1
|
Siamidi A, Dedeloudi A, Vlachou M. Probing the Release of Bupropion and Naltrexone Hydrochloride Salts from Biopolymeric Matrices of Diverse Chemical Structures. Polymers (Basel) 2021; 13:polym13091456. [PMID: 33946250 PMCID: PMC8125139 DOI: 10.3390/polym13091456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/25/2021] [Accepted: 04/28/2021] [Indexed: 11/16/2022] Open
Abstract
In the last decades, the notion of including excipients in the formulations, as inert substances aiding production processes, has changed and they are recently viewed as multifunctional discrete entities. It is now well documented that excipients serve several roles, spreading from the stabilization and modified release, to providing biocompatible properties and targeting moieties. The aim of this study was to develop matrix-based oral drug delivery systems of bupropion hydrochloride (BUP·HCl) and naltrexone hydrochloride (NTX·HCl), suitable for releasing these active substances in a modified manner, providing a stable level of drug release, which is simultaneously therapeutically effective and non-toxic, thus reducing side effects, after a single dose administration, throughout the gastrointestinal tract. The new formulations, employing hydroxypropylmethycellulose (HPMC K15M) (a cellulosic polymer, which, generally hydrates to form a gelatinous layer that is critical to prevent wetting and rapid drug release from the matrices), poly(methacylic acid-co-ethyl acrylate) 1:1 (Eudragit® L100-55: effective for site specific drug delivery in intestine), poly(ethylene oxide) (PEO) (7 × 106: a high molecular weight polymer, water-soluble, in micro-granular powder form), as the rate controlling polymers, were chosen to lead to a "soothing out" release pattern of these drugs, at 0 ≤ t ≤ 120 min. Moreover, the release of the two drugs from the ulvan-based tablets, was found to follow the desired profile, throughout the entire course of the dissolution experiments.
Collapse
|
2
|
Abraham AJ, Andrews CM, Harris SJ, Friedmann PD. Availability of Medications for the Treatment of Alcohol and Opioid Use Disorder in the USA. Neurotherapeutics 2020; 17:55-69. [PMID: 31907876 PMCID: PMC7007488 DOI: 10.1007/s13311-019-00814-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Despite high mortality rates due to opioid overdose and excessive alcohol consumption, medications for the treatment of alcohol and opioid use disorder have not been widely used in the USA. This paper provides an overview of the literature on the availability of alcohol and opioid used disorder medications in the specialty substance use disorder treatment system, other treatment settings and systems, and among providers with a federal waiver to prescribe buprenorphine. We also present the most current data on the availability of alcohol and opioid use disorder medications in the USA. These estimates show steady growth in availability of opioid use disorder medications over the past decade and a decline in availability of alcohol use disorder medications. However, overall use of medications in the USA remains low. In 2017, only 16.3% of specialty treatment programs offered any single medication for alcohol use disorder treatment and 35.5% offered any single medication for opioid use disorder treatment. Availability of buprenorphine-waivered providers has increased significantly since 2002. However, geographic disparities in access to buprenorphine remain. Some of the most promising strategies to increase availability of alcohol and opioid use disorder medications include the following: incorporating substance use disorder training in healthcare education programs, educating the substance use disorder workforce about the benefits of medication treatment, reducing stigma surrounding the use of medications, implementing medications in primary care settings, implementing integrated care models, revising regulations on methadone and buprenorphine, improving health insurance coverage of medications, and developing novel medications for the treatment of substance use disorder.
Collapse
Affiliation(s)
- Amanda J. Abraham
- School of Public and International Affairs, University of Georgia, 280F Baldwin Hall, 355 S. Jackson Street, Athens, GA 30602 USA
| | - Christina M. Andrews
- College of Social Work, University of South Carolina, 1512 Pendleton St., Room 309, Columbia, SC 29208 USA
| | - Samantha J. Harris
- School of Public and International Affairs, University of Georgia, 280F Baldwin Hall, 355 S. Jackson Street, Athens, GA 30602 USA
| | - Peter D. Friedmann
- University of Massachusetts Medical School Baystate, 280 Chestnut St., Springfield, MA 01199 USA
| |
Collapse
|
3
|
Moskal D, Maisto SA, Possemato K, Lynch KG, Oslin DW. Testing Mediators of Reduced Drinking for Veterans in Alcohol Care Management. Mil Med 2018; 183:e594-e602. [PMID: 29590436 DOI: 10.1093/milmed/usy024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/05/2018] [Accepted: 02/11/2018] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Alcohol Care Management (ACM) is a manualized treatment provided by behavioral health providers working in a primary care team aimed at increasing patients' treatment engagement and decreasing their alcohol use. Research has shown that ACM is effective in reducing alcohol consumption; however, the mechanisms of ACM are unknown. Therefore, the purpose of this study is to examine the mechanisms of change in ACM in the context of a randomized clinical trial evaluating the effectiveness of ACM. MATERIALS AND METHODS This study performed secondary data analysis of existing data from a larger study that involved a sample of U.S. veterans (N = 163) who met criteria for current alcohol dependence. Upon enrollment into the study, participants were randomized to receive either ACM or standard care. ACM was delivered in-person or by telephone within the primary care clinic and focused on the use of oral naltrexone and manualized psychosocial support. According to theory, we hypothesized several ACM treatment components that would mediate alcohol consumption outcomes: engagement in addiction treatment, reduced craving, and increased readiness to change. Parallel mediation models were performed by the PROCESS macro Model 4 in SPSS to test study hypotheses. The institutional review boards at each of the participating facilities approved all study procedures before data collection. RESULTS As hypothesized, results showed that treatment engagement mediated the relation between treatment and both measures of alcohol consumption outcomes, the percentage of alcohol abstinent days, and the percentage of heavy drinking days. Neither craving nor readiness to change mediated the treatment effect on either alcohol consumption outcome. CONCLUSIONS Findings suggest that ACM may be effective in changing drinking patterns partially due to an increase in treatment engagement. Future research may benefit from evaluating the specific factors that underlie increased treatment engagement. The current study provides evidence that alcohol use disorder interventions should aim to increase treatment engagement and reduce barriers to care.
Collapse
Affiliation(s)
- Dezarie Moskal
- Center for Integrated Healthcare, Syracuse Department of Veterans Affairs Medical Center, Syracuse, NY.,Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY
| | - Stephen A Maisto
- Center for Integrated Healthcare, Syracuse Department of Veterans Affairs Medical Center, Syracuse, NY.,Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY
| | - Kyle Possemato
- Center for Integrated Healthcare, Syracuse Department of Veterans Affairs Medical Center, Syracuse, NY
| | - Kevin G Lynch
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA
| | - David W Oslin
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA.,Mental Illness Research, Education and Clinical Center at the Cpl. Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA
| |
Collapse
|
4
|
Ritter A, Hull P, Berends L, Chalmers J, Lancaster K. A conceptual schema for government purchasing arrangements for Australian alcohol and other drug treatment. Addict Behav 2016; 60:228-34. [PMID: 27174218 DOI: 10.1016/j.addbeh.2016.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/15/2016] [Accepted: 04/20/2016] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study was to establish a conceptual schema for government purchasing of alcohol and other drug treatment in Australia which could encompass the diversity and variety in purchasing arrangements, and facilitate better decision-maker by purchasers. There is a limited evidence base on purchasing arrangements in alcohol and drug treatment despite the clear impact of purchasing arrangements on both treatment processes and treatment outcomes. METHODS The relevant health and social welfare literature on purchasing arrangements was reviewed; data were collected from Australian purchasers and providers of treatment giving detailed descriptions of the array of purchasing arrangements. Combined analysis of the literature and the Australian purchasing data resulted in a draft schema which was then reviewed by an expert committee and subsequently finalised. RESULTS The conceptual schema presented here was purpose-built for alcohol and other drug treatment, with its overlap between health and social welfare services. It has three dimensions: 1. The ways in which providers are chosen; 2. The ways in which services are paid for; and 3. How price is managed. Distinguishing between the methods for choosing providers (such as competitive or individually negotiated processes) from the way in which organisations are paid for their provision of treatment (such as via a block grant or payment for activity) provides conceptual clarity and enables closer analysis of each mechanism. CONCLUSIONS Governments can improve health and wellbeing by making informed decisions about the way they purchase and fund alcohol and other drug treatment. Research comparing different purchasing arrangements can provide a vital evidence-base to inform funders; however a first step is to accurately and consistently categorise current approaches against a typology or conceptual schema.
