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Opioid CME

Clinical Skills Training on Opioids

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Treatment and Management of Opiate-Dependent Patients

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Please Note: This activity was last reviewed and updated 06/14/2019. For more up-to-date materials, please visit bup.clinicalencounters.com.

Treatment and Management of Opiate-Dependent Patients

Training to Meet the California Continuing Medical Education Requirement for Physicians and Surgeons

12 hr(s) CE

Goal: To train physicians in the Treatment and Management of Opiate-Dependent Patients, fulfilling the requirement option of 12 hours of training on the treatment and management of opiate-dependent patients including 8 hours of training in the medicinal treatment for opioid use disorder

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This activity is designed to change: Competence, Performance, Patient Outcome.   12 hr(s)

Overview

Professional Practice Gaps

Educational Objectives:

After completing this activity participants will be able to:

  • Describe the stages of office-based buprenorphine treatment, basic regulations, and requirements
  • Relate buprenorphine’s pharmacological properties to its drug effects
  • Understand the physiological effects of opioids and opioid treatments on patients
  • Identify, assess, and diagnose opioid use disorder in patients
  • Use medical and substance use disorder history information to assess patients in terms of suitability for treatment with buprenorphine
  • Describe effective and successful treatment of patients in buprenorphine treatment and complications that may arise
  • Describe how buprenorphine treatment guidelines are adapted to needs of specific patient populations, including those with psychiatric comorbidities, adolescents, the elderly, pregnant women, methadone transfers, and patients with pain
  • Prescribe, refer, or implement appropriate psychosocial therapies for treating opioid use disorder for patients
  • Monitor patients being treated with opioids for chronic pain to screen for substance use problems
  • Identify patients with a high risk of opioid use disorder or other misuse before prescribing any opioids
  • Identify risk for diversion and overdose by patients being treated with opioids and take prevention steps
  • Use a patient-centered, non-authoritarian, collaborative approach to work with a patient to change substance use behaviors or other health behaviors

Training Activity References

Audience and Accreditation

Audience: Medical Residents, Medical Students

TypeEst. TimeReleasedExpires
AMA PRA Category 1 Credit(s)™12 hr(s)7/1/1912/31/20

Accreditation Statement: Clinical Tools, Inc. is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

AMA PRA Category 1 Credit™ Designation Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 12 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

A letter of completion for 12 hours is available.

A score of 70% on the post-test is required to complete the activity.

Participation Requirements

Funding

Development of this website was funded by grant #R44DA12066, contract #HHSN271200655304C, contracts #HHSN271200900003C and Grant #1R44DA027245-01 from the National Institute on Drug Abuse (NIDA), as well as grants #1R43AA020456-01A1 and #2R44AA020456-02 from the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health.

Authors

As an ACCME accredited provider of continuing medical education, Clinical Tools, Inc.requires everyone who is in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest to the provider. The ACCME defines ‘relevant’ financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. Any conflicts of interest are resolved prior to the delivery of the educational activity to the learner. CTI does not permit individuals with financial conflicts of interest to participate in any stage of activity development.

T Bradley Tanner, MD (President, Clinical Tools, Inc.)

Disclosure: Has no relevant financial relationship(s) with ineligible companies to disclose. Dr. Tanner is the owner of Clinical Tools.

Read Bio
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 Bup.ClinicalEncounters.com. He also has a strong background in technology and oversees the 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 as a Clinical Associate Professor of Psychiatry at the University of North Carolina at Chapel Hill.

Karen Rossie, DDS, PhD (Research Scientist, Clinical Tools, Inc. )

Disclosure: Has no relevant financial relationship(s) with ineligible companies to disclose.

Read Bio
Karen Rossie, DDS, PhD, directs projects at Clinical Tools. She majored in biology at Cleveland State University and studied dentistry at Case Western Reserve University followed by completing a Masters in pathology at Ohio State University, and later, a PhD in Psychology from the Institute of Transpersonal Psychology. She taught and practiced oral pathology and oral medicine for 15 years at the Ohio State University and the University of Pittsburgh, doing research in autoimmune disease, bone marrow transplantation, oral cancer, salivary gland disease, candidiasis, and diabetes. She has used this diverse background to lead or contribute to CTI projects related to tobacco cessation, opioid abuse treatment, anxiety, dementia care, alcohol use disorder, screening and brief interventions for substance abuse, obesity, and pain and addiction.

Reviewers

Judith Martin, MD (President of California Society of Addiction Medicine (CSAM) and Medical Director, BAART Turk Street Clinic)
Disclosure: Has no relevant financial relationship(s) with ineligible companies to disclose.

Read Bio
Dr. Martin’s residency specialty is family practice and she has worked in addiction medicine since 1986 and is certified in addiction medicine by the American Society of Addiction Medicine (ASAM). She works with heroin-addicted patients and their families in East Oakland, as the Medical Director of The 14th Street Clinic. She also serves as the Medical Director for the East Bay Community Recovery Project, a multi-service agency that includes a residential program for addicted women and their children, Project Pride. Dr. Martin has published several papers related to methadone maintenance and she has taught in the Division of Family Medicine at Stanford University School of Medicine. Currently, Dr. Martin is the President of the California Society of Addiction Medicine (CSAM), has served on CSAM’s executive council, and she chairs their Committee for the Treatment of Opiate Dependence. Since 2001, she has been involved in efforts to train physicians in opiate dependence and the use of buprenorphine for the treatment of opiate addiction. She is currently co-chair of the American Society of Addiction Medicine’s Buprenorphine Training Subcommittee.

Steve Applegate, MEd, MEd (President, Applegate Consulting, )

Disclosure: Has no relevant financial relationship(s) with ineligible companies to disclose.

Read Bio
Mr. Applegate has experience in substance use counseling, state initiatives impacting substance use, and professional training. His prior positions include director of higher education and instructional design at the North Carolina Governor’s Institute on Alcohol and Substance Abuse, project director of the North Carolina Initiative of the Mid-Atlantic Addiction Technology Transfer Center, and program director of the Addiction Sciences Center (an outpatient substance abuse treatment center at the University of Virginia Health Sciences Center). Mr. Applegate works as an on-site consultant and travels to the Clinical Tools (CTI) office on a monthly basis from his office in Richmond, VA. Mr. Applegate helped design the CTI Instructional Manual and works to continue to revise it as we expand our Instructional Design methodology. Mr. Applegate has extensive experience with online education and training, especially in the area of substance abuse. He often pushes the envelope of technology and brainstorms with Clinical Tools how we can utilize new technology in our products. He helped guide development of the curriculum plan and assessments in Phase I of the current project.

Most Recent Updates/Reviews

CTI Content Update: 06/14/2019
CTI Editorial Review: 06/14/2019

Activity Content

About Prescribing Buprenorphine
Course not enrolled
Screening, Detection, and Diagnosis of Opioid Use Disorder
Course not enrolled
Assessing Patients for Buprenorphine Treatment
Course not enrolled
Understanding Opioids Medications and Buprenorphine Formulations
Course not enrolled
Induction of Buprenorphine
Course not enrolled
Maintenance and Discontinuation of Buprenorphine
Course not enrolled
Pregnancy, Young Adults, Methadone Patients, and Other Populations
Course not enrolled
Motivating Patients in Opioid Use Interventions
Course not enrolled
Problematic Behaviors with Buprenorphine
Course not enrolled
Opioids and Pain: Identifying, Assessing, and Responding to an Aberrant Behavior
Course not enrolled
Minimizing Opioid Diversion and Overdose Risk
Course not enrolled
Recognizing High-Risk Patients in Treatment for Pain
Course not enrolled
Pre-Assessments
Course not enrolled
Test Your Knowledge
Course not enrolled
Demographics
Course not enrolled
Post Survey
Course not enrolled
Satisfaction Survey
Course not enrolled

Primary Sidebar

Activity Home Expand All
Pre-Assessments
1 Test
Pre-Test
About Prescribing Buprenorphine
Screening, Detection, and Diagnosis of Opioid Use Disorder
Assessing Patients for Buprenorphine Treatment
Understanding Opioids Medications and Buprenorphine Formulations
Induction of Buprenorphine
Maintenance and Discontinuation of Buprenorphine
Pregnancy, Young Adults, Methadone Patients, and Other Populations
Motivating Patients in Opioid Use Interventions
Problematic Behaviors with Buprenorphine
Opioids and Pain: Identifying, Assessing, and Responding to an Aberrant Behavior
Minimizing Opioid Diversion and Overdose Risk
Recognizing High-Risk Patients in Treatment for Pain
Test Your Knowledge
1 Test
Post-Test
Demographics
Post Survey
Satisfaction Survey
Funding Information Development of this website was funded by grant #R44DA12066, contract #HHSN271200655304C, contracts #HHSN271200900003C and Grant #1R44DA027245-01 from the National Institute on Drug Abuse (NIDA), as well as grants #1R43AA020456-01A1 and #2R44AA020456-02 from the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health. The website contents are solely the responsibility of the authors and do not necessarily represent the official views of NIH. Ongoing development and maintenance is funded by the training fee and Clinical Tools, Inc. No commercial support is received.
Clinical Tools is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

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ClinicalTools

A member of The Clinical Encounters Training Group: SBIRT Training | BupPractice | PainTx Challenge | CE:Vaping | CE:Alcohol | CE:Obesity | OpioidCME

Clinical Tools, Inc. staff have disclosed no relevant financial relationships.

