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Published in: Substance Abuse Treatment, Prevention, and Policy 1/2008

Open Access 01-12-2008 | Research

State policy influence on the early diffusion of buprenorphine in community treatment programs

Authors: Lori J Ducharme, Amanda J Abraham

Published in: Substance Abuse Treatment, Prevention, and Policy | Issue 1/2008

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Abstract

Background

Buprenorphine was approved for use in the treatment of opioid dependence in 2002, but its diffusion into everyday clinical practice in community-based treatment programs has been slow. This study examines the net impact of efforts by state agencies, including provision of Medicaid coverage, on program-level adoption of buprenorphine as of 2006.

Methods

Interviews were conducted with key informants in 49 of the 50 state agencies with oversight responsibility for addiction treatment services. Information from these interviews was integrated with organizational data from the 2006 National Survey of Substance Abuse Treatment Services. A multivariate logistic regression model was estimated to identify the effects of state efforts to promote the use of this medication, net of a host of organizational characteristics.

Results

The availability of Medicaid coverage for buprenorphine was a significant predictor of its adoption by treatment organizations.

Conclusion

Inclusion of buprenorphine on state Medicaid formularies appears to be a key element in ensuring that patients have access to this state-of-the-art treatment option. Other potential barriers to the diffusion of buprenorphine require identification, and the value of additional state-level policies to promote its use should be evaluated.
Literature
1.
go back to reference Lamb S, Greenlick MR, McCarty D: Bridging the gap between practice and research: Forging partnerships with community-based drug and alcohol treatment. 1998, Washington DC: National Academy Press Lamb S, Greenlick MR, McCarty D: Bridging the gap between practice and research: Forging partnerships with community-based drug and alcohol treatment. 1998, Washington DC: National Academy Press
2.
go back to reference Sloboda Z, Schildhaus S: A discussion of the concept of technology transfer of research-based drug abuse prevention and treatment interventions. Subst Use Misuse. 2002, 37: 1079-1087. 10.1081/JA-120004167.CrossRefPubMed Sloboda Z, Schildhaus S: A discussion of the concept of technology transfer of research-based drug abuse prevention and treatment interventions. Subst Use Misuse. 2002, 37: 1079-1087. 10.1081/JA-120004167.CrossRefPubMed
3.
go back to reference Andrzejewski ME, Kirby KC, Morral AR, Iguchi MY: Technology transfer through performance management: the effects of graphical feedback and positive reinforcement on drug treatment counselors' behavior. Drug Alcohol Depen. 2001, 63 (2): 179-186. 10.1016/S0376-8716(00)00207-6.CrossRef Andrzejewski ME, Kirby KC, Morral AR, Iguchi MY: Technology transfer through performance management: the effects of graphical feedback and positive reinforcement on drug treatment counselors' behavior. Drug Alcohol Depen. 2001, 63 (2): 179-186. 10.1016/S0376-8716(00)00207-6.CrossRef
4.
go back to reference Liddle HA, Rowe CL, Quille TJ, Dakof GA, Mills DS, Sakran E, Biaggi H: Transporting a research-based adolescent drug treatment into practice. J Subst Abuse Treat. 2002, 22: 231-243. 10.1016/S0740-5472(02)00239-8.CrossRefPubMed Liddle HA, Rowe CL, Quille TJ, Dakof GA, Mills DS, Sakran E, Biaggi H: Transporting a research-based adolescent drug treatment into practice. J Subst Abuse Treat. 2002, 22: 231-243. 10.1016/S0740-5472(02)00239-8.CrossRefPubMed
5.