Collapse
|
5
|
Alanis-Hirsch K, Croff R, Ford JH, Johnson K, Chalk M, Schmidt L, McCarty D. Extended-Release Naltrexone: A Qualitative Analysis of Barriers to Routine Use. J Subst Abuse Treat 2015; 62:68-73. [PMID: 26654934 DOI: 10.1016/j.jsat.2015.10.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 10/02/2015] [Accepted: 10/22/2015] [Indexed: 11/30/2022]
Abstract
The Medication Research Partnership (a national health plan and nine addiction treatment centers contracted with the health plan) sought to facilitate the adoption of pharmacotherapy for alcohol and opioid use disorders. Qualitative analysis of interviews with treatment center change leaders, individuals working for the manufacturer and its technical assistance contractor, and health plan managers extracted details on the processes used to order, store, bill for, and administer extended-release naltrexone. Qualitative themes were categorized using domains from the Consolidated Framework for Implementation Research (intervention characteristics, outer setting, inner setting, and provider characteristics). Characteristics of XR-NTX that inhibited use included the complexity of ordering and using the medication; cost was also a barrier. Outer setting barriers reflected patient needs and external health plan policies on formulary coverage, benefit management, and reimbursement. Program structures, the lack of physician linkages, a culture resistant to the use of medication, and unease with change were inner setting elements that limited use of XR-NTX. Patient stereotypes and a lack of knowledge about XR-NTX affected practitioner willingness to treat patients and prescribe XR-NTX. The Consolidated Framework for Implementation Research provided a useful lens to understand and interpret the processes affecting access to XR-NTX.
Collapse
Affiliation(s)
| | - Raina Croff
- OHSU-PSU School of Public Health, Oregon Health & Science University
| | - James H Ford
- Center for Health Systems Research and Analysis, University of Wisconsin-Madison
| | - Kim Johnson
- Center for Health Enhancement System Studies, University of Wisconsin-Madison
| | - Mady Chalk
- Policy Center, Treatment Research Institute
| | - Laura Schmidt
- Philip R. Lee Institute for Health Policy Studies and Department of Anthropology, History and Social Medicine, University of California at San Francisco
| | - Dennis McCarty
- OHSU-PSU School of Public Health, Oregon Health & Science University.
| |
Collapse
|
6
|
Robertson A, Walker CS, Stovall M, McCluskey L. Use of evidence-based substance use treatment practices in Mississippi. EVALUATION AND PROGRAM PLANNING 2015; 52:198-204. [PMID: 26151861 DOI: 10.1016/j.evalprogplan.2015.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 06/02/2015] [Accepted: 06/07/2015] [Indexed: 06/04/2023]
Abstract
Over the past decade, substance abuse treatment professionals have begun to implement evidence-based practices (EBPs) into the treatment of substance use disorders. There is a growing body of research on the diffusion of EBP in addiction treatment; however, less is known about individual state initiatives to implement EBPs among community providers. The current study aimed to evaluate the progress of an initiative of the Mississippi Department of Mental Health (MDMH) to increase the implementation of evidence-based substance abuse treatment practices by certified providers. In addition, the study examines potential barriers to implementing these practices. To accomplish this goal, we reported the findings of two surveys of Mississippi addiction professionals conducted in 2010 and in 2013.
Collapse
Affiliation(s)
- Angela Robertson
- Social Science Research Center, Mississippi State University, 1 Research Blvd., Suite 103, Starkville, MS 39759, United States.
| | - Courtney S Walker
- Social Science Research Center, Mississippi State University, 1 Research Blvd., Suite 103, Starkville, MS 39759, United States.
| | - Mark Stovall
- Mississippi Department of Mental Health, Bureau of Alcohol and Drug Services, 801 Robert E. Lee Building, 239 North Lamar Street, Jackson, MS 39201, United States.
| | - Lee McCluskey
- Social Science Research Center, Mississippi State University, 1 Research Blvd., Suite 103, Starkville, MS 39759, United States.
| |
Collapse
|
7
|
Ahamad K, Milloy MJ, Nguyen P, Uhlmann S, Johnson C, Korthuis TP, Kerr T, Wood E. Factors associated with willingness to take extended release naltrexone among injection drug users. Addict Sci Clin Pract 2015; 10:12. [PMID: 25935714 PMCID: PMC4636793 DOI: 10.1186/s13722-015-0034-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 04/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although opioid-agonist therapy with methadone or buprenorphine/naloxone is currently the mainstay of medical treatment for opioid use disorder, these medications often are not well accepted or tolerated by patients. Recently, extended release naltrexone (XR-NTX), an opioid antagonist, has been advanced as an alternative treatment. The willingness of opioid-addicted patients to take XR-NTX has not been well described. METHODS Opioid-using persons enrolled in a community-recruited cohort in Vancouver, Canada, were asked whether or not they would be willing to take XR-NTX. Logistic regression was used to independently identify factors associated with willingness to take the medication. RESULTS Among the 657 participants surveyed between June 1, 2013, and November 30, 2013, 342 (52.1%) were willing to take XR-NTX. One factor positively associated with willingness was daily heroin injection (adjusted odds ratio [AOR] = 1.53; 95% confidence interval [CI] = 1.02-2.31), whereas Caucasian ethnicity was negatively associated (AOR = 0.59; 95% CI = 0.43-0.82). Satisfaction with agonist therapy (13.4%) and unwillingness to stop opioids being used for pain (26.9%) were the most common reasons for being unwilling to take XR-NTX. CONCLUSIONS A high level of willingness to take XR-NTX was observed in this setting. Interestingly, daily injection heroin use was positively associated with willingness, whereas Caucasian participants were less willing to take XR-NTX. Although explanations for unwillingness were described in this study, further research is needed to investigate real-world acceptability of XR-NTX as an additional option for the treatment of opioid use disorder.
Collapse
Affiliation(s)
- Keith Ahamad
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Department of Family Practice, University of British Columbia, 5950 University Boulevard Street, Vancouver, BC, V6T 1Z3, Canada.
| | - M J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Paul Nguyen
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Sasha Uhlmann
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Cheyenne Johnson
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Todd P Korthuis
- Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
- Department of Public Health-Preventive Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Department of Medicine, University of British Columbia, 10th Floor 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
- Division of Epidemiology and Population Health, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| |
Collapse
|
8
|
Knudsen HK, Roman PM. Service delivery and pharmacotherapy for alcohol use disorder in the era of health reform: Data from a national sample of treatment organizations. Subst Abus 2015; 37:230-7. [PMID: 25893539 DOI: 10.1080/08897077.2015.1028699] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although there is a growing literature examining organizational characteristics and medication adoption, little is known about service delivery differences between specialty treatment organizations that have and have not adopted pharmacotherapy for alcohol use disorder (AUD). This study compares adopters and nonadopters across a range of treatment services, including levels of care, availability of tailored services for specific populations, treatment philosophy and counseling orientations, and adoption of comprehensive wraparound services. METHODS In-person interviews were conducted with program leaders from a national sample of 372 organizations that deliver AUD treatment services in the United States. RESULTS About 23.6% of organizations had adopted at least 1 AUD medication. Organizations offering pharmacotherapy were similar to nonadopters across many measures of levels of care, tailored services, treatment philosophy, and social services. The primary area of difference between the 2 groups was for services related to health problems other than AUD. Pharmacotherapy adopters were more likely to offer primary medical care, medications for smoking cessation, and services to address co-occurring psychiatric conditions. CONCLUSIONS Service delivery differences were modest between adopters and nonadopters of AUD pharmacotherapy, with the exception of health-related services. However, the greater adoption of health-related services by organizations offering AUD pharmacotherapy represents greater medicalization of treatment, which may mean these programs are more strongly positioned to respond to opportunities for integration under health reform.
