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


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,
17 Reads
  • 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
    • "In conclusion, a small, but growing body of research indicates that community-based providers who engage in clinical research more rapidly adopt evidence-based clinical services than those who do not engage in clinical research [36-41]. These studies suggest that CBPPR holds promise as a strategy for accelerating the translation of research results into clinical practice. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Since 2003, the United States National Institutes of Health (NIH) has sought to restructure the clinical research enterprise in the United States by promoting collaborative research partnerships between academically-based investigators and community-based physicians. By increasing community-based provider participation in research (CBPPR), the NIH seeks to advance the science of discovery by conducting research in clinical settings where most people get their care, and accelerate the translation of research results into everyday clinical practice. Although CBPPR is seen as a promising strategy for promoting the use of evidence-based clinical services in community practice settings, few empirical studies have examined the organizational factors that facilitate or hinder the implementation of CBPPR. The purpose of this study is to explore the organizational start-up and early implementation of CBPPR in community-based practice. Methods We used longitudinal, case study research methods and an organizational model of innovation implementation to theoretically guide our study. Our sample consisted of three community practice settings that recently joined the National Cancer Institute’s (NCI) Community Clinical Oncology Program (CCOP) in the United States. Data were gathered through site visits, telephone interviews, and archival documents from January 2008 to May 2011. Results The organizational model for innovation implementation was useful in identifying and investigating the organizational factors influencing start-up and early implementation of CBPPR in CCOP organizations. In general, the three CCOP organizations varied in the extent to which they achieved consistency in CBPPR over time and across physicians. All three CCOP organizations demonstrated mixed levels of organizational readiness for change. Hospital management support and resource availability were limited across CCOP organizations early on, although they improved in one CCOP organization. As a result of weak IPPs, all three CCOPs created a weak implementation climate. Patient accrual became concentrated over time among those groups of physicians for whom CBPPR exhibited a strong innovation-values fit. Several external factors influenced innovation use, complicating and enriching our intra-organizational model of innovation implementation. Conclusion Our results contribute to the limited body of research on the implementation of CBPPR. They inform policy discussions about increasing and sustaining community clinician involvement in clinical research and expand on theory about organizational determinants of implementation effectiveness.
    Implementation Science 05/2012; 7(1):41. DOI:10.1186/1748-5908-7-41 · 4.12 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
Show more