Collaborative Care of Opioid-Addicted Patients in Primary Care Using Buprenorphine: Five-Year Experience
Open accessAbstract
BACKGROUND: Opioid addiction is a chronic disease treatable in primary care settings with buprenorphine hydrochloride, but this treatment remains underused. We describe a collaborative care model for managing opioid addiction with buprenorphine hydrochloride-naloxone hydrochloride dihydrate sublingual tablets. METHODS: Ours is a cohort study of patients treated for opioid addiction using collaborative care between nurse care managers and generalist physicians in an urban academic primary care practice during a 5-year period. We examine patient characteristics, 12-month treatment success (ie, retention or taper after 6 months), and predictors of successful outcomes. RESULTS: From September 1, 2003, through September 30, 2008, 408 patients with opioid addiction were treated with buprenorphine. Twenty-six patients were excluded from analysis because they left treatment owing to preexisting legal or medical conditions or a need to transfer to another buprenorphine program. At 1 year, 196 of 382 patients (51.3%) underwent successful treatment. Of patients remaining in treatment at 12 months, 154 of 169 (91.1%) were no longer using illicit opioids or cocaine based on urine drug test results. On admission, patients who were older, were employed, and used illicit buprenorphine had significantly higher odds of treatment success; those of African American or Hispanic/Latino race had significantly lower odds of treatment success. These outcomes were achieved with a model that facilitated physician involvement. CONCLUSION: Collaborative care with nurse care managers in an urban primary care practice is an alternative and successful treatment method for most patients with opioid addiction that makes effective use of time for physicians who prescribe buprenorphine.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 32 cited sources checked · 0 supported · 0 flagged
- Findingown data
At 12 months, 6% of patients were neither successful nor unsuccessful because they transferred to methadone maintenance.
“A minority (6%) of patients were considered neither successful nor unsuccessful as they voluntarily transferred to methadone maintenance treatment for more structured care or for full opioid agonist therapy.”
Quote in the paperNot a substantial claim - Findingown data
Each OBOT physician prescribed to an average of 35 patients per month, with a range of 13 to 68.
“A nurse care manager saw 75 patients per week and each OBOT physician prescribed to an average of 35 patients (range 13 – 68) per month.”
Quote in the paperNot a substantial claim - Findingown data
At 3, 6, 9, and 12 months, at least 93% of patients remaining in treatment had negative urine drug tests for illicit opioids and cocaine.
“At 3-, 6-, 9- and 12-month intervals, at least 93% of patients remaining in treatment had negative urine drug tests for illicit opioids and cocaine (Table 4).”
Quote in the paperSubstantial claim- Rests on an assumption: Urine drug test results accurately indicate patients' illicit opioid and cocaine use.
- Findingown data
At 12 months, 42% (162/382) of patients had unsuccessful treatment.
“At 12 months, 51% (196/382) were successful (49% remained in treatment and 2% were tapered after 6 months of adherence and absence of illicit drug use) and 42% (162/382) were unsuccessful (29% lost to follow-up and 13% discharged).”
Quote in the paperSubstantial claim - Findingown data
Patients who self-maintained with illicit buprenorphine reported self-treating their addiction rather than trying to get high.
“These patients reported “self-treating” their opioid addiction with illicit buprenorphine rather than trying to get high.”
Quote in the paperSubstantial claim
- Findingown data
At 12 months, 51% (196/382) of patients achieved successful treatment.
“At 12 months, 51% (196/382) were successful (49% remained in treatment and 2% were tapered after 6 months of adherence and absence of illicit drug use) and 42% (162/382) were unsuccessful (29% lost to follow-up and 13% discharged).”
Quote in the paperSubstantial claim- Rests on an assumption: The definition of successful treatment validly captures treatment success.
- Findingown data
In multivariable analysis, African American or Hispanic race on admission was significantly associated with lower odds of treatment success.
“On admission, patients who were older, employed, and who self-maintained with illicit buprenorphine had significantly higher odds of treatment success while those of African American or Hispanic race had significantly lower odds of treatment success.”
Quote in the paperNot a substantial claim - Findingown data
Once prescription opioid testing began, rates of urines positive for illicit opioids did not change.
“However, once prescription opioid testing began, the rates of urines positive for illicit opioids did not change.”
Quote in the paperNot a substantial claim - Interpretationcitation
The 51% success rate is comparable to previous primary care studies with smaller numbers and 6-12 month follow-up.
“Collaborative care with nurse care managers resulted in feasible initiation and maintenance of buprenorphine for the majority (51%) of patients admitted which is comparable to previous studies in primary care settings involving smaller numbers of patients with 6–12 month follow-up.9–15”
Quote in the paperSubstantial claim0 of 7 sources checked- cites [9] Colameco S Armando J Trotz C Opiate dependence treatment with buprenorphine: One year’s experience in a family practice residency setting J Addict Dis 2005 24 2 25 32 15784521
Not checked in the free run.
- cites [10] Fiellin DA Moore BA Sullivan LE Long-term treatment with buprenorphine/naloxone in primary care: Results at 2–5 years Am J Addict 2008 17 2 116 120 18393054
Not checked in the free run.
