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 ResearchConceptsOpioid 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 ResearchConceptsOpioid 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 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
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 evidence
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 veteransPrescribing, Prescription Monitoring, and Health Policy
Gordon A, Cochran G, Smid M, Manhapra A, Kertesz S. Prescribing, Prescription Monitoring, and Health Policy. Current Clinical Psychiatry 2019, 223-238. DOI: 10.1007/978-3-030-16257-3_11.Peer-Reviewed Original ResearchOpioid use disorderPrescription drug monitoring programsUse disordersOpioid prescribingOpioid prescriptionsOpioid useOpioid misuseClinical interventionsOpioid-related harmsPrescription opioid useDrug monitoring programsOpioid-related morbidityOpioid addiction epidemicUnited States CentersTreatment of personsPrescribing opioidsChronic painIllicit opioidsCDC guidelinesMedication treatmentPrescription monitoringOpioid epidemicHealth of communitiesAddiction epidemicDisease controlSystematic 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
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 Research