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The NIDA CCTN convened stakeholders, experts, and federal staff to discuss and identify research and other efforts needed to continue to improve care for people with opioid use disorder and other substance use disorders in emergency settings. An aspirational goal is for ED-initiated buprenorphine to be the standard of care in every emergency department across the United States.
Download complete agenda.
Slides available for:
Day One:
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- Welcome/Meeting Goals – Betty Tai, PhD and Kristen Huntley, PhD, CCTN
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- Current Status of ED Initiation of Buprenorphine for OUD in EDs – Edouard Coupet Jr., MD, MS, Yale School of Medicine
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- SAMHSA Efforts to Enhance ED Care for OUD – Robert Baillieu, MD, MPH, SAMHSA
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- American College of Emergency Physicians (ACEP) Activities to Address the Overdose Epidemic – Sandy Schneider, MD, FACEP, ACEP
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- Research in the Field: Paramedic-Administered Buprenorphine – Martha Waller, PhD, MA, Pacific Inst. for Research and Evaluation
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- Health Coach, Peer, & Navigator Interventions in EDs – Kelly Barth, DO, Medical University of South Carolina
- CReDO: Community Response to Drug Overdoses – Roneet Lev, MD, FACEP, Scripps Mercy Hospital
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- Stakeholder Voices – Perspectives of Clinicians & Health Systems – Arjun Venkatesh, MD, MBA, MHS (Yale School of Medicine), Tania Strout, PhD, RN, MS (Tufts University School of Medicine), Jason Wilson, MD, MA, CPHQ, FACEP (University of South Florida), Adam L. Sharp, MD, MSc (Kaiser Permanente)
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- EMBED Trial: Clinical Decision Support for OUD in the ED (Part 1) – Ted Melnick, MD, MHS, Yale School of Medicine
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- EMBED Trial: Clinical Decision Support for OUD in the ED (Part 2) – Jason Hoppe, DO, FACEP, University of Colorado School of Medicine)
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- MATTERS Network: Medication for Addiction Treatment and Electronic Referrals – Joshua Lynch, DO, EMT-P, FAAEM, FACEP, University at Buffalo
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- U.S. Acute Care Settings – Arianna Campbell, PA-C (California Bridge) and Jesse Pines, MD (US Acute Care Solutions)
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- American College of Emergency Physicians Clinical Emergency Data Registry – Pawan Goyal, MD, MHA, ACEP
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- Quality Improvement for Care of OUD in Community EDs: The Vituity Experience – Bradford Tinloy, MD, FACEP, FAAEM, Vituity
- ED-Initiated Buprenorphine: Economic Considerations – Sean Murphy, PhD (CHERISH, Weill Cornell Medicine)
The Patient-Centered Outcomes Research Institute (PCORI) is an independent, nonprofit organization created by the Affordable Care Act in March 2010 that funds comparative effective research to answer important real life questions. In 2014, the PCORI Advisory Panel on Assessment of Prevention, Diagnosis, and Treatment Options prioritized 14 new research topics, including Treatment Options for Substance Abuse.
The National Drug Abuse Treatment Clinical Trials Network (CTN) sponsored this workshop for all NIDA investigators interested in learning how to apply for PCORI funding. It was also broadcast via webinar to remote participants. The workshop was co-chaired by Betty Tai, Director, CCTN and Redonna Chandler, Acting Director, DESPR. The goal of the workshop was to provide technical assistance to NIDA grantees regarding PCORI funding opportunities, given that PCORI identified treatment options for opioid substance abuse as a high-priority research topic, and that their funding process is different from the NIH process. The agenda included a presentation from PCORI staff summarizing PCORI’s objectives, priorities, available funding, and application process. NIDA researchers discussed the state of the science regarding opioid substance abuse and presented experiences with the PCORI funding/review process. Presenters included: Dr. Joe Selby and Dr. David Hickam, PCORI, Dr. Walter Ling, UCLA, Dr. Adam Brooks, TRI, Dr. Cynthia Campbell, Kaiser Permanente, and Dr. Jay Ford, Univ. of Wisconsin.
View the workshop agenda and speaker bios. Slides from the presentations are available below. (Additional PCORI-related resources are available in the sidebar to the right.)
Overview of PCORI — David Hickam, MD, MPH; Bryan Luce, PhD, MS, MBA; Joe V. Selby, MD, MPH.