Collapse
Affiliation(s)
- Hannah K Knudsen
- a Department of Behavioral Science and Center on Drug and Alcohol Research , University of Kentucky , Lexington , Kentucky , USA
| | - Paul M Roman
- b Owens Institute for Behavioral Research and Department of Sociology , University of Georgia , Athens , Georgia , USA
| |
Collapse
|
9
|
Molfenter T, Sherbeck C, Zehner M, Quanbeck A, McCarty D, Kim JS, Starr S. Implementing buprenorphine in addiction treatment: payer and provider perspectives in Ohio. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2015; 10:13. [PMID: 25884206 PMCID: PMC4395880 DOI: 10.1186/s13011-015-0009-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 03/11/2015] [Indexed: 11/16/2022]
Abstract
Background Buprenorphine is under-utilized in treating opioid addiction. Payers and providers both have substantial influence over the adoption and use of this medication to enhance recovery. Their views could provide insights into the barriers and facilitators in buprenorphine adoption. Methods We conducted individual interviews with 18 Ohio county Alcohol, Drug Addiction, and Mental Health Services (ADAMHS) Boards (payers) and 36 addiction treatment centers (providers) to examine barriers and facilitators to buprenorphine use. Transcripts were reviewed, coded, and qualitatively analyzed. First, we examined reasons that county boards supported buprenorphine use. A second analysis compared county boards and addiction treatment providers on perceived barriers and facilitators to buprenorphine use. The final analysis compared county boards with low and high use of buprenorphine to determine how facilitators and barriers differed between those settings. Results County boards (payers) promoted buprenorphine use to improve clinical care, reduce opioid overdose deaths, and prepare providers for participation in integrated models of health care delivery with primary care clinics and hospitals. Providers and payers shared many of the same perceptions of facilitators and barriers to buprenorphine use. Common facilitators identified were knowledge of buprenorphine benefits, funds allocated to purchase buprenorphine, and support from the criminal justice system. Common barriers were negative attitudes toward use of agonist pharmacotherapy, payment environment, and physician prescribing capacity. County boards with low buprenorphine use rates cited negative attitudes toward use of agonist medication as a primary barrier. County boards with high rates of buprenorphine use dedicated funds to purchase buprenorphine in spite of concerns about limited physician prescribing capacity. Conclusions This qualitative analysis found that attitudes toward use of medication and medication funding environment play important roles in an organization’s decision to begin buprenorphine use and that physician availability influences an organization’s ability to expand buprenorphine use over time. Additional education, reimbursement support, and policy changes are needed to support buprenorphine adoption and use, along with a greater understanding of the roles payers, providers, and regulators play in the adoption of targeted practices.
Collapse
Affiliation(s)
- Todd Molfenter
- University of Wisconsin-Madison, 1513 University Avenue, Madison, Wisconsin, 53706, USA.
| | - Carol Sherbeck
- University of Wisconsin-Madison, 1513 University Avenue, Madison, Wisconsin, 53706, USA.
| | - Mark Zehner
- University of Wisconsin-Madison, 1513 University Avenue, Madison, Wisconsin, 53706, USA.
| | - Andy Quanbeck
- University of Wisconsin-Madison, 1513 University Avenue, Madison, Wisconsin, 53706, USA.
| | - Dennis McCarty
- Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, Oregon, 97239-3098, USA.
| | - Jee-Seon Kim
- University of Wisconsin-Madison, School of Education, 1057 Educational Sciences, Madison, WI, 53706, USA.
| | - Sandy Starr
- Ohio Department of Mental Health and Addiction Services (OhioMHAS), 30 East Broad Street, 8th Floor, Columbus, Ohio, 43215, USA.
| |
Collapse
|
10
|
Knudsen HK, Roman PM. The transition to medication adoption in publicly funded substance use disorder treatment programs: organizational structure, culture, and resources. J Stud Alcohol Drugs 2014; 75:476-85. [PMID: 24766760 DOI: 10.15288/jsad.2014.75.476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Medications for the treatment of substance use disorders (SUDs) are not widely available in publicly funded SUD treatment programs. Few studies have drawn on longitudinal data to examine the organizational characteristics associated with programs transitioning from not delivering any pharmacotherapy to adopting at least one SUD medication. METHOD Using two waves of panel longitudinal data collected over a 5-year period, we measured the transition to medication adoption in a cohort of 190 publicly funded treatment organizations that offered no SUD medications at baseline. Independent variables included organizational characteristics, medical resources, funding, treatment culture, and detailing activities by pharmaceutical companies. RESULTS Of 190 programs not offering SUD pharmacotherapy at baseline, 22.6% transitioned to offering at least one SUD medication at follow-up approximately 5 years later. Multivariate logistic regression results indicated that the employment of at least one physician at baseline, having a greater proportion of Medicaid clients, and pharmaceutical detailing were positively associated with medication adoption. CONCLUSIONS Adoption of pharmacotherapy was more likely in programs that had greater medical resources, Medicaid funding, and contact with pharmaceutical companies. Given the potential expansion of Medicaid under the Affordable Care Act, patients served by publicly funded programs may gain greater access to such treatments, but research is needed to document health reform's impact on this sector of the treatment system.
Collapse
Affiliation(s)
- Hannah K Knudsen
- Department of Behavioral Science, University of Kentucky, Lexington, Kentucky
| | - Paul M Roman
- Owens Institute for Behavioral Research and Department of Sociology, University of Georgia, Athens, Georgia
| |
Collapse
|
11
|
Heinrich CJ, Cummings GR. Adoption and diffusion of evidence-based addiction medications in substance abuse treatment. Health Serv Res 2014; 49:127-52. [PMID: 23855719 PMCID: PMC3922470 DOI: 10.1111/1475-6773.12093] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine the roles of facility- and state-level factors in treatment facilities' adoption and diffusion of pharmaceutical agents used in addiction treatment. DATA SOURCES Secondary data from the National Survey of Substance Abuse Treatment Services (N-SSATS), Substance Abuse and Mental Health Services Administration (SAMHSA), Centers for Medicare and Medicaid Services, Alcohol Policy Information System, and Kaiser Family Foundation. STUDY DESIGN We estimate ordered logit and multinomial logit models to examine the relationship of state and treatment facility characteristics to the adoption and diffusion of three pharmaceutical agents over 4 years when each was at a different stage of adoption or diffusion. DATA COLLECTION N-SSATS data with facility codes, obtained directly from SAMHSA, were linked by state identifiers to the other publicly available, secondary data. PRINCIPAL FINDINGS The analysis confirms the importance of awareness and exposure to the adoption behavior of others, dissemination of information about the feasibility and effectiveness of innovations, geographical clustering, and licensing and accreditation in legitimizing facilities' adoption and continued use of pharmacotherapies in addiction treatment. CONCLUSIONS Policy and administrative levers exist to increase the availability of pharmaceutical technologies and their continued use by substance abuse treatment facilities.
Collapse
Affiliation(s)
- Carolyn J Heinrich
- Address correspondence to Carolyn J. Heinrich, Ph.D., Professor, Lyndon B. Johnson School of Public Affairs and Department of Economics, The University of Texas at Austin, P.O. Box Y, Austin, TX 78713-8925; e-mail: . Grant R. Cummings,MPA, is with the Wisconsin Legislative Fiscal Bureau, Madison, WI
| | | |
Collapse
|
12
|
Wessell AM, Nemeth LS, Jenkins RG, Ornstein SM, Miller PM. Medications for Alcohol Use Disorders in a Primary Care Practice-Based Research Network Implementation Study. ALCOHOLISM TREATMENT QUARTERLY 2014. [DOI: 10.1080/07347324.2014.856224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
13
|
Abraham AJ, Knudsen HK, Rieckmann T, Roman PM. Disparities in access to physicians and medications for the treatment of substance use disorders between publicly and privately funded treatment programs in the United States. J Stud Alcohol Drugs 2013; 74:258-65. [PMID: 23384373 PMCID: PMC3568164 DOI: 10.15288/jsad.2013.74.258] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 10/28/2012] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Prior research suggests that publicly funded substance use disorder (SUD) treatment programs lag behind privately funded programs in adoption of evidence-based practices, resulting in disparities in access to high-quality SUD treatment. These disparities highlight a critical public health concern because the majority of SUD patients in the United States are treated in the publicly funded treatment sector. This study uses recent data to examine disparities in access to physicians and availability of medications for the treatment of SUDs between publicly and privately funded SUD treatment programs. METHOD Data were collected from 595 specialty SUD treatment programs from 2007 to 2010 via face-to-face interviews, mailed surveys, and telephone interviews with treatment program administrators. RESULTS Publicly funded programs were less likely than privately funded programs to have a physician on staff, even after controlling for several organizational characteristics that were associated with access to physicians. The results of negative binomial regression indicated that, even after taking into account physician access and other organizational variables, publicly funded programs prescribed fewer SUD medications than privately funded SUD treatment programs. CONCLUSIONS Patients seeking treatment in publicly funded treatment programs continue to face disparities in access to high-quality SUD treatment that supports patients' choices among a range of medication options. However, implementation of the Affordable Care Act may facilitate greater access to physicians and use of medications in publicly funded SUD treatment programs.
