A multi‐center randomized trial of buprenorphine–naloxone versus clonidine for opioid, detoxification: findings from the National Institute on Drug Abuse Clinical Trials Network

Ling, Walter; Amass, Leslie; Shoptaw, Steven; Annon, Jeffrey J.; Hillhouse, Maureen; Babcock, Dean; Brigham, Gregory S.; Harrer, Judy M.; Reid, Malcolm S.; Muir, Joan A.; Buchan, Betty J.; Orr, Debbie; Woody, George; Krejci, Jonathan; Ziedonis, Douglas M.

doi:10.1111/j.1360-0443.2005.01154.x

Cited by 207 publications

(205 citation statements)

References 25 publications

(24 reference statements)

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“…Published results indicate that buprenorphine performed favorably compared to clonidine in terms of both treatment retention and drug-free urine tests (Ling et al, 2005). Equally important, buprenorphine protocols were successfully implemented in both inpatient and outpatient settings, including treatment programs having little or no prior experience with medication-assisted detoxification or maintenance for opioid dependence treatment (Amass et al, 2004).…”

Section: Buprenorphinementioning

confidence: 93%

Innovation adoption in substance abuse treatment: Exposure, trialability, and the Clinical Trials Network

Ducharme

Knudsen

Roman

et al. 2007

Journal of Substance Abuse Treatment

101

150

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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.

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Section: Buprenorphinementioning

confidence: 93%

Innovation adoption in substance abuse treatment: Exposure, trialability, and the Clinical Trials Network

Ducharme

Knudsen

Roman

et al. 2007

Journal of Substance Abuse Treatment

101

150

View full text Add to dashboard Cite

show abstract

“…Buprenorphine reduces withdrawal symptoms and blocks the effects of opiates (Walsh and Eissenberg, 2003). Numerous clinical trials have evaluated the effectiveness of buprenorphine in comparison to placebo , clonidine (Ling et al, 2005;Gowling et al, 2004;Lintzeris et al, 2002), and methadone (Johnson et al, 1992;Johnson et al, 2000;Pani et al, 2000;Schottenfeld et al, 1997;Strain et al, 1994). Although buprenorphine may not be more effective than methadone, it has three key advantages: it does not require daily dosing (Amass et al, 2001), its chemical composition reduces the likelihood of diversion (Amass et al, 2000), and federal regulations encouraging its prescription by primary care physicians may facilitate its integration into community-based treatment programs (Amass et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

The adoption of medications in substance abuse treatment: Associations with organizational characteristics and technology clusters

Knudsen

Ducharme

Roman

2007

Drug and Alcohol Dependence

124

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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 forprofit 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.

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“…CTN protocols, moreover, documented the value of treatments that incorporate medications (Amass et al, 2004;Ling et al, 2005) and use motivational incentives (contingency management) to reduce use of stimulants among methadone patients (Peirce et al, 2006) and to increase retention in care among stimulant users in outpatient services (Petry et al, 2005). The CTN Workforce survey, therefore, included items assessing opinions toward the use of evidence-based treatments including manualized treatment, medications, mental health services, and motivational incentives as well as support for the use of confrontation and discharge for non-compliance.…”

Section: Evidence-based Treatmentmentioning

confidence: 99%

Organizational Readiness for Change and opinions toward treatment innovations

Fuller

Rieckmann

Nunes

et al. 2007

Journal of Substance Abuse Treatment

103

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Program administrators and staff in treatment programs participating in the National Drug Abuse Treatment Clinical Trials Network (CTN) completed surveys to characterize participating programs and practitioners. A two-level random effects regression model assessed the influence of Organizational Readiness for Change (ORC) and organizational attributes on opinions toward the use of four evidence-based practices (manualized treatments, medication, integrated mental health services, and motivational incentives) and practices with less empirical support (confrontation and noncompliance discharge). The ORC Scales suggested greater support for evidence-based practices in programs where staff perceived more program need for improvement, better Internet access, higher levels of peer influence, more opportunities for professional growth, a stronger sense of organizational mission and more organizational stress. Support for confrontation and noncompliance discharge, in contrast, was strong when staff saw less opportunity for professional growth, weaker peer influence, less Internet access, and perceived less organizational stress. The analysis provides evidence of the ORC's utility in assessing agency strengths and needs during the implementation of evidence-based practices. IntroductionThe Institute of Medicine's Crossing the Quality Chasm series recommended increased use of treatments with empirical evidence of efficacy and effectiveness for health care (Institute of Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Corresponding NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptMedicine, 2000;Institute of Medicine, 2001) and for the treatment of alcohol, drug, and mental health disorders (Institute of Medicine, 2006). There is, however, a significant lag between science-based treatment innovations and the widespread adoption of those strategies in health care (Balas & Boren, 2000;Institute of Medicine, 2001). A comprehensive review of implementation research identified six core components that must be present to initiate and sustain the use of proven programs in new locations and environments: 1) select staff who can implement the program, 2) train staff, 3) require ongoing coaching, 4) use supervision and fidelity assessments to provide performance feedback to staff, 5) evaluate overall program functioning, and 6) facilitate implementation and sustainability with administrative supports (Fixsen et al., 2005). Many programs neglect one or more core implementation components and struggle to develop the skills required to effectively ...

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A multi‐center randomized trial of buprenorphine–naloxone versus clonidine for opioid, detoxification: findings from the National Institute on Drug Abuse Clinical Trials Network

Abstract: The benefits of bup-nx for opioid detoxification are supported and illustrate important ways in which clinical research can be conducted in community treatment programs.

Cited by 207 publications

References 25 publications

Innovation adoption in substance abuse treatment: Exposure, trialability, and the Clinical Trials Network

Innovation adoption in substance abuse treatment: Exposure, trialability, and the Clinical Trials Network

The adoption of medications in substance abuse treatment: Associations with organizational characteristics and technology clusters

Organizational Readiness for Change and opinions toward treatment innovations

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