- cites [11] Magura S Lee SJ Salsitz EA Outcomes of buprenorphine maintenance in office-based practice J Addict Dis 2007 26 2 13 23 17594994
Not checked in the free run.
- cites [12] Mintzer IL Eisenberg M Terra M MacVane C Himmelstein DU Woolhandler S Treating opioid addiction with buprenorphine-naloxone in community-based primary care settings Ann Fam Med 2007 5 2 146 150 17389539 PMC1838690
Not checked in the free run.
- cites [13] Parran TV Adelman CA Merkin B Long-term outcomes of office-based buprenorphine/naloxone maintenance therapy Drug Alcohol Depend 2010 106 1 56 60 19717249 PMC3263699
Not checked in the free run.
- cites [14] Soeffing JM Martin LD Fingerhood MI Jasinski DR Rastegar DA Buprenorphine maintenance treatment in a primary care setting: Outcomes at 1 year J Subst Abuse Treat 2009 37 4 426 430 19553061
Not checked in the free run.
- cites [15] Stein MD Cioe P Friedmann PD Buprenorphine retention in primary care J Gen Intern Med 2005 20 11 1038 1041 16307630 PMC1490248
Not checked in the free run.
- Interpretationreasoning
The nurse care manager was central to day-to-day clinical care.
“As described, the nurse care manager (NCM) was central to day-today clinical care with daily open access to address the myriad needs (e.g., housing, employment, insurance) of this complicated population.”
Quote in the paperSubstantial claim - Interpretationreasoning
In this setting, collaborative care allowed academic generalist physicians with part-time clinical practices to treat many patients with complex psychosocial needs.
“In this particular setting, collaborative care allowed academic generalist physicians with research, administrative and part-time clinical responsibilities to treat a large number of patients, many of whom had complex psychosocial needs.”
Quote in the paperSubstantial claim - Premisecitation
Experience with collaborative care for opioid addiction treatment in primary care had not been described.
“While collaborative care improves management of other chronic diseases (e.g. hypertension19, diabetes20) experience with this model for the treatment of opioid addiction in primary care has not been described.21”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [21] Saitz R Larson MJ Labelle C Richardson J Samet JH The case for chronic disease management for addiction J Addict Med 2008 2 2 55 65 19809579 PMC2756688
Not checked in the free run.
- Study design and conductnone given
Follow-up information was not available after patient departure from the program.
“In addition, follow-up information was not available after patient departure from the program.”
Quote in the paperNot a substantial claim - Study design and conductreasoning
The study did not have a control group.
“This study did not have a control group but this was acceptable as its purpose was not to retest the efficacy of buprenorphine treatment but rather to evaluate the feasibility of delivering this known effective treatment using a collaborative care model.”
Quote in the paperSubstantial claim - Interpretationreasoning
Having relevant clinical data before physician visits allowed efficient use of physician time for patient management.
“Having relevant clinical data (e.g., nursing assessments, documentation of treatment adherence, urine drug test results) prior to physician visits allowed efficient use of physician time to focus on patient management (e.g. dose adjustments, continued maintenance versus taper).”
Quote in the paperSubstantial claim - Premisecitation
A commonly cited barrier to expanding OBOT is insufficient clinical support for patient monitoring.
“One consistently cited barrier preventing OBOT expansion is lack of adequate clinical support given the additional needs for patient monitoring.16–18”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [16] Netherland J Botsko M Egan JE Factors affecting willingness to provide buprenorphine treatment J Subst Abuse Treat 2009 36 3 244 251 18715741 PMC2866292
Not checked in the free run.
- cites [17] Walley AY Alperen JK Cheng DM Office-based management of opioid dependence with buprenorphine: Clinical practices and barriers J Gen Intern Med 2008 23 9 1393 1398 18592319 PMC2518016
Not checked in the free run.
- cites [18] Barry DT Irwin KS Jones ES Integrating buprenorphine treatment into office-based practice: A qualitative study J Gen Intern Med 2009 24 2 218 225 19089500 PMC2628993
Not checked in the free run.
- Interpretationreasoning
Self-maintenance with illicit buprenorphine suggests patients were highly motivated to obtain a dependable, insurance-covered source and avoid the illicit market.
“This suggests that these patients were highly motivated to obtain a dependable and insurance covered source of buprenorphine and to avoid relying on the illicit market.”
Quote in the paperSubstantial claim - Premisecitation
OBOT remains underutilized in traditional care models.
“OBOT has been shown to be effective in primary care settings,8–15 however remains underutilized in traditional care models.16”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [16] Netherland J Botsko M Egan JE Factors affecting willingness to provide buprenorphine treatment J Subst Abuse Treat 2009 36 3 244 251 18715741 PMC2866292
Not checked in the free run.
- Premisecitation
The finding that self-maintaining with illicit buprenorphine predicted success is similar to other studies finding self-treatment with illicit methadone predicted positive outcomes.
“This finding is similar to other studies27, 28 that found patients who “self treated” with illicit methadone were more likely to have positive treatment outcomes.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [27] Sohler NL Li X Kunins HV Home- versus office-based buprenorphine inductions for opioid-dependent patients J Subst Abuse Treat 2010 38 2 153 159 19801178 PMC2849656
Not checked in the free run.