Unless otherwise noted, individuals pictured are models and are used for illustrative purposes only.
This site is for educational purposes only and medical decisions should not be based solely on its content. This site, its authors, and its consultants do not assume liability for errors or omissions.
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Professional Practice Gaps

Professional practice gaps exist when there is a disparity between educational needs and the ideal or desired level of knowledge, competence, and performance. Only around 6% of U.S. physicians are waivered to prescribe buprenorphine for office-based treatment of opioid use disorder (SAMHSA, 2017). Physicians are likely to encounter patients having this disorder due to the size of the opioid epidemic: 11.8 million people aged 12 or older engage in misuse of pain relievers (SAMHSA, 2017). Many people who need treatment are still not receiving it (SAMHSA, 2016). Federal law requires physicians to complete an 8-hour training in order to prescribe buprenorphine (CARA, 2016; DATA, 2000). Providing physician this training will prepare them to treat the many patients having opioid use disorder.

Buprenorphine is a safe and effective treatment for opioid use disorder for which 8 hours of training by an approved organization is required by law in order to prescribe it (SAMHSA, 2004; SAMHSA, 2016). Providing information on all aspects of buprenorphine treatment will help address this knowledge need. Moreover, buprenorphine treatment has a complex protocol that must be followed for successful outcomes and to minimize risks of overdose, death, and poison (FSMB, 2013), which validates the need for mandatory training in order to prescribe it. Understanding of clinical protocol and how to apply it will help address this competence need. Lastly, despite the demonstrated effectiveness of buprenorphine, a relatively small percentage (3%) of U.S. physicians are trained and credentialed to prescribe it (NAABT, 2017). Experience with interactive case scenarios helps address the performance need of translating competence in following the protocol into actual practice.

The guidelines for prescribing opioids produced by the CDC recommend a baseline and periodic drug screening of urine and checking of the prescription drug monitoring database for all patients being prescribed chronic opioids (Dowell et al., 2016; Gourlay et al., 2009). Providers need to intensify that treatment structure when risk of substance misuse is identified when screening patients for chronic opioid therapy and continue to monitor patients on chronic opioid therapy (Chou et al, 2009). This is particularly important when treating the patient with high risk for addiction/misuse. However, a national survey of physicians revealed multiple deficits in the skills needed to provide the necessary monitoring (CASA, 2006) The need for prescribers to do more to prevent diversion can be inferred from studies showing that a majority of patients do not take their pain medication as prescribed (Couto, 2009) and that the source for the majority of nonmedically used prescription drugs is a friend or relative (SAMHSA, 2013).

Practice Gap References

  • American Society of Addiction Medicine (ASAM). The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use. American Society of Addiction Medicine. June 1, 2015. Available at: http://www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline-supplement1b630f9472bc604ca5b7ff000030b21a.pdf?sfvrsn=0 Accessed on: 2015-10-06.
  • CDC. Opioid Data Analysis. Centers for Disease Control and Prevention. 2016. Available at: https://www.cdc.gov/drugoverdose/data/analysis.html Accessed on: 2017-03-27.
  • Couto J, Romney M, Leider H, et al. High Rates of Inappropriate Drug Use in the Chronic Pain Population Population Health Management. 2009;12(4):185-190.
  • Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep. 2016; ePub: March 2016: DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1er. Available at: http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm Accessed on: 2016-03-16.
  • FSMB. Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office. FSMB Website http://www.fsmb.org. 2013. Available at: https://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/2013_model_policy_treatment_opioid_addiction.pdf Accessed on: 2013-10-11.
  • Gourlay Douglas L, Heit Howard A. Universal Precautions Revisited: Managing the Inherited Pain Patient. Pain Med. July 2009;10 Suppl 2:S115-123. doi:10.1111/j.1526-4637.2009.00671.x .
  • Hughes A, Williams MR, Lipari RN, et al. Prescription Drug Use and Misuse in the United States: Results from the 2015 National Survey on Drug Use and Health. SAMHSA. 2016. Available at: http://www.samhsa.gov/data/sites/default/files/NSDUH-FFR2-2015/NSDUH-FFR2-2015.htm Accessed on: 2016-09-13.
  • NAABT. The National Alliance of Advocates for Buprenorphine Treatment. NAABT The National Alliance of Advocates for Buprenorphine Treatment. 2017. Available at: https://www.naabt.org/tl/buprenorphine-suboxone-treatment.cfm Accessed on: 2018-02-23.
  • Substance Abuse and Mental Health Services Administration (SAMHSA). 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. 2004b. Available at: https://www.ncbi.nlm.nih.gov/books/NBK64245/ Accessed on: 2013-10-08.
  • Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2012 national survey
    on drug use and health: summary of national findings. U.S. Department of Health and Human Services; 2013.
    http://archive.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/NationalFindings/NSDUHresults2012.htm. Accessed April 1, 2015.
  • Substance Abuse and Mental Health Services Administration. Results from the 2016 National Survey on Drug Use and Health: Summary of National Findings . NSDUH Series H-52. 2017; HHS Publication No. SMA 17-5044: . Available at: https://www.samhsa.gov/sites/default/files/topics/data_outcomes_quality/nsduh-ppt-09-2017.pdf Accessed on: 2018-02-20.
  • Substance Abuse and Mental Health Services Administration. Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder: Review and Update. Advisory. Winter 2016; 15 (1): . Available at: http://store.samhsa.gov/shin/content//SMA16-4938/SMA16-4938.pdf Accessed on: 2016-03-05.
  • U.S. House of Representatives. Comprehensive Addiction and Recovery Act of 2016. docs.house.gov. 2016. Available at: http://docs.house.gov/billsthisweek/20160704/CRPT-114HRPT-S524.pdf Accessed on: 2016-11-17.
  • United States Congress. Drug Addiction Treatment Act of 2000. United States Congress. 2000. Available at: http://www.deapersion.usdoj.gov/pubs/docs/dwp_buprenorphine.htm Accessed on: 2011-06-29.
Training Activity References

About This Training Activity

  1. SAMHSA. Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. SAMHSA.gov. 2017.

  2. CDC. Understanding the epidemic. Cent Dis Control Prev Natl Cent Inj Prev Control Div Unintentional Inj Prev. 2017.

  3. SAMHSA. Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder: Review and Update. Winter 2016.

  4. FSMB. Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office. FSMB Website. 2013.

  5. NAABT. Physical Dependence and Addiction An Important Distinction. Natl Alliance Advocates Buprenorphine Treat. 2014.

  6. CADCA. Comprehensive Addiction and Recovery Act (CARA). CADCA.org. 2016.

  7. American Psychiatric Association. Substance-Related and Addictive Disorders. APA. 2013.

  8. ASAM Board of Directors. ASAM Public Policy Statement: Definition of Addiction. 2011.

  9. SAMHSA. Treatments for Substance Use Disorders. 2015.

  10. USDHHS. Medication Assisted Treatment for Opioid Use Disorders Reporting Requirements. 2016.

  11. Reuter N. Personal Communication via E-Mail Re: Buprenorphine Waivered Physicians. 2011.

Planning To Add Buprenorphine To Your Practice

  1. Institute of Medicine (IOM). Crossing The Quality Chasm: A New Health System For The 21st Century. IOM. 2001.

  2. Alford DP, Labelle CT, Kretsch N, et al. Collaborative care of opioid-addicted patients in primary care using buprenorphine: five-year experience. Arch Intern Med. 2011;171(5):425-431.

  3. Gerteis M. Through the Patient’s Eyes : Understanding and Promoting Patient-Centered Care. Vol 1st ed. San Francisco: Jossey-Bass; 1993.

  4. Davis Karen, Schoenbaum Stephen C, Audet Anne-Marie. A 2020 Vision of Patient-Centered Primary Care. J Gen Intern Med. 2005;20(10):953-957. doi:10.1111/j.1525-1497.2005.0178.x.

  5. Epstein Ronald M, Street Richard L. The Values and Value of Patient-Centered Care. Ann Fam Med. 2011;9(2):100-103. doi:10.1370/afm.1239.

