatorsReferral to treatmentCase managementBrief interventionHybrid type 2 effectiveness-implementation trialPain managementImplementation strategiesPrimary implementation outcomeSubstance misuseProportion of participantsPain careUsefulness of screeningVeteran engagementVA sitesImplementation outcomesPragmatic trialPain serviceVeteran participantsCase management systemPain intensityDischarged veteransStudy enrollmentVeteransChronic pain
2021
Who Uses Veterans Mental Health Services?
Manhapra A, Stefanovics EA, Rhee TG, Rosenheck RA. Who Uses Veterans Mental Health Services? The Journal Of Nervous And Mental Disease 2021, 209: 702-709. PMID: 33993183, DOI: 10.1097/nmd.0000000000001369.Peer-Reviewed Original ResearchConceptsVeterans Health AdministrationPosttraumatic stress disorderHealth service usersMH service usersSubstance use disorder diagnosisClinical practice guidelinesMental health servicesMental health service usersClinical characteristicsMedicaid insurancePain interferenceService usersBlack raceSimilar prevalenceMental health researchMH researchPractice guidelinesGreater prevalenceHealth AdministrationHealth servicesPTSD diagnosisRacial distributionMH statusStress disorderDisorder diagnosisThe 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 ResearchConceptsOpioid 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
All-cause mortality among males living with and without HIV initiating long-term opioid therapy, and its association with opioid dose, opioid interruption and other factors
Gordon K, Manhapra A, Crystal S, Dziura J, Edelman E, Skanderson M, Kerns R, Justice A, Tate J, Becker W. All-cause mortality among males living with and without HIV initiating long-term opioid therapy, and its association with opioid dose, opioid interruption and other factors. Drug And Alcohol Dependence 2020, 216: 108291. PMID: 33011662, PMCID: PMC7644145, DOI: 10.1016/j.drugalcdep.2020.108291.Peer-Reviewed Original ResearchConceptsMorphine equivalent daily doseCause mortalityLong-term opioid therapyTime-updated Cox regressionStrong dose-response relationshipUnnatural deathsEquivalent daily doseDose-response relationshipOpioid doseOpioid therapyUninfected patientsOpioid useDaily doseCox regressionMortality outcomesTherapy doseHigh doseMale veteransOverdose fatalitiesOverdose mortalityPLWHMortalityHIVPatientsDoseAssociations between stopping prescriptions for opioids, length of opioid treatment, and overdose or suicide deaths in US veterans: observational evaluation
Oliva E, Bowe T, Manhapra A, Kertesz S, Hah J, Henderson P, Robinson A, Paik M, Sandbrink F, Gordon A, Trafton J. Associations between stopping prescriptions for opioids, length of opioid treatment, and overdose or suicide deaths in US veterans: observational evaluation. The BMJ 2020, 368: m283. PMID: 32131996, PMCID: PMC7249243, DOI: 10.1136/bmj.m283.Peer-Reviewed Original ResearchConceptsLength of treatmentVeterans Health AdministrationOpioid treatmentHealth AdministrationLong patientsObservational evaluationRisk of deathHazards regression modelsFocus of guidelinesLong-term useOpioid cessationOpioid prescriptionsOpioid analgesicsOutpatient prescriptionsPlace patientsSafe prescribingPatient deathUS veteransNon-proportional hazards regression modelsPatient's perspectiveFiscal year 2014OpioidsPatientsOverdoseGreater risk
2019
High-dose prescribed opioids are associated with increased risk of heroin use among United States military veterans.
Banerjee G, Edelman EJ, Barry DT, Crystal S, Gordon KS, Gordon AJ, Gaither JR, Green TC, Kerns RD, Manhapra A, Moore BA, Fiellin DA, Marshall BDL. High-dose prescribed opioids are associated with increased risk of heroin use among United States military veterans. Pain 2019, 160: 2126-2135. PMID: 31145217, PMCID: PMC6699915, DOI: 10.1097/j.pain.0000000000001606.Peer-Reviewed Original ResearchConceptsHigh-dose opioid prescriptionsOpioid prescriptionsHeroin useCohort studyPrior receiptHepatitis C virus (HCV) infection statusLong-term opioid prescriptionsPast-year heroin useVeterans Aging Cohort StudyHigh-dose opioidsOpioid-prescribing patternsProspective cohort studyAging Cohort StudyOpioid use disorderCurrent national guidelinesUnhealthy alcohol useUnited States veteransUnited States military veteransVirus infection statusPosttraumatic stress disorderOpioid receiptPrescribed opioidsPain interferenceCox regressionStates veterans
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 2012