Daniel P Alford's research while affiliated with Boston Medical Center and other places
What is this page?
This page lists the scientific contributions of an author, who either does not have a ResearchGate profile, or has not yet added these contributions to their profile.
It was automatically created by ResearchGate to create a record of this author's body of work. We create such pages to advance our goal of creating and maintaining the most comprehensive scientific repository possible. In doing so, we process publicly available (personal) data relating to the author as a member of the scientific community.
If you're a ResearchGate member, you can follow this page to keep up with this author's work.
If you are this author, and you don't want us to display this page anymore, please let us know.
It was automatically created by ResearchGate to create a record of this author's body of work. We create such pages to advance our goal of creating and maintaining the most comprehensive scientific repository possible. In doing so, we process publicly available (personal) data relating to the author as a member of the scientific community.
If you're a ResearchGate member, you can follow this page to keep up with this author's work.
If you are this author, and you don't want us to display this page anymore, please let us know.
Publications (104)
Background
Community-based perspectives are needed to more broadly inform policy-makers, public health practitioners, prescribers, and pharmacists about community-led and broader efforts to reduce opioid overprescribing, and ultimately reduce prescription opioid use disorder, overdoses and fatalities. The aim of this study is to explore community-b...
Objective:
To determine the proportion and characteristics of adults in primary care (PC) who screen positive for unhealthy substance use (SU) (alcohol and/or other drug) 1 year or more after screening negative.
Methods:
Screening consisted of single-item questions for unhealthy use of alcohol and other drugs (illicit drugs and prescription medi...
Background
Urine drug testing (UDT) is a recommended risk mitigation strategy for patients prescribed opioids for chronic pain, but evidence that UDT supports identification of substance misuse is limited.Objective
Identify the prevalence of UDT results that may identify substance misuse, including diversion, among patients prescribed opioids for c...
Introduction
Back and neck pain are the leading causes of disability worldwide. Doctors of chiropractic (DCs) are trained to manage these common conditions and can provide non-pharmacological treatment aligned with international clinical practice guidelines. Although DCs practice in over 90 countries, chiropractic care is rarely available within in...
Background
Many national guidelines recommend the use of patient provider agreements (PPAs) when prescribing opioids for chronic pain. There are no standards for PPA content, readability, or administration processes.Objective
Conduct a national survey of providers who use PPAs to describe the process of administering them, assess views on their uti...
Background
The number of opioid-involved overdose deaths in the United States remains a national crisis. The HEALing Communities Study (HCS) will test whether Communities That HEAL (CTH), a community-engaged intervention, can decrease opioid-involved deaths in intervention communities (n = 33), relative to wait-list communities (n = 34), from four...
Introduction: Back and neck pain are the leading causes of disability worldwide. Doctors of chiropractic (DCs) are trained to manage these common conditions and can provide nonpharmacologic treatment aligned with international clinical practice guidelines. Although DCs practice in at least 90 countries, chiropractic care is often not available with...
Background: Many health professionals lack adequate training needed to effectively address alcohol and other drug (AOD)-related problems. Building upon our previously successful in-person faculty training programs, we designed and pilot tested the brief online Faculty Education in Addiction Training (FEAT) Program for social work and internal medic...
Aims
The efficacy of screening and brief intervention for lower-risk drug use is unknown. This pilot study tested the efficacy of two brief interventions (BIs) for drug use compared to no BI in primary care patients with lower-risk drug use identified by screening.
Methods
We randomly assigned participants identified by screening with Alcohol Smok...
On March 6, 2019, a self-designated committee sent a public letter to the Centers for Disease Control and Prevention (CDC) urging the agency to address the widespread misapplication of its 2016 guideline on prescribing opioids. Three hundred and eighteen health care professionals, and three former Directors of the White House Office of National Dru...
Objective:
To implement a skills-based faculty development program (FDP) to improve Internal Medicine faculty's clinical skills and resident teaching about safe opioid prescribing.
Design:
An FDP for Internal Medicine attendings that included a one-hour didactic presentation followed immediately by an Objective Structured Clinical Examination (O...
Background:
A national crisis of opioid-related morbidity, mortality, and misuse has led to initiatives to address the appropriate role of opioids to treat pain. Deployment of a guideline from the Centers for Disease Control and Prevention to reduce the risks of opioid therapy has raised substantial clinical and public policy challenges. The agenc...