- cites [28] Cunningham C Giovanniello A Sacajiu G Buprenorphine treatment in an urban community health center: What to expect Fam Med 2008 40 7 500 506 18928077 PMC2840630
Not checked in the free run.
- Premisecitation
Office-based opioid treatment (OBOT) with buprenorphine has been shown effective in primary care settings.
“OBOT has been shown to be effective in primary care settings,8–15 however remains underutilized in traditional care models.16”
Quote in the paperSubstantial claim0 of 8 sources checked- cites [8] Alford DP LaBelle CT Richardson JM Treating homeless opioid dependent patients with buprenorphine in an office-based setting J Gen Intern Med 2007 22 2 171 176 17356982 PMC1824722
Not checked in the free run.
- cites [9] Colameco S Armando J Trotz C Opiate dependence treatment with buprenorphine: One year’s experience in a family practice residency setting J Addict Dis 2005 24 2 25 32 15784521
Not checked in the free run.
- cites [10] Fiellin DA Moore BA Sullivan LE Long-term treatment with buprenorphine/naloxone in primary care: Results at 2–5 years Am J Addict 2008 17 2 116 120 18393054
Not checked in the free run.
- cites [11] Magura S Lee SJ Salsitz EA Outcomes of buprenorphine maintenance in office-based practice J Addict Dis 2007 26 2 13 23 17594994
Not checked in the free run.
- cites [12] Mintzer IL Eisenberg M Terra M MacVane C Himmelstein DU Woolhandler S Treating opioid addiction with buprenorphine-naloxone in community-based primary care settings Ann Fam Med 2007 5 2 146 150 17389539 PMC1838690
Not checked in the free run.
- cites [13] Parran TV Adelman CA Merkin B Long-term outcomes of office-based buprenorphine/naloxone maintenance therapy Drug Alcohol Depend 2010 106 1 56 60 19717249 PMC3263699
Not checked in the free run.
- cites [14] Soeffing JM Martin LD Fingerhood MI Jasinski DR Rastegar DA Buprenorphine maintenance treatment in a primary care setting: Outcomes at 1 year J Subst Abuse Treat 2009 37 4 426 430 19553061
Not checked in the free run.
- cites [15] Stein MD Cioe P Friedmann PD Buprenorphine retention in primary care J Gen Intern Med 2005 20 11 1038 1041 16307630 PMC1490248
Not checked in the free run.
- Interpretationown data
Collaborative care with nurse care managers resulted in feasible initiation and maintenance of buprenorphine for the majority (51%) of admitted patients.
“Collaborative care with nurse care managers resulted in feasible initiation and maintenance of buprenorphine for the majority (51%) of patients admitted which is comparable to previous studies in primary care settings involving smaller numbers of patients with 6–12 month follow-up.9–15”
Quote in the paperSubstantial claim - Interpretationown data
Collaborative care with nurse care managers in an urban primary care practice is an alternative and successful method of service delivery for the majority of patients with opioid addiction.
“Collaborative care with nurse care managers in an urban primary care practice is an alternative and successful method of service delivery for the majority of patients with opioid addiction while effectively utilizing the time of physicians prescribing buprenorphine.”
Quote in the paperSubstantial claim - Interpretationown data
This study adds to the growing body of evidence that office-based treatment of opioid addiction is feasible in primary care settings.
“This study of collaborative care adds to the growing body of evidence that office-based treatment of opioid addiction is feasible in primary care settings.”
Quote in the paperSubstantial claim - Interpretationown data
Office-based opioid treatment can be effectively offered in a primary care practice using a collaborative care model.
“In conclusion, office-based opioid treatment (OBOT) can be effectively offered in a primary care practice utilizing a collaborative care model.”
Quote in the paperSubstantial claim - Interpretationnone given
In this model, heavily reliant on nurse care managers, patient-level outcomes were comparable to other physician-centered approaches.
“In this model, heavily reliant on nurse-care managers, patient-level outcomes were comparable to other physician-centered approaches.”
Quote in the paperNot a substantial claim - Interpretationreasoning
Collaboration with pharmacists reduced the OBOT physician burden by allowing buprenorphine prescriptions with multiple refills that could be canceled if the patient was non-adherent.
“Collaboration with pharmacists reduced the OBOT physician burden by allowing buprenorphine prescriptions with multiple refills while allowing for cancelation of the refills if the patient was non-adherent.”
Quote in the paperNot a substantial claim - Interpretationreasoning
The collaborative care model effectively utilizes the time of physicians prescribing buprenorphine.
“Collaborative care with nurse care managers in an urban primary care practice is an alternative and successful method of service delivery for the majority of patients with opioid addiction while effectively utilizing the time of physicians prescribing buprenorphine.”
Quote in the paperSubstantial claim
- Classified as probably not a substantial claim. 20
- May combine two claims. 12
- The quote only partly states this claim. 1
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataTwenty-six patients were excluded from analysis, leaving 382 patients.
“Twenty-six patients were excluded from exploratory analysis because they left treatment due to preexisting legal issues leading to incarceration [13] and medical conditions unrelated to their buprenorphine treatment (chronic pain [3], advanced stage AIDS [1]), or transferred to another OBOT program due to relocation or consolidating their care [9], leaving 382 patients.”