Opportunities to Test Effective Opiate Treatments — Walter Ling, MD
Engaging Patients and Clinicians to Improve Patient-Centered Treatment Outcome: Stakeholders’ Substance Use Research and Treatment Information Exchange — Walter Ling, MD
Prescription Opioid Management in Chronic Pain Patients: A Patient-Centered Activation Intervention — Cynthia Campbell, PhD, MPH
Review Experience — Jay Ford, PhD
This session presented information about the CTN Public Data Share website (now called the NIDA Data Share website), an electronic environment that allows data from completed clinical trials to be distributed to investigators and the public in order to promote new research, encourage further analyses, and disseminate information to the community. Secondary analyses produced from data sharing multiply the scientific contribution of the original research, optimizing the use of resources invested in the trials, as well as increasing scientific productivity.
Presentations in the session described the methods and results of secondary analyses conducted using the datasets, as well as the value of conducting secondary analyses to advance knowledge of evidence-based treatments.
Speakers included:
Overview of CTN Datashare – Carmen Rosa, MS, CCTN, NIDA
Practical Approaches for Using the CTN Datashare: Proposing Parameters, Creating Data Tables, and Analyzing Results – Abigail G. Matthews, PhD, the EMMES Corporation
Using the CTN Datashare: An Example Utilizing Data from Multiple Protocols – Audrey J. Brooks, PhD, University of Arizona
Secondary Analyses: Value and Limitations – Daniel J. Feaster, PhD, University of Miami Miller School of Medicine
This session presented information about the CTN Public Data Share website (now called the NIDA Data Share website), an electronic environment that allows data from completed clinical trials to be distributed to investigators and the public in order to promote new research, encourage further analyses, and disseminate information to the community. Secondary analyses produced from data sharing multiply the scientific contribution of the original research, optimizing the use of resources invested in the trials, as well as increasing scientific productivity.
Presentations in the session described the methods and results of secondary analyses conducted using the datasets, as well as the value of conducting secondary analyses to advance knowledge of evidence-based treatments.
Speakers included:
Overview of CTN Datashare – Carmen Rosa, MS, CCTN, NIDA
Practical Approaches for Using the CTN Datashare: Proposing Parameters, Creating Data Tables, and Analyzing Results – Abigail G. Matthews, PhD, the EMMES Corporation
Using the CTN Datashare: An Example Utilizing Data from Multiple Protocols – Audrey J. Brooks, PhD, University of Arizona
Secondary Analyses: Value and Limitations – Daniel J. Feaster, PhD, University of Miami Miller School of Medicine
This Blending Initiative Workshop focused on clinical management of prescription opioid use disorders and screening and brief intervention for substance use disorders in the emergency department. [view flyer | view agenda]
View videos in order by clicking on player window (to advance to the next video in the playlist, hover over the screen and click the >>| button at the bottom), or individually using the links below.
Session 1: Clinical Management of Prescription Opioid Use Disorders (moderator: Andrew J. Saxon, MD)
- Introduction to the Workshop — Andrew J. Saxon, MD and Megan L. Ranney, MD, MPH
- ACEP Clinical Policy: Review and Implementation of the Clinical Guideines — Knox H. Todd, MD, MPH, FACEP
- Hard Conversations: Addressing Patients with Chronic Pain — Kavita M. Babu, MD, FACEP, FACMT
- Facilitation Through Technology: Prescription Drug Monitoring Programs — Edward W. Boyer, MD, PhD
Session 2: Panel Discussion of Working and Successful Models
- North Carolina Emergency Department Care Coordination Trial — Chris L. Ringwalt, DrPH
- A Randomized Controlled Trial of Citywide Emergency Department Care Coordination — Darin E. Nevin, MD, MS
- Guidance for Opioid Prescribing: Lessons Learned from the NYC Experience — Lewis S. Nelson, MD, FACEP
- Rural Strategy to Reduce Drug Diversion — John J. Graykowski, MPAS, PA-C
- Morning Panel Discussion
Luncheon Roundtable Discussion: Implementation and Application of ACEP Clinical Policy Critical Issues in the Prescribing of Opioids for Adult Patients in the Emergency Department. Moderated by Lewis S. Nelson, MD, FACEP and Knox H. Todd, MD, MPH, FACEP
Session 4: Screening and Brief Intervention for Substance Use Disorders (moderator: Megan L. Ranney, MD, MPH)
- Overview of Screening and Brief Intervention in the Emergency Department — Gail D’Onofrio, MD, MS, FACEP
- Addressing Patients with Comorbid Conditions — Douglas F. Zatzick, MD
- Using Technology to Facilitate SBIRT: Web and Computer-Based Screening and Brief Intervention — Rebecca M. Cunningham, MD
Session 5: Panel Discussion of Working and Successful Models
- Training Trauma Center Clinicians to Perform Screening and Brief Intervention: Results from a National Training Effort — Christopher W. Dunn, PhD
- Statewide Dissemination of Emergency Room Screening and Brief Intervention: Lessons Learned Blending Research and Practice — Edward Bernstein, MD, FACEP
- Implementation of a Screening and Brief Intervention Program in a Large Safety-Net Trauma Center — Kerryann B. Broderick, MD, BSN, FACEP
- Screening and Brief Intervention Strategies for Emergency Nurses — Patricia K. Howard, PhD, RN, CEN, CPEN, NC-BC, FAEN
- Afternoon Panel Discussion
To date, the National Drug Abuse Clinical Trials Network Starting Treatment with Agonist Replacement Treatment Study (START) includes the largest database of patients (n=1269) entering opioid agonist treatment programs at community methadone centers around the United States (U.S.). Participants in the study were randomized to either Methadone (MET) treatment or Buprenorphine/Naloxone (BUP/Nx) treatment, and closely monitored during induction as well as throughout active treatment and follow-up. Pharmacotherapy was provided for 24 weeks with taper or continuation possible through week 32. Primary outcomes showed low rates of liver injury and no differences in liver functions between MET and BUP/Nx groups. Secondary findings present a multitude of interesting and clinically relevant outcomes. This Blending Initiative workshop presented several of those secondary outcomes from both a U.S. and international perspective.