Objectives:
To assess national trends in selected prescription opioid risk mitigation practices and associations with prescriber type, state-specific opioid overdose severity, and required pain education.
Methods:
Analysis of the national SCOPE of Pain registrants' baseline self-report of five safer opioid prescribing practices over three years...
In the United States, there is a prescription medication misuse crisis including increases in unintentional drug overdose deaths, medications obtained on the illicit market (i.e., diversion), and in the number of individuals seeking treatment for addiction to prescription medications. Neurologists manage patients suffering from conditions (e.g., pa...
Background:
Urine drug tests (UDTs) are recommended to monitor patients treated for opioid use disorder in primary care. The aims are to (1) estimate the frequency of self-report and UDT results of opioid and cocaine use and (2) evaluate the association between treatment time with non-disclosure of opioid or cocaine use and having a positive UDT....
This study is an educational evaluation of participants (N = 50) in a 4-day immersion training program funded by the National Institute on Alcohol Abuse and Alcoholism. Using a pretest–posttest design, clinical social work faculty participants showed statistically significant (p < .001) improvement in overall alcohol and other drug-related knowledg...
This study provides up-to-date information on the practices and barriers faced by 50 clinical faculty from 29 Council on Social Work Education-accredited master’s in social work programs across the United States in the integration of alcohol and other drug (AOD) content into social work education. Faculty report that AOD-related content is covered...
This article presents the Alcohol and Other Drugs Education Program (ADEP) as a model for faculty training in evidence-based alcohol and other drug (AOD) identification and treatment. We make the case that AOD use is a serious social and public health issue and highlight faculty training as a strategic approach for addressing the pressing demand fo...
Background: Generalist physicians should play a vital role in identifying and managing individuals with substance use but are inadequately trained to do so.
Methods: This 5 year (2008-2012) controlled educational study assessed whether internal medicine and family medicine chief residents’ (CRs) addiction medicine teaching increased by co-training...
Objective:
To develop consensus recommendations on urine drug monitoring (UDM) in patients with chronic pain who are prescribed opioids.
Methods:
An interdisciplinary group of clinicians with expertise in pain, substance use disorders, and primary care conducted virtual meetings to review relevant literature and existing guidelines and share the...
Importance
Prescription opioid misuse is a national crisis. Few interventions have improved adherence to opioid-prescribing guidelines.
Objective
To determine whether a multicomponent intervention, Transforming Opioid Prescribing in Primary Care (TOPCARE; http://mytopcare.org/), improves guideline adherence while decreasing opioid misuse risk.
De...
Objective:
Buprenorphine is a highly effective treatment for opioid use disorders, but its continuation in the perioperative setting remains controversial, unlike the accepted practice of perioperative methadone continuation.
Methods:
We conducted a retrospective cohort study from 2006 to 2014 comparing post-cesarean section opioid analgesic req...
Background:
Due to the high prevalence of prescription opioid misuse, the US Food and Drug Administration (FDA) mandated a Risk Evaluation and Mitigation Strategy (REMS) requiring manufacturers of extended-release/long-acting (ER/LA) opioids to fund continuing education based on an FDA curricular Blueprint. This paper describes the Safe and Compet...
Background:
Residents feel unprepared to care for patients with chronic pain on long-term opioids who exhibit signs of prescription opioid misuse.
Objective:
Describe an educational intervention for internal medicine residents to improve confidence, practices, attitudes, and self-reported knowledge of resources for chronic pain and opioid misuse...
Background:
In 2012, the US Food and Drug Administration (FDA) responded to the opioid crisis with a Risk Evaluation and Mitigation Strategy, requiring manufacturers of extended-release/long-acting opioids to fund continuing medical education based on the "FDA Blueprint for Prescriber Education." Topics in the Blueprint are "Assessing Patients for...
The increase in overdose deaths from prescription opioids and heroin in the United States over the past 20 years is believed to have resulted from increases in prescription of opioids for management of acute and chronic pain. Managing chronic pain is challenging for primary care clinicians for many reasons, including the lack of evidence to guide p...
The publication of Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health presents an historic moment not only for the field of addiction medicine, but also for the United States as a nation. The Board of Directors of the Association for Medical Education and Research in Substance Abuse (AMERSA), on behalf of our or...
Aims:
In a sample of patients receiving opioid agonist therapy, we evaluated whether having chronic pain was associated with (a) craving for opioids and (b) illicit opioid use.
