2024
Implementation, intervention, and downstream costs for implementation of a multidisciplinary complex pain clinic in the Veterans Health Administration
Daniels S, Cave S, Wagner T, Perez T, Edmond S, Becker W, Midboe A. Implementation, intervention, and downstream costs for implementation of a multidisciplinary complex pain clinic in the Veterans Health Administration. Health Services Research 2024 PMID: 38956400, DOI: 10.1111/1475-6773.14345.Peer-Reviewed Original ResearchVeterans Health AdministrationIntervention sitesIntervention costsHealth AdministrationPain clinicDownstream costsQuasi-experimental study designChronic painVA administrative dataAverage intervention costComplex chronic painRoutes of careActivity-based cost dataHealthcare utilization costsVA Medical CenterHistory of chronic painMicro-costing methodImplementation facilitatorsHospice patientsCost of treating patientsControl groupAdministrative dataInpatient costsIntervention cohortClinically similar characteristicsT50 Receipt of Prescribed Opioids and Benzodiazepines After Non-Fatal Overdose and Risk of Subsequent Overdose
Howell B, Black A, Lin H, Lauretta G, Heimer R, Hawk K, D'Onofrio G, Fiellin D, Becker W. T50 Receipt of Prescribed Opioids and Benzodiazepines After Non-Fatal Overdose and Risk of Subsequent Overdose. Drug And Alcohol Dependence 2024, 260: 110499. DOI: 10.1016/j.drugalcdep.2023.110499.Peer-Reviewed Original ResearchFocus on Function: Aligning Patient Values with Clinician Reassessment of Long-Term Opioid Therapy
Edmond S, Becker W. Focus on Function: Aligning Patient Values with Clinician Reassessment of Long-Term Opioid Therapy. Journal Of General Internal Medicine 2024, 1-2. PMID: 38806796, DOI: 10.1007/s11606-024-08821-8.Peer-Reviewed Original ResearchPrescription Opioid Dose Change Prior to Fatal Opioid-Detected Overdose.
Kazemitabar M, Howell B, Becker W, Lin H, Grau L, Heimer R, D'Onofrio G, Hawk K, Fiellin D, Black A. Prescription Opioid Dose Change Prior to Fatal Opioid-Detected Overdose. Journal Of Studies On Alcohol And Drugs 2024 PMID: 38775307, DOI: 10.15288/jsad.24-00026.Peer-Reviewed Original ResearchPrescribed opioidsOpioid dose changesRapid dose increaseNon-HispanicOverdose deathsToxicological resultsNon-prescription opioidsBlack non-HispanicMorphine equivalentsOpioid therapyWhite non-HispanicDose changesDaily doseMean ageDispensed opioidsPrescription opioidsPrescribing patternsOpioidDose increaseOpioid overdose crisisIncreasing dosesStudy investigated patternsEffect of timeEffects of ageSecondary analysisInitial Feasibility of a Randomized Controlled Trial for Long-Term Opioid Therapy Tapering via the Summit Program
Schneider V, Wesolowicz D, Moore B, Becker W, Edmond S. Initial Feasibility of a Randomized Controlled Trial for Long-Term Opioid Therapy Tapering via the Summit Program. Journal Of Pain 2024, 25: 71. DOI: 10.1016/j.jpain.2024.01.323.Peer-Reviewed Original ResearchLong-term opioid therapyOpioid therapyPatients prescribed long-term opioid therapyRandomized feasibility trialMotivational interviewing sessionsSelf-management skillsAssessment completion ratesSummit programPeer specialistsRandomized controlled trialsTapering opioidsPatient-centeredMailed lettersChronic painFeasibility trialAdverse eventsTheory-informedWebsite programRecruitment difficultiesMedication changesMedical comorbiditySupport programsOpioidCompletion ratesControlled trialsIdentifying 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 painProvidersPrescribingEfficacy of Integrating the Management of Pain and Addiction via Collaborative Treatment (IMPACT) in Individuals With Chronic Pain and Opioid Use Disorder: Protocol for a Randomized Clinical Trial of a Digital Cognitive Behavioral Treatment
MacLean R, Ankawi B, Driscoll M, Gordon M, Frankforter T, Nich C, Szollosy S, Loya J, Brito L, Ribeiro M, Edmond S, Becker W, Martino S, Sofuoglu M, Heapy A. Efficacy of Integrating the Management of Pain and Addiction via Collaborative Treatment (IMPACT) in Individuals With Chronic Pain and Opioid Use Disorder: Protocol for a Randomized Clinical Trial of a Digital Cognitive Behavioral Treatment. JMIR Research Protocols 2024, 13: e54342. PMID: 38506917, PMCID: PMC10993119, DOI: 10.2196/54342.Peer-Reviewed Original ResearchPain Care at Home to Amplify Function: Protocol Article.