Collapse
Affiliation(s)
- Amanda J Abraham
- Department of Health Services Policy and Management, University of South Carolina, Columbia, South Carolina 29208, USA.
| | | | | | | |
Collapse
|
14
|
Collao JF, Smith F, Barber N. Selection of medicines in Chilean public hospitals: an exploratory study. BMC Health Serv Res 2013; 13:10. [PMID: 23294543 PMCID: PMC3542206 DOI: 10.1186/1472-6963-13-10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 12/26/2012] [Indexed: 11/10/2022] Open
Abstract
Background There is a growing interest in high income countries to control expenditure on medicines by improving the rationale for their selection. However, in middle income countries with differing priorities and needs, little attention has been paid to this issue. In this paper we explore the policies and processes for the selection and use of medicines in a group of hospitals in Chile, a middle income country which has recently joined the OECD. Methods A combination of qualitative and quantitative methods was used. A national survey questionnaire was distributed to investigate the role and operation of PTCs (Pharmacy and Therapeutics Committees). Interviews were conducted with key actors in the selection of medicines in large urban public hospitals. Results The national survey had an overall response rate of 42% (83 out of 196), whilst 7 out of 14 hospitals participated in the qualitative study. High complexity hospitals are large urban hospitals; all of which claim to have a working PTC. The pharmacy offices are mainly involved in dispensing medicines with little involvement in clinical duties. The interviews conducted suggest that the formulary of all the hospitals visited is no more than a stock list. PTCs are unable to influence the prescribing practices of doctors. Members do not feel prepared to challenge the opinions of specialists requesting a certain drug, and decisions are based primarily on costs. The inclusion of medicines in the clinical practice of hospitals is as a result of doctors bypassing the PTC and requesting the purchase of exceptional items, some of which are included in the formulary if they are widely used. Conclusions There is an urgent need to develop medicine policies in hospitals in Chile. The procedures used to purchase medicines need to be revised. Central guidance for PTCs could help ensure a more rational use of medicines. PTCs need to be empowered to design formularies which cover all the clinical needs of doctors, training members in the analysis of scientific evidence beyond their own specialities. An influential PTC can take the appropriate measures and design workable policies to enforce a cost effective-use of resources.
Collapse
Affiliation(s)
- Juan F Collao
- Departamento de Ciencias Farmacéuticas, Facultad de Farmacia, Universidad de Valparaíso, Gran Bretaña 1093, Valparaíso, Chile.
| | | | | |
Collapse
|
15
|
Savage SA, Abraham AJ, Knudsen HK, Rothrauff TC, Roman PM. Timing of buprenorphine adoption by privately funded substance abuse treatment programs: the role of institutional and resource-based interorganizational linkages. J Subst Abuse Treat 2012; 42:16-24. [PMID: 21831565 PMCID: PMC3225636 DOI: 10.1016/j.jsat.2011.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 06/21/2011] [Accepted: 06/22/2011] [Indexed: 11/17/2022]
Abstract
Identifying facilitators of more rapid buprenorphine adoption may increase access to this effective treatment for opioid dependence. Using a diffusion of innovations theoretical framework, we examine the extent to which programs' interorganizational institutional and resource-based linkages predict the likelihood of being an earlier adopter, later adopter, or nonadopter of buprenorphine. Data were derived from face-to-face interviews with administrators of 345 privately funded substance abuse treatment programs in 2007-2008. Results of multinomial logistic regression models show that interorganizational and resource linkages were associated with timing of adoption. Programs reporting membership in provider associations were more likely to be earlier adopters of buprenorphine. Programs that relied more on resource linkages, such as detailing activities by pharmaceutical companies and the National Institute on Drug Abuse website, were more likely to be earlier adopters of buprenorphine. These findings suggest that institutional and resource-based interorganizational linkages may expose programs to effective treatments, thereby facilitating more rapid and sustained adoption of innovative treatment techniques.
Collapse
Affiliation(s)
| | - Amanda J. Abraham
- Institute for Behavioral Research, University of Georgia
- Department of Sociology, University of Georgia
| | - Hannah K. Knudsen
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky
| | | | - Paul M. Roman
- Institute for Behavioral Research, University of Georgia
- Department of Sociology, University of Georgia
| |
Collapse
|
16
|
Rieckmann TR, Kovas AE, McFarland BH, Abraham AJ. A multi-level analysis of counselor attitudes toward the use of buprenorphine in substance abuse treatment. J Subst Abuse Treat 2011; 41:374-85. [PMID: 21821379 PMCID: PMC3486698 DOI: 10.1016/j.jsat.2011.05.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 05/13/2011] [Accepted: 05/16/2011] [Indexed: 11/16/2022]
Abstract
Despite evidence that buprenorphine is effective and safe and offers greater access as compared with methadone, implementation for treatment of opiate dependence continues to be weak. Research indicates that legal and regulatory factors, state policies, and organizational and provider variables affect adoption of buprenorphine. This study uses hierarchical linear modeling to examine National Treatment Center Study data to identify counselor characteristics (attitudes, training, and beliefs) and organizational factors (accreditation, caseload, access to buprenorphine, and other evidence-based practices) that influence implementation of buprenorphine for treatment of opiate dependence. Analyses showed that provider training about buprenorphine, higher prevalence of opiate-dependent clients, and less treatment program emphasis on a 12-step model predicted greater counselor acceptance and perceived effectiveness of buprenorphine. Results also indicate that program use of buprenorphine for any treatment purpose (detoxification, maintenance, and/or pain management) and time (calendar year in data collection) was associated with increased diffusion of knowledge about buprenorphine among counselors and with more favorable counselor attitudes toward buprenorphine.
Collapse
Affiliation(s)
- Traci R Rieckmann
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR 97239, USA.
| | | | | | | |
Collapse
|
17
|
Facilitating factors and barriers to the use of medications in publicly funded addiction treatment organizations. J Addict Med 2011; 4:99-107. [PMID: 20835350 DOI: 10.1097/adm.0b013e3181b41a32] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Publicly funded addiction treatment organizations have been slow to adopt pharmacotherapies. Few studies have examined the organizational factors associated with adoption of different types of medication in this treatment sector. This study identifies organization-level facilitators and barriers to the use of medications in publicly funded addiction treatment organizations. METHODS Face-to-face interviews with a sample of 318 administrators of a representative sample of publicly funded addiction treatment centers in the US. RESULTS Only 23.4% of programs reported using any of the five FDA-approved pharmacotherapies for treating addiction. An additional 14.3% of programs only used medications approved for the treatment of psychiatric disorders. Multivariate multinomial logistic regression results revealed that the odds of adoption of addiction pharmacotherapies were significantly greater in government-owned programs and in programs with more medical personnel. Programs that relied more heavily on non-Medicaid public funding tended to be less likely to adopt addiction treatment medications. Greater contact with pharmaceutical representatives was positively associated with medication adoption. CONCLUSIONS Current public funding policies and lack of access to medical personnel are barriers to the adoption of medications by publicly funded addiction treatment organizations. Efforts to promote adoption may also benefit from greater detailing activities by pharmaceutical representatives. These findings suggest that the large research investment devoted to developing addiction treatment medications may have limited public health impact due to the characteristics of publicly funded service delivery system as well as the limited attention given to this system by commercial purveyors of medications.
Collapse
|
18
|
Abstract
OBJECTIVES Little is known about the extent to which medications are being implemented as routine care in addiction treatment programs. This research describes medication adoption and implementation within the privately funded treatment sector. METHODS Face-to-face interviews were conducted with 345 administrators of a nationally representative sample of privately funded substance treatment organizations in the United States. RESULTS Rates of adoption of addiction treatment medications in private sector programs were lower than the adoption of psychiatric medications. Even when analyses were restricted to programs with access to physicians, adoption of each addiction treatment medication had occurred in less than 50% of programs. Within adopting programs, implementation was highly variable. While about 70% of patients with co-occurring psychiatric diagnoses received psychiatric medications, rates of implementation of medication-assisted treatment for opioid dependence and alcohol use disorders were just 34.4% and 24.0%, respectively. CONCLUSIONS Although previous research has documented higher rates of medication adoption in privately funded treatment programs, this study revealed that both adoption and implementation of pharmacotherapies to treat addiction remains modest. Future research should examine the different types of barriers to implementation, such as physician decision-making, patient preferences, and system-level barriers stemming from financing and public policy.