Methods:
In a cross-sectional study of adults on buprenorphine or methadone maintenance recruited from an urban medical center, we examined any craving for opioids (prima...
Background:
Internal medicine residents care for a sizable number of patients with chronic pain. Programs need educational strategies to promote safe opioid prescribing.
Objective:
To describe a safe opioid prescribing education program utilizing an objective structured clinical examination (OSCE) and report the resulting impact on residents' kn...
Groups advocating quick fixes to the opioid-misuse epidemic seek regulations limiting opioid availability, but prescriber education is a more finely tuned approach, allowing us to individualize care appropriately after a careful benefit-risk assessment.
BACKGROUND
Chronic pain is common among patients with drug use disorders. The prevalence of chronic pain and its consequences in primary care patients who use drugs is unknown. OBJECTIVES
To examine: 1) the prevalence of chronic pain and pain-related dysfunction among primary care patients who screen positive for drug use, and 2) the prevalence of...
Background:
The use of brief intervention for decreasing frequent marijuana use holds potential, but its efficacy in primary care is not known.
Methods:
Objective: To assess the impact of two brief interventions on marijuana use among daily/ or almost daily marijuana users.
Design:
Subgroup analysis of a 3-arm randomized clinical trial of two...
Due to the high prevalence of prescription opioid misuse, the US Food and Drug Administration (FDA) mandated a Risk Evaluation and Mitigation Strategy (REMS) requiring manufacturers of extended-release/long-acting (ER/LA) opioid analgesics to fund continuing education based on a FDA Blueprint. This article describes the Safe and Competent Opioid Pr...
Patients with opioid use disorders on opioid agonist therapy (OAT) have lower pain tolerance compared to controls. While chronic viral infections such as HCV and HIV have been associated with chronic pain in this population, no studies have examined their impact on pain sensitivity.
We recruited 106 adults (41 uninfected controls; 40 HCV mono-infec...
Symptomatic androgen deficiency is common in patients taking opioid analgesics, as these drugs potently suppress the hypothalamic-pituitary-gonadal axis. However, the efficacy of testosterone replacement in this setting remains unclear. The objective of this trial was to evaluate the efficacy of testosterone replacement on pain perception and other...
Importance
The United States has invested substantially in screening and brief intervention for illicit drug use and prescription drug misuse, based in part on evidence of efficacy for unhealthy alcohol use. However, it is not a recommended universal preventive service in primary care because of lack of evidence of efficacy.Objective
To test the...
This manuscript reviews peer-reviewed literature published from 2010-2012 relevant to the management of chronic pain in the primary care setting.
Narrative review of peer-reviewed literature.
We searched MEDLINE, PubMed, and reference lists and queried expert contacts for English-language studies related to the management of chronic noncancer pain...
Surgery may be required for complications of alcohol use such as the management of traumatic injuries and cancers. Patients with unhealthy alcohol use will also be among those who are planning to undergo surgery for conditions that are unrelated to alcohol use. Alcohol use disorders (AUDs), alcohol-associated chronic medical conditions, and even he...
For the primary care clinician treating patients with unhealthy alcohol use, pain syndromes are frequently clinical issues that pose unique challenges relative to the management of low risk or non-alcohol users with pain. Unhealthy alcohol use and its consequences may impact both the assessment and management of pain. Such considerations are partic...
The MASBIRT program was a federally (SAMHSA) funded cooperative agreement to the Massachusetts Department of Public Health, Bureau of Substance Abuse Services and implemented by Boston Medical Center. Methods: MASBIRT was implemented in 3 medical centers and 5 community health centers in the greater Boston area. Health Promotion Advocates conducted...
It is estimated that approximately 100 million US residents have chronic pain, costing more than $600 billion per year in direct medical treatment and lost productivity costs.1 In the 1980s, several reports began to support use of opioid therapy for chronic noncancer pain.2 Over the ensuing decades, a 4-fold increase in opioid prescribing has occur...
Objectives:
Health educators are increasingly being used to deliver preventive care including screening and brief intervention (SBI) for unhealthy substance use (SU) (alcohol or drug). There are few data, however, about the "handoff" of information from health educator to primary care clinician (PCC). Among patients identified with unhealthy SU an...