  6. Hashim MJ. Patient-Centered Communication: Basic Skills. Am Fam Physician. 2017;95(1):39-34.

  7. Alves Paula CG, Sales Célia MD, Ashworth Mark. Personalising the evaluation of substance misuse treatment: a new approach to outcome measurement. Int J Drug Policy. 2015;26(4):333-335. doi:10.1016/j.drugpo.2014.11.014.

  8. Bray Jeremy W, Aden Brandon, Eggman Ashley A, et al. Quality of life as an outcome of opioid use disorder treatment: A systematic review.. J Subst Abuse Treat. 2017;76:88-93. doi:10.1016/j.jsat.2017.01.019.

  9. Tofighi Babak, Grossman Ellie, Buirkle Emily, McNeely Jennifer, Gourevitch Marc, Lee Joshua D. Mobile Phone Use Patterns and Preferences in Safety Net Office-Based Buprenorphine Patients.. J Addict Med. 2015;9(3):217-221. doi:10.1097/ADM.0000000000000121.

  10. Renner J, Lavounis P. Handbook of Office-Based Buprenorphine Treatment of Opioid Dependence. Arlington, VA: American Psychiatric Publishing; 2011.

  11. Zubkoff L, Shiner B, Watts BV. Staff Perceptions of Substance Use Disorder Treatment in VA Primary Care–Mental Health Integrated Clinics. J Subst Abuse Treat. 2016;70:44-49.

  12. Sullivan L, Fiellin D. Narrative Review: Buprenorphine for Opioid-Dependent Patients in Office Practice. Ann Intern Med. 2008;148(9):662-670.

  13. Drugs.com. Buprenorphine/Naloxone. 2017.

  14. Blueshift Research. Camurus and Indivior Set to Significantly Sway the Opioid Abuse Treatment Market. Blueshift Research Report; 2017.

  15. ASAM. Advancing access to addiction medications. 2013.

  16. Szabo L. Addiction treatment hard to find, even as overdose deaths soar. USA Today. 2015.

  17. Walden Greg. H.R.6 – 115th Congress (2017-2018): SUPPORT for Patients and Communities Act. October 2018.

  18. Stanton A, McLoed C, Luckey B, et al. SAMHSA/CSAT Evaluation of the Buprenorphine Waiver Program. 37th Annual Medical- Scientific Conference of the American Society of Addiction Medicine. 2006.

  19. SAMHSA. Substance Use Disorders. SAMHSA Website. 2014.

  20. Egan JE, Casadonte P, Gartenmann T, et al. The Physician Clinical Support System-Buprenorphine (PCSS-B): a novel project to expand/improve buprenorphine treatment. J Gen Intern Med. 2010;25(9):936-941.

  21. SAMHSA. Number of DATA Certified Physicians. SAMHSA.gov. 2015.

  22. Addiction Treatment Forum. History of Buprenorphine. Addict Treat Forum Website. 2013.

  23. CADCA. Comprehensive Addiction and Recovery Act (CARA). CADCA.org. 2016.

  24. Madras BK, Wilson MC, Avula D, et al. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: Comparison at intake and six months. Drug Alcohol Depend. 2010;99(1-3):280-295.

  25. SAMHSA. Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. SAMHSA.gov. 2017.

  26. SAMHSA. Physician and Program Data. SAMHSA.gov. 2018.

  27. ASAM. The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use. June 2015.

  28. Chychula NM, Sciamanna C. Help substance abusers attain and sustain abstinence. Nurse Pract. 2002;27(11):30-47.

  29. SAMHSA. Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder: Review and Update. Winter 2016.

  30. SAMHSA. Methadone. SAMHSA.gov. 2015.

  31. Office of National Drug Control Policy. Medication-Assisted Treatment for Opioid Addiction. 2012.

  32. Martin J. Personal Communication Re: Number of Patients Maintained on Buprenorphine. 2011.

  33. Maxwell JC, McCance-Katz EF. Indicators of buprenorphine and methadone use and abuse: what do we know?. Am J Addict. 2010;19(1):73-88.

  34. Drug Enforcement Administration (DEA). Buprenorphine. 2013.

  35. Sokol Randi, Albanese Chiara, Chaponis Deviney, et al. Why Use Group Visits for Opioid Use Disorder Treatment in Primary Care? A Patient-Centered Qualitative Study.. Subst Abuse. 2018;39(1):52-58. doi:10.1080/08897077.2017.1356792.

  36. Roll David, Spottswood Margaret, Huang Hsiang. Using Shared Medical Appointments to Increase Access to Buprenorphine Treatment.. J Am Board Fam Med JABFM. 2015;28(5):676-677. doi:10.3122/jabfm.2015.05.150017.

  37. Food and Drug Administration (FDA). Physician Information: Answers to Frequently Asked Questions. 2010.

Implementing Buprenorphine In Your Practice

  1. Öhlin L, Fridell M, Nyhlén A. Buprenorphine maintenance program with contracted work/education and low tolerance for non-prescribed drug use: a cohort study of outcome for women and men after seven years. BMC Psychiatry. 2015;15(56).

  2. Manchikanti L, Manchukonda R, Damron KS. Does adherence monitoring reduce controlled substance abuse in chronic pain patients?. Pain Physician. 2006;9(1):57-60.

  3. Chou Roger, Fanciullo Gilbert J, Fine Perry G, et al. Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain. J Pain Off J Am Pain Soc. 2009;10(2):113-130. doi:10.1016/j.jpain.2008.10.008.

  4. FSMB. Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office. FSMB Website. 2013.

  5. SAMHSA. Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder: Review and Update. Winter 2016.

  6. Drug Enforcement Administration. State Prescription Drug Monitoring Programs. 2011.

  7. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep. 2016;65(1):1-49. doi:10.15585/mmwr.rr6501e1er.

  8. Wang J, Christo PJ. The influence of prescription monitoring programs on chronic pain management. Pain Physician. 2009;12:507-515.

  9. U.S. House of Representatives. Comprehensive Addiction and Recovery Act of 2016. docs.house.gov. 2016.

  10. American Society of Addiction Medicine (ASAM). Drug Testing As A Component Of Addiction Treatment and Monitoring Programs and in Other Clinical Settings. ASAM.org. 2010.

  11. Reisfield Gary M, Maschke Karen J. Urine Drug Testing in Long-Term Opioid Therapy: Ethical Considerations. Clin J Pain. 2014;30(8):679-684. doi:10.1097/01.ajp.0000435448.34761.c9.

  12. Gourlay D. Urine Drug Testing in Chronic Pain: A Patient Centered Approach (AMA) [webinar]. 2013.

  13. Romano G, Barbera N, Spadaro G, et al. Determination of drugs of abuse in hair: evaluation of external heroin contamination and risk of false positives. Forensic Sci Int. 2003;131(2-3):98-102.

  14. ASAM. The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use. June 2015.

  15. SAMHSA. Clinical Drug Testing in Primary Care. SAMHSA Website. 2012.

  16. Gourlay D, Heit HA, Caplan YH. Urine Drug Testing in Clinical Practice: The Art and Science of Patient Care. Johns Hopkins Med. 2012;5.

  17. FDA. CLIA – Clinical laboratory improvement amendments – currently waived analytes. 2016.

  18. Christo PJ, Manchikanti L, Ruan X, et al. Urine Drug Testing In Chronic Pain. Pain Physician. 2011;14:123-143.

  19. TransMed. CLIA Screen In-Vitro (CSI) 12-Panel Drug Test Screening Cup CLIA Waived. TransMed Drug Test Lab Supplies. 2018.

Impact of Opioid Use Disorder

  1. SAMHSA/CSAT. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. 2004.

  2. ASAM. The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use. June 2015.

  3. SAMHSA. Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. SAMHSA.gov. 2017.

  4. FSMB. Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office. FSMB Website. 2013.

  5. National Center for Complementary and Integrative Health. NIH Analysis Shows Americans are in Pain. Natl Inst Health. 2015.

  6. CDC. Opioid Data Analysis | Drug Overdose | CDC Injury Center. Cent Dis Control Prev. 2016.

  7. CDC. Understanding the epidemic. Cent Dis Control Prev Natl Cent Inj Prev Control Div Unintentional Inj Prev. 2017.

  8. Drug Abuse Warning Network (DAWN). Highlights of the 2011 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits. The Dawn Report; 2013:127.

  9. Frenk SM, Porter KS, Paulozzi LJ. Prescription opioid analgesic use among adults: United States, 1999-2012. NCHS Data Brief. 2015;189.

  10. CDC. Vital Signs: Overdoses of prescription opioid pain relievers – United States, 1999-2008. MMWR. 2011;60(43):1487-1492.

  11. Warner M, Hedegaard H, Chen LH. Trends in drug-poisoning deaths involving opioid analgesics and heroin: United States, 1999-2012. 2014.

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Screening and Detection of Opioid Use Disorder

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  2. SAMHSA. Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder: Review and Update. Winter 2016.

