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Overview

Goal: The learner will be knowledgeable about the prevalence of opioid use and dependence, including heroin and prescription opioids.

Professional Practice GapsIn 2004, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that there were 270,000 heroin users and another 1.4 million Americans who were dependent on prescription opioids (SAMSHA, 2005). In fact, these figures probably vastly underestimate the true prevalence of opioid use disorders in the United States (SAMHSA, 2005). Further, only a small fraction of these users have received treatment for an opioid use disorder (SAMHSA, 2005). Buprenorphine is a safe and effective treatment for opioid dependence that offers patients a more widely available, accessible, convenient treatment option as compared to traditional opioid treatment programs (OTP) (SAMHSA, 2001; Johnson et al., 2003; SAMHSA, 2004). This buprenorphine training program prepares physicians to prescribe buprenorphine safely and effectively to address needs of the millions of Americans with opioid use problems.
Buprenorphine: how to use it right. Drug Alcohol Depend. 2003; 70(suppl 2): S59-S77.
SAMHSA. Quick Guide For Clinicians Based on TIP 34 . U.S. Department of Health and Human Services. 2001-2011. Available at: https://store.samhsa.gov/shin/content/SMA06-4136/SMA06-4136.pdf Accessed on: 2015-03-19.
Substance Abuse and Mental Health Services Administration. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Rockville, Md: Center For Substance Abuse Treatment. Treatment Improvement Protocol Series, No. 40, USDHHS Publication (SMA) 04-3939. 2004. Available at: http://www.ncbi.nlm.nih.gov/books/NBK64766/ Accessed on: 2011-12-12.
Substance abuse treatment for persons with co-occurring disorders. Treatment Improvement Protocol (TIP) Series. DHHS Publication No. (SMA) 05-3922. 2005. Available at: http://www.ncbi.nlm.nih.gov/books/NBK64197/ Accessed on: 2010-06-15.

Educational Objectives:

After completing this activity participants will be able to:
  • Understand how to conduct a basic patient interview assessing for opioid use disorders.

  • Differentiate between opioid abuse and opioid dependence according to the DSM-IV, along with associated terminology, such as withdrawal and tolerance.

  • How to use standardized instruments and appropriate language when assessing patients for opioid use disorders.

  • The significance of a diagnosis and how to approach the patient regarding a diagnosable opioid use disorder.

  • Discuss the physician's role in addiction treatment.

  • Explain the requirements and process of becoming certified to prescribe buprenorphine for opioid dependence.

  • Describe the referral process and ways to provide seamless treatment to the patient using specialty resources.

  • Identify ethical considerations physicians should acknowledge when treating individuals with an opioid use disorder.

Authors

As an ACCME accredited provider of continuing medical education, Clinical Tools, Inc.complies with the Standards for Commercial Support issued by the ACCME and requires disclosure of and resolution of any conflicts of interest for those in control of content.
Clinical Tools, Inc (Committee on Medical Student Education on Substance Abuse, CTI)The material was developed by Clinical Tools, Inc. employees including T. Bradley Tanner, MD, Meghan Coulehan, MPH, Amanda Buchanan, MA, Sara Virgil, BA; Colleen Prince-Elcan, MSW, and Mary P. Metcalf, PhD, MPH, CHES. Questions should be directed to Meghan Coulehan, MPH at cmefeedback@clinicaltools.com
Disclosure: Funded via NIH SBIR grant #R44-DA12066
, ,
Disclosure:
T Bradley Tanner, MD (President, Clinical Tools, Inc.)T. Bradley Tanner, MD is president of Clinical Tools and responsible for the vision of the company. He has received funding via grants and contracts from NIDA, NIAAA, NIMH, NCI, AHRQ, CDC, the Dept of Defense, and NASA to develop medical and health education projects. Dr. Tanner served as principal investigator on 2 NIDA grants to develop the DATA-2000 qualifying buprenorphine training program and clinical practice tools on BupPractice.com. He also has a strong background in technology and oversees development and delivery of all Clinical Tools websites. Dr. Tanner is also a board-certified psychiatrist with experience in inpatient, outpatient, and emergency health settings. He currently treats patients and educates medical students and residents via his role a Clinical Associate Professor of Psychiatry at the University of North Carolina Chapel Hill.
Disclosure: Has disclosed no relevant financial relationships.
Clinical Tools, MD, MD (Company, CTI)Clinical Tools, Inc. (CTI) is a small, physician-run business dedicated to harnessing the potential of the Internet to create scalable, usable, and broadly available tools to improve the ability of physicians and other health care providers to care for patients. We achieve this goal by providing education and training to students and professionals and creating Web-based support tools for clinicians, researchers, and consumers. Information technology can and should serve as a stable framework that supports researchers and clinicians in their roles. We provide dissemination and management tools that empower clinicians and consumers to understand and control the vast amount of information related to making individual health choices. We serve our clients creatively, effectively, and with the highest quality of service.
Disclosure: Has disclosed no relevant financial relationships.