Data on the effectiveness and safety of long-term opioid therapy for chronic pain are limited. Opioid adherence monitoring includes urine drug testing. Determining whether a patient's opioid prescription should be discontinued after an unexpected urine test result can be clinically complex.
To review safe opioid prescribing practices and appropriat...
We describe universal screening in a large urban hospital-based primary care practice. Trained staff aimed to screen all adult patients presenting for primary care visits between July 2010 and February 2011. Screening included three items about past three-month drug use: frequency of heavy drinking (>3 standard drinks in a day for women and >4 for...
Objectives:
Among patients receiving methadone maintenance treatment (MMT) for opioid dependence, receipt of unobserved dosing privileges (take homes) and adequate doses (ie, ≥ 80 mg) are each associated with improved addiction treatment outcomes, but the association with acute care hospitalization is unknown. We studied whether take-home dosing a...
Opioid addiction affects over 2 million patients in the United States. The advent of buprenorphine and the passage of the Drug Addiction Treatment Act in 2000 have revolutionized the opioid treatment delivery system by granting physicians the ability to administer office-based opioid treatment (OBOT), thereby giving patients greater access to treat...
Objective To compare cancer screening and flu vaccination among persons with and without unhealthy substance use.
Design The authors analysed data from 4804 women eligible for mammograms, 4414 eligible for Papanicolou (Pap) smears, 7008 persons eligible for colorectal cancer (CRC) screening and 7017 persons eligible for flu vaccination. All patient...
Opioid addiction is a chronic disease treatable in primary care settings with buprenorphine hydrochloride, but this treatment remains underused. We describe a collaborative care model for managing opioid addiction with buprenorphine hydrochloride-naloxone hydrochloride dihydrate sublingual tablets.
Ours is a cohort study of patients treated for opi...
This study determined the frequency of reporting being introduced to opioids by a physician among opioid-dependent patients. Cross-sectional analyses were performed using baseline data from a cohort of opioid addicts seeking treatment with buprenorphine. The primary outcome was a response to the question: "Who introduced you to opiates?" Covariates...
Abstract Education in substance use disorders remains inadequate in medical training curricula. Although it is a growing health problem, prescription drug abuse is specifically addressed even less comprehensively. This curriculum module provides an overview of prescription drug abuse framed within the common clinical scenario of chronic pain manage...
MAssachusetts SBIRT screens healthcare patients for unhealthy substance use; those screening positive get a brief intervention, those whose scores indicate possible abuse/dependence are either referred to Brief Treatment (6-12 sessions of manualized treatment based on motivational interviewing and cognitive behavioral therapy) or to more traditiona...
More than 75 million Americans have chronic or recurrent pain.1 Pain accounts for 20% of all outpatient visits2 and more than $100 billion dollars per year in direct (i.e., health care services) and indirect costs (i.e., lost productivity)3; analgesics account for 12% of all prescriptions.4 Chronic pain is a leading cause of work loss, and disabili...
An abstract is unavailable. This article is available as HTML full text and PDF.
The efficacy of screening and brief intervention (SBI) for drug use in primary care patients is largely unknown. Because of this lack of evidence, US professional organizations do not recommend it. Yet, a strong theoretical case can be made for drug SBI. Drug use is common and associated with numerous health consequences, patients usually do not se...
Experts recommend opioid treatment agreements and urine drug testing to reduce opioid analgesia misuse, but evidence of their effectiveness has not been systematically reviewed.
To synthesize studies of the association of treatment agreements and urine drug testing with opioid misuse outcomes in outpatients with chronic noncancer pain.
MEDLINE, Psy...
Many opioid-dependent patients do not receive care for addiction issues when hospitalized for other medical problems. Based on 3 years of clinical practice, we report the Transitional Opioid Program (TOP) experience using hospitalization as a "reachable moment" to identify and link opioid-dependent persons to addiction treatment from medical care....
Unhealthy substance use is the spectrum from use that risks harm, to use associated with problems, to the diagnosable conditions of substance abuse and dependence, often referred to as substance abuse disorders. Despite the prevalence and impact of unhealthy substance use, medical education in this area remains lacking, not providing physicians wit...
Aim:
: To examine the prevalence and risk factors of low vitamin D status (vitamin D deficiency or insufficiency) among patients in a methadone maintenance treatment (MMT) program.
Design:
: Cross-sectional study of subjects recruited from an MMT program in a higher latitude (Boston, MA).
Measurements:
: Standardized survey and medical record...