Quote in the paperNot a substantial claim- Rests on an assumption: Excluding the 26 patients who left for preexisting legal or medical reasons or transfer does not bias the treatment success estimate.
May combine two claims.
Findingown dataIn bivariate analyses, treatment success at 12 months was significantly associated with female gender, White race, employment, self-maintaining with illicit buprenorphine, prescription opioid abuse or methadone maintenance, and no past-year cocaine use.
“In bivariate analyses, treatment success at 12 months was significantly associated with the following characteristics on admission: female gender, White race, being employed, self-maintaining with illicit buprenorphine, prescription opioid abuse or methadone maintenance, and no self report of past year cocaine use.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataThe program coordinator received an average of 20 calls per week requesting OBOT.
“On average, the program coordinator received 20 calls per week requesting OBOT.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataCocaine use and psychiatric illness were not associated with worse treatment outcomes.
“We did not find that cocaine use and psychiatric illness were associated with worse outcomes.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataIn multivariable analysis, older age, employment, and self-maintenance with illicit buprenorphine on admission were significantly associated with higher odds of treatment success.
“On admission, patients who were older, employed, and who self-maintained with illicit buprenorphine had significantly higher odds of treatment success while those of African American or Hispanic race had significantly lower odds of treatment success.”
Quote in the paperSubstantial claim- Rests on an assumption: Patients' self-reports of illicit buprenorphine use on admission are accurate.
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataA nurse care manager saw 75 patients per week.
“A nurse care manager saw 75 patients per week and each OBOT physician prescribed to an average of 35 patients (range 13 – 68) per month.”
Quote in the paperNot a substantial claimThe quote only partly states this claim.
Findingown dataFrom September 2003 to September 2008, 408 patients with opioid dependence were admitted to the BMC OBOT program.
“In 60 months, 408 patients with opioid dependence were admitted to the office-based opioid treatment (OBOT) program.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
FindingreasoningThe patients transferred to methadone maintenance were excluded from the treatment success analysis, leaving 358 patients.
“The patients who were transferred to methadone maintenance treatment were excluded from the analysis of treatment success as they could be arguably perceived as successful or not, leaving 358 patients.”
Quote in the paperSubstantial claim- Rests on an assumption: Excluding patients transferred to methadone maintenance from the regression does not bias the predictor estimates.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationMethadone, an opioid agonist therapy, is highly effective for opioid addiction when provided outside primary care.
“For over 45 years, research has confirmed that opioid agonist therapy (i.e., methadone) is a highly effective treatment for opioid addiction provided outside of primary care.4–6”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [4] Gibson A Degenhardt L Mattick RP Ali R White J O’Brien S Exposure to opioid maintenance treatment reduces long-term mortality Addiction 2008 103 3 462 468 18190664
Not checked in the free run.
- cites [5] Mattick RP Breen C Kimber J Davoli M Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence Cochrane Database Syst Rev 2009 3 CD002209 19588333 PMC7097731
Not checked in the free run.
- cites [6] National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction Effective medical treatment of opiate addiction JAMA 1998 280 22 1936 1943 9851480
Not checked in the free run.
May combine two claims.
Study design and conductnone givenUrine drug test protocols changed over time; testing for semi-synthetic and synthetic opioids was not standardized until 2007, so early urine results may underestimate prescription opioid abuse.
“Urine drug test protocols also changed over time; testing for semi-synthetic and synthetic opioids was not standardized until 2007, so early urine results may underestimate prescription opioid abuse.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Interpretationnone givenAn experienced, skilled nurse care manager played an essential role in caring for patients.
“Lastly an experienced, skilled nurse care manager played an essential role in caring for patients and the ability to generalize such a model may depend on skills of such key individuals.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductreasoningThe study was retrospective, examining patients from a clinical program, although data were collected prospectively using an OBOT medical record.
“While data was collected prospectively using a medical record designed for OBOT patients, the study was retrospective examining patients from a clinical program.”
Quote in the paperNot a substantial claim- Rests on an assumption: Data abstracted from retrospective clinical charts are accurate and complete.
Classified as probably not a substantial claim.
Study design and conductreasoningThe absence of a control group was acceptable because the study's purpose was to evaluate feasibility of delivering known effective treatment, not to retest efficacy.
“This study did not have a control group but this was acceptable as its purpose was not to retest the efficacy of buprenorphine treatment but rather to evaluate the feasibility of delivering this known effective treatment using a collaborative care model.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationOpioid addiction is a chronic, relapsing brain disease.
“Opioid addiction is a chronic, relapsing brain disease that affects millions of Americans and produces tremendous burden on the healthcare system.1, 2”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [1] McLellan AT Lewis DC O’Brien CP Kleber HD Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation JAMA 2000 284 13 1689 1695 11015800
Not checked in the free run.
- cites [2] Leshner AI Science-based views of drug addiction and its treatment JAMA 1999 282 14 1314 1316 10527162
Not checked in the free run.
May combine two claims.
InterpretationcitationThe model satisfied a key coordinated care principle of assuring accessibility, continuity, high quality care, communication, education, and outreach.