go back to reference Martin GW, Herie MA, Turner BJ, Cunningham JA: A social marketing model for disseminating research-based treatments to addiction treatment providers. Addiction. 1998, 93: 1703-1715. 10.1046/j.1360-0443.1998.931117038.x.CrossRefPubMed Martin GW, Herie MA, Turner BJ, Cunningham JA: A social marketing model for disseminating research-based treatments to addiction treatment providers. Addiction. 1998, 93: 1703-1715. 10.1046/j.1360-0443.1998.931117038.x.CrossRefPubMed
6.
go back to reference Ball S, Bachrach K, DeCarlo J, Fareninos C, Keen M, McSherry T, Polcin D, Snead N, Sockriter R, Wrigley P, Zammarelli L, Carroll K: Characteristics, beliefs, and practices of community clinicians trained to provide manual-guided therapy for substance abusers. J Subst Abuse Treat. 2002, 23: 309-318. 10.1016/S0740-5472(02)00281-7.CrossRefPubMed Ball S, Bachrach K, DeCarlo J, Fareninos C, Keen M, McSherry T, Polcin D, Snead N, Sockriter R, Wrigley P, Zammarelli L, Carroll K: Characteristics, beliefs, and practices of community clinicians trained to provide manual-guided therapy for substance abusers. J Subst Abuse Treat. 2002, 23: 309-318. 10.1016/S0740-5472(02)00281-7.CrossRefPubMed
7.
go back to reference Forman RF, Bovasso G, Woody G: Staff beliefs about addiction treatment. J Subst Abuse Treat. 2001, 21: 1-9. 10.1016/S0740-5472(01)00173-8.CrossRefPubMed Forman RF, Bovasso G, Woody G: Staff beliefs about addiction treatment. J Subst Abuse Treat. 2001, 21: 1-9. 10.1016/S0740-5472(01)00173-8.CrossRefPubMed
8.
go back to reference Mark T, Kranzler HR, Song X: Understanding US addiction physicians' low rate of naltrexone prescription. Drug Alcohol Depen. 2003, 71 (3): 219-228. 10.1016/S0376-8716(03)00134-0.CrossRef Mark T, Kranzler HR, Song X: Understanding US addiction physicians' low rate of naltrexone prescription. Drug Alcohol Depen. 2003, 71 (3): 219-228. 10.1016/S0376-8716(03)00134-0.CrossRef
9.
go back to reference Miller WR, Mount KA: A small study of training in motivational interviewing: does one workshop change clinician and client behavior?. Behav Cogn Psychoth. 2001, 29: 457-471. 10.1017/S1352465801004064.CrossRef Miller WR, Mount KA: A small study of training in motivational interviewing: does one workshop change clinician and client behavior?. Behav Cogn Psychoth. 2001, 29: 457-471. 10.1017/S1352465801004064.CrossRef
10.
go back to reference Morgenstern J, Morgan TJ, McCrady BS, Keller DS, Carroll KM: Manual-guided cognitive-behavioral therapy training: a promising method for disseminating empirically supported substance abuse treatments to the practice community. Psychol Addict Behav. 2001, 15: 83-88. 10.1037/0893-164X.15.2.83.CrossRefPubMed Morgenstern J, Morgan TJ, McCrady BS, Keller DS, Carroll KM: Manual-guided cognitive-behavioral therapy training: a promising method for disseminating empirically supported substance abuse treatments to the practice community. Psychol Addict Behav. 2001, 15: 83-88. 10.1037/0893-164X.15.2.83.CrossRefPubMed
11.
go back to reference Thomas CP, Wallack SS, Lee S, McCarty D, Swift R: Research to practice: adoption of naltrexone in alcoholism treatment. J Subst Abuse Treat. 2003, 24: 1-11. 10.1016/S0740-5472(02)00319-7.CrossRefPubMed Thomas CP, Wallack SS, Lee S, McCarty D, Swift R: Research to practice: adoption of naltrexone in alcoholism treatment. J Subst Abuse Treat. 2003, 24: 1-11. 10.1016/S0740-5472(02)00319-7.CrossRefPubMed
12.
go back to reference Simpson DD: A conceptual framework for transferring research to practice. J Subst Abuse Treat. 2002, 22: 171-182. 10.1016/S0740-5472(02)00231-3.CrossRefPubMed Simpson DD: A conceptual framework for transferring research to practice. J Subst Abuse Treat. 2002, 22: 171-182. 10.1016/S0740-5472(02)00231-3.CrossRefPubMed
13.
go back to reference Knudsen HK, Roman PM: Modeling the use of innovations in private treatment organizations: the role of absorptive capacity. J Subst Abuse Treat. 2004, 26: 353-361. 10.1016/S0740-5472(03)00158-2.CrossRefPubMed Knudsen HK, Roman PM: Modeling the use of innovations in private treatment organizations: the role of absorptive capacity. J Subst Abuse Treat. 2004, 26: 353-361. 10.1016/S0740-5472(03)00158-2.CrossRefPubMed