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Diagnosis of Opioid Use Disorder

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  2. SAMHSA. Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder: Review and Update. Winter 2016.

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  8. SAMHSA. Use of Buprenorphine in the Pharmacologic Management of Opioid Dependence: A Curriculum for Physicians. 2001.

  9. Food and Drug Administration (FDA). Buprenorphine-containing Transmucosal products for Opioid Dependence (BTOD) Risk Evaluation and Mitigation Strategy (REMS). 2013.

Assessing Patients for Buprenorphine Treatment

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  2. ASAM. The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use. June 2015.

  3. SAMHSA. Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder: Review and Update. Winter 2016.

  4. FSMB. Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office. FSMB Website. 2013.

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  12. UMBCtube. SBIRT: Screen for Substance Use – Negative Screen. UMBCtube; 2011.

  13. FDA. CLIA – Clinical laboratory improvement amendments – currently waived analytes. 2016.

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Opioid Medications

  1. SAMHSA/CSAT. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. 2004.

  2. SAMHSA. Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder: Review and Update. Winter 2016.

  3. FSMB. Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office. FSMB Website. 2013.

  4. De Vries TJ, Shippenberg TS. Neural systems underlying opiate addiction. J Neurosci. 2002;22(9):3321-3325.

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  17. FDA. Medication Guide: ButransTM CIII (buprenorphine) Transdermal System. 2010.

  18. Labelle CT, Han SC, Bergeron A, et al. Office-Based Opioid Treatment with Buprenorphine (OBOT-B): Statewide Implementation of the Massachusetts Collaborative Care Model in Community Health Centers. J Subst Abuse Treat. 2015;15.

  19. Kraus ML, Alford DP, Kotz MM, et al. Statement of the American Society of Addiction Medicine Consensus Panel on the Use of Buprenorphine in Office-Based Treatment of Opioid Addiction. J Addict Med. 2011;5(4):254-263.

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  31. Nasser AF, Heidbreder C, Liu Y, et al. Pharmacokinetics of sublingual buprenorphine and naloxone in subjects with mild to severe hepatic impairment (Child-Pugh classes A, B, and C), in hepatitis C virus-seropositive subjects, and in healthy volunteers. Clin Pharmacokinet. 2015;54(8):837-849.

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  35. Kissin W, McLeod C, Sonnefeld J, et al. Experiences of a National Sample of Qualified Addiction Specialists Who Have and Have Not Prescribed Buprenorphine for Opioid Dependence. J Addict Dis. 2006;25(4):91-103.

  36. Alford DP, Labelle CT, Kretsch N, et al. Collaborative care of opioid-addicted patients in primary care using buprenorphine: five-year experience. Arch Intern Med. 2011;171(5):425-431.

  37. Arfken CL, Johanson CE, di Menza S, et al. Expanding treatment capacity for opioid dependence with office-based treatment with buprenorphine: National surveys of physicians. J Subst Abuse Treat. 2010;39(2):96-104.

  38. Mintzer IL, Eisenberg M, Terra M, et al. Treating opioid addiction with buprenorphine-naloxone in community-based primary care settings. Ann Fam Med. 2007;5(2):146-150.

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  40. FDA. FDA approves first once-monthly buprenorphine injection, a medication-assisted treatment option for opioid use disorder. November 2017.

  41. Reckitt Benckiser Pharmaceuticals Inc. Suboxone Prescribing Information. 2014.

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  43. Lintzeris N, Clark N, Muhleisen P, et al. National Clinical Guidelines and Procedures for the Use of Buprenorphine in the Treatment of Heroin Dependence. 2001.

  44. Weiss RD, Potter JS, Fiellin DA. Adjunctive Counseling During Brief and Extended Buprenorphine-Naloxone Treatment for Prescription Opioid Dependence. Arch Gen Psychiatry. 2012;68(12):1238-1246.

  45. Fiellin DA, Schottenfeld RS, Cutter CJ, et al. Primary care-based buprenorphine taper vs maintenance therapy for prescription opioid dependence: A randomized clinical trial. JAMA Intern Med. 2014;174(12):1947-1954.

  46. Dunn KE, Sigmon SC, Strain EC. The association between outpatient buprenorphine detoxification duration and clinical treatment outcomes: a review. Drug Alcohol Depend. 2011;119(1-2):1-9.

  47. Kao Ming-Chih, Zheng Patricia, Mackey Sean, et al. Trends in Benzodiazepine Prescription and Co-Prescription with Opioids in the United States, 2002––2009. AAPM Annual Meeting. July 2014.

  48. Maxwell JC, McCance-Katz EF. Indicators of buprenorphine and methadone use and abuse: what do we know?. Am J Addict. 2010;19(1):73-88.

  49. ASAM. The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use. June 2015.

  50. Stein DJ, Isper JC, Seedat S. Pharmacotherapy for post traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2006;1:CD002795.

  51. Taylor FB, Martin P, Thompson C, et al. Prazosin effects on objective sleep measures and clinical symptoms in civilian trauma posttraumatic stress disorder: A placebo-controlled study. Biol Psychiatry. 2008;63(6):629-632.

  52. Drugs.com. Doxazosin. Drugs.com. November 2015.

  53. McNicholas LF. Buprenorphine: Induction, Dosing and Related Issues. American Psychiatric Association Sponsored Webinar; 2011.

  54. Food and Drug Administration (FDA). Buprenorphine-containing Transmucosal products for Opioid Dependence (BTOD) Risk Evaluation and Mitigation Strategy (REMS). 2013.

  55. NIAAA. Alcohol Facts and Statistics. NIAAA. 2015.

  56. Saber-Tehrani AS, Bruce RD, Altice FL. Pharmacokinetic drug interactions and adverse consequences between psychotropic medications and pharmacotherapy for the treatment of opioid dependence. Am J Drug Alcohol Abuse. 2011;37(1):1-11.

  57. Guo AY, Ma JD, Best BM, et al. Urine specimen detection of concurrent nonprescribed medicinal and illicit drug use in patients prescribed buprenorphine. J Anal Toxicol. 2013;37(9):636-641.

  58. NIH. National Trends. 2014.

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  60. McCance-Katz EF. Treatment of Opioid Dependence and Coinfection with HIV and Hepatitis C Virus in Opioid-Dependent Patients: The Importance of Drug Interactions between Opioids and Antiretroviral Agents. Clin Infect Dis. 2005;41(suppl 1):S89-95.

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  62. McCance-Katz EF, Moody DE, Morse GD, et al. Interaction between buprenorphine and atazanavir or atazanavir/ritonavir. Drug Alcohol Depend. 2007;91(2-3):269-278.

  63. Saxon AJ, Ling W, Hillhouse M, et al. Buprenorphine/naloxone and methadone effects on laboratory indices of liver health: A randomized trial. Drug Alcohol Depend. 2013;128:71-76.

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Buprenorphine Formulations

  1. SAMHSA/CSAT. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. 2004.

  2. SAMHSA. Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder: Review and Update. Winter 2016.

  3. FSMB. Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office. FSMB Website. 2013.

  4. Chiang CN, Hawks RL. Pharmacokinetics of the combination tablet of buprenorphine and naloxone. Drug Alcohol Depend. 2003;70(suppl 2):S39-S47.

  5. Nasser AF, Heidbreder C, Liu Y, et al. Pharmacokinetics of sublingual buprenorphine and naloxone in subjects with mild to severe hepatic impairment (Child-Pugh classes A, B, and C), in hepatitis C virus-seropositive subjects, and in healthy volunteers. Clin Pharmacokinet. 2015;54(8):837-849.

  6. Fudin J. A Brief Review of Buprenorphine Products. March 2016.

  7. Breen C. There’s a New Buprenorphine on the Block | Dr. Jeffrey Fudin. PainDr. February 2018.

  8. Strain EC, Moody DE, Stoller KE, et al. Relative bioavailability of different buprenorphine formulations under chronic dosing conditions. Drug Alcohol Depend. 2004;74(1):37-43.

  9. Yokell MA, Zaller ND, Green TC, et al. Buprenorphine and buprenorphine/naloxone diversion, misuse, and illicit use: an international review. Curr Drug Abuse Rev. 2011;4:28-41.

  10. Ling W, Casadonte P, Bigelow G. Buprenorphine Implants for Treatment of Opioid Dependence. JAMA. 2010;304(14):1576-1583.

  11. Johnson RE, Strain EC, Amass L. Buprenorphine: how to use it right. Drug Alcohol Depend. 2003;70(suppl 2):S59-S77.

  12. Larance B, Lintzeris N, Dietze P, et al. The diversion and injection of a buprenorphine-naloxone soluble film formulation. Drug Alcohol Depend. 2014;136:21-27.