“This model satisfied a key principle of coordinated care by “assuring accessibility, continuity and high quality care that included effective communication with, education of, and outreach to patients.”26”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [26] Blue Ribbon Panel of the Society of General Internal Medicine Redesigning the practice model for general internal medicine. A proposal for coordinated care: A policy monograph of the society of general internal medicine J Gen Intern Med 2007 22 3 400 409 17356976 PMC1824765
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Interpretationnone givenOpen communication between the nurse care manager and addiction counselors improved patients' ability to comply with addiction counseling.
“Open communication between the NCM and addiction counselors improved the patients’ ability to comply with this essential element of good addiction care.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationCollaborative care improves management of other chronic diseases such as hypertension and diabetes.
“While collaborative care improves management of other chronic diseases (e.g. hypertension19, diabetes20) experience with this model for the treatment of opioid addiction in primary care has not been described.21”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [19] Hunt JS Siemienczuk J Pape G A randomized controlled trial of team-based care: Impact of physician-pharmacist collaboration on uncontrolled hypertension J Gen Intern Med 2008 23 12 1966 1972 18815843 PMC2596500
Not checked in the free run.
- cites [20] DiPiero A Dorr DA Kelso C Bowen JL Integrating systematic chronic care for diabetes into an academic general internal medicine resident-faculty practice J Gen Intern Med 2008 23 11 1749 1756 18752028 PMC2585684
Not checked in the free run.
May combine two claims.
InterpretationcitationThe collaborative care model ensured compliance with federal laws while maintaining access to a large number of patients.
“The collaborative care model ensured program compliance with federal laws25 (e.g., limits to the number of patients treated per OBOT physician) while maintaining access to a large number of patients.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [25] Drug addiction treatment act of 2000. 2000; Public Law 106-310:Page 114 STAT. 1223–1227.
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Interpretationnone givenAccess to methadone maintenance allowed safe transfer of patients needing more structured treatment.
“Access to methadone maintenance allowed the program to safely transfer patients who required a more structured treatment modality.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationOpioid dependence diagnosis was documented based on a checklist of DSM IV criteria.
“The NCM intake included documenting opioid dependence diagnosis based on a checklist of the DSM IV22 criteria”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [22] American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders 4 Text Revision Washington, DC American Psychiatric Association 2000
Not checked in the free run.
Classified as probably not a substantial claim.
InterpretationreasoningThe ability to generalize the collaborative care model may depend on the skills of key individuals such as the nurse care manager.
“Lastly an experienced, skilled nurse care manager played an essential role in caring for patients and the ability to generalize such a model may depend on skills of such key individuals.”
Quote in the paperSubstantial claim- Rests on an assumption: The skills of the nurse care manager are not the primary driver of outcomes, or the model can be generalized despite dependence on such skills.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataOf patients who left the program before 12 months, the reasons for leaving were known.
“However, of patients who left the program earlier than 12 months, the reasons for leaving (i.e., successful or unsuccessful treatment or methadone maintenance treatment transfer) were known.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataUrine drug tests were mostly unsupervised, but measures were taken to minimize falsified tests, such as testing urine temperature.
“Urine drug tests were mostly unsupervised but measures were taken to try to minimize falsified tests (e.g., testing urine temperature).”
Quote in the paperNot a substantial claim- Rests on an assumption: Urine drug test results accurately indicate patients' illicit opioid and cocaine use.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenThe nurse care managers followed treatment protocols and maintained a standard of clinical practice that satisfied federal regulations for buprenorphine treatment.
“The NCMs, registered nurses who completed a one day buprenorphine training, performed patient care roles, followed treatment protocols and maintained a standard of clinical practice that satisfied federal regulations for buprenorphine treatment.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Interpretationnone givenThese outcomes were achieved with a model that facilitated physician involvement.
“These outcomes were achieved with a model that facilitated physician involvement.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductreasoningFor patients who missed appointments within a 3-month interval, no urine sample was obtained, so the number of urine samples at each interval was less than the number of enrolled patients.
“For those patients who missed appointments within the 3-month interval, no urine sample was obtained; consequently, the number of urine samples available at each testing interval was less than the number of patients enrolled in that interval.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Interpretationnone givenThe model accommodated large public demand for OBOT and faculty physicians with part-time clinical practices.
“This model accommodated both the large public demand for OBOT and faculty physicians with part-time clinical practices.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
Urine drug test results accurately indicate patients' illicit opioid and cocaine use.
“Urine drug tests were mostly unsupervised but measures were taken to try to minimize falsified tests (e.g., testing urine temperature).”
The paper relies on this without support.
Patients' self-reports of illicit buprenorphine use on admission are accurate.
“On admission, patients who were older, employed, and used illicit buprenorphine had significantly higher odds of treatment success”
The paper relies on this without support.
The observed treatment outcomes are attributable to the collaborative care model rather than to other unmeasured factors.
“Other important factors may have impacted the outcomes of this intervention.”
The paper relies on this without support.
The definition of successful treatment validly captures treatment success.
“Successful treatment was defined as treatment retention or buprenorphine taper after treatment adherence and absence of illicit drug use for at least 6 months.”