Collapse
|
19
|
Abraham AJ, Knudsen HK, Roman PM. A longitudinal examination of alcohol pharmacotherapy adoption in substance use disorder treatment programs: patterns of sustainability and discontinuation. J Stud Alcohol Drugs 2011; 72:669-77. [PMID: 21683049 PMCID: PMC3125890 DOI: 10.15288/jsad.2011.72.669] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The objectives of this study were to (a) identify the patterns of disulfiram (Antabuse) and tablet naltrexone (Revia) adoption over a 48-month period in a nationally representative sample of privately funded programs that deliver substance use disorder treatment; (b) examine predictors of sustainability, later adoption, discontinuation, and nonadoption of disulfiram and tablet naltrexone; and (c) measure reasons for medication discontinuation. METHOD Two waves of data were collected via face-to-face structured interviews with 223 program administrators. RESULTS These data demonstrated that adoption of medications for alcohol use disorders (AUDs) was a dynamic process. Although nonadoption was the most common pattern, approximately 20% of programs sustained use of the AUD medications and 30% experienced organizational change in adoption over the study period. Bivariate multinomial logistic regression models revealed that organizational characteristics were associated with sustainability including location in a hospital setting, program size, accreditation, revenues from private insurance, referrals from the criminal justice system, number of medical staff, and use of selective serotonin reuptake inhibitors at baseline. Two patterns of discontinuation were found: Programs either discontinued use of all substance use disorder medications or replaced disulfiram/tablet naltrexone with a newer AUD medication. CONCLUSIONS These findings suggest that adoption of AUD medications may be positively affected by pressure from accreditation bodies, partnering with primary care physicians, medication-specific training for medical staff, greater availability of resources to cover the costs associated with prescribing AUD medications, and amending criminal justice contracts to include support for AUD medication use.
Collapse
Affiliation(s)
- Amanda J. Abraham
- Correspondence may be sent to Amanda J. Abraham at the above address or via email at: . Amanda J. Abraham and Paul M. Roman are also with the Department of Sociology, University of Georgia, Athens, GA. Hannah K. Knudsen is with the Department of Behavioral Science and Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, Lexington, KY
| | - Hannah K. Knudsen
- Correspondence may be sent to Amanda J. Abraham at the above address or via email at: . Amanda J. Abraham and Paul M. Roman are also with the Department of Sociology, University of Georgia, Athens, GA. Hannah K. Knudsen is with the Department of Behavioral Science and Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, Lexington, KY
| | - Paul M. Roman
- Correspondence may be sent to Amanda J. Abraham at the above address or via email at: . Amanda J. Abraham and Paul M. Roman are also with the Department of Sociology, University of Georgia, Athens, GA. Hannah K. Knudsen is with the Department of Behavioral Science and Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, Lexington, KY
| |
Collapse
|
20
|
Abstract
Extended-release naltrexone (XR-NTX; Vivitrol), developed to address poor adherence in addictive disorders, is approved for use in alcohol and opioid-dependence disorders. In alcohol-dependent adults with ≥ 4-day initial abstinence, XR-NTX increased initial and 6-month abstinence. An fMRI study found that XR-NTX attenuated the salience of alcohol visual and olfactory cues in the absence of alcohol, and post hoc analyses demonstrated efficacy even during high cue-exposure holiday periods. Safety and tolerability have generally been good, without adverse hepatic impact or intractable acute pain management. XR-NTX use appears feasible in primary care and public systems, and retrospective claims analyses have found cost savings and decreased intensive service utilization relative to oral agents. In opioid dependence, following detoxification, XR-NTX shows efficacy for maintaining abstinence, improving retention, decreasing craving, and preventing relapse. Trials are also exploring its use for the treatment of stimulant dependence. XR-NTX appears compatible with counseling and self-help attendance. While more research is needed, current findings suggest that a formulation of naltrexone that was sought beginning over three decades ago is fulfilling its promise as an extended-release pharmacotherapeutic.
Collapse
|
21
|
Abraham AJ, Rieckmann T, McNulty T, Kovas AE, Roman PM. Counselor attitudes toward the use of naltrexone in substance abuse treatment: a multi-level modeling approach. Addict Behav 2011; 36:576-583. [PMID: 21382667 DOI: 10.1016/j.addbeh.2011.01.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Accepted: 01/20/2011] [Indexed: 11/17/2022]
Abstract
Alcohol use disorders (AUDs) continue to be one of the most pervasive and costly of the substance use disorders (SUDs). Despite evidence of clinical effectiveness, adoption of medications for the treatment of AUDs is suboptimal. Low rates of AUD medication adoption have been explained by characteristics of both treatment organizations and individual counselor's attitudes and behaviors. However, few studies have simultaneously examined the impact of organizational-level and counselor-level characteristics on counselor perceptions of EBPs. To address this gap in the literature, we use data from a national sample of 1178 counselors employed in 209 privately funded treatment organizations to examine the effects of organizational and individual counselor characteristics on counselor attitudes toward tablet and injectable naltrexone. Results of hierarchical linear modeling (HLM) show that organizational characteristics (use of tablet/injectable naltrexone in the program, 12-step orientation) were associated with counselor perceptions of naltrexone. Net of organizational characteristics, several counselor level characteristics were associated with attitudes toward tablet and injectable naltrexone including gender, tenure in the field, recovery status, percentage of AUD patients, and receipt of medication-specific training. These findings reveal that counselor receptiveness toward naltrexone is shaped in part by the organizational context in which counselors are embedded.
Collapse
Affiliation(s)
- Amanda J Abraham
- Institute for Behavioral Research, Center for Research on Behavioral Health and Human Services Delivery, University of Georgia, 112 Barrow Hall, Athens, GA 30602, USA; Department of Sociology, University of Georgia, Athens, GA 30602, USA.
| | - Traci Rieckmann
- Department of Public Health and Preventative Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Thomas McNulty
- Department of Sociology, University of Georgia, Athens, GA 30602, USA
| | - Anne E Kovas
- Department of Public Health and Preventative Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Paul M Roman
- Institute for Behavioral Research, Center for Research on Behavioral Health and Human Services Delivery, University of Georgia, 112 Barrow Hall, Athens, GA 30602, USA; Department of Sociology, University of Georgia, Athens, GA 30602, USA
| |
Collapse
|
22
|
Thomas CP, Garnick DW, Horgan CM, McCorry F, Gmyrek A, Chalk M, Gastfriend DR, Rinaldo SG, Albright J, Capoccia VA, Harris AHS, Harwood HJ, Greenberg P, Mark TL, Un H, Oros M, Stringer M, Thatcher J. Advancing performance measures for use of medications in substance abuse treatment. J Subst Abuse Treat 2011; 40:35-43. [PMID: 20934836 PMCID: PMC2997925 DOI: 10.1016/j.jsat.2010.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 08/07/2010] [Accepted: 08/11/2010] [Indexed: 11/16/2022]
Abstract
Performance measures have the potential to drive high-quality health care. However, technical and policy challenges exist in developing and implementing measures to assess substance use disorder (SUD) pharmacotherapy. Of critical importance in advancing performance measures for use of SUD pharmacotherapy is the recognition that different measurement approaches may be needed in the public and private sectors and will be determined by the availability of different data collection and monitoring systems. In 2009, the Washington Circle convened a panel of nationally recognized insurers, purchasers, providers, policy makers, and researchers to address this topic. The charge of the panel was to identify opportunities and challenges in advancing use of SUD pharmacotherapy performance measures across a range of systems. This article summarizes those findings by identifying a number of critical themes related to advancing SUD pharmacotherapy performance measures, highlighting examples from the field, and recommending actions for policy makers.
Collapse
Affiliation(s)
- Cindy Parks Thomas
- Brandeis University, Institute for Behavioral Health, Heller School for Social Policy and Management, Waltham, MA 02454, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Impact of Treatment With Intramuscular, Injectable, Extended-Release Naltrexone on Counseling and Support Group Participation in Patients With Alcohol Dependence. J Addict Med 2010; 4:181-5. [DOI: 10.1097/adm.0b013e3181c82207] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
24
|
Rieckmann T, Kovas AE, Rutkowski BA. Adoption of medications in substance abuse treatment: priorities and strategies of single state authorities. J Psychoactive Drugs 2010; Suppl 6:227-38. [PMID: 21138199 PMCID: PMC3640346 DOI: 10.1080/02791072.2010.10400546] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Research has confirmed the effectiveness of medications, when used in conjunction with ongoing counseling, to treat substance abuse disorders. This article describes a national, mixed-methods research project designed to investigate single state authorities' (SSAs) perceptions of adoption of evidence-based practices in substance abuse treatment. Results are focused specifically on medication-assisted treatment, one of five evidence-based practices defined by the National Quality Forum. Medication-assisted treatment (MAT) is an important and effective part of comprehensive care options available to clients who are chronically ill with alcohol and other drug disorders. Despite mounting clinical evidence and increased availability, overall rates of implementation and sustained adoption of medications to treat addiction remain limited. The results illustrate that the SSA representatives who fund public treatment programs believe MAT is a priority and worthy of system-wide implementation. Current strategies utilized by SSAs to support the adoption of MAT are detailed, as are barriers to adoption and implementation.