14.
go back to reference Rogers EM: Diffusion of Innovations. 1995, New York: Free Press Rogers EM: Diffusion of Innovations. 1995, New York: Free Press
15.
go back to reference Amass L, Ling W, Freese TE: Bringing buprenorphine-naloxone detoxification to community treatment providers: the NIDA Clinical Trials Network field experience. Am J Addiction. 2004, 13 (Suppl): 42-66. 10.1080/10550490490440807.CrossRef Amass L, Ling W, Freese TE: Bringing buprenorphine-naloxone detoxification to community treatment providers: the NIDA Clinical Trials Network field experience. Am J Addiction. 2004, 13 (Suppl): 42-66. 10.1080/10550490490440807.CrossRef
16.
go back to reference Knudsen HK, Ducharme LJ, Roman PM: Early buprenorphine adoption in substance abuse treatment centers: data from the public and private sectors. J Subst Abuse Treat. 2006, 30: 363-373. 10.1016/j.jsat.2006.03.013.CrossRefPubMed Knudsen HK, Ducharme LJ, Roman PM: Early buprenorphine adoption in substance abuse treatment centers: data from the public and private sectors. J Subst Abuse Treat. 2006, 30: 363-373. 10.1016/j.jsat.2006.03.013.CrossRefPubMed
17.
go back to reference Koch AL, Arfken CL, Schuster CR: Characteristics of US substance abuse treatment facilities adopting buprenorphine in its initial stage of availability. Drug Alcohol Depen. 2006, 83: 274-278. 10.1016/j.drugalcdep.2005.12.005.CrossRef Koch AL, Arfken CL, Schuster CR: Characteristics of US substance abuse treatment facilities adopting buprenorphine in its initial stage of availability. Drug Alcohol Depen. 2006, 83: 274-278. 10.1016/j.drugalcdep.2005.12.005.CrossRef
18.
go back to reference Ducharme LJ, Knudsen HK, Roman PM: Trends in the adoption of pharmacotherapies for alcohol dependence. J Clin Psychopharm. 2006, 26 (Suppl 1): 13-19. 10.1097/01.jcp.0000246209.18777.14.CrossRef Ducharme LJ, Knudsen HK, Roman PM: Trends in the adoption of pharmacotherapies for alcohol dependence. J Clin Psychopharm. 2006, 26 (Suppl 1): 13-19. 10.1097/01.jcp.0000246209.18777.14.CrossRef
19.
go back to reference Fuller BE, Rieckman T, McCarty D, Smith KW, Levine H: Adoption of naltrexone to treat alcohol dependence. J Subst Abuse Treat. 2005, 28: 273-280. 10.1016/j.jsat.2005.02.003.CrossRefPubMed Fuller BE, Rieckman T, McCarty D, Smith KW, Levine H: Adoption of naltrexone to treat alcohol dependence. J Subst Abuse Treat. 2005, 28: 273-280. 10.1016/j.jsat.2005.02.003.CrossRefPubMed
20.
go back to reference Knudsen HK, Roman PM, Ducharme LJ, Johnson JA: Organizational predictors of pharmacological innovation adoption: the case of disulfiram. J Drug Issues. 2005, 35: 559-574.CrossRef Knudsen HK, Roman PM, Ducharme LJ, Johnson JA: Organizational predictors of pharmacological innovation adoption: the case of disulfiram. J Drug Issues. 2005, 35: 559-574.CrossRef
21.
go back to reference Knudsen HK, Ducharme LJ, Roman PM: The adoption of medications in substance abuse treatment: associations with organizational characteristics and technology clusters. Drug Alcohol Depen. 2007, 87 (2-3): 164-174. 10.1016/j.drugalcdep.2006.08.013.CrossRef Knudsen HK, Ducharme LJ, Roman PM: The adoption of medications in substance abuse treatment: associations with organizational characteristics and technology clusters. Drug Alcohol Depen. 2007, 87 (2-3): 164-174. 10.1016/j.drugalcdep.2006.08.013.CrossRef
22.
go back to reference Roman PM, Johnson JA: Adoption and implementation of new technologies in substance abuse treatment. J Subst Abuse Treat. 2002, 22: 211-218. 10.1016/S0740-5472(02)00241-6.CrossRefPubMed Roman PM, Johnson JA: Adoption and implementation of new technologies in substance abuse treatment. J Subst Abuse Treat. 2002, 22: 211-218. 10.1016/S0740-5472(02)00241-6.CrossRefPubMed
23.
