David Fiellin

..To determine the impact of cognitive behavioral therapy on outcomes in primary care, office-based buprenorphine/naloxone treatment of opioid dependence...

..Educational experiences in ambulatory medicine vary by site. Purpose: To evaluate variations in patient mix and challenges in patient care at 3 ambulatory training sites...

..Serum transaminases remained stable from baseline. No serious adverse events related to treatment occurred. We conclude that select opioid-dependent patients exhibit moderate levels of retention in primary care office-based treatment...

..The optimal level of counseling and frequency of attendance for medication distribution has not been established for the primary care, office-based buprenorphine-naloxone treatment of opioid dependence...

....

..Chart audits and mentoring should be considered as a mechanism to foster quality care. These processes of care are likely to require attention for treatment using methadone or buprenorphine...

..This review focuses on the neurobiological basis of opioid dependence, the rationale for methadone and buprenorphine treatments, and issues in prescribing these medications to patients with HIV infection...

..Buprenorphine/naloxone allows the integration of opioid dependence and HIV treatment...

..We outline the process and describe the two guidelines that were produced by this process that are targeted at physicians, narcotic treatment programs, and policy makers...

..Primary care physicians can play a unique role in recognizing and treating patients with alcohol problems...

..8 (95% CI 4.36-460). Elevated blood pressure, prior complicated alcohol withdrawal and medical comorbidity, alone and in combination, are associated with an increased risk of delirium tremens...

..This perspective describes these initiatives and their implications for internists...

..Office-based care of stabilized methadone maintenance patients is a promising alternative but no data are available from controlled trials regarding this type of program...

..Eleven patients (79%) were retained through the maintenance phase. We conclude that buprenorphine maintenance is feasible in a primary care setting...

..This article summarizes a presentation by David A. Fiellin, MD, in March 2004 at the International AIDS Society-USA New York course...

..Evaluation of the DATA-2000 training session small-group facilitators was uniformly positive. This faculty development workshop was successful in improving teaching skills for our small-group faculty facilitators...

..Further research, designed to identify the barriers to provider satisfaction with office-based opioid agonist therapy, is needed to ensure that these barriers do not limit expansion of this practice...

..We conclude that providing clinic-based methadone is least expensive. The price of buprenorphine accounts for a major portion of the difference in costs. For patients, office-based treatment may be less expensive...

..Gender differences exist regarding alcohol and illicit drug use disorders in the United States. Little is known about the gender-related factors associated with non-medical use of prescription opioids...

..We conclude that primary-care-based buprenorphine/naloxone treatment is associated with decreased drug-related HIV risk, but additional efforts may be needed to address sex-related HIV risk when present...

..Non-medical use of sedatives and tranquilizers carries risks including development of abuse/dependence. Such use may correlate with psychiatric symptoms...

....

..Prescription opioid dependence is increasing, but treatment outcomes with office-based buprenorphine/naloxone among these patients have not been described...

..Factors associated with satisfaction among patients receiving primary care-based buprenorphine/naloxone are unknown...

..Non-medical use of prescription opioids carries risks including development of abuse/dependence. Such use may correlate with psychiatric, medical, and substance use characteristics...

..To determine the efficacy of emergency practitioner-performed brief intervention for hazardous/harmful drinkers in reducing alcohol consumption and negative consequences in an emergency department (ED) setting...

..Despite the availability and demonstrated effectiveness of office-based buprenorphine maintenance treatment (BMT), the systematic examination of physicians' attitudes towards this new medical practice has been largely neglected...

..35%, p = .001). We conclude that both baseline and in-treatment cocaine use is associated with worse treatment outcomes in patients receiving office-based buprenorphine/naloxone and may benefit from targeted interventions...

..A diagnosis of an STI should prompt clinicians to screen for substance use, in particular, alcohol abuse/dependence and marijuana use. ..

..Having opioid dependence and HIV infection are associated with poor HIV-related treatment outcomes...