Collapse
Affiliation(s)
- Traci Rieckmann
- Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR 97239, USA.
| | | | | |
Collapse
|
25
|
4-Hydroxy-2-quinolones. 174.* Hydrochlorides of [(alkylamino)alkyl]amides of 1-allyl- 4-hydroxy-6,7-dimethoxy-2-oxo-1,2-dihydro- quinoline-3-carboxylic acid – a new class of opioid receptor antagonists. Chem Heterocycl Compd (N Y) 2010. [DOI: 10.1007/s10593-010-0529-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
26
|
Abraham AJ, Roman PM. Early adoption of injectable naltrexone for alcohol-use disorders: findings in the private-treatment sector. J Stud Alcohol Drugs 2010; 71:460-6. [PMID: 20409441 DOI: 10.15288/jsad.2010.71.460] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The U.S. substance-abuse treatment system has been slow to adopt medications for the treatment of alcohol-use disorders (AUDs). The objectives of this study are to (a) determine how the inherent characteristics of injectable naltrexone (i.e., relative advantage, complexity, trialability, observability, compatibility) shape organizational-level decisions to adopt the medication and (b) identify key predictors of adoption and barriers that impede adoption. METHOD This study uses data from a nationally representative sample of 345 privately funded U.S. substance-abuse treatment programs to examine adoption (current use) of injectable naltrexone. RESULTS Sixteen percent of private treatment programs are early adopters of injectable naltrexone. Multivariate logistic regression models reveal that organizational size and percentage of patients paying with private insurance are significant predictors of adoption. The most salient predictor of adoption is innovation compatibility, measured by program use of other AUD pharmacotherapies. Barriers to adoption include cost, lack of access to prescribing physicians, and lack of knowledge about the medication. Injectable naltrexone, however, is addressing the patient compliance barrier, demonstrated by 70% of patients receiving at least 2 months of medication. CONCLUSIONS The adoption of AUD pharmacotherapies remains low, with only half of the sampled programs prescribing any AUD pharmacotherapies. Patterns of early adoption of injectable naltrexone are, however, promising. Results highlight innovation compatibility and relative advantage as explanations of organizational decisions to adopt injectable naltrexone. Future research will move beyond issues of adoption and provide a more detailed examination of the implementation process.
Collapse
Affiliation(s)
- Amanda J Abraham
- Institute for Behavioral Research, 112 Barrow Hall, University of Georgia, Athens, Georgia 30602-2401, USA.
| | | |
Collapse
|
27
|
Abraham AJ, Knudsen HK, Rothrauff TC, Roman PM. The adoption of alcohol pharmacotherapies in the Clinical Trials Network: the influence of research network participation. J Subst Abuse Treat 2010; 38:275-83. [PMID: 20117908 DOI: 10.1016/j.jsat.2010.01.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Revised: 12/14/2009] [Accepted: 01/04/2010] [Indexed: 11/27/2022]
Abstract
Organizational participation in clinical research may lead to adoption of the intervention by treatment agencies, but it is not known whether research involvement enhances innovativeness beyond the specific interventions that are tested. The National Institute on Drug Abuse's Clinical Trials Network (CTN) is a platform for considering this research question. To date, the CTN has not conducted research on medications for alcohol use disorders (AUDs), so greater adoption of innovative AUD pharmacotherapies by CTN-affiliated programs would suggest an added value of research network participation. Using longitudinal data from a pooled sample of CTN and non-CTN publicly funded treatment programs, we investigate adoption of tablet naltrexone and acamprosate over a 2-year period. CTN-affiliated programs were more likely to have adopted tablet naltrexone and acamprosate at 24-month follow-up, net of the effects of a range of organizational characteristics. Research network participation may thus enhance organizational innovativeness to include interventions beyond the scope of the network.
Collapse
Affiliation(s)
- Amanda J Abraham
- Center for Research on Behavioral Health and Human Services Delivery, University of Georgia, Athens, GA 30602-2401, USA.
| | | | | | | |
Collapse
|
28
|
Abraham AJ, Ducharme LJ, Roman PM. Counselor attitudes toward pharmacotherapies for alcohol dependence. J Stud Alcohol Drugs 2009; 70:628-35. [PMID: 19515305 DOI: 10.15288/jsad.2009.70.628] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Addiction treatment counselors play a central role in the dissemination of information about new treatment techniques to alcohol-dependent patients and are key in the implementation of new treatment technologies. Building on previous research, this study examines counselors' perceptions of the effectiveness and acceptability of pharmacotherapies for the treatment of alcohol dependence. METHOD Mail questionnaires were received from 1,140 counselors employed in a nationally representative sample of public-sector addiction treatment programs in 2006. Counselors answered a series of questions about three U.S. Food and Drug Administration (FDA)-approved medications used in the treatment of alcohol dependence (disulfiram [Antabuse], tablet naltrexone [Revia], and acamprosate [Campral]), indicating their extent of familiarity with the medication, its perceived effectiveness in the treatment of alcohol dependence, and its acceptability for use with alcohol-dependent patients. RESULTS The extent of diffusion of these pharmacotherapies was associated with time since FDA approval. Counselors reported receiving little or no pharmacotherapy-specific training. Multivariate models showed that the receipt of medication-specific training as well as indirect observation of the medication's use in the treatment program were significantly associated with diffusion of information about these pharmacotherapies and counselors' perceptions of the effectiveness and acceptability of the medications for use in addiction treatment. CONCLUSIONS When exposed to information about medications to treat alcohol dependence, counseling staff appear quite receptive. More efforts are needed to disseminate information about alcohol pharmacotherapies to front-line addiction treatment staff.
Collapse
Affiliation(s)
- Amanda J Abraham
- Institute for Behavioral Research, 112 Barrow Hall, University of Georgia, Athens, GA 30602-2401, USA.
| | | | | |
Collapse
|
29
|
Oser CB, Knudsen HK, Staton-Tindall M, Taxman F, Leukefeld C. Organizational-level correlates of the provision of detoxification services and medication-based treatments for substance abuse in correctional institutions. Drug Alcohol Depend 2009; 103 Suppl 1:S73-81. [PMID: 19108957 PMCID: PMC2784603 DOI: 10.1016/j.drugalcdep.2008.11.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 11/05/2008] [Accepted: 11/05/2008] [Indexed: 01/23/2023]
Abstract
In recent years, there has been an increased examination of organizational-level innovation adoption in substance abuse treatment organizations. However, the majority of these studies have focused on community-based treatment centers. One understudied area of the substance abuse treatment system is correctional institutions. This study uses the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) cooperative's National Criminal Justice Treatment Practices (NCJTP) survey to examine the adoption of detoxification services and pharmacotherapies for the treatment of substance abuse across a nationally representative sample of correctional institutions (n=198). There were significant differences between jails and prisons in the percentage of organizations offering detoxification services and medications. Specifically, detoxification services were offered by 5% of prisons and 34% of jails; and, medications were offered by 6% of prisons and 32% of jails. Binary logistic regression models were used to examine the associations between these services and organizational characteristics, including context, resources, previously introduced practices, culture, and systems integration. Variables measuring organizational context and previously introduced practices were significant correlates of the provision of both detoxification services and medications. Multivariate results indicated that the differences between jails and prisons remained significant after controlling for other organizational factors. Although the adoption of detoxification services and pharmacotherapies may be a controversial topic for correctional institutions, these services have the potential to improve offender well-being and reduce public health risks associated with substance abuse.
Collapse
Affiliation(s)
- Carrie B Oser
- University of Kentucky, Sociology Department, Center on Drug & Alcohol Research, Lexington, 40506, USA.
| | | | | | | | | |
Collapse
|
30
|
|
31
|
Knudsen HK, Roman PM. Racial and Ethnic Composition as a Correlate of Medication Availability within Addiction Treatment Organizations. ACTA ACUST UNITED AC 2009; 42:133-151. [PMID: 20414366 DOI: 10.1080/00380237.2009.10571347] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Most analyses of racial and ethnic disparities in healthcare focus on individuals rather than organizations. Healthcare organizations may be one mechanism that produces disparities if the representation of minorities within organizations' patient populations is associated with differential patterns of service delivery. This research considers whether the racial and ethnic composition of addiction treatment centers' caseloads is associated with the likelihood that organizations offer any prescription medications to treat addiction, psychiatric conditions, or pain. Data were collected from 288 publicly-funded substance abuse treatment centers in the US. Logistic regression was used to estimate models of medication availability. The percentage of racial and ethnic minority patients was negatively associated with the odds of medication availability, even after controlling for organizational characteristics and patients' diagnostic characteristics. Future research should continue to investigate how healthcare organizations may produce inequalities in access to high-quality care.