go back to reference Knudsen HK, Ducharme LJ, Roman PM: The use of antidepressant medications in substance abuse treatment: the public-private distinction, organizational compatibility, and the environment. J Health Soc Behav. 2007, 48: 195-210.CrossRefPubMed Knudsen HK, Ducharme LJ, Roman PM: The use of antidepressant medications in substance abuse treatment: the public-private distinction, organizational compatibility, and the environment. J Health Soc Behav. 2007, 48: 195-210.CrossRefPubMed
24.
go back to reference Substance Abuse and Mental Health Services Administration: The DASIS Report: Treatment Admissions with Medicaid as the Primary Expected or Actual Payment Source: 2005. Rockville, MD. 2007 Substance Abuse and Mental Health Services Administration: The DASIS Report: Treatment Admissions with Medicaid as the Primary Expected or Actual Payment Source: 2005. Rockville, MD. 2007
25.
go back to reference Scott WR: Institutions and Organizations. 1995, Thousand Oaks, CA: Sage Scott WR: Institutions and Organizations. 1995, Thousand Oaks, CA: Sage
26.
go back to reference DiMaggio PJ, Powell WW: The iron cage revisited: institutional isomorphism and collective rationality in organizational fields. Admin Sci Quart. 1983, 48: 147-160. DiMaggio PJ, Powell WW: The iron cage revisited: institutional isomorphism and collective rationality in organizational fields. Admin Sci Quart. 1983, 48: 147-160.
27.
go back to reference Meyer JW, Rowan B: Institutional organizations: Formal structure as myth and ceremony. Am J Sociol. 1977, 83: 340-363. 10.1086/226550.CrossRef Meyer JW, Rowan B: Institutional organizations: Formal structure as myth and ceremony. Am J Sociol. 1977, 83: 340-363. 10.1086/226550.CrossRef
28.
go back to reference Koyanagi C, Forquer S, Alfano E: Medicaid policies to contain psychiatric drug costs. Health Aff (Millwood). 2005, 24 (2): 536-544. 10.1377/hlthaff.24.2.536.CrossRef Koyanagi C, Forquer S, Alfano E: Medicaid policies to contain psychiatric drug costs. Health Aff (Millwood). 2005, 24 (2): 536-544. 10.1377/hlthaff.24.2.536.CrossRef
29.
go back to reference McCarty D, Frank RG, Denmead GC: Methadone maintenance and state Medicaid managed care programs. Milbank Q. 1999, 77: 341-362. 10.1111/1468-0009.00139.PubMedCentralCrossRefPubMed McCarty D, Frank RG, Denmead GC: Methadone maintenance and state Medicaid managed care programs. Milbank Q. 1999, 77: 341-362. 10.1111/1468-0009.00139.PubMedCentralCrossRefPubMed
30.
go back to reference D'Aunno TA, Vaughn TE, McElroy P: An institutional analysis of HIV prevention efforts by the nation's outpatient drug abuse treatment units. J Health Soc Behav. 1999, 40: 175-192. 10.2307/2676372.CrossRefPubMed D'Aunno TA, Vaughn TE, McElroy P: An institutional analysis of HIV prevention efforts by the nation's outpatient drug abuse treatment units. J Health Soc Behav. 1999, 40: 175-192. 10.2307/2676372.CrossRefPubMed
31.
go back to reference D'Aunno TA, Pollack HA: Changes in methadone treatment practices: Results from a national panel study, 1988–2002. J Amer Med Assoc. 2002, 288: 50-856. 10.1001/jama.288.7.850.CrossRef D'Aunno TA, Pollack HA: Changes in methadone treatment practices: Results from a national panel study, 1988–2002. J Amer Med Assoc. 2002, 288: 50-856. 10.1001/jama.288.7.850.CrossRef
32.
go back to reference D'Aunno T, Folz-Murphy N, Lin X: Changes in methadone treatment practices: Results from a panel study, 1988–1995. Am J Drug Alcohol Ab. 1999, 25: 681-699. 10.1081/ADA-100101886.CrossRef D'Aunno T, Folz-Murphy N, Lin X: Changes in methadone treatment practices: Results from a panel study, 1988–1995. Am J Drug Alcohol Ab. 1999, 25: 681-699. 10.1081/ADA-100101886.CrossRef
33.