  13. Orexo US Inc. Zubsolv prescribing information. 2013.

  14. Rx List. Suboxone. Rx List Website. 2014.

  15. BioDelivery Sciences International. Bunavail prescribing information. 2014.

  16. Sontag D. Addiction Treatment With a Dark Side. N Y Times. 2013.

  17. ASAM. The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use. June 2015.

  18. Dart R. Evaluation of ADFs Using RADARS System Data. 2011.

  19. Alho H, Sinclair D, Vuori E, et al. Abuse liability of buprenorphine-naloxone tablets in untreated IV drug users. Drug Alcohol Depend. 2007;88(1):75-78.

  20. FDA. FDA approves first buprenorphine implant for treatment of opioid dependence. FDA News Events. May 2016.

  21. Chen MC, Beebe K. A randomized trial of Probuphine implants in adults stabilized on sublingual buprenorphine. American Society of Addiction Medicine (ASAM) Annual Meeting. 2016.

  22. Rosenthal RN, Lofwall MR, Kim S, et al. Effect of buprenorphine implants on illicit opioid use among abstinent adults with opioid dependence treated with sublingual buprenorphine. A randomized clinical trial. JAMA. 2016;316:282-290.

  23. FDA. FDA approves first once-monthly buprenorphine injection, a medication-assisted treatment option for opioid use disorder. November 2017.

  24. Sublocade. Medication Guide Sublocade (buprenorphine extended-release) injection, for subcutaneous use (CIII). November 2017.

  25. Medscape. Sublocade (buprenorphine, long-acting injection) dosing, indications, interactions, adverse effects, and more. 2018.

  26. American Society of Health-System Pharmacists. Buprenorphine Injection: MedlinePlus Drug Information. April 2018.

  27. Reckitt Benckiser Pharmaceuticals Inc. Buprenex injectable – RX only – Schedule III. 2007.

  28. Belbuca. Belbuca HPC important safety information. www.belbuca.com. 2015.

  29. Purdue Pharma. ButransTM CIII (buprenorphine) Transdermal System. Butrans Website. 2010.

  30. Sullivan MA, Gordon AJ. MAT training: Provider’s clinical support system for medication assisted treatment. 2013.

Induction – Initiating Buprenorphine Treatment

  1. SAMHSA/CSAT. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. 2004.

  2. SAMHSA. Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder: Review and Update. Winter 2016.

  3. FSMB. Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office. FSMB Website. 2013.

  4. Gunderson E. Models of Buprenorphine Induction. PCSSMAT Train. 2014.

  5. Indivior Inc. Suboxone Highlights of Prescribing Information. http://www.suboxone.com/. December 2016.

  6. McNicholas LF. Buprenorphine: Induction, Dosing and Related Issues. American Psychiatric Association Sponsored Webinar; 2011.

  7. Kraus ML, Alford DP, Kotz MM, et al. Statement of the American Society of Addiction Medicine Consensus Panel on the Use of Buprenorphine in Office-Based Treatment of Opioid Addiction. J Addict Med. 2011;5(4):254-263.

  8. Food and Drug Administration (FDA). Appropriate Use Checklist. http://btodrems.com/. 2013.

  9. American Psychiatric Association. Substance-Related and Addictive Disorders. APA. 2013.

  10. Labelle CT, Han SC, Bergeron A, et al. Office-Based Opioid Treatment with Buprenorphine (OBOT-B): Statewide Implementation of the Massachusetts Collaborative Care Model in Community Health Centers. J Subst Abuse Treat. 2015;15.

  11. Orexo US Inc. Zubsolv prescribing information. 2013.

  12. Alford DP, Labelle CT, Richardson JM, et al. Treating Homeless Opioid Dependent Patients with Buprenorphine in an Office-Based Setting. Soc Gen Intern Med. 2007;22:171-176.

  13. Lee JD, Grossman E, DiRocco D, et al. Home Buprenorphine/Naloxone Induction in Primary Care. J Gen Intern Med. 2009;24(2):226-232.

  14. ASAM. The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use. June 2015.

  15. Casadonte PP. PCSS Guidance: Buprenorphine Induction. Physician Clin Support Syst Website. 2009.

  16. Bliesener N, Albrecht S, Schwager A, et al. Plasma testosterone and sexual function in men receiving buprenorphine maintenance for opioid dependence. J Clin Endocrinol Metab. 2005;90(1):203.

  17. Mannelli P, Peindl KS, Lee T. Buprenorphine-mediated transition from opioid agonist to antagonist treatment: state of the art and new perspectives. Curr Drug Abuse Rev. 2012;5(1):52-63.

  18. Glasper A, Reed LJ, de Wet CJ, et al. Induction of patients with moderately severe methadone dependence onto buprenorphine. Addict Biol. 2005;10(2):149-155.

  19. Johanson CE, Arfken CL, DiMenza S, et al. Diversion and abuse of buprenorphine: Findings from national surveys of treatment patients and physicians. Drug Alcohol Depend. 2012;120(1-3):190-195.

  20. Lofwall MR, Havens JR. Inability to access buprenorphine treatment as a risk factor for using diverted buprenorphine. Drug Alcohol Depen. 2012;Jun 13 [Epub ahead of print].

  21. Wish ED, Artigiani D, Billing A, et al. The emerging buprenorphine epidemic in the United States. J Addict Dis. 2012;31(1):3-7.

  22. Oreskovich MR, Saxon AJ, Ellis ML, et al. A double-blind, double-dummy, randomized, prospective pilot study of the partial mu opiate agonist, buprenorphine, for acute detoxification from heroin. Drug Alcohol Depend. 2005;77(1):71-79.

  23. Amass L, Ling W, Freese TE, et al. Bringing buprenorphine-naloxone detoxification to community treatment providers: the NIDA Clinical Trials Network field experience. Am J Addict. 2004;13:Suppl 1: S42-66.

  24. Kosten TR, George TP. The neurobiology of opioid addiction: implications for treatment. NIDA Sci Pract Perspect. 2002;1(1):13-20.

  25. Kakko J, Svanborg KD, Kreek MJ, et al. 1-year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: a randomised, placebo-controlled trial. Lancet. 2003;361(9358):662-668.

  26. Farmer Carrie M, Lindsay Dawn, Williams Jessica, et al. Practice Guidance for Buprenorphine for the Treatment of Opioid Use Disorders: Results of an Expert Panel Process. Subst Abuse. 2015;36(2):209-216. doi:10.1080/08897077.2015.1012613.

  27. Lintzeris N, Clark N, Muhleisen P, et al. National Clinical Guidelines and Procedures for the Use of Buprenorphine in the Treatment of Heroin Dependence. 2001.

Maintenance and Discontinuation

  1. Weiss RD, Potter JS, Griffin ML, et al. Long-term outcomes from the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study. Drug Alcohol Depend. 2015.

  2. Ling W, Hillhouse M, Domier C, et al. Buprenorphine tapering schedule and illicit opioid use. Addiction. 2009;104(2):256-265.

  3. SAMHSA. Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder: Review and Update. Winter 2016.

  4. SAMHSA/CSAT. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. 2004.

  5. FSMB. Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office. FSMB Website. 2013.

  6. McNicholas LF. Buprenorphine: Induction, Dosing and Related Issues. American Psychiatric Association Sponsored Webinar; 2011.

  7. Kraus ML, Alford DP, Kotz MM, et al. Statement of the American Society of Addiction Medicine Consensus Panel on the Use of Buprenorphine in Office-Based Treatment of Opioid Addiction. J Addict Med. 2011;5(4):254-263.

  8. Kosten TR, George TP. The neurobiology of opioid addiction: implications for treatment. NIDA Sci Pract Perspect. 2002;1(1):13-20.

  9. Fiellin DA, Schottenfeld RS, Cutter CJ, et al. Primary care-based buprenorphine taper vs maintenance therapy for prescription opioid dependence: A randomized clinical trial. JAMA Intern Med. 2014;174(12):1947-1954.

  10. Weiss RD, Potter JS, Fiellin DA. Adjunctive Counseling During Brief and Extended Buprenorphine-Naloxone Treatment for Prescription Opioid Dependence. Arch Gen Psychiatry. 2012;68(12):1238-1246.

  11. FDA. FDA approves first buprenorphine implant for treatment of opioid dependence. FDA News Events. May 2016.

  12. ASAM. The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use. June 2015.

  13. Farmer CM, Lindsay D, Williams J, et al. Practice Guidelines for Burprenorphine for the Treatment of Opioid Use Disorders: Results of an Expert Panel Process. 2015;36(2).

  14. Renner Britta, Kwon Sunkyo, Yang Byung-Hwan, et al. Social-Cognitive Predictors of Dietary Behaviors in South Korean Men and Women. Int J Behav Med. 2008;15(1):4-13. doi:10.1080/10705500701783785.