The paper relies on this without support.
Data abstracted from retrospective clinical charts are accurate and complete.
“A retrospective clinical chart review was conducted for all patients admitted to the Boston Medical Center (BMC) OBOT program from September 2003 to September 2008 with 12-month outcome data continued through September 2009.”
The paper relies on this without support.
Excluding the 26 patients who left for preexisting legal or medical reasons or transfer does not bias the treatment success estimate.
“Twenty-six patients were excluded from exploratory analysis because they left treatment due to preexisting legal issues leading to incarceration [13] and medical conditions unrelated to their buprenorphine treatment (chronic pain [3], advanced stage AIDS [1]), or transferred to another OBOT program due to relocation or consolidating their care [9], leaving 382 patients.”
The paper relies on this without support.
Excluding patients transferred to methadone maintenance from the regression does not bias the predictor estimates.
“The patients who were transferred to methadone maintenance treatment were excluded from the analysis of treatment success as they could be arguably perceived as successful or not, leaving 358 patients.”
The paper relies on this without support.
The finding that self-maintaining with illicit buprenorphine predicts success has not been previously published.
“The finding that self-maintaining on illicit buprenorphine on admission predicted success has not been previously published.”
The paper relies on this without support.
The skills of the nurse care manager are not the primary driver of outcomes, or the model can be generalized despite dependence on such skills.
“Lastly an experienced, skilled nurse care manager played an essential role in caring for patients and the ability to generalize such a model may depend on skills of such key individuals.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Retention in buprenorphine/naloxone treatment is low, with only about 46-68% of patients retained at 24 weeks.
“Unfortunately, retention rates for patients in B/N treatment are only about 46–68% at 24-weeks. (Alford et al., 2011; Y.-I. Hser et al., 2014).”
From Feasibility and acceptability of mindful recovery opioid use care continuum (M-ROCC): A concurrent mixed methods study (2021) · cites this paper as Alford et al., 2011
The retention rate is notable considering lower retention rates found in standard of care OBOT interventions.
“which is notable considering the lower retention rates found in standard of care OBOT interventions (Alford et al., 2011; Y.-I. Hser et al., 2014).”
From Feasibility and acceptability of mindful recovery opioid use care continuum (M-ROCC): A concurrent mixed methods study (2021) · cites this paper as Alford et al., 2011
Cites
Drug Dependence, a Chronic Medical Illness
McLellan, A. T., Lewis, D. C., O'Brien, C. P., & Kleber, H. D. (2000) · JAMA · doi:10.1001/jama.284.13.1689 · Cited by 2,622 · cited 2× · see citing works
“The treatment model included 3 stages: (1) NCM and physician assessment (appropriateness for OBOT and intake evaluations), (2) NCM-supervised induction and stabilization (buprenorphine dose adjustments during days 1-7), and (3) maintenance (buprenorphine treatment with monitoring for illicit drug use and weekly counse…”
MethodMethadone maintenance therapy versus no opioid replacement therapy for opioid dependence
Mattick, R. P., Breen, C., Kimber, J., & Davoli, M. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002209.pub2 · Cited by 1,654 · see citing works
Effective Medical Treatment of Opiate Addiction
Addiction, N. C. D. P. O. E. M. T. O. O. (1998) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.280.22.1936 · Cited by 577 · see citing works
Office-Based Management of Opioid Dependence with Buprenorphine: Clinical Practices and Barriers
Walley, A. Y., Alperen, J. K., Cheng, D. M., Botticelli, M. P., Castro-Donlan, C., Samet, J. H., & Alford, D. P. (2008) · Journal of General Internal Medicine · doi:10.1007/s11606-008-0686-x · Cited by 220 · see citing works
Self-citationExposure to opioid maintenance treatment reduces long‐term mortality
Gibson, A., Degenhardt, L. J., Mattick, R. P., Ali, R. L., White, J. M., & O’Brien, S. (2008) · Addiction · doi:10.1111/j.1360-0443.2007.02090.x · Cited by 194 · see citing works
Science-Based Views of Drug Addiction and Its Treatment
Leshner, A. I. (1999) · JAMA · doi:10.1001/jama.282.14.1314 · Cited by 191 · see citing works
Factors affecting willingness to provide buprenorphine treatment
Netherland, J. C., Botsko, M., Egan, J. E., Saxon, A. J., Cunningham, C. O., Finkelstein, R., Gourevitch, M. N., Renner, J. A., Sohler, N., Sullivan, L. E., et al. (2008) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2008.06.006 · Cited by 182 · see citing works