Reviewers

Jodie Trafton, PhD (Director, VA Program Evaluation and Resource Center)Dr. Trafton is director of the VA Program Evaluation and Resource Center, which conducts research, evaluation, education and quality improvement projects on substance use disorder treatment at the approximately 1400 medical clinics run by the Veteran's Health Administration. She teaches addiction and behavioral medicine at Stanford University Medical School, and writes and edits texts on behavioral health for the non-profit Institute for Disease Management.
Disclosure: Has disclosed no relevant financial relationships.
Darwin Telias, PhD (Director, "MATARA" Opioid Treatment Program of the Beer Sheva Mental Health Center)Dr. Telias is a psychiatrist and an expert in addictions. He has worked in the field of addictions for over 30 years. He was the director of the Addictions Treatment Program for the Israel Prison Service, and started the first national facility for the treatment of Dual Diagnosis in Israel. Dr. Telias is also a consultant for the Department of Addictions at the MOH, Israel. Dr. Telias is a Honorary Professor at MAIMONIDES University, in Buenos Aires, and a lecturer at Ben Gurion University, for the School of Medicine, for the Columbia University exchange program, and for the School of Social Work. He has authored 4 books on the subjects of Personality Disorders and Addictions, and also several journal papers on such subjects.
Disclosure: Has disclosed no relevant financial relationships.
Stuart Gitlow, MD, MPH, MBA (, Beacon Health Strategies, LLC)Dr. Gitlow is a practicing physician with experience and expertise in psychiatry, managed care, organized medicine, and online services. He received his medical degree from Mount Sinai School of Medicine and completed his training in general psychiatry and psychiatric epidemiology at the University of Pittsburgh. He is certified by the American Board of Psychiatry and Neurology in general, addiction, and forensic psychiatry. He has been active in organized medicine since 1985 and is past chair of the American Medical Association's Young Physician Section. He also has provided consultation for the US Public Health Service, the New York Board of Medicine, the New Hampshire Public Defender's Office, the Pennsylvania Bureau of Disability Determination, and the Massachusetts Disability Determination Services. In addition, he provides expert medical services for the Social Security Administration and is medical director of the Family and Children's Service of Nantucket, where he sees patients in outpatient and residential settings.
Disclosure: Has disclosed no relevant financial relationships.
Leslie A O'Neill, MD (Infectious Disease Researcher, Dartmouth-Hitchcock Medical Center )Dr. O'Neill works at Dartmouth-Hitchcock Medical Center and specializes in infectious disease.
Disclosure: Has disclosed no relevant financial relationships.
Shelly Henderson, PhD (Director of Psychology Training, Department of Family and Community Medicine)Shelly Henderson has a Ph.D. in Clinical Psychology from Pacific Graduate School of Psychology. After completing her Internship and Postdoctoral Fellowship in Primary Care Psychology at UC Davis, she joined the Family & Community Medicine faculty as an Assistant Clinical Professor. Prior to coming to UCDMC, Dr. Henderson worked in the Veterans Affairs Health Care System, Palo Alto and San Francisco, providing clinical care to veterans and their families. As the Director of Behavioral Medicine in the Department of Family and Community Medicine, Dr. Henderson works to integrate substance abuse education into the curriculum for primary healthcare providers. Her interests include addiction disorders, motivational interviewing, and health behavior change. She is also the Director of Psychology Training and provides education for psychology trainees in the primary care setting.
Disclosure: Has disclosed no relevant financial relationships.
William Renn , MSW (Director, Alcohol and Substance Abuse Program, University of North Carolina School of Medicine)Mr. Renn has been involved with substance abuse programs for more than 25 years as a counselor, clinical associate, and program director. Since 1998, he has served as the program director of the Alcohol and Substance Abuse Program at the University of North Carolina at Chapel Hill. Mr. Renn also holds appointments at UNC's Department of Psychiatry and the Bowles Center for Alcohol Studies. He has several addiction certifications and serves on multiple committees with statewide organizations, including the National Association of Social Workers - North Carolina, Addiction Professionals of North Carolina, and the North Carolina Foundation for Alcohol and Drug Studies.
Disclosure: Has disclosed no relevant financial relationships.
Peter Friedmann, MD (Associate Professor of Medicine and Community Health, Brown Medical School)Dr. Friedmann is a primary care physician, ASAM-certified addictionist, and substance abuse researcher. He is a nationally recognized expert on screening for substance use disorders in medical settings, the organization of care for patients with addictive disorders, and the role of the primary care physician in the diagnosis and treatment of substance problems. He has given several invited presentations on buprenorphine in primary care and on substance abuse treatment in primary care. He is a course director for ASAM's buprenorphine training series, a member of ASAM's Buprenorphine Training Subcommittee and a mentor in the SAMHSA-funded Physician Clinical Support System (www.pcssmentor.org). He is also president-elect for the Association for Medical Education and Research in Substance Abuse (www.amersa.org).
Disclosure: Has disclosed no relevant financial relationships.
Sybil Marsh, MD (Assistant Professor of Family Medicine, Case University Hospitals Medical Center)Dr. Sybil Marsh is an Assistant Professor of Family Medicine at Case University Hospitals Medical Center located in Cleveland, Ohio.
Disclosure: Has disclosed no relevant financial relationships.

