Buprenorphine adoption in the National Drug Abuse Treatment Clinical Trials Network

Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY 40536-0086, USA.
Journal of substance abuse treatment (Impact Factor: 2.9). 08/2009; 37(3):307-12. DOI: 10.1016/j.jsat.2008.12.004
Source: PubMed

ABSTRACT The National Drug Abuse Treatment Clinical Trials Network (CTN), a collaborative federal research initiative that brings together universities and community-based treatment programs (CTPs), has conducted multiple clinical trials of buprenorphine for opioid dependence. Part of the CTN's mission is to promote the adoption of evidence-based treatment technologies. Drawing on a data collected during face-to-face interviews with administrators from a panel of 206 CTPs, this research examines the adoption of buprenorphine over a 2-year period. These data indicated that the adoption of buprenorphine doubled between the baseline and 24-month follow-up interviews. Involvement in a buprenorphine protocol continued to be a strong predictor of adoption at the 2-year follow-up, although adoption of buprenorphine tripled among those CTPs without buprenorphine-specific protocol experience. For-profit CTPs and those offering inpatient detoxification services were more likely to adopt buprenorphine over time. A small percentage of programs discontinued using buprenorphine. These findings point to the dynamic nature of service delivery in community-based addiction treatment and the continued need for longitudinal studies of organizational change.

Download full-text


Available from: Paul Michael Roman, Aug 27, 2015
  • Source
    • "Additionally, methadone has been shown to reduce mortality (Degenhardt, Bucello, Mathers, et al., 2011) and HIV transmission (MacArthur, Minozzi, Martin, et al., 2012) in those with opioid use disorders . Despite their effectiveness for alcohol and opioid use disorders, these treatments remain underutilized by patients and underprescribed by clinicians (Harris et al., 2012; Knudsen, Abraham, Johnson, & Roman, 2009). In addition some substance use disorders do not have efficacious medication treatments (e.g. "
    [Show abstract] [Hide abstract]
    ABSTRACT: People with addictive disorders commonly do not receive efficacious medications. Chronic care management (CCM) is designed to facilitate delivery of effective therapies. Using data from the CCM group in a trial testing its effectiveness for addiction (N=282), we examined factors associated with the prescription of addiction medications. Among participants with alcohol dependence, 17% (95% CI 12.0-22.1%) were prescribed alcohol dependence medications. Among those with drug dependence, 9% (95% CI 5.5-12.6%) were prescribed drug dependence medications. Among those with opioids as a substance of choice, 15% (95% CI 9.3-20.9%) were prescribed opioid agonist therapy. In contrast, psychiatric medications were prescribed to 64% (95% CI 58.2-69.4%). Absence of co-morbid drug dependence was associated with prescription of alcohol dependence medications. Lower alcohol addiction severity and recent opioid use were associated with prescription of drug dependence medications. Better understanding of infrequent prescription of addiction medications, despite a supportive clinical setting, might inform optimal approaches to delivering addiction medications. Copyright © 2014 Elsevier Inc. All rights reserved.
    Journal of Substance Abuse Treatment 12/2014; 52. DOI:10.1016/j.jsat.2014.11.008 · 3.14 Impact Factor
  • Source
    • "The experience of being in the CTN, in which treatment programs are involved in considerable inter-organizational communication as well as clinical research on treatment effectiveness, has been noted as a promising facilitator of innovation diffusion (Forman, Bovasso, & Woody, 2001; Roman et al., 2010). Indeed, programs in the CTN are more likely to adopt medications than non-CTN programs, even though medications that have not been the focus of its clinical trials (Abraham et al., 2010; Ducharme et al., 2007; Knudsen et al., 2009). While the CTN is an important inter-organizational system for studying innovation adoption, participation by treatment programs is limited to those who partner with university-based researchers in a successful grant application, making it a relatively " closed " inter-organizational system. "
    [Show abstract] [Hide abstract]
    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.
    Journal of substance abuse treatment 08/2011; 42(1):16-24. DOI:10.1016/j.jsat.2011.06.009 · 2.90 Impact Factor
  • Source
    • "This multi-site database allows for exploration regarding the use of buprenorphine. NTCS data collected from 2002 to 2004 has been used to assess counselor attitudes and buprenorphine adoption in public and private substance abuse treatment centers (Knudsen et al., 2005, 2007) and centers affiliated with the National Institute on Drug Abuse's (NIDA) Clinical Trials Network (Knudsen et al., 2007, 2009). Findings from these earlier NTCS studies provided a theoretical framework to assess influences of counselorlevel and program-level factors on counselor attitudes toward buprenorphine. "
    [Show abstract] [Hide abstract]
    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.
    Journal of substance abuse treatment 08/2011; 41(4):374-85. DOI:10.1016/j.jsat.2011.05.005 · 2.90 Impact Factor
Show more