Session One: United States Perspective
This segment of the session presented several important secondary outcomes from the START study including: From a comparison of the impact of MET vs. BUP/Nx treatment on HIV risk behaviors; a description of six different BUP/Nx and three different MET induction trajectories and their outcomes; and an association between genotype and treatment outcome in African-American participants receiving BUP/Nx or MET.
Session Two: International Perspective
To complement the findings and dissemination strategies from the U.S. perspective, a panel of international collaborators presented findings from studies conducted abroad and implementation strategies that have been successful. Presentations included outcomes from a collaborative project between NIDA and treatment providers in Indonesia, data from epidemiological studies showing the association between the length of MET treatment and mortality rates and dissemination and implementation strategies, and the use of incentive-based interventions in reducing drug use and associated consequences. The session also described the N-ALIVE (NALoxone InVEstigation) study–a large, prison-based, trial that assesses the number of lives that could be saved by providing Naloxone-on-release to adult prisoners with a history of heroin injection. The discussion after session two focused on on how the knowledge gained from these analyses and findings can be translated for the implementation of relevant MET or BUP/Nx treatment in clinical settings treating opioid dependent patients in the U.S. as well as internationally
Related protocols: CTN-0027
This workshop, led by Carmen Rosa of NIDA’s Center for the Clinical Trials Network, featured three presentations focused on the use of various types of new media in the design and conduct of clinical trials. Over 82% of adults now use internet or email, including 53% of those age 65 and older. Additionally, 67% of online adults use social networking sites. Mobile devices such as smartphones, tablets, netbooks, and laptops are now a primary source of Internet connectivity, and 79% of cell phone owners say they use text messaging. As use of these tools continues to grow, exploring ways to put them to use in clinical trials seems increasingly relevant.
The first presentation, by Erin Winstanley, “Using New Media Tools in the Design and Conduct of Clinical Trials,” provided an overview of the concept of “new media” and ways it can be applied to research, including advertising of studies, recruiting/tracking participants, communicating with participants, and disseminating research findings. An introduction to Facebook and Twitter is provided, as well as a look at the use of blogs, Pinterest, and LinkedIn.
Gloria Miele presented on “Social Media Communication Strategy,” giving participants a look at ways to think about and draft policies regarding the use of social media in your study or workplace. A variety of legal considerations, as well as examples of using social media to recruit study participants is also provided. Sample IRB guidance is included, along with IRB Best Practices for using new media. The presentation ends with a case study based on CTN-0044 (“Web Delivery of Evidence-Based, Psychosocial Treatment for Substance Use Disorders”), which used social media platforms like Facebook, as well as email and texting, to contact and follow-up with participants.
The third presentation, by Lynn Simpson, was a demonstration of the variety of uses for “REDCap, Research Electronic Data Capture, A Data Management and Survey Tool.” REDCap is a web-based application designed to give researchers and clinicians the capacity to create and manage databases and surveys in order to support data capture for research.
Related protocols: CTN-0044
This one-day conference was designed to benefit front-line clinical staff delivering addiction treatments in Texas. Speakers presented sessions in the morning on Motivational Interviewing (MI) with a focus on shifting talk to action, an introduction to Acceptance and Commitment Therapy (ACT) and review of its effectiveness, and a review of pharmacological treatments for addictive disorders. Afternoon breakout sessions for MI and ACT expanded upon information discussed in the morning sessions and attendees engaged in experiential learning and practice.