Review Dates

Content Review:Editorial Review:
Mon, 11/1/2010Mon, 11/1/2010

Modules in this Training Activity

  • Opioid Addiction: Introduction to Opioids

  • Opioid Addiction: Prevalence, Trends and Impact on Health

  • Opioid Use Disorders and Common Comorbidities

  • Opioid Medications and Prescription Drug Abuse

  • Opioid Misuse Detection

  • Opioid Addiction: Treatment with Buprenorphine

Module Practice Gap References
How Well is Chronic Pain Managed? Who Does it Well? . Journal of Pain Medicine. 2002; 3(1): 56-65.
Errors in opioid prescribing: A prospective survey in cancer pain. The American Journal of Pain Symptom Management. 2010; 39(4): 702-711.

Audience and Accreditation

Audience:

Medical and other health professional students

A letter of completion for up to 2 hour(s) is available for non-physicians.
A score of 70% on the post-test is required to complete the activity.
Participation Requirements

Activity Credit: Obtaining credit for participation in this activity requires that you complete the pre-assessments, work through the modules (including all in-module interactive activities), complete the post-assessments with a 70% score on the post-test, and then request credit. At the end of the activity, you will be instructed on how to print out a certificate for your records.

Time Requirement: Keep track of the amount of time it takes you to complete this activity. You will be required to spend a set amount of time in order to claim credit. You should claim credit only for the time actually spent in the activity.

Technical Requirement: To participate in this activity, you will need a computer, an Internet connection, and a Web browser. This activity requires Chrome, Firefox, and IE7 or higher.