Black A, Edmond S, Frank J, Abelleira A, Snow J, Wesolowicz D, Becker W. Pain Care at Home to Amplify Function: Protocol Article. Substance Use & Addiction Journal 2024, 29767342241236032. PMID: 38469833, DOI: 10.1177/29767342241236032.Peer-Reviewed Original ResearchPrimary care providersVeterans Health AdministrationPromote self-management strategiesImplementation facilitation strategyEffectiveness-implementation trialChronic painSelf-management strategiesGuideline-concordant practicesMedication management supportOpioid medication safetyIntervention cost-effectivenessOutcomes of alcohol useLong-term opioid therapyManagement of chronic painCognitive behavioral therapy techniquesNational Institutes of HealthPain carePain interferenceCare providersMedication safetyHealthcare providersInstitutes of HealthSelf-managementAddiction Long-termHealth AdministrationLong-term opioid therapy trajectories in veteran patients with and without substance use disorder
Axson S, Becker W, Merlin J, Lorenz K, Midboe A, C Black A. Long-term opioid therapy trajectories in veteran patients with and without substance use disorder. Addictive Behaviors 2024, 153: 107997. PMID: 38442438, PMCID: PMC11080947, DOI: 10.1016/j.addbeh.2024.107997.Peer-Reviewed Original Research
2023
The design and baseline characteristics for the HOPE Consortium Trial to reduce pain and opioid use in hemodialysis
Dember L, Hsu J, Bernardo L, Cavanaugh K, Charytan D, Crowley S, Cukor D, Doorenbos A, Edwards D, Esserman D, Fischer M, Jhamb M, Joffe S, Johansen K, Kalim S, Keefe F, Kimmel P, Krebs E, Kuzla N, Mehrotra R, Mishra P, Pellegrino B, Steel J, Unruh M, White D, Yabes J, Becker W, Consortium F. The design and baseline characteristics for the HOPE Consortium Trial to reduce pain and opioid use in hemodialysis. Contemporary Clinical Trials 2023, 136: 107409. PMID: 38086444, PMCID: PMC10922728, DOI: 10.1016/j.cct.2023.107409.Peer-Reviewed Original ResearchThe Association of Prescribed Opioids and Incident Cardiovascular Disease
Sung M, Eden S, Becker W, Crystal S, Duncan M, Gordon K, Kerns R, Kundu S, Freiberg M, So-Armah K, Edelman E. The Association of Prescribed Opioids and Incident Cardiovascular Disease. Journal Of Pain 2023, 25: 104436. PMID: 38029949, PMCID: PMC11058015, DOI: 10.1016/j.jpain.2023.11.019.Peer-Reviewed Original ResearchIncident cardiovascular diseaseModifiable CVD risk factorsCVD risk factorsHuman immunodeficiency virusCardiovascular diseasePrescribed opioidsOpioid receiptRisk factorsUse disordersCox proportional hazards regression modelVeterans Aging Cohort StudyVeterans Health Administration (VHA) carePropensity scoreProportional hazards regression modelsCVD incidence ratesPrescription opioid exposureIncident CVD eventsPrevalence of hypertensionAging Cohort StudyHigher opioid dosesOpioid use disorderHazards regression modelsNational prospective cohortVeterans Administration dataCocaine use disorderAre opioids effective analgesics and is physiological opioid dependence benign? Revising current assumptions to effectively manage long‐term opioid therapy and its deprescribing
Manhapra A, MacLean R, Rosenheck R, Becker W. Are opioids effective analgesics and is physiological opioid dependence benign? Revising current assumptions to effectively manage long‐term opioid therapy and its deprescribing. British Journal Of Clinical Pharmacology 2023 PMID: 37990580, DOI: 10.1111/bcp.15972.Peer-Reviewed Original ResearchLong-term opioid therapyOpioid therapyFunctional gainsChronic pain syndromeMaximum functional recoveryOngoing opioid crisisParadoxical worseningAnalgesic benefitAnalgesic therapyPain reliefPain syndromeEffective analgesicMost patientsAntinociceptive effectAntinociceptive systemChronic painFunctional recoveryOpioid actionOpioid dependenceMedical instabilityFunctional improvementPlacebo effectClinical principlesOpioid crisisTherapeutic inductionPaths Forward for Clinicians Amidst the Rise of Unregulated Clinical Decision Support Software: Our Perspective on NarxCare
Buonora M, Axson S, Cohen S, Becker W. Paths Forward for Clinicians Amidst the Rise of Unregulated Clinical Decision Support Software: Our Perspective on NarxCare. Journal Of General Internal Medicine 2023, 39: 858-862. PMID: 37962733, PMCID: PMC11043299, DOI: 10.1007/s11606-023-08528-2.Peer-Reviewed Original ResearchClinical decision support toolClinical decision support softwareHealthcare institutionsOpioid prescribingOverdose epidemicPatient encountersIndividual cliniciansPatient careProprietary formulaRigorous external validationCliniciansWider implementationExternal validationPrescribingPotential harmSufficient evidencePublic healthDecision support softwareDecision support toolSpecific actionsMortalityCareA 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 consensusPainPatients