Presentations:
Advanced Motivational Interviewing: Shifting from Talk to Action, Scott Walters, PhD
An Introduction to Acceptance and Commitment Therapy (ACT) with a Focus on Opioid Dependent Patients (morning session | afternoon session), Angela Stotts, PhD.
Pharmacotherapy for Addictive Disorders, Sidarth Wakhlu, MD
This day-long conference, co-sponsored by the Western States Node, featured presentations focused on the theme of innovations in treatment.
Presentations included:
Health Information Technology’s Role in the Integration of Delivery Systems for Primary Care and Substance Abuse (Keynote Address) — Wilson Washington, Jr, MS, Center for Substance Abuse Treatment (CSAT/SAMHSA)
Integrating Alcohol and Drug Treatment with Primary Care: A Medical Home Model — Connie Weisner, DrPH, MSW, UCSF
What Can Human Brain Imaging Tell Us About Addiction and Recovery from Substance Use? — Dieter Meyerhoff, Dr.rer.nat
HIV Rapid Testing and Counseling in Drug Abuse Treatment Programs in the U.S. — Lisa R. Metsch, PhD, UCSF (protocol CTN-0032)
Substance Use Disorder/Post Traumatic Stress Disorder — Moving from Dichotomous to Dialectic — John Straznickas, MD, UCSF
Promoting Awareness of Motivational Incentives (PAMI) — Michael Shopshire, PhD, UCSF.
Related protocols: CTN-0032
This conference took place on July 13, 2012 in the Baltimore-Washington Metro area. It was sponsored by the Central East Addiction Technology Transfer Center (a program of the Danya Institute), and the Mid-Atlantic Node of the National Drug Abuse Treatment Clinical Trials Network (CTN). It featured presentations about the NIDA/SAMHSA Blending Products, a suite of training tools developed by the NIDA/SAMHSA Blending Initiative and aimed at helping reduce the gap that exists between the publication of research results and the impact on treatment delivery. The initiative incorporates collaboration between clinicians, scientists, and experienced trainers to catalyze the creation of user-friendly treatment tools and products and facilitate the adoption of research-based interventions into front-line clinical settings. Through this initiative, NIDA and SAMHSA’s Addiction Technology Transfer Centers (ATTCs) disseminate treatment and training products based on results from studies conducted by the National Drug Abuse Clinical Trials Network (CTN) as well as other NIDA-supported research. The audience for this conference was made up of practitioners in the substance abuse treatment workforce and was intended to introduce the variety of tools available in the Blending Products suite to clinicians, giving them an opportunity to learn how to implement the various evidence-based practices that have emerged from the CTN.
Presentations are available for viewing on YouTube:
Overview of the Clinical Trials Process, Maxine Stitzer, PhD
Taking a Look at the NIDA Blending Products, Christine Higgins, MA
MIA-Step, Christine Higgins, MA
Promoting Awareness of Motivational Incentives (PAMI), Melissa Wesner, LCPC
MI-Presto, Lori Peterson
Looking at the NIDA Treatment Protocols from a Program Director’s Perspective, Patricia Stabile, LCSW-C
The Perspective from the Clinical Side, Amy Pearce
This one-day conference was designed to benefit front-line clinical staff delivering addiction treatments in Texas. Speakers presented on a wide variety of topics, focusing primarily on the scientific basis for selected pharmacological and behavioral evidence-based practices, providing concrete examples, experiential learning experiences, and practical implementation guidance.
Presentations:
Exercise for the Treatment of Addiction, Madhukar H. Trivedi, M.D.
Motivational Interviewing: Implementing an Evidence-Based Practice, Mary M. Velasquez, PhD.
Conducting Research in a Community-Based Setting: Challenges and Rewards, A. Rebecca Crowell, MEd, LPC, LCDC; Douglas Denton, MA, LCDC, LCCA
Addictions Pharmacotherapy, Thomas Kosten, MD
CTN-0030 POATS Blending Review, Jennifer Sharpe Potter, PhD, MPH
Evidence-Based Treatments for Traumatic Stress and Addictions, Denise Hien, PhD
HIV Blending Product, Richard Spence, PhD
Research into Practice – Motivational Incentives, Michael Levy, PhD
Brief Strategic Family Therapy, Joan Muir, PhD
This 2.5 hour workshop, developed by the Research Utilization Committee (RUC), focuses on the outcomes and clinical utility of National Drug Abuse Treatment Clinical Trials Network protocols CTN-0018 and CTN-0019, which were designed to test gender-specific interventions to reduce HIV sexual risk behavior among clients in drug treatment programs.