Training Activity References
Heroin-related noncardiogenic pulmonary edema: a case series. Chest. 2001; 120: 1628-1632.
In 12-step groups, helping helps the helper. Addiction. 2004; 99(8): 1015-23.
Substance Abuse in Brief Fact Sheet DHHS Publication No. (SMA) 06-4187. DHHS. 2006; (4)2: .
2004 National Survey on Drug Use and Health. Rockville, MD. 2005. Available at: http://oas.samhsa.gov/NSDUH/2k4nsduh/2k4tabs/Sect1peTabs1to66.htm#tab1.26a
A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States. MMWR. 2005; 54(RR-16): 1-39.
A comprehensive review of the psychometric properties of the drug abuse screening test. Journal of Substance Abuse Treatment. 2007; 32(2): 189-198.
A Guide to Substance Abuse Services for Primary Care Clinicians. Rockville, Md: Center For Substance Abuse Treatment. Treatment Improvement Protocol Series, No. 24. USDHHS Publication (SMA) 97-3139. 1997.
A psychometric study of the prevalence of DSM-IV personality disorders among office-based methadone maintenance patients. The American Journal of Drug and Alcohol Abuse. 2004; 30(3): 515-524.
A randomized controlled trial of intensive referral to 12-step self-help groups: one-year outcomes. Drug and Alcohol Dependence. 2007; 90(2): 270-279.
A risk-benefit analysis of methadone maintenance treatment. In: Graham AW, Schultz TK, Mayo-Smith MF, Ries RK, Wilford BB, eds. Principles of Addiction Medicine. 3rd ed. Chevy Chase, Md: American Society of Addiction Medicine. 2003.
A two-item conjoint screen for alcohol and other drug problems. J Am Board Fam Pract. 2001; 14(2): 95-106.
Accessing opiate dependence treatment medications: buprenorphine products in an office-based setting. Drug Alcohol Depend. . 2003; 70(2 Suppl): S103-4.
Adherence to pharmacotherapy in patients with alcohol and opioid dependence. Addiction. 2004; 1382-1392: .
Adolescent substance abuse. Confidentiality and consent. The Pediatric Clinics of North America. 2002; 49(2): 301-315.
Adolescents with co-occurring mental health and substance use disorders in primary care. Adolescent Medical Clinics. 2006; 17(2): 427-452.
Advances in diagnosis of adolescent substance abuse. Adolescent Medical Clinics. 2006; 17(2): 411-425.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed, Text Revision. Washington, DC. American Psychiatric Association. 2000.
Anxiety disorders, comorbid substance abuse, and benzodiazepine discontinuation: implications for treatment. NIDA Res Monogr. 1997; 172: 33-51.
Assessment and treatment of comorbid psychiatric disorders in opioid-dependent patients. The Clinical Journal of Pain. 2002; 18(4): 14-26.
Balancing confidentiality and the information provided to families of patients in primary care. Journal of Medical Ethics. 2005; 31(9): 531-535.
Basal opioid receptor activity, neutral antagonists, and therapeutic opportunities. Life Sciences. 2005; 76(13): 1427-1437.
Bipolar disorder and alcoholism. Alcohol Research and Health . 2002; 26(2): 103-108. Available at: http://pubs.niaaa.nih.gov/publications/arh26-2/103-108.htm Accessed on: 2009-01-12.
Bipolar disorder and substance abuse. Journal of Biological Psychiatry. 2004; 56: 738-748.
Borg L, Kreek MJ. The pharmacology of opioids. In: Graham AW, Schultz TK, Mayo-Smith MF, Ries RK, Wilford BB. Principles of Addiction Medicine. 3rd ed. Chevy Chase, Md: American Society of Addiction Medicine. 2003.
Borg L, Kreek MJ. The pharmacology of opioids. In: Graham AW, Schultz TK, Mayo-Smith MF, Ries RK, Wilford BB. Principles of Addiction Medicine. 3rd ed. Chevy Chase, Md: American Society of Addiction Medicine. 2003.
Brief substance use screening instruments for primary care settings: a review. Journal of Substance Abuse Treatment. 2000; 18(2): 193-202.
Buprenorphine and naloxone co-administration in opiate-dependent patients stabilized on sublingual buprenorphine. Drug and Alcohol Dependence. 2000; 61(1): 85-94.
Buprenorphine/naloxone treatment in primary care is associated with decreased human immunodeficiency virus risk behaviors. Journal of Substance Abuse Treatment. 2008; 35(1): 87-92.
Buprenorphine: Considerations for Pain Management. Journal of Pain and Symptom Management. 2005; 29(3): 297-326.
Buprenorphine: field trials of a new drug. Qual Health Res. 2001; 11(1): 69-84.
Buprenorphine: how to use it right. Drug Alcohol Depend. 2003; 70(suppl 2): S59-S77.
Characteristics of older opioid maintenance patients. J Subst Abuse Treat. 2005; 28(3): 265-72.
Characteristics of older opioid maintenance patients. Journal of Substance Abuse Treatment. 2005; 28(3): 265-272.
Clinic-based treatment for opioid dependence: a qualitative inquiry. American Journal of Health Behavior. 2006; 30(5): 544-554.
Co-occurrence of personality disorders with mood, anxiety, and substance use disorders in a young adult population. Journal of Personality Disorders. 2006; 20(1): 102-112.
Co-occurring psychiatric disorders in women with addictions. Obstetrics and Gynecology Clinics of North America. 2003; 2003: 469-481.
Coinfection with HIV and hepatitis C virus. CDC website. 2005. Available at: http://wwwnc.cdc.gov/eid/article/13/3/06-1069_article.htm
College on Problems of Drug Dependence Taskforce on prescription opioid non-medical use and abuse: position statement. Drug Alcohol Depend. 2003; 69(3): 215-232.
Community drug alert bulletin: prescription drugs. Rockville, MD: US Dept of Health and Human Services. 2005b. Available at: http://archives.drugabuse.gov/PrescripAlert/ Accessed on: 2008-04-16.