  15. NIDA. Principles of drug addiction treatment: A research-based guide (Third Edition_. December 2012.

  16. USDHHS. Medication Assisted Treatment for Opioid Use Disorders Reporting Requirements. 2016.

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  18. Finch JW, Kamien JB, Amass L. Two-year experience with buprenorphine-naloxone (Suboxone) for maintenance treatment of opioid dependence within a private practice setting. J Addict Med. 2014;1(2):104-110.

  19. Mintzer IL, Eisenberg M, Terra M, et al. Treating opioid addiction with buprenorphine-naloxone in community-based primary care settings. Ann Fam Med. 2007;5(2):146-150.

  20. Soyka M. Buprenorphine and buprenorphine/naloxone intoxication in children — How strong is the risk?. Curr Drug Abuse Rev. 2013;6(1):63-70.

  21. Drug Enforcement Administration (DEA). Buprenorphine. 2013.

  22. SAMHSA Press Office. Sharp rise in buprenorphine-related emergency department visits from 2005 to 2010. 2013.

  23. Martin T, Rocque M. Accidental and Non-Accidental Ingestion of Methadone and Buprenorphine in Childhood: A Single Center Experience, 1999-2009. Curr Drug Saf. 2009;6:12-16.

  24. Indivior Inc. Suboxone Highlights of Prescribing Information. http://www.suboxone.com/. December 2016.

  25. Food and Drug Administration (FDA). Buprenorphine-containing Transmucosal products for Opioid Dependence (BTOD) Risk Evaluation and Mitigation Strategy (REMS). 2013.

  26. FDA Drug Safety Communication: FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning. US Food Drug Adm Cent Drug Eval Res. August 2016.

  27. FDA Drug Safety Communication: FDA urges caution about withholding opioid addiction medications from patients taking benzodiazepines or CNS depressants: careful medication management can reduce risks. US Food Drug Adm Cent Drug Eval Res. September 2017.

  28. Wartenberg A. Management of Buprenorphine Side Effects. 2013.

  29. RxList. Oxazepam (Oxazepam Tablets): Side Effects, Interactions, Warning, Dosage & Uses. RxList. 2017.

  30. RxList. Ativan (Lorazepam): Side Effects, Interactions, Warning, Dosage & Uses. RxList. 2017.

  31. RxList. Diazepam (Diazepam Tablets): Side Effects, Interactions, Warning, Dosage & Uses. RxList. 2017.

  32. Drugs.com. Naloxone. Drugs.com. 2015.

  33. Irwin RS, Rippe JM. Irwin and Rippe’s Intensive Care Medicine. Lippincott Williams & Wilkins; 2012.

  34. BMJ. Benzodiazepine overdose. 2017.

  35. Substance Abuse and Mental Health Services Administration (SAMHSA). About Buprenorphine Therapy. 2011.

  36. SAMHSA. SAMHSA opioid overdose prevention toolkit. 2014.

  37. Morasco BJ, Cavanagh R, Gritzner S, et al. Care management practices for chronic pain in veterans prescribed high doses of opioid medications. Farm Pract. 2013;6:671-678.

  38. Jones HE, Fischer G, Heil SH. Maternal Opioid Treatment: Human Experimental Research (MOTHER) – approach, issues and lessons learned. Addiction. 2012;107:28-35.

  39. Daitch D, Daitch J, Novinson D, et al. Conversion from high-dose full-opioid agonists to sublingual buprenorphine reduces pain scores and improves quality of life for chronic pain patients. Pain Med. 2014;15(12):2087-2094.

  40. Waknine Y. FDA Approves 7-Day Buprenorphine Pain Patch. 2010.

  41. FDA. Medication Guide: ButransTM CIII (buprenorphine) Transdermal System. 2010.

  42. Purdue Pharma. ButransTM CIII (buprenorphine) Transdermal System. Butrans Website. 2010.

  43. Davis MP. Twelve reasons for considering buprenorphine as a frontline analgesic in the management of pain. SupportiveOncology.net. 2012.

  44. Fiellin D. Treatment of acute pain in patients receiving buprenorphine/naloxone. March 2014.

  45. Alford DP, Labelle CT, Kretsch N, et al. Collaborative care of opioid-addicted patients in primary care using buprenorphine: five-year experience. Arch Intern Med. 2011;171(5):425-431.

  46. Alford DP, Compton P, Samet JH. Acute Pain Management for Patients Receiving Maintenance Methadone or Buprenorphine Therapy. Ann Intern Med. 2006;144(2):127-134.

  47. Stephenson DK, SAM Committee on Treatment of Opioid Dependence. Draft Guidelines for Physicians Working in California Opioid Treatment Programs. 2008.

  48. Weiss Roger D, Potter Jennifer S, Copersino Marc L, et al. Conducting Clinical Research with Prescription Opioid Dependence: Defining the Population. Am J Addict. 2010;19(2):141-146. doi:10.1111/j.1521-0391.2009.00017.x.

  49. Department of Veterans Affairs, Department of Defense. VA/DoD Clinical Practice Guideline for the Management of Substance Use Disorders Stabilization Pocket Card. 2015.

  50. Melemis SM. Relapse prevention and the five rules of recovery. Yale J Biol Med. 2015;88:3.

  51. Nielsen S, Hillhouse M, Thomas C. A comparison of buprenorphine taper outcomes between prescription opioid and heroin users. J Addict Med. 2013;7(1):33-38.

  52. Dunn KE, Sigmon SC, Strain EC. The association between outpatient buprenorphine detoxification duration and clinical treatment outcomes: a review. Drug Alcohol Depend. 2011;119(1-2):1-9.

Pregnancy, Young Adults, Methadone Patients, and Other Populations

  1. SAMHSA/CSAT. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. 2004.

  2. SAMHSA. Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder: Review and Update. Winter 2016.

  3. ASAM. The ASAM National Practice Guideline For the Use of Medications in the Treatment of Addiction Involving Opioid Use. June 2015.

  4. Department of Veterans Affairs, Department of Defense. VA/DoD Clinical Practice Guideline for the Management of Substance Use Disorders Stabilization Pocket Card. 2015.

  5. Jones HE. Treating opioid use disorders during pregnancy: historical, current, and future directions. Subst Abus. 2013;34(2):89-91.

  6. Kraus ML, Alford DP, Kotz MM, et al. Statement of the American Society of Addiction Medicine Consensus Panel on the Use of Buprenorphine in Office-Based Treatment of Opioid Addiction. J Addict Med. 2011;5(4):254-263.

  7. Food and Drug Administration (FDA). Buprenorphine Drug Label. 2010.

  8. Jones HE, Fischer G, Heil SH. Maternal Opioid Treatment: Human Experimental Research (MOTHER) – approach, issues and lessons learned. Addiction. 2012;107:28-35.

  9. McCarthy JJ, Leamon MH, Parr MS, et al. High-dose maintenance in pregnancy: maternal and neonatal outcomes. Am J Obstet Gynecol. 2005;193(3 Pt 1):606-610.

  10. Thomas CP, Fullerton CA, Kim M, et al. Medication-assisted treatment with buprenorphine: assessing the evidence. Psychiatr Serv. 2014;65(2):158-170.

  11. Sullivan M, Martin J (original author). New Information on Buprenorphine Treatment During Pregnancy. 2014.

  12. Stanhope TJ, Gill LA, Rose C. Chronic opioid use during pregnancy: maternal and fetal implications. Clin Perinatol. 2013;40(3):337-350.

  13. Martin J. PCSS-MAT Guidance: Pregnancy and buprenorphine treatment. Physicians’ Clinical Support System for Medication Assisted Treatment (PCSS-MAT). 2006.

  14. Association of State and Territorial Health Officials (ASTHO). Neonatal Abstinence Syndrome: How States Can Help Advance the Knowledge Base for Primary Prevention and Best Practices of Care. 2014.

  15. O’Connor AB, Collett A, Alto WA, et al. Breastfeeding rates and the relationship between breastfeeding and neonatal abstinence syndrome in women maintained on buprenorphine during pregnancy. Journal of Midwifery Women’s Health. 2013;58(4):383-388.

  16. Reckitt Benckiser Pharmaceuticals Inc. SUBOXONE (buprenorphine hydrochloride, naloxone hydrochloride) film, soluble [Reckitt Benckiser Pharmaceuticals Inc]. DailyMed. 2014.

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  19. Levy S, Vaughan BL, Angulo M, et al. Buprenorphine replacement therapy for adolescents with opioid dependence: early experience from a children’s hospital-based outpatient treatment program. J Adolesc Health. 2007;40(5):477-482.

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  25. SAMHSA. An Introduction to Extended-Release Injectable Naltrexone for the Treatment of People With Opioid Dependence. SAMHSA Advis. 2012;HHS Publication No. (SMA) 12-4682:1-8.