Four Workshop Components:
Louise Haynes, MSW
Watch: Introduction to the Article (3 min.)
Read: Addressing Sexual Issues in Addictions Treatment (Counselor article)
Don Calsyn, PhD
Watch: The Real Men Are Safe (REMAS) Clinical Trial (40 min.)
Susan Tross, PhD
Watch: HIV/STD Safer Sex Skills Building (SSB) Groups for Women in Methadone Maintenance or Drug-Free Outpatient Treatment (50 min.)
Related protocols: CTN-0018, CTN-0019
This collection of presentations from the 8th International Network on Brief Interventions for Alcohol Problems (INEBRIA) conference begins with an introduction by Harold Perl of the Center for the Clinical Trials Network at NIDA, providing an overview of the mission of the CTN and information on how to access the CTN Dissemination Library.
Dan Fischer’s presentation follows, with a review of the research on Screening, Brief Intervention, Referral to Treatment (SBIRT) intervention design, outcomes, implementation, and cost benefits.
Next, Dennis Donovan’s slides describe the study design for SMART-ED (Screening, Motivational Assessment and Referral to Treatment in Emergency Departments), the CTN’s protocol evaluating the use of SBIRT for drug use patients presenting for treatment in the emergency department.
Alyssa Forcehimes’s presentation looks at factors associated with effective implementation of SBIRT delivered in an emergency room setting.
And closing out the symposium is Michael Bogenschutz, reviewing the screening tools and procedures used in SMART-ED to identify problematic substance users in medical emergency departments.
Related protocols: CTN-0047
This workshop, the third dissemination workshop organized by the CTN Research Utilization Committee (RUC), highlighted different methods CTPs have used to disseminate evidence-based treatment into their practice settings. Speakers from a number of community treatment providers presented at the workshop, which focused primarily on smoking cessation and implementation of the Matrix Model.
Presentations included:
Nicotine Replacement Prescribing Trends in a Large Psychiatric Hospital, Before and After Implementation of a Hospital-Wide Smoking Ban by Antoine Douaihy, MD, University of Pittsburgh School of Medicine, Pennsylvania, ATS Node
Recovery Network of Programs, Inc. (RNP) Tobacco Dependence Treatment Pilot by John Hamilton, LMFT, LADC, Regional Network of Programs, Inc., Connecticut, NEC Node
We Still Haven’t Come a Long Way, Baby! Smoking Cessation Efforts in an Oregon CTP by Lucy Zammarelli, MA, Willamette Family, Inc., WS Node; and Barbara Tajima, Institute for Health Policy Studies, UCSF, WS Node
Matrix Intensive Outpatient Treatment with Adolescents by Martin Moskowitz, LCSW and Seamus McEntee, LMSW, Mineola Community Treatment Center, NSLIJ, New York
The Matrix Model of Intensive Outpatient Treatment by Jeanne Obert, MFT, MSM, Matrix Institute on Addictions, California
This workshop, held in Bethesda, MD, on September 24, 2010, addressed a number of issues related to the present status and future prospects for adoption of e-technology innovations in substance use treatment. The major topics included: 1) current use of e-technology in community-based substance use treatment programs, 2) implementing an electronic information system to enhance practice at an opioid treatment program, 3) a panel discussion on institutional or agency challenges, barriers, and benefits to implementing EMR, and 4) the Office of National Drug Control Policy’s recommendations for use of EMR in the field.
Specific presentations were:
U.S. National Drug Control Strategy: Health Care Reform and Electronic Health Records – June S. Sivilli, Sr. Advisor, Office of Demand Reduction, Office of National Drug Control Policy (ONDCP).
Development of an Electronic Medical Record (EMR) in Substance Use Disorders – Betty Tai, PhD, Director, Center for the Clinical Trials Network, NIDA
Common Data Elements (CDEs): A Perspective from the National Cancer Institute and the caBIG Program – Dianne M. Reeves, RN, MSN, National Cancer Institute Center for Biomedical Informatics and Information Technology
Process of EMR/CDE Initiative: A Panel – EMMES staff
An Electronic Information System to Enhance Practice at an Opioid Treatment Program – Lawrence S. Brown, Jr., MD, MPH, FASAM, Addiction Research & Treatment Corporation, NY
Medical Records in Drug and Alcohol Abuse Treatment Centers: Data Standards Needed to Get You There – Clement J. McDonald, MD, Director, Lister Hill Center for Biomedical Communications, US National Library of Medicine
Review of EMR Questions – EMMES Staff
Synthesis of Questions for the Four Main Substance Abuse Domains Based on CTP and HCP Intake Forms (a PDF chart)