Compounds in development for chronic hepatitis B. HBF Drug Watch. 2005. Available at: http://www.hepb.org/professionals/hbf_drug_watch.htm Accessed on: 2008-04-21.
Comprehensive review of hepatitis C for psychiatrists: risks, screening, diagnosis, treatment, and interferon-based therapy complications. Journal of Psychiatric Practice. 2003; 9(2): 93-110.
Conceptualizing and assessing treatment structure and process in community-based drug dependency treatment programs. Substance Use Misuse . 2000; 35(12-14): 1757-1795.
Concerns over confidentiality may deter adolescents from consulting their doctors. A qualitative exploration. Journal of Medical Ethics. 2006; 32(3): 133-137.
Consent to treatment and confidentiality provisions affecting minors in Pennsylvania. 2nd edition. Philadelphia: Juvenile Law Center. 2006.
Constitutive Activity and Inverse Agonists of G Protein-Coupled Receptors: a Current Perspective. Molecular Pharmacology. 2003; 64(6): 1271-1276.
Definitions related to the use of opioids for the treatment of pain. Available at: http://www.painmed.org/pdf/definition.pdf. 2001. Accessed on: 2008-04-14.
Delivery of HIV risk-reduction services in drug treatment programs. J Subst Abuse Treat. 2000; 19(3): 229-237.
Developments in the treatment of drug dependence. Curr Opin Psychiatry. . 2000 ; 13(3): 333-338.
Diagnosis and treatment of drug abuse in family practice. NIH. 2005. Available at: http://archives.drugabuse.gov/diagnosis-treatment/diagnosis1.html Accessed on: 2006-10-11.
Diagnosis of comorbid psychiatric disorders in substance users assessed with the psychiatric research interview for substance and mental disorders for DSM-IV. American Journal of Psychiatry. 2006; 193: 689-696.
Dilemmas in diagnosing and treating co-occurring disorders. Behavioral Healthcare Tomorrow. 2004; 13(4): 42-47.
Drug Abuse Warning Network, 2005: National Estimates of Drug-Related Emergency Department Visits. DAWN Series D-29. DHHS Publication No. (SMA) 07-4256. Rockville, MD. 2007.
Dual diagnosis: substance-related and psychiatric disorders. The Nursing Clinics of North America. 2003; 38: 67-73.
Effects of buprenorphine sublingual tablet maintenance on opioid drug-seeking behavior by humans. Psychopharmacology (Berl). 2002; 160(4): 344-52.
Exercise activates the endocannibinoid system. NeuroReport. 2003; 14(17): 2209-2211.
Fact Sheet: Viral Hepatitis. CDC website. 2006. Available at: http://www.cdc.gov/hepatitis/index.htm Accessed on: 2008-04-21.
Family interventions for drug and alcohol misuse: is there a best practice?. Curr Opin Psychiatry. 2006; 19(3): 271-6.
Foundations of Opioid Risk Management. Clinical Journal of Pain. 2007; 23(2): 103-118.
GABAergic mechanisms of opiate reinforcement. Alcohol & Alcoholism. 2002; 37(5): 485-494.
Generalized Anxiety Disorder, Post-traumatic Stress Disorder. NIH. 2006. Available at: http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml Accessed on: 2010-06-25.
Gitlow S. Substance Use Disorders. Philadelphia, Pa: Lippincott Williams & Wilkins. 2006.
Harrison L. The validity of self-reported drug use in survey research: an overview and critique of research methods. In: Harrison L, Hughes A, eds. The Validity of Self-Reported Drug Use: Improving the Accuracy of Survey Estimates. Rockville, Md: National Institute on Drug Abuse; 1997:17-36. Publication 97-4147, NIDA Research Monograph 167. 1997.
Helping 'them': our role in recovery from opioid dependence. Annals of Family Medicine. 2006; 4(2): 168-171.
Hepatitis B virus infection and vaccination among young injection and non-injection drug users: missed opportunities to prevent infection. Drug and Alcohol Dependence. 2004; 73(1): 69-78.
Hepatitis B. WHO. 2002. Available at: http://www.who.int/csr/resources/publications/surveillance/whocdscsrisr992.pdf Accessed on: 2010-06-25.
Hepatitis B. World Health Organization, Department of Communicable Diseases Surveillance and Response. 2002. Available at: http://www.who.int/csr/resources/publications/surveillance/whocdscsrisr992.pdf Accessed on: 2008-04-11.
Hepatitis C and HIV risk behaviors in polydrug users on methadone maintenance. J Subst Abuse Treat. 2008; 35(1): 78-86.
Hepatitis C Virus and HIV Coinfection. Prevention Among Injection Drug Users. 2002; September: . Available at: http://www.cdc.gov/hepatitis/HCV/Management.htm
Hepatitis C virus infection and substance abuse. Clinical Infectious Diseases. 2005; 40: 259-262.
Hepatitis C. Mayo Clinic website. 2005. Available at: http://www.mayoclinic.org Accessed on: 2014-07-31.
Hepatitis Surveillance Report. No. 58. 2004. Available at: http://www.cdc.gov/mmwr/PDF/ss/ss5803.pdf
Hirschfeld R. Guideline watch: Practice guideline for the treatment of patients with bipolar disorder, 2nd Edition. Psychiatry Online. 2007. Available at: http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/bipolar-watch.pdf Accessed on: 2014-10-17.
HIV Diagnoses Among Injection-Drug Users in States with HIV Surveillance --- 25 States, 1994--2000. MMWR. 2003; 52(27): 634-636.
HIV/AIDS Among Women. Fact Sheet. 2008.
How Buprenorphine Works. NAABT, Inc. 2007. Available at: http://www.naabt.org/collateral/How_Bupe_Works.pdf Accessed on: 2010-06-15.
How much can treatment reduce national drug problems?. Addiction. 2006; 101(3): 341-347.
Illicit Drug Use. Women's Health USA . 2005. Available at: http://mchb.hrsa.gov/whusa_05/pages/0405idu.htm
Illicit use of opioid analgesics by high school seniors. Journal of Substance Abuse Treatment. 2005; 28(3): 225-230.