Brief report: Buprenorphine retention in primary care
Stein, M. D., Cioe, P. A., & Friedmann, P. D. (2005) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2005.0228.x · Cited by 171 · see citing works
Hunt, J. S., Siemienczuk, J., Pape, G., Rozenfeld, Y., Mackay, J., LeBlanc, B., & Touchette, D. R. (2008) · Journal of General Internal Medicine · doi:10.1007/s11606-008-0791-x · Cited by 171 · see citing works
The Case for Chronic Disease Management for Addiction
Saitz, R., Larson, M. J., LaBelle, C. T., Richardson, J. M., & Samet, J. H. (2008) · Journal of Addiction Medicine · doi:10.1097/adm.0b013e318166af74 · Cited by 165 · see citing works
Self-citationLong‐Term Treatment with Buprenorphine/Naloxone in Primary Care: Results at 2–5 Years
Fiellin, D. A., Moore, B. A., Sullivan, L. E., Becker, W. C., Pantalon, M. V., Chawarski, M. C., Barry, D. T., O’Connor, P. G., & Schottenfeld, R. S. (2008) · American Journal on Addictions · doi:10.1080/10550490701860971 · Cited by 162 · see citing works
Office-Based Treatment of Opioid-Dependent Patients
Fiellin, D. A., & O'Connor, P. G. (2002) · New England Journal of Medicine · doi:10.1056/nejmcp013579 · Cited by 148 · see citing works
Buprenorphine maintenance treatment in a primary care setting: Outcomes at 1 year
Soeffing, J. M., Martin, L. D., Fingerhood, M., Jasinski, D. R., & Rastegar, D. A. (2009) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2009.05.003 · Cited by 144 · see citing works
Integrating Buprenorphine Treatment into Office-based Practice: a Qualitative Study
Barry, D. T., Irwin, K. S., Jones, E. S., Becker, W. C., Tetrault, J. M., Sullivan, L. E., Hansen, H., O’Connor, P. G., Schottenfeld, R. S., & Fiellin, D. A. (2008) · Journal of General Internal Medicine · doi:10.1007/s11606-008-0881-9 · Cited by 130 · see citing works
Long-term outcomes of office-based buprenorphine/naloxone maintenance therapy
Parran, T. V., Adelman, C., Merkin, B., Pagano, M. E., Defranco, R., Ionescu, R. A., & Mace, A. G. (2009) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2009.07.013 · Cited by 122 · see citing works
Treating Opioid Addiction With Buprenorphine-Naloxone in Community-Based Primary Care Settings
Mintzer, I. L., Eisenberg, M., Terra, M., MacVane, C., Himmelstein, D. U., & Woolhandler, S. (2007) · The Annals of Family Medicine · doi:10.1370/afm.665 · Cited by 117 · see citing works
Treating Homeless Opioid Dependent Patients with Buprenorphine in an Office-Based Setting
Alford, D. P., LaBelle, C. T., Richardson, J. M., O’Connell, J. J., Hohl, C., Cheng, D. M., & Samet, J. H. (2007) · Journal of General Internal Medicine · doi:10.1007/s11606-006-0023-1 · Cited by 104 · see citing works
Self-citationBuprenorphine treatment in an urban community health center: what to expect.
Cunningham, C. O., Giovanniello, A., Sacajiu, G. M., Whitley, S. D., Mund, P. A., Beil, R., & Sohler, N. (2008) · PubMed · Cited by 61 · see citing works
Home- versus office-based buprenorphine inductions for opioid-dependent patients
Sohler, N., Li, X., Kunins, H. V., Sacajiu, G. M., Giovanniello, A., Whitley, S. D., & Cunningham, C. O. (2009) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2009.08.001 · Cited by 56 · see citing works
Outcomes of Buprenorphine Maintenance in Office-Based Practice
Magura, S., Lee, S. J., Salsitz, E. A., Kolodny, A., Whitley, S. D., Taubes, T., Seewald, R., Joseph, H., Kayman, D. J., Fong, C., et al. (2007) · Journal of Addictive Diseases · doi:10.1300/j069v26n02_03 · Cited by 41 · see citing works
DiPiero, A., Dorr, D. A., Kelso, C., & Bowen, J. L. (2008) · Journal of General Internal Medicine · doi:10.1007/s11606-008-0751-5 · Cited by 26 · see citing works
Flagged first, then by citations
Research works printed but not linked: 3
- [9]Colameco S Armando J Trotz C Opiate dependence treatment with buprenorphine: One year’s experience in a family practice residency setting J Addict Dis 2005 24 2 25 32 15784521
- [23]Center for Substance Abuse Treatment TIP 40: Clinical guidelines for the use of buprenorphine in the treatment of opioid addiction Rockville, MD Substance Abuse and Mental Health Services Administration 2004 DHHS Publication No. (SMA) 07-3939 22514846
- [26]Blue Ribbon Panel of the Society of General Internal Medicine Redesigning the practice model for general internal medicine. A proposal for coordinated care: A policy monograph of the society of general internal medicine J Gen Intern Med 2007 22 3 400 409 17356976 PMC1824765
Cited by
Sorted by citations
Mental health collaborative care and its role in primary care settings
Goodrich, D. E., Kilbourne, A. M., Nord, K. M., & Bauer, M. S. (2013) · Current Psychiatry Reports · doi:10.1007/s11920-013-0383-2 · Cited by 216 · see citing works
The Role of Behavioral Interventions in Buprenorphine Maintenance Treatment: A Review