Collapse
|
32
|
Fitzgerald JP, McCarty D. Understanding attitudes towards use of medication in substance abuse treatment: A multilevel approach. Psychol Serv 2009; 6:74-84. [PMID: 20401336 DOI: 10.1037/a0013420] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Individual and organizational variables influence attitudes towards use of naltrexone, methadone, and buprenorphine for the treatment of alcohol and drug disorders. Prior research has not considered both sets of influences simultaneously. Hierarchical linear modeling tested the contribution of individual and organizational variables using data from the National Drug Abuse Treatment Clinical Trials Network treatment unit and workforce surveys (n = 2,269 staff nested within 247 treatment units). Individual-level variables consistently had more influence on attitudes, but a unique blend of variables existed for each medication. One predictor, support for psychiatric medications, influenced attitudes across all medications. Staff attitudes towards addiction medications varied significantly between treatment units. Implications for increasing the appropriate use of addiction medications are discussed.
Collapse
|
33
|
Garner BR. Research on the diffusion of evidence-based treatments within substance abuse treatment: a systematic review. J Subst Abuse Treat 2008; 36:376-99. [PMID: 19008068 DOI: 10.1016/j.jsat.2008.08.004] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Revised: 08/12/2008] [Accepted: 08/23/2008] [Indexed: 10/21/2022]
Abstract
This article provides a comprehensive review of research studies that have examined the diffusion of evidence-based treatments (EBTs) within the field of substance abuse treatment. Sixty-five research studies were identified and were grouped into one of three major classifications: attitudes toward EBTs, adoption of EBTs, and implementation of EBTs. This review suggests significant progress has been made with regard to the advancement of the fields' knowledge about attitudes toward and the extent to which specific EBTs have been adopted in practice, as well as with regard to the identification of organizational factors related to EBT adoption. In an effort to advance the substance abuse treatment field toward evidence-based diffusion practices, recommendations are made for greater use of methodologically rigorous experimental or quasi-experimental designs, psychometrically sound instruments, and integration of quantitative and qualitative data collection.
Collapse
Affiliation(s)
- Bryan R Garner
- Chestnut Health Systems, 448 Wylie Dr., Normal, IL 61761, USA.
| |
Collapse
|
34
|
Ducharme LJ, Abraham AJ. State policy influence on the early diffusion of buprenorphine in community treatment programs. Subst Abuse Treat Prev Policy 2008; 3:17. [PMID: 18570665 PMCID: PMC2464589 DOI: 10.1186/1747-597x-3-17] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Accepted: 06/20/2008] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Buprenorphine was approved for use in the treatment of opioid dependence in 2002, but its diffusion into everyday clinical practice in community-based treatment programs has been slow. This study examines the net impact of efforts by state agencies, including provision of Medicaid coverage, on program-level adoption of buprenorphine as of 2006. METHODS Interviews were conducted with key informants in 49 of the 50 state agencies with oversight responsibility for addiction treatment services. Information from these interviews was integrated with organizational data from the 2006 National Survey of Substance Abuse Treatment Services. A multivariate logistic regression model was estimated to identify the effects of state efforts to promote the use of this medication, net of a host of organizational characteristics. RESULTS The availability of Medicaid coverage for buprenorphine was a significant predictor of its adoption by treatment organizations. CONCLUSION Inclusion of buprenorphine on state Medicaid formularies appears to be a key element in ensuring that patients have access to this state-of-the-art treatment option. Other potential barriers to the diffusion of buprenorphine require identification, and the value of additional state-level policies to promote its use should be evaluated.
Collapse
Affiliation(s)
- Lori J Ducharme
- Institute for Behavioral Research, 111 Barrow Hall, University of Georgia, Athens, GA 30602, USA
| | - Amanda J Abraham
- Institute for Behavioral Research, 111 Barrow Hall, University of Georgia, Athens, GA 30602, USA
| |
Collapse
|
35
|
Pettinati HM, Kampman KM, Lynch KG, Xie H, Dackis C, Rabinowitz AR, O′Brien CP. A double blind, placebo-controlled trial that combines disulfiram and naltrexone for treating co-occurring cocaine and alcohol dependence. Addict Behav 2008; 33:651-67. [PMID: 18079068 DOI: 10.1016/j.addbeh.2007.11.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Revised: 11/02/2007] [Accepted: 11/12/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND This is a double blind, placebo-controlled trial that evaluated the efficacy of disulfiram, naltrexone and their combination in patients with co-occurring cocaine and alcohol dependence. METHODS 208 patients were randomized to disulfiram (250 mg/day), naltrexone (100 mg/day), the combination, or placebo for 11 weeks. Outcomes were in-trial abstinence from cocaine and/or alcohol. RESULTS Few safety concerns were reported, although medication adherence was low in a number of patients for both medications, alone or in combination. In the primary analyses (GEE modeling), abstinence from cocaine as measured by cocaine-negative urines and days of self-reported abstinence from cocaine or alcohol did not differ between placebo and any of the medication groups. However, patients taking disulfiram (alone or in combination) were most likely to achieve combined abstinence from cocaine and alcohol. Secondary analyses revealed that patients taking the disulfiram-naltrexone combination were most likely to achieve 3 consecutive weeks of abstinence from cocaine and alcohol. CONCLUSION There was an association between disulfiram treatment and abstinence from cocaine and alcohol. More patients taking the disulfiram-naltrexone combination achieved 3 consecutive weeks of abstinence in treatment than placebo-treated patients.
Collapse
|
36
|
Empirically supported substance abuse treatment approaches: a survey of treatment providers' perspectives and practices. Addict Behav 2008; 33:699-712. [PMID: 18207334 DOI: 10.1016/j.addbeh.2007.12.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Revised: 12/06/2007] [Accepted: 12/16/2007] [Indexed: 11/23/2022]
Abstract
To better understand the extent that empirically supported and promising substance abuse treatment approaches are implemented in community settings, treatment providers were surveyed regarding their perceptions and use of several psychosocial and pharmacological treatment interventions. Program directors (n=30) and staff members (n=331) from diverse community settings rated the effectiveness and extent of use of various treatment interventions, and provided information on program and workforce characteristics via self-administered questionnaires. On average, program directors and staff rated the psychosocial treatment interventions as effective, with the exception of vouchers/motivational incentives. About half of the treatment providers did not know the effectiveness of certain pharmacological treatments, including buprenorphine and naltrexone. Respondents from the majority of programs (55%-80%) reported using Motivational Enhancement Therapy, Community Reinforcement Approach, and Supportive Expressive Psychotherapy. The extent that programs used several of the treatment interventions was related to organizational training and information resources. The study findings provide important information regarding training and research dissemination efforts.
Collapse
|
37
|
Thomas SE, Miller PM, Randall PK, Book SW. Improving acceptance of naltrexone in community addiction treatment centers: a pilot study. J Subst Abuse Treat 2008; 35:260-8. [PMID: 18329227 DOI: 10.1016/j.jsat.2007.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 11/13/2007] [Accepted: 11/19/2007] [Indexed: 10/22/2022]
Abstract
Alcoholism pharmacotherapies are underused in community addiction treatment settings, in part because individuals who practice in these settings--nonmedical addiction counselors and administrators--lack knowledge about and confidence in the value of adjunctive alcohol pharmacotherapies. We developed and tested an intervention to improve knowledge and attitudes about naltrexone. A team of researchers, physicians, addiction treatment counselors, and administrators collaborated to develop a naltrexone educational intervention designed for nonmedical addiction professionals. The intervention was compared with a control condition in a pilot study with 6 addiction treatment agencies (3 agencies per group). Participants (counselors and administrators, N = 84) were assessed before and 6 months after the intervention. Results revealed that the intervention significantly improved naltrexone knowledge, and participants who received the intervention reported greater satisfaction with the education they received, as well as greater use of the information. The effect of the intervention on attitudes about naltrexone was encouraging but did not to reach statistical significance. This study is the first reported attempt to develop and test an intervention specifically to improve acceptance of adjunctive medications for alcoholism among nonmedical addiction professionals.