Informed consent to undergo treatment for substance abuse: a recommended approach. Journal of Substance Abuse Treatment. 2005; 29(4): 241-251.
Kleber HD, Weiss RD, Anton RF, Rounsaville BJ, George TP, Strain EC, Greenfield SF, Ziedonis DM, Kosten TR, Hennessy G, O'Brien CP, Connery HS, McIntrye JS, Charles SC, Anzia DJ, Nininger JE, Cook IA, Summergrad P, Finnerty MT, Woods SM, Johnson BR, Yager J, Pyles R, Lurie L, Cross CD, Walker RD, Peele R, Barnovitz MA, Gray SH, Shemo JP, Saxena S, Tonnu T, Kunkle R, Albert AB, Fochtmann LJ, Hart C, Regier D. Practice guideline for the treatment of patients with substance use disorders, 2nd edition. Am J Psychiatry. 2006; 163(8 Suppl): 5-82.
Kreek MJ. Opiate Antagonist Treatment, Molecular Pharmacology, and Physiology. Presentation at the Consensus Conference on Effective Medical Treatment of Heroin Addiction. Bethesda, Md: National Institutes of Health. 1997.
Management of opioid dependence. Current Opinion in Psychiatry. 2003; 16(3): 297-304.
Maremmani I, Pani PP, Mellini A, Pacini M, et al. Alcohol and cocaine use and abuse among opioid addicts engaged in a methadone maintenance treatment program. J Addict Dis. 2007; 26(1): 61-70.
Mattick RP, Kimber J, Breen C, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Systematic Reviews. CD002207. 2002.
Medical illness and comorbidities in drug users: implications for addiction pharmacotherapy treatment. Substance Use and Misuse. 2005; 40(13-14): 1899-1921.
Medical management of chronic hepatitis B and chronic hepatitis C. CDC website. 2002. Available at: http://www.cdc.gov/hepatitis/HCV/Management.htm Accessed on: 2008-04-21.
Medication development for addictive disorders: the state of the science. American Journal of Psychiatry. 2005; 162(8): 1432-40.
Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Rockville, MD: Substance Abuse and Mental Health Services Administration. Treatment Improvement Protocol (TIP) Series 43. DHHS Publication No. (SMA) 05-4048. 2005.
Medications development: successes and challenges. Pharmacology & Therapeutics. 2005; 108(1): 94-108.
Metabolic consequences of drug misuse. Br J Anaesth. 2000; 85(1): 136-142.
Naloxone reversal of buprenorphine-induced respiratory depression. Anesthesiology. 2006; 105(1): 51-57.
National Drug Intelligence Center. Information Bulletin January 2001: OxyContin Diversion and Abuse. Johnstown, Pa: National Drug Intelligence Center. Product 2001-L0424-001. 2001.
National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A Research-Based Guide. Rockville, Md: National Institute on Drug Abuse. 1999.
Network Therapy for addiction: assessment of the clinical outcome of training. Am J Drug Alcohol Abuse. 1997; 23(3): 355-67.
Network therapy: decreased secondary opioid use during buprenorphine maintenance. J Subst Abuse Treat. 2004; 26(4): 313-8.
Neural systems underlying opiate addiction. J Neurosci. 2002; 22(9): 3321-3325.
Nonmedical oxycodone users: a comparison with heroin users.. Rockville, MD. 2005. Available at: http://oas.samhsa.gov/2k4/oxycodoneH/oxycodoneH.htm
O'Brien CP, Cornish JW. Opioids: antagonists and partial agonists. In: Galanter M, Kleber HD, eds. Textbook of Substance Abuse Treatment. 2nd ed. Washington, DC: American Psychiatric Press, Inc. 1999.
Office of National Drug Control Policy. What America’s Users Spend on Illegal Drugs, 1988–2000. Office of National Drug Control Policy. 2001.
Office-based practice and opioid-use disorders. New England Journal of Medicine. 2004; 349(10): 928-930.
Office-based treatment of opioid-dependent patients. American Family Physician. New England Journal of Medicine. 2002; 347(11): 817-822.
Opiate Drugs Increase Vulnerability to Stress. APA Online. 2005. Available at: http://www.apa.org/releases/opiate0805.html Accessed on: 2007-06-05.
Opioid Abuse. JAMA. 2004; 291(11): 1394.
Opioid Analgesia. New York: McGraw Hill. 2004.
Opioid Dependence: Rationale for and Efficacy of Existing and New Treatments. Clinical Infectious Diseases. 2006; 43: S173-177.
Opioid maintenance: a comparative review of pharmacological strategies. Expert Opinion on Pharmacotherapy. 2007; 8(1): 1-11.
Opioid prescriptions soar: increase in legitimate use as well as abuse. Journal of the American Medical Association. 2007; 297(3): 249-251.
Outcome and impact of mental disorder in primary care at 5 years. Pychosomatic Medicine. 2007; 69(3): 270-276.
Overcoming barriers to prevention, care, and treatment of hepatitis C in illicit drug users. Clinical Infectious Diseases. 2005; 40(S5): 276-285.
Parental substance use disorder and the risk of adolescent drug abuse: an event history analysis. Drug and Alcohol Dependence. 2002; 66(3): 255-264.
Patient assessment and selection for buprenorphine treatment. Addiction Professional. 2005; 2:17: .
Patient characteristics and risk factors for development of dependence on hydrocodone and oxycodone. American Journal of Therapeutics. 2004; 11(1): 26-32.
Patient-doctor communication. Medical Clinics of North America. 2003; 87(5): 1115-45.
Patients with pain and addiction: what's a doctor to do?. Minnesota Medicine. . 2006; 89(9): 41-43.
Pharmacokinetics of the combination tablet of buprenorphine and naloxone. Drug Alcohol Depend. 2003; 70(suppl 2): S39-S47.
Pharmacologic treatment of heroin-dependent patients. Ann Intern Med. 2000; 133(1): 40-54.
Pharmacotherapy of Comorbid Mood, Anxiety, and Substance Use Disorders. Substance Use and Misuse. 2005; 40: 2021-2041.