Carroll, K. M., & Weiss, R. D. (2017) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2016.16070792 · Cited by 211 · see citing works
Emerging adult age status predicts poor buprenorphine treatment retention
Schuman-Olivier, Z., Weiss, R. D., Hoeppner, B. B., Borodovsky, J., & Albanese, M. J. (2014) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2014.04.006 · Cited by 127 · see citing works
Gordon, M. S., Kinlock, T. W., Schwartz, R. P., Fitzgerald, T. T., O’Grady, K. E., & Vocci, F. J. (2014) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2014.05.011 · Cited by 112 · see citing works
Integration of behavioral health and primary care: current knowledge and future directions
Vogel, M. E., Kanzler, K. E., Aikens, J. E., & Goodie, J. L. (2017) · Journal of Behavioral Medicine · doi:10.1007/s10865-016-9798-7 · Cited by 96 · see citing works
Schackman, B. R., Leff, J. A., Polsky, D., Moore, B. A., & Fiellin, D. A. (2012) · Journal of General Internal Medicine · doi:10.1007/s11606-011-1962-8 · Cited by 100 · see citing works
Reif, S., Brolin, M. F., Stewart, M. T., Fuchs, T. J., Speaker, E., & Mazel, S. B. (2020) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2019.07.007 · Cited by 58 · see citing works
Group-based treatment of opioid use disorder with buprenorphine: A systematic review
Sokol, R., LaVertu, A. E., Morrill, D., Albanese, C., & Schuman-Olivier, Z. (2018) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2017.11.003 · Cited by 50 · see citing works
Schuman-Olivier, Z., Borodovsky, J. T., Steinkamp, J., Munir, Q., Butler, K., Greene, M. A., Goldblatt, J., Xie, H. Y., & Marsch, L. A. (2018) · Addiction Science & Clinical Practice · doi:10.1186/s13722-018-0122-4 · Cited by 44 · see citing works
Principles of Care for Young Adults With Co-Occurring Psychiatric and Substance Use Disorders
Spencer, A. E., Valentine, S. E., Sikov, J., Yule, A. M., Hsu, H., Hallett, E., Xuan, Z., Silverstein, M., & Fortuna, L. (2021) · Pediatrics · doi:10.1542/peds.2020-023523f · Cited by 34 · see citing works
Price, C. J., Merrill, J. O., McCarty, R. L., Pike, K. C., & Tsui, J. I. (2020) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2019.05.013 · Cited by 33 · see citing works
Dissemination of Contingency Management for the Treatment of Opioid Use Disorder
DeFulio, A. (2023) · Perspectives on Behavior Science · doi:10.1007/s40614-022-00328-z · Cited by 28 · see citing works
Osilla, K. C., Becker, K., Ecola, L., Hurley, B., Manuel, J. K., Ober, A., Paddock, S. M., & Watkins, K. E. (2020) · Addiction Science & Clinical Practice · doi:10.1186/s13722-020-00199-2 · Cited by 20 · see citing works
Weinstein, Z. M., Gryczynski, G., Cheng, D. M., Quinn, E., Hui, D., Kim, H. W., Labelle, C., & Samet, J. H. (2018) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2018.05.010 · Cited by 23 · see citing works
Self-citationBuprenorphine Treatment for Probationers and Parolees
Gordon, M. S., Kinlock, T. W., Schwartz, R. P., Couvillion, K. A., Sudec, L. J., O'Grady, K. E., Vocci, F. J., & Shabazz, H. (2015) · Substance Abuse · doi:10.1080/08897077.2014.902787 · Cited by 21 · see citing works
Fatkin, T., Moore, S. K., Okst, K., Creedon, T. B., Samawi, F., Fredericksen, A. K., Roll, D., Oxnard, A., Lê Cook, B., & Schuman-Olivier, Z. (2021) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2021.108415 · Cited by 14 · see citing works
- Authors
- Alford, D. P., LaBelle, C. T., Kretsch, N., Bergeron, A., Winter, M., Botticelli, M., & Samet, J. H.
- Affiliations
- Boston Medical Center (US)
- Boston University (US)
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2011-03-14
- Volume
- 171
- Issue
- 5
- Pages
- 425-31
- ISSN
- 0003-9926 (ISSN-L)
- PMC
- PMC3059544
- OpenAlex
- W2030329606
- Semantic Scholar
- 98d22d8453672d915f5de07ff18cee6f90c5b191
- Cited by
- 267
- References
- 21
- Citations by year
- 2026: 10 · 2025: 17 · 2024: 19 · 2023: 20 · 2022: 15 · 2021: 39 · 2020: 24 · 2019: 29 · 2018: 17 · 2017: 17 · 2016: 11 · 2015: 14 · 2014: 13 · 2013: 13 · 2012: 8
- FWCI
- 11.01
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- other-oa
- Locations
- Archives of Internal Medicine (publishedVersion, other-oa)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (K24AA015674)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- opioid use disorder, buprenorphine, buprenorphine/naloxone, collaborative care, nurse care managers, primary care, treatment retention, predictors of treatment success, racial disparities, illicit opioid use, cocaine use, physician participation
- MeSH terms
- Adult, Black or African American, Buprenorphine, Female, Hispanic or Latino, Humans, Male, Middle Aged, Naloxone, Narcotic Antagonists, Opioid-Related Disorders, Primary Health Care, Prospective Studies, Retrospective Studies, Cohort Studies, Behavior, Addictive, Treatment Outcome, White People, Drug Users
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