  26. Subramaniam G, Levy S. PCSS-MAT Guidance: Treatment of opioid dependent adolescents and young adults using sublingual buprenorphine. 2010.

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Problematic Behaviors

  1. Renner J, Saxon A, Levounis P. Buprenorphine Update and Evolving Standards of Care. IPS: The Mental Health Services Conference. October 2015. New York City.

  2. Öhlin L, Fridell M, Nyhlén A. Buprenorphine maintenance program with contracted work/education and low tolerance for non-prescribed drug use: a cohort study of outcome for women and men after seven years. BMC Psychiatry. March 24, 2015;15(56).

  3. FSMB. Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office. FSMB Website. 2013.

  4. SAMHSA. Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder: Review and Update. Winter 2016.

  5. McNicholas LF. Buprenorphine: Induction, Dosing and Related Issues. American Psychiatric Association Sponsored Webinar. 2011.

  6. FDA Drug Safety Communication: FDA urges caution about withholding opioid addiction medications from patients taking benzodiazepines or CNS depressants: careful medication management can reduce risks. US Food Drug Adm Cent Drug Eval Res. September 20, 2017.

  7. Martin J. Adherence, Diversion and Misuse of Sublingual Buprenorphine. updated 2014 2009.

  8. Monte AA, Mandell T, Wilford BB, et al. Diversion of Buprenorphine/Naloxone Coformulated Tablets in a Region with High Prescribing Prevalence. J of Addictive Diseases. 2009;28:226-231.

  9. Johanson CE, Arfken CL, DiMenza S, et al. Diversion and Abuse of Buprenorphine: Findings from National Surveys of Treatment Patients and Physicians. Drug Alcohol Depend. 2012;120(1-3):190-195.

  10. Dart R. Evaluation of ADFs Using RADARS System Data. 2011.

  11. Dasgupta N. RADARS System Subutex & Suboxone: How Much is Prescribed vs. Abuse/Diversion Reports. SAMHSA Meeting on Buprenorphine. 2010.

  12. Lofwall M. Minimizing the Risks of Buprenorphine Diversion and Misuse from Office-Based Treatment. 2011.

  13. Lavonas EJ, Banner W, Bradt P, et al. Root Causes, Clinical Effects, and Outcomes of Unintentional Exposures to Buprenorphine by Young Children. J Pediatr. 2013;163(5):1377-1383.

  14. Clinical Tools, Inc. Motivational Interviewing: Managing Challenging Patient Behavior – YouTube. September 15, 2016.

  15. Christo PJ, Manchikanti L, Ruan X, et al. Urine Drug Testing In Chronic Pain. Pain Physician. 2011;14:123-143.

  16. Gourlay D. Urine Drug Testing in Chronic Pain: A Patient Centered Approach (AMA) [webinar]. 2013.

  17. Gourlay D, Heit HA, Caplan YH. Urine Drug Testing in Clinical Practice: The Art and Science of Patient Care. Johns Hopkins Med. 2012;5.

  18. Heit HA, Gourlay DL. Urine Drug Testing in Pain Medicine. J Pain Symptom Manage. 2004;27:260-267.

  19. Department of Health and Human Services (DHHS). Mandatory Guidelines for Federal Workplace Drug Testing Programs. Fed Regist. 2008;73(228):71858-71907.

Federal Laws and Regulations

  1. SAMHSA/CSAT. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. 2004.

  2. SAMSHA. Treatment Episode Data Set (TEDS): 2000-2010. National Admissions to Substance Abuse Treatment Services. 2012.

  3. CADCA. Comprehensive Addiction and Recovery Act (CARA). CADCA.org. 2016.

  4. Walden Greg. Text – H.R.6 – 115th Congress (2017-2018): SUPPORT for Patients and Communities Act. October 2018.

  5. SAMSHA. National Survey of Substance Abuse Treatment Services (N-SSATS): 2014. ; 2016.

  6. Alford DP, Labelle CT, Kretsch N, et al. Collaborative care of opioid-addicted patients in primary care using buprenorphine: five-year experience. Arch Intern Med. 2011;171(5):425-431.

  7. Pade PA, Cardon KE, Hoffman RM, et al. Prescription opioid abuse, chronic pain, and primary care: a Co-occurring Disorders Clinic in the chronic disease model. J Subst Abuse Treat. 2012;43(4):446-450.

  8. Kahan M, Srivastava A, Ordean A, et al. Buprenorphine: new treatment of opioid addiction in primary care. Can Fam Physician. 2011;57(3):281-289.

  9. FSMB. Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office. FSMB Website. 2013.

  10. ASAM. Summary of the Comprehensive Addiction and Recovery Act. 2016.

  11. SAMHSA/CSAT. Confidentiality of Patient Records for Alcohol and Other Drug Treatment. Rockville, Md: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration; 1994.

  12. SAMHSA. Substance Abuse Confidentiality Regulations. 2015.

  13. SAMHSA/CSAT. Treatment for Alcohol and Other Drug Abuse: Opportunities for Coordination. Rockville, Md: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration; 1994.

  14. SAMHSA/CSAT. Intensive Outpatient Treatment for Alcohol and Other Drug Abuse. Rockville, Md: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration; 1994.

  15. Gallagher C. What Waivered Physicans Need to Understand About DEA Requirements. 2010.

  16. Drug Enforcement Administration, Justice. § 1301.75 Physical security controls for practitioners. 2005.

  17. Drug Enforcement Administration. Code of Federal Regulations: Section 1304.03 Maintenance of records and inventories. 2000.

  18. US Department of Justice. Title 21 Code of Federal Regulations: PART 1311 —REQUIREMENTS FOR ELECTRONIC ORDERS AND PRESCRIPTIONS. 2010.

  19. Lowes R. e-Prescribing Controlled Substances Now Legal Nationwide. MedScape. 2015.

  20. Salsitz EA, Wunsch MJ. PCSS-B Guidance on Drug Enforcement Administration Requirements for Prescribers and Dispensers of Buprenorphine and Buprenorphine/Naloxone. 2010.

  21. Renner J, Saxon A, Levounis P. Buprenorphine Update and Evolving Standards of Care. IPS: The Mental Health Services Conference. October 2015. New York City.

  22. HHS. HHS announces new actions to combat opioid epidemic. HHS.gov. July 2016.

  23. USDHHS. Medication Assisted Treatment for Opioid Use Disorders Reporting Requirements. 2016.

  24. Stanton A, McLoed C, Luckey B, et al. SAMHSA/CSAT Evaluation of the Buprenorphine Waiver Program. 37th Annual Medical- Scientific Conference of the American Society of Addiction Medicine. 2006.

  25. Lofwall MR, Walsh SL. A review of buprenorphine diversion and misuse: the current evidence base and experiences from around the world. J Addict Med. 2014;8(5):315-326.

  26. SAMHSA. Physician and Program Data. SAMHSA.gov. 2018.

  27. U.S. Census Bureau. 2012 Statistical Abstract of the United States. Census.gov. 2012.

  28. SAMHSA. Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. SAMHSA.gov. 2017.

Motivating Patients in Opioid Use Interventions

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  4. Rahm A, Boggs J, Martin C, et al. Facilitators and barriers to implementing SBIRT in primary care in integrated health care settings. Substance Abuse. 2015;36(3):281-288. https://www.ncbi.nlm.nih.gov/pubmed/25127073. Accessed May 27, 2015.

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  7. Saitz R. Addressing Unhealthy Alcohol Use in Primary Care. Springer; 2013. https://www.amazon.com/Addressing-Unhealthy-Alcohol-Primary-Care/dp/146144778X. Accessed July 27, 2017.

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  9. Le Berre A, Vabret F, Cauvin C, et al. Cognitive barriers to readiness to change in alcohol-dependent patients. Alcoholism: Clinical and Experimental Research. 2012;36:1542-1549. http://www.ncbi.nlm.nih.gov/pubmed/22458335. Accessed June 18, 2015.

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  13. Norcross J, Krebs P, Prochaska J. Stages of change. Journal of Clinical Psychology. 2011;67:143-154. http://www.ncbi.nlm.nih.gov/pubmed/21157930. Accessed June 18, 2015.

  14. SAMHSA. Enhancing Motivation For Change in Substance Abuse Treatment. January 2013. https://store.samhsa.gov/product/TIP-35-Enhancing-Motivation-for-Change-in-Substance-Abuse-Treatment/SMA13-4212. Accessed March 19, 2015.

  15. Westra H, Aviram A. Core skills in motivational interviewing. Psychotherapy. 2013;50(3):278-8. https://www.ncbi.nlm.nih.gov/pubmed/24000834. Accessed March 19, 2015.

  16. Ager R, Roahen-Harrison S, Toriello P, et al. Predictors of adopting motivational enhancement therapy. Research on Social Work Practice. 2011;21:65-76. http://rsw.sagepub.com/content/early/2010/01/20/1049731509353170. Accessed June 16, 2015.