go back to reference Goldman DP, Bhattacharya J, Leibowitz AA, Joyce GF, Shapiro MF, Bozette SA: The impact of state policy on the costs of HIV infection. Med Care Res Rev. 2001, 58: 31-53. 10.1177/107755870105800408.CrossRefPubMed Goldman DP, Bhattacharya J, Leibowitz AA, Joyce GF, Shapiro MF, Bozette SA: The impact of state policy on the costs of HIV infection. Med Care Res Rev. 2001, 58: 31-53. 10.1177/107755870105800408.CrossRefPubMed
34.
go back to reference Heinrich CJ, Hill CJ: Role of state policies in the adoption of naltrexone for substance abuse treatment. Health Serv Res. 2008, 43: 951-970. 10.1111/j.1475-6773.2007.00812.x.PubMedCentralCrossRefPubMed Heinrich CJ, Hill CJ: Role of state policies in the adoption of naltrexone for substance abuse treatment. Health Serv Res. 2008, 43: 951-970. 10.1111/j.1475-6773.2007.00812.x.PubMedCentralCrossRefPubMed
35.
go back to reference Ling W, Rawson RA, Compton MA: Substitution pharmacotherapies for opioid addiction: from methadone to LAAM and buprenorphine. J Psychoactive Drugs. 1994, 26: 119-128.CrossRefPubMed Ling W, Rawson RA, Compton MA: Substitution pharmacotherapies for opioid addiction: from methadone to LAAM and buprenorphine. J Psychoactive Drugs. 1994, 26: 119-128.CrossRefPubMed
36.
go back to reference Prendergast ML, Grella C, Perry SM, Anglin MD: Levo-alpha-acetylmethadol (LAAM): Clinical, research, and policy issues of a new pharmacotherapy for opioid addiction. J Psychoactive Drugs. 1995, 27: 239-247.CrossRefPubMed Prendergast ML, Grella C, Perry SM, Anglin MD: Levo-alpha-acetylmethadol (LAAM): Clinical, research, and policy issues of a new pharmacotherapy for opioid addiction. J Psychoactive Drugs. 1995, 27: 239-247.CrossRefPubMed
37.
go back to reference Rawson RA, Hasson AL, Huber AM, McCann MJ, Ling W: A 3-year progress report on the implementation of LAAM in the United States. Addiction. 1998, 93: 533-540. 10.1046/j.1360-0443.1998.9345338.x.CrossRefPubMed Rawson RA, Hasson AL, Huber AM, McCann MJ, Ling W: A 3-year progress report on the implementation of LAAM in the United States. Addiction. 1998, 93: 533-540. 10.1046/j.1360-0443.1998.9345338.x.CrossRefPubMed
38.
go back to reference Jaffe JH, O'Keeffe C: From morphine clinics to buprenorphine: regulating opioid agonist treatment of addiction in the United States. Drug Alcohol Depen. 2003, 70 (Suppl 2): 3-11. 10.1016/S0376-8716(03)00055-3.CrossRef Jaffe JH, O'Keeffe C: From morphine clinics to buprenorphine: regulating opioid agonist treatment of addiction in the United States. Drug Alcohol Depen. 2003, 70 (Suppl 2): 3-11. 10.1016/S0376-8716(03)00055-3.CrossRef
39.
go back to reference Institute of Medicine: Federal Regulation of Methadone Treatment. 1995, Washington, DC: National Academy Press Institute of Medicine: Federal Regulation of Methadone Treatment. 1995, Washington, DC: National Academy Press
40.
go back to reference Substance Abuse and Mental Health Services Administration: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction (TIP 40). Rockville, MD. 2004 Substance Abuse and Mental Health Services Administration: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction (TIP 40). Rockville, MD. 2004
41.
go back to reference Substance Abuse and Mental Health Services Administration: Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs (TIP 43). Rockville, MD. 2005 Substance Abuse and Mental Health Services Administration: Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs (TIP 43). Rockville, MD. 2005
43.
go back to reference Kohler U, Kreuter F: Data Analysis Using Stata. 2005, College Station, TX: Stata Corp Kohler U, Kreuter F: Data Analysis Using Stata. 2005, College Station, TX: Stata Corp
Metadata
Title
State policy influence on the early diffusion of buprenorphine in community treatment programs
Authors
Lori J Ducharme
Amanda J Abraham
Publication date
01-12-2008
Publisher
BioMed Central
Published in
Substance Abuse Treatment, Prevention, and Policy / Issue 1/2008
Electronic ISSN: 1747-597X
DOI
https://doi.org/10.1186/1747-597X-3-17

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