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The authors wish to thank the following individuals for their dedication to the patients in CODC and the clinic • Barbara Grover, RN • Kristin Harrison, RN • Charlene Angus, LPN • Harriet Hill, RN • Cassandra Duran, RN • Rebecca Gutierrez • Leslie Johns • Pedro Lugo • Martin Schimmel, MD Many thanks to Laura Martin, MD for her assistance with this presentation.
References 1. Institute of Medicine(IOM), Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research. The National Academies Press 2011 Washington DC. 2. Clark JD. Chronic pain prevalence and analgesic prescribing in a general medical population. J Pain Symptom Manage 2002;23:131-7. 3. IMS’s Source Prescription Audit (SPA) & Vector One®: National (VONA) 4. Chabal, C., M. K. Erjavec, et al. (1997). "Prescription opiate abuse in chronic pain patients: clinical criteria, incidence, and predictors." Clin J Pain 13(2): 150-155. 5. Caudill-Slosberg MA, Schwartz LM, Woloshin S. Office visits and analgesic prescriptions for musculoskeletal pain in US: 1980 vs. 2000. Pain 2004;109:514-9. 6. The SUD-QUERI Executive Committee, "Improving Access to Opioid Agonist Therapy,", QUERI Update, VA Office of Research and Development and HSR&D Quality Enhancement Research Initiative, June 2012. 7. Bohnert M, Valenstein M, Bair M, Ganoczy D, McCarthy J, Ilgen M, Blow F. Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA 2011;305(13):1315-1321. 8. Web-based Injury Statistics Query and Reporting System: leading causes of death reports. Centers for Disease Control and Prevention. http://www.cdc.gov/injury/wisqars/index.html. 9. Fudala PJ, Bridge TP, Herbert S, et al. Office-based treatment of opiate addiction with a sublingual-tablet formulation of buprenorphine and naloxone. N Engl J Med 2003;349:949-58. 10. O'Connor PG, Oliveto AH, Shi JM, et al. A randomized trial of buprenorphine maintenance for heroin dependence in primary care clinic for substance users versus a methadone clinic. Am J Med 1998;105:100-5. 11. Johnson RE, Fudala PJ, Payne R. Buprenorphine: considerations for pain management. J Pain Symptom Manage 2005;29:297-326.
Page 1 and 2: Patricia Pade, MD University of Col
Page 3 and 4: Objectives • To provide a brief o
Page 5 and 6: Chronic Pain • 116 million people
Page 7 and 8: Opioid Use • Use of opioids has i
Page 9 and 10: Fatal Drug Poisoning • Between 19
Page 11 and 12: Opioid Pharmacology: How do these M
Page 13 and 14: • Tolerance: Repeated Dosing: Opi
Page 15 and 16: Brief pharmacology overview: full o
Page 17 and 18: Brief pharmacology overview: opioid
Page 19 and 20: The Use of Buprenorphine/Naloxone t
Page 21 and 22: The Problem for Veterans
Page 23 and 24: Improvement Change: Creation of Co-
Page 25 and 26: Patient population • Referrals fr
Page 27 and 28: Initial Evaluation A. PAIN Detailed
Page 29 and 30: Buprenorphine induction process •
Page 31 and 32: Study participants Participant Data
Page 33 and 34: Months Average duration of opioid u
Page 35 and 36: Number Number Number 60 40 Co-morbi
Page 37 and 38: Adjuvant Medications Na and Interve
Page 39 and 40: Ongoing monitoring for compliance
Page 41 and 42: 93/143 patients remained in treatme
Page 43 and 44: Conclusions 11. Patients with co-oc
Page 45: Office Based Opioid Treatment: Bupr

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