title: The prescription of addiction medications after implementation of chronic care management for substance dependence in primary care.
abstract: People with addictive disorders commonly do not receive efficacious medications. Chronic care management (CCM) is designed to facilitate delivery of effective therapies. Using data from the CCM group in a trial testing its effectiveness for addiction (N=282), we examined factors associated with the prescription of addiction medications. Among participants with alcohol dependence, 17% (95% CI 12.0-22.1%) were prescribed alcohol dependence medications. Among those with drug dependence, 9% (95% CI 5.5-12.6%) were prescribed drug dependence medications. Among those with opioids as a substance of choice, 15% (95% CI 9.3-20.9%) were prescribed opioid agonist therapy. In contrast, psychiatric medications were prescribed to 64% (95% CI 58.2-69.4%). Absence of co-morbid drug dependence was associated with prescription of alcohol dependence medications. Lower alcohol addiction severity and recent opioid use were associated with prescription of drug dependence medications. Better understanding of infrequent prescription of addiction medications, despite a supportive clinical setting, might inform optimal approaches to delivering addiction medications.
authors.affiliation: VA Boston Healthcare System, Boston, MA 02114, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA 02118, USA; Department of Psychiatry, Boston Medical Center, Boston, MA 02118, USA. Electronic address: tpark1@lifespan.org.
authors.forename: Tae Woo
authors.initials: TW
authors.lastname: Park
authors.affiliation: Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA 02118, USA; Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
authors.affiliation: Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA 02118, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA; Data Coordinating Center, Boston University School of Public Health, Boston, MA 02118, USA.
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.affiliation: Data Coordinating Center, Boston University School of Public Health, Boston, MA 02118, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Winter
authors.affiliation: Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA 02118, USA.
authors.forename: Theresa W
authors.initials: TW
authors.lastname: Kim
authors.affiliation: Department of Psychiatry, Boston Medical Center, Boston, MA 02118, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Fitzgerald
authors.affiliation: Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA 02118, USA; Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
mesh_terms: D000328:Adult; D000427:Alcohol Deterrents / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D019966:Substance-Related Disorders / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000427:Alcohol Deterrents; D000701:Analgesics, Opioid
keywords: Acamprosate; Buprenorphine; Chronic care management; Medications; Naltrexone; Substance abuse treatment