  17. NIDA. Motivational enhancement therapy (alcohol, marijuana, nicotine). NIDA. 2012. http://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-2. Accessed June 17, 2015.

  18. Dieperink E, Fuller B, Isenhart C, et al. Efficacy of motivational enhancement therapy on alcohol use disorders in patients with chronic hepatitis C: a randomized controlled trial. Addiction. 2014;109:1869-1877. http://www.ncbi.nlm.nih.gov/pubmed/25040898. Accessed March 25, 2015.

  19. CDC. Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use: A Step-by-Sep Guide for Primary Care Practices. 2014. https://www.cdc.gov/ncbddd/fasd/documents/AlcoholSBIImplementationGuide.pdf. Accessed August 17, 2017.

Opioids and Pain: Identifying, Assessing, and Responding to Aberrant Behavior

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  2. Chou R, Fanciullo G, Fine P, Miaskowski C, Passik S, Portenoy R. Opioids for Chronic Noncancer Pain: Prediction and Identification of Aberrant Drug-Related Behaviors: A Review of Evidence for an American Pain Society and American Academy of Pain Medicine Clinical Practice Guideline J Pain. 2009;10(2):131-146.

  3. CASA Columbia. Under the counter: the diversion and abuse of controlled prescription drugs in the U.S.. Columbia; 2005. http://www.casacolumbia.org/addiction-research/reports/under-the-counter-diversion-abuse-controlled-perscription-drugs. Accessed April 1, 2015.

  4. Heit H. Aberrant behaviors – refer or triage. Emerging Solutions in Pain Website. 2009. http://www.emergingsolutionsinpain.com/87-resources/newsletter/243-the-beacon-newsletter-volume-i-issue-2#askexpert. Accessed October 23, 2013.

  5. VA/DoD. Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain. 2010. https://www.va.gov/painmanagement/docs/cpg_opioidtherapy_summary.pdf. Accessed April 28, 2014.

  6. FSMB. Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office. FSMB Website. 2013. https://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/2013_model_policy_treatment_opioid_addiction.pdf. Accessed October 11, 2013.

  7. Passik S, Kirsh K, Webster L. Pseudoaddiction Revisited: A Commentary on Clinical and Historical Considerations Pain Management. 2011;1(3):239-248.

  8. NAABT. Physical Dependence and Addiction An Important Distinction. The National Alliance of Advocates for Buprenorphine Treatment. 2014. http://www.naabt.org/addiction_physical-dependence.cfm. Accessed July 1, 2015.

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  10. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Vol 5th edition. Washington, DC: Author; 2013. https://www.amazon.com/Diagnostic-Statistical-Manual-Mental-Disorders/dp/0890425558/ref=sr_1_1?s=books&ie=UTF8&qid=1492003452&sr=1-1&keywords=dsm+5. Accessed August 10, 2013.

  11. Substance Abuse and Mental Health Services Administration (US), Office of the Surgeon General (US). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington (DC): US Department of Health and Human Services; 2016. http://www.ncbi.nlm.nih.gov/books/NBK424857/. Accessed November 17, 2016.

  12. Chou R, Fanciullo GJ, Fine PG, et al. Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain J Pain. 2009;10(2):113-130. doi:10.1016/j.jpain.2008.10.008.

  13. Butler S, Budman S, Fernandez K, et al. Development and Validation of the Current Opioid Misuse Measure Pain. 2007;130(1-2):144-156.

  14. Compton P, Darakjian J, Miotto K. Screening for Addiction in Patients with Chronic Pain and “Problematic” Substance Use: Evaluation of a Pilot Assessment Tool J Pain Symptom Manage. 1998;16(6):355-363.

  15. Compton P, Wu S, Schieffer B, et al. Introduction to a Self-Report Version of the Prescription Drug Use Questionnaire and Relationship to Medication Agreement Noncompliance J Pain Symptom Manage. 2008;36(4):383-395.

  16. Adams L, Gatchel R, Robinson R, et al. Development of a Self-Report Screening Instrument for Assessing Potential Opioid Medication Misuse in Chronic Pain Patients J Pain Symptom Manage. 2004;27:440-459.

  17. Peppin J, Passik S, Couto J, et al. Recommendations for Urine Drug Monitoring as a Component of Opioid Therapy in the Treatment of Chronic Pain Pain Medicine. 2012;13(7):886-896.

Minimizing Opioid Diversion and Overdose Risk

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  2. Dowell D, Haegerich T, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016 MMWR Recomm Rep. 2016;65(1):1-49. doi:10.15585/mmwr.rr6501e1er.

  3. Couto J, Romney M, Leider H, et al. High Rates of Inappropriate Drug Use in the Chronic Pain Population Population Health Management. 2009;12(4):185-190.

  4. Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2012 national survey on drug use and health: summary of national findings. U.S. Department of Health and Human Services; 2013. http://archive.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/NationalFindings/NSDUHresults2012.htm. Accessed April 1, 2015.

  5. CASA Columbia. Under the counter: the diversion and abuse of controlled prescription drugs in the U.S.. Columbia; 2005. http://www.casacolumbia.org/addiction-research/reports/under-the-counter-diversion-abuse-controlled-perscription-drugs. Accessed April 1, 2015.

  6. Adams N, Plane M, Fleming M, et al. Opioids and the Treatment of Chronic Pain in a Primary Care Sample J Pain Symptom Manage. 2001;21:791-796.

  7. Hall A, Logan J, Toblin R, et al. Patterns of Abuse Among Unintentional Pharmaceutical Overdose Fatalities JAMA. 2008;300(22):2613-2620.

  8. Dart R. Opioid Abuse, Misuse, and Diversion: Strategies for Prevention. Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS)American Academy of Pain Medicine Meeting. 2009.

  9. Simeone R. Doctor shopping behavior and the diversion of opioid analgesics: 2008-2012. 2014. http://www.pdmpassist.org/pdf/Opioid_Diversion_08142014.pdf. Accessed July 6, 2015.

  10. Center for Medicare & Medicaid Services. What is a prescriber’s role in preventing the diversion of prescription drugs?. 2014. https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Provider-Education-Toolkits/Downloads/prescriberrole-drugdiversion-factsheet-082914.pdf. Accessed July 6, 2015.

  11. Cicero J, Dart R, Inciardi J, et al. The Development of a Comprehensive Risk-Management Program for Prescription Opioid Analgesics: Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS) Pain Medicine. 2007;8(2):157-169.

  12. Inciardi J, Surratt H, Cicero T, et al. Prescription Opioid Abuse and Diversion in an Urban Community: The Results of an Ultra-Rapid Assessment Pain Med. 2009;10(3):537-548.

  13. Merrick M. Prescription Opioids and Overdose Deaths JAMA. 2009;301(17):1767.

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  17. SAMHSA, CSAT. OxyContin®: Prescription Drug Abuse b 2001.

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  19. U.S. Department of Justice, Drug Enforcement Administration. Dispensing Controlled Substances for the Treatment of Pain Federal Register Notices. 2006;71(172):52715-52723.

  20. Walker M, Webster L. Risk Factors for Drug Diversion in a Pain Clinic Patient Population Journal of Opioid Management. 2012;8(6):351-362.

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  23. VA/DoD. Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain 2003.

  24. SAMHSA. Managing chronic pain in adults with or in recovery from substance use disorders. Treatment Improvement Protocol (TIP) Series, No. 54; 2012. https://www.ncbi.nlm.nih.gov/books/NBK92046/#_ch4_s15. Accessed July 8, 2015.

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  26. FSMB. Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office. FSMB Website. 2013. https://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/2013_model_policy_treatment_opioid_addiction.pdf. Accessed October 11, 2013.

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  30. Office o f National Drug Control Policy. Proper Disposal of Prescription Drugs. October 2009. http://projectdrugdrop.org/wp-content/uploads/Documents/proper.disposal.gov.pdf. Accessed August 15, 2018.

  31. Taylor R, Raffa R, Pergolizzi J. Opioid Formulations with Sequestered Naltrexone: A Perspective Review Ther Adv Drug Saf. 2014;5(3):129-137.

  32. Center for Drug Evaluation and Research. Abuse-deterrent opioids – evaluation and labeling. 2015. https://www.fda.gov/downloads/Drugs/Guidances/UCM334743.pdf. Accessed July 7, 2015.

  33. NDIC. Methadone Diversion, Abuse, and Misuse: Deaths Increasing at Alarming Rate. 2010. https://www.justice.gov/archive/ndic/pubs25/25930/25930p.pdf. .

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  37. Katz N, Adams E, Benneyan J, et al. Foundations of Opioid Risk Management Clinical Journal of Pain. 2007;23(2):103-118.

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Recognizing High-Risk Patients in Treatment for Pain

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