Physicians advised on how to offer pain relief while preventing opioid abuse. Journal of the American Medical Association. 2004; 292(4): 1164-1166.
Physicians-in-training attitudes toward caring for and working with paitents with alcohol and drug abuse diagnoses. South Med J. 2006; 99: 28-35.
Potential for abuse of buprenorphine in office-based treatment of opioid dependence (letter). New England Journal of Medicine. 2005; 353(17): 1863-1865.
Practice guideline for the treatment of patients with substance use disorders, 2nd edition. Am J Psychiatry. 2006; 163(8): 5-82.
Prescription Drug Abuse Chart. http://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts. 2004. Available at: http://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts Accessed on: 2014-11-26.
Prescription Drugs: OxyContin Abuse and Diversion and Efforts to Address the Problem. Report to Congressional Requesters. 2003.
Prevalence and characteristics of clients with co-occurring disorders in outpatient substance abuse treatment. The American Journal of Drug and Alcohol Abuse.. 2004; 20(4): 749-764.
Prevalence and co-occurrence of substance disorders and independent mood and anxiety disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry. 2004; 61(8): 807-816.
Prevalence of psychiatric and substance use disorders in opioid abusers in a community syringe exchange program. Drug and Alcohol Dependence. 2004; 74-2: 115-122.
Professional satisfaction experienced when caring for substance-abusing patients . Journal of General Internal Medicine. 2002; 17(5): 1525-1597.
Psychoactive drug abuse in older adults. The American Journal of Geriatric Pharmacotherapy. 2006; 4(4): 380-394.
Pulmonary effects of illicit drug use. Clinics in Chest Medicine. 2004; 25: 203-216.
Pulse Check: Trends in Drug Abuse, January - June 2002 Reporting Period. Publication NCJ-197242. 2002.
Recent trends in adolescent substance use, primary care screening, and updates in treatment options. Curr Op in Pediatr. 2006; 18(4): 352-8.
Recognition of alcohol and substance abuse. American Family Physician. 2003; 67(7): 1529-1532,1535-1536.
Report of the CSAT National Advisory Council (NAC) subcommittee on oral fluid testing. USDHHS. 2003b.
Report to congress on the prevention and treatment of co-occurring substance abuse disorders and mental disorders. Available at: http://www.nasmhpd.org/sites/default/files/CoOccurringIVFinalReportsubmitted.pdf. 2005. Available at: http://www.nasmhpd.org/sites/default/files/CoOccurringIVFinalReportsubmitted.pdf Accessed on: 2007-07-19.
Report to Congress on the prevention and treatment of co-occurring substance abuse disorders and mental disorders. US Department of Health and Human Services. 2002. Available at: http://www.ct.gov/dmhas/lib/dmhas/cosig/cooccurringreport.pdf Accessed on: 2007-07-19.
Research Report Series - Prescription Drugs: Abuse and Addiction. NIDA Website. 2005. Available at: http://www.drugabuse.gov/publications/research-reports/prescription-drugs/director Accessed on: 2014-08-28.
Research Report Series: Heroin Abuse and Addiction. Rockville, MD: US Dept of Health and Human Services. 2005.
Research Report Series: MDMA (Ecstasy) Abuse. Bethesda, MD: U.S. Department of Health and Human Services.. 2004. Available at: http://www.drugabuse.gov/sites/default/files/rrmdma_0.pdf Accessed on: 2014-08-01.
Results from the 2005 National Survey on Drug Use and Health: National Findings. Rockville, MD. 2006. Available at: http://oas.samhsa.gov/nsduh/2k5nsduh/2k5Results.pdf
Retention in publicly funded methadone maintenance treatment in two western states.. J Behav Health Serv Res. 2005; 32(1): 43-60.
Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. MMWR. 2006; 55(RR14): 1-17. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm
Role of the primary care physician in problems of substance abuse. Archives of Internal Medicine. 1999; 159(9): 913-924.
SAMHSA/CSAT Evaluation of the buprenorphine waiver program. Paper presented at: 37th Annual Medical- Scientific Conference of the American Society of Addiction Medicine. 2006.
Screening for serious mental illness in populations with co-occurring substance use disorders: performance of the K6 scale. Journal of Substance Abuse Treatment. 2006; 31: 287-296.
Screening for serious mental illness in populations with co-occurring substance use disorders: performance of the K6 scale. Journal of Substance Abuse Treatment.. 2006; 31: 287-296.
Senay EC. Opioids: methadone maintenance. In: Galanter M, Kleber HD, eds. Textbook of Substance Abuse Treatment. 2nd ed. Washington, DC: American Psychiatric Press, Inc. 1999.
Shea SC. The Practical Art of Suicide Assessment. New York, NY: John Wiley. 1999.
Shift seen in patterns of drug use among teens. Journal of the American Medical Association. 2006; 295(6): 612-613.
Should patients' religiosity influence clinicians' referral to 12-step self-help groups? Evidence from a study of 3,018 male substance abuse patients. J Consult Clin Psychol. 1999; 67(5): 790-794.
Six deaths linked to concomitant use of buprenorphine and benzodiazepines. Addiction. 1998; 93(9): 1385-92.
Stenbacka M, Beck O, Leifman A, Romelsjo A, Helander A. Problem drinking in relation to treatment outcome among opiate addicts in methadone maintenance treatment. Drug and Alcohol Review. 2007; 26(1): 55-63.
Stephens RC. The Street Addict Role: A Theory of Heroin Addiction. Albany: State University of New York Press. 1991.
Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. A Guide to Substance Abuse Services for Primary Care Clinicians. Rockville, Md: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration. Treatment Improvement Protocol Series, No. 24. Publication (SMA) 02-3687. 1997.
Substance Abuse and Mental Health Services Administration. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Rockville, Md: Center For Substance Abuse Treatment. Treatment Improvement Protocol Series, No. 40, USDHHS Publication (SMA) 04-3939. 2004. Available at: http://www.ncbi.nlm.nih.gov/books/NBK64766/ Accessed on: 2011-12-12.
Substance Abuse and Mental Health Services Administration. Overview of Findings From the 2002 National Survey on Drug Use and Health. Rockville, Md: Office of Applied Studies. NHSDA Series H-21. USDHHS Publication SMA 03-3774. 2003.
Substance Abuse and Mental Health Services Administration. Preliminary Results From the 1996 National Household Survey on Drug Abuse. Rockville, Md: US Dept of Health and Human Services. 1997.
Substance abuse treatment for persons with co-occurring disorders. Treatment Improvement Protocol (TIP) Series. DHHS Publication No. (SMA) 05-3922. 2005. Available at: http://www.ncbi.nlm.nih.gov/books/NBK64197/ Accessed on: 2010-06-15.
Substance abuse treatment providers' referral to self-help: review and future empirical directions. Int J Self Help Self Care. 2000; 1(3): 213-225.
Suicide prevention plan calls for physicians' help. JAMA. 2001; 285(21): 2701-2703.
The Addiction behaviors checklist: validation of a new clinician-based measure of inappropriate opioid use in chronic pain. Journal of Pain and Symptom Management. 2006; 32(4): 342-351.
The availability of web sites offering to sell opioid medications without prescriptions. Am J Psychiatry. 2006; 8(5): 377-8.
The Clinical Opiate Withdrawal Scale (COWS). Journal of Psychoactive Drugs. 2003; 35(2): 253-259.
The development of a comprehensive risk-management program for prescription opiod analgesics: researched abuse, diversion, and addiction-related surveillance (RADARS). Pain Medicine. 2007; 2(8): 157-170.
The health insurance portability and accountability act (HIPAA): its broad effect on practice. American Journal of Gastroenterology. 2005; 100: 1440-1443.
The heroin epidemic in New York City: current status and prognoses. J Psychoactive Drugs. 1997; 29(4): 375-391.
The initiation of the use of heroin in the age of crack-cocaine. In: Inciardi JA, Harrison LD, eds. Heroin in the Age of Crack-Cocaine. Thousand Oaks, Calif: SAGE Publications, Inc. 1998.
The medical complications of heroin use. Current Opinion in Psychiatry. 2005; 18(3): 257-263.
The National Center on Addiction and Substance Abuse (CASA). Missed Opportunity: National Survey of Primary Care Physicians and Patients on Substance Abuse. The National Center on Addiction and Substance Abuse at Columbia University, Survey Research Laboratory. Chicago, IL: University of Illinois at Chicago. 2000. Available at: http://www.casacolumbia.org/addiction-research/reports/national-survey-primary-care-physicians-patients-substance-abuse Accessed on: 2014-06-04.
The neurobiology of opioid addiction: implications for treatment. NIDA Science and Practice Perspectives. 2002; 1(1): 13-20.
The NSDUH Report: Nonmedical Users of Pain Relievers: Characteristics of Recent Initiates. Rockville, MD. 2006c. Available at: http://www.samhsa.gov/prescription-drug-misuse-abuse
The reality of comorbidity: depression and drug abuse. Biological Psychiatry. 2004; 56: 714-717.
The right of minors to confidentiality and informed consent. Journal of Child Neurology. 2004; 19(2): 145-148.
Treating opioid dependence. Archives of Internal Medicine. 2004; 164(3): 277-288.
Treatment Episode Data Set (TEDS): 1994-2004. National Admissions to Substance Abuse Treatment Services. DASIS Series: S-33, DHHS Publication No. (SMA) 06-4180. Rockville, MD. 2006b.
Treatment of depression in patients with opiate dependence. Biological Psychiatry. 2004; 56: 793-802.
Treatment structure and program services in the drug abuse treatment outcome study (DATOS). Psychology of Addictive Behaviors. 1997; 11(4): 244-260.
Understanding polydrug use: review of heroin and cocaine co-use. Addiction. 2003; 98: 7-22.
Unifying perspective of the mechanisms underlying the development of tolerance and physical dependence to opioids. J Pharmacol Exp Ther. 2001; 297(1): 11-18.
Use of Buprenorphine in the Pharmacologic Management of Opioid Dependence: A Curriculum for Physicians. Substance Abuse and Mental Health Services Administration. 2001.
Use of standardized patients in undergraduate medical genetics education. Teach Learn Med. 2006; 18(3): 203-7.
What are HIV and AIDS?. National Institute of Allergy and Infectious Disease. 2008. Available at: http://www.niaid.nih.gov/topics/HIVAIDS/Understanding/Pages/whatAreHIVAIDS.aspx
What I need to know about Hepatitis C. National Digestive Diseases Information Clearinghouse (NDDIC). NIH Publication No. 09–4229. 2009. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/hepc_ez/index.aspx Accessed on: 2010-04-07.
When you suspect a drug problem. Minnesota Medicine. 2006; 89: .
Why physicians are unprepared to treat patients who have alcohol- and drug-related disorders. Academic Medicine. 2001; 76(5): 410-418.
FundingInitial development of this activity was supported by a grant from the National Institute on Drug Abuse (#R44-DA12066), a grant from the National Institute on Drug Abuse (#1R44DA027245-01).