Collapse
Affiliation(s)
- Suzanne E Thomas
- Center for Drug and Alcohol Programs, Charleston Alcohol Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
| | | | | | | |
Collapse
|
38
|
Use of surveillance data in developing geographic dissemination strategies: a study of the diffusion of olanzapine to Michigan children insured by medicaid. Clin Ther 2007; 29:359-70; discussion 358. [PMID: 17472829 DOI: 10.1016/j.clinthera.2007.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the diffusion of olanzapine to urban and rural children insured by Medicaid in Michigan by identifying prescribing clusters through surveillance of claims records. METHODS Prescription claims records for all antipsychotic medications for 3,567 children insured by Medicaid in Michigan from 1996 through 1998 were examined through the state Medicaid database. There were 29,069 pediatric prescriptions for antipsychotic medications; 2949 were for olanzapine (576 children, 510 providers). These data were linked to the Area Resource File, Provider Enrollment File, and Rural-Urban Commuting Area codes. Patient and provider locations were geocoded by ZIP code. Mixed logistic regression analysis was performed to determine the probability of a child's being prescribed olanzapine given certain community, patient, and provider characteristics. Spatial clusters were identified through the local Moron's L statistic and empirical Bayes standardized incidence rates. RESULTS Rural children were more likely than urban children to be prescribed olanzapine (odds ratio [OR], 1.29; P < 0.001). There were significant differences by age and sex, with older children and girls more likely than younger children and boys to be prescribed olanzapine (OR, 1.30 and 1.37, respectively; both, P < 0.001). At the county level, the number of pediatricians per primary care physician reduced the likelihood of a child's being prescribed olanzapine (OR, 0.88; P = 0.039). The effect of the number of available mental health professionals was not significant. The global Moran's L statistic was U indicating moderate clustering of the use of olanzapine. CONCLUSION Graphic surveillance data may be useful for studying the delivery and use of health cue services. Further research is needed to determine how this method can be used strategically to facilitate or impede the diffusion of new medications.
Collapse
|
39
|
Knudsen HK, Ducharme LJ, Roman PM. The adoption of medications in substance abuse treatment: associations with organizational characteristics and technology clusters. Drug Alcohol Depend 2007; 87:164-74. [PMID: 16971059 PMCID: PMC1868517 DOI: 10.1016/j.drugalcdep.2006.08.013] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Revised: 08/14/2006] [Accepted: 08/15/2006] [Indexed: 11/21/2022]
Abstract
Despite growing interest in closing the "research to practice gap", there are few data on the availability of medications in American substance abuse treatment settings. Recent research suggests that organizational characteristics may be associated with medication availability. It is unclear if the availability of medications can be conceptualized in terms of "technology clusters", where the availability of a medication is positively associated with the likelihood that other medications are also offered. Using data from 403 privately funded and 363 publicly funded specialty substance abuse treatment centers in the US, this research models the availability of agonist medications, naltrexone, disulfiram, and SSRIs. Bivariate logistic regression models indicated considerable variation in adoption across publicly funded non-profit, government-owned, privately funded non-profit, and for-profit treatment centers. Some of these differences were attenuated by organizational characteristics, such as accreditation, the presence of staff physicians, and the availability of detoxification services. There was some evidence that naltrexone, disulfiram, and SSRIs represent a group of less intensely regulated medications that is distinct from more intensely regulated medications. These types of medications were associated with somewhat different correlates. Future research should continue to investigate the similarities and differences in the predictors of medication availability across national contexts.
Collapse
Affiliation(s)
- Hannah K Knudsen
- Center for Research on Behavioral Health and Human Services Delivery, The University of Georgia, 101 Barrow Hall, Athens, GA 30602-2401, USA.
| | | | | |
Collapse
|
40
|
Ducharme LJ, Knudsen HK, Roman PM, Johnson JA. Innovation adoption in substance abuse treatment: exposure, trialability, and the Clinical Trials Network. J Subst Abuse Treat 2007; 32:321-9. [PMID: 17481455 PMCID: PMC2365704 DOI: 10.1016/j.jsat.2006.05.021] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Accepted: 05/14/2006] [Indexed: 10/23/2022]
Abstract
Researchers and policymakers are increasingly focusing on factors that facilitate or impede the diffusion of evidence-based treatment techniques into routine clinical practice. One potentially fruitful avenue of research is the influence of involvement in research networks as a predictor of organizational innovation. The Clinical Trials Network (CTN) is examining a number of behavioral and pharmacological treatment techniques in controlled multisite studies. Using data from participating CTN treatment programs and large samples of programs outside the CTN, these analyses examine the influence of exposure to clinical trials on the subsequent adoption of buprenorphine and voucher-based motivational incentives. The analyses show that, controlling for a variety of organizational characteristics, direct exposure to buprenorphine clinical trials in the CTN significantly increased the odds of subsequent adoption. By contrast, the adoption of motivational incentives was entirely explained by organizational characteristics. The findings suggest that adoption of treatment innovations is a function of exposure, organizational resources, nature of innovations, and stage of the diffusion process.
Collapse
Affiliation(s)
- Lori J Ducharme
- Institute for Behavioral Research, University of Georgia, Athens, GA 30602-2401, USA.
| | | | | | | |
Collapse
|
41
|
Abstract
Increasing attention is being paid to the development and dissemination of effective pharmacotherapies for the treatment of alcohol and other drug dependence. However, numerous structural and philosophical barriers impede the widespread adoption of these treatment approaches in everyday clinical practice. Research is needed to understand and overcome this gap. Drawing upon data collected from 2 large samples of substance abuse treatment providers at multiple time points, this article examines the prevalence and correlates of the adoption of the currently available pharmacotherapies for alcohol dependence: disulfiram, oral naltrexone, and acamprosate. These data suggest that the proportion of treatment programs using pharmacotherapies for alcohol dependence has been declining over time. In addition, the proportion of patients to whom these medications are prescribed is notably low. The adoption of disulfiram and naltrexone is significantly more likely in programs that are accredited, employ at least 1 physician, offer integrated care for patients with co-occurring psychiatric conditions, derive proportionately more revenue from commercial insurance payers, and have fewer linkages with the criminal justice system. Preliminary data suggest that the early adoption of acamprosate is following a similar pattern. Recommendations for addressing challenges to the diffusion of pharmacotherapies for alcohol dependence are presented.
Collapse
Affiliation(s)
- Lori J Ducharme
- Institute for Behavioral Research, University of Georgia, Athens, GA 30602-2401, USA.
| | | | | |
Collapse
|
42
|
Knudsen HK, Ducharme LJ, Roman PM. Early adoption of buprenorphine in substance abuse treatment centers: data from the private and public sectors. J Subst Abuse Treat 2006; 30:363-73. [PMID: 16716852 DOI: 10.1016/j.jsat.2006.03.013] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Revised: 02/21/2006] [Accepted: 03/22/2006] [Indexed: 11/22/2022]
Abstract
The recent approval of buprenorphine for the treatment of opiate dependence offers an opportunity to analyze innovation adoption in community-based treatment. Using data collected from national samples of 299 privately funded and 277 publicly funded treatment centers, this research examines buprenorphine adoption using baseline data collected between 2002 and 2004 as well as follow-up data collected 12 months later. Private centers were significantly more likely than public centers to report current use of buprenorphine. The baseline data indicated that early adoption was positively associated with center accreditation, physician services, availability of detoxification services, current use of naltrexone, and the percentage of opiate-dependent clients. Multivariate analyses of follow-up data suggest that adoption was greater in accredited centers, for-profit facilities, organizations offering detoxification services, and naltrexone-using centers. Future research should continue to monitor the extent to which buprenorphine is adopted in these settings.
Collapse
Affiliation(s)
- Hannah K Knudsen
- Center for Research on Behavioral Health and Human Services Delivery, The University of Georgia, 101 Barrow Hall, Athens, GA 30602-2401, USA.
| | | | | |
Collapse
|
43
|
Abstract
The National Institutes of Health (NIH) are under increasing pressure to identify practical, cost-effective interventions, therapies, and medications. Overall, the public health impact could be substantial if effective science-based prevention and treatment programs were implemented on large scales with sufficient fidelity. Yet penetration of even the most successful interventions rarely occurs at a quick pace. Research-to-practice gaps are pervasive throughout various fields of behavioral health and safety. In this article the authors explore factors contributing to the pace of translation and reaffirm that research advances or retreats the progress of scientific discovery as data accumulate in what can be described as a translational research loop that is iterative and bidirectional. They also touch on the challenges inherent in deploying science to the marketplace, and in an attempt to foreshadow what's next for translational efforts, they conclude by offering some ideas about how researchers might more accurately conceptualize "best practices."
Collapse
Affiliation(s)
- Elizabeth M Ginexi
- National Institute on Drug Abuse, Prevention Research Branch, Division of Epidemiology, Services and Prevention Research, 6001 Executive Blvd., Room 5185 MSC 9589, Bethesda, MD 20892, USA.
| | | |
Collapse
|