..Cocaine use is common in opioid-dependent HIV-infected patients, but its impact on treatment outcomes in these patients receiving buprenorphine/naloxone is not known...

..Given the public health impact of HIV infection, federal and private partnerships should be considered to establish routine HIV screening practices...

..The different components of treatment; the role of the physician who provides this treatment; and the logistics of treating this growing, multifaceted patient population are also examined...

..The prevalence, efficacy, and risk for addiction for persons receiving opioids for chronic back pain are unclear...

....

..Treatment outcomes with buprenorphine in a PCC do not vary based on history of prior methadone treatment...

..Patient and staff satisfaction was high, although the intervention was very difficult for the providers...

..This review addresses the introduction of buprenorphine, in terms of public health, policy, and clinical implications for HIV-infected patients and for HIV care providers...

....

..We were unable to detect a difference in hospital use or functional status, mental health function, or medication adherence among patients who require frequent hospital admissions using our intervention...

..To examine the role of expanded access to opioid agonist treatment as a means to decrease international HIV transmission...

..This opportunity has a three-year window, however, and a critical need will be to attract a sufficient number of physicians into prescribing buprenorphine/naloxone in order to allow our patients increased access to this treatment...

..Providers caring for patients who are or were IDUs must be aware of the management of these diseases and make efforts to integrate their medical care with the treatment of their substance abuse...

..HIV physicians' concerns regarding interactions between buprenorphine and HAART need to be addressed in future training efforts...

..Behaviors associated with opioid dependence often involve criminal activity, which can lead to incarceration. The impact of a history of incarceration on outcomes in primary care office-based buprenorphine/naloxone is not known...

....

..We investigated the feasibility and efficacy of integrating buprenorphine, along with 2 levels of counseling, into HIV clinical care...

..In addition, the literature focuses almost exclusively on patients with alcohol abuse or dependence in psychiatric inpatient settings, and excludes patients with less severe alcohol problems and primary care outpatient settings...

..Addressing these barriers in physician training and in existing office-based programs might benefit both noncancer chronic pain patients and their medical providers...

..Nonetheless office-based treatment may provide a solution for women concerned about anonymity, stigma, and the requirement of daily visits to a MMP...

..3% were brought back attached to the skin) and that weekly sweat testing is less sensitive than weekly urine testing in detecting opiate use, suggest limited utility of sweat patch testing in outpatient clinical settings...

..Practice guidelines rarely consider comorbid illness, and resulting overuse of health services may increase costs without conferring benefit...

..Findings have the potential to inform screening and intervention efforts in aging drug users with and without HIV...

..09, 95% CI 1.04, 4.24). Primary care and HIV providers were equally unlikely to treat active depressive symptoms. Treatment variation by race, site, and availability of a mental health provider, suggests targets for intervention...

..CONCLUSIONS: Alcohol-related diagnoses are not a barrier to receiving most quality of care measures in elderly patients hospitalized for acute myocardial infarction...

..Overall, physicians preferred in person instruction and may benefit from additional experiential training and support after curriculum participation...

..OBOT is not a replacement for more structured, traditional models of care, but provides an additional opportunity to help address the tremendous public health impact of opioid dependence...

..In the United States, insurance status and rates of treatment for individuals with opioid use disorder are unknown...

..Our objective was to assess the impact of marijuana smoking on the development of premalignant lung changes and lung cancer...

..Although alcohol problems are common in human immunodeficiency virus (HIV)-infected patients, their impact on health care services use in HIV-infected patients is not well understood...

..The results of this study will help define the role of professional evidence-based drug counseling in expanding access to treatment with Bup. ..

..Relevance to public health: The results of this study will help define the role of maintenance vs. detoxification with buprenorphine in the care of prescription opioid dependent patients in primary care. ..

..The results of this study will help define the role of professional evidence-based drug counseling in expanding access to treatment with Bup. ..

..Relevance to public health: The results of this study will help define the role of maintenance vs. detoxification with buprenorphine in the care of prescription opioid dependent patients in primary care. ..