In examining how the CTN functions and assessing its effects on the treatment community, a primary question regarding CTN efficacy was its own sustainability as well as the topic of whether the research conducted in CTPs actually drove any changes in practice. Reviews of CTN research confirmed that the CTN approach using a coordinated network of mutually contributing entities proved viable and productive, as reviewed in the assessment of the buprenorphine research conducted in the early years of the CTN. Again, buprenorphine's success in being proven and translated into real-world practice via the CTN is a marker for the efficacy of the CTN itself.
Knudsen, Abraham, Johnson, and Roman (2009)
, for example, examined the uptake of buprenorphine in mainstream practice as a result of the CTN research. They conducted interviews with administrators of 206 CTPs, finding that buprenorphine implementation doubled in the two-year period before the interviews. While CTPs with inpatient capability more readily used buprenorphine, as did for-profit CTPs, the most significant factor in promoting use of buprenorphine was prior involvement in a CTN buprenorphine study. In similar work, Ducharme and Roman (2009)
explored the characteristics of opioid treatment programs within the CTN to determine factors that affected the adoption of buprenorphine and influenced its implementation.
McCarty and colleagues provided further evidence of the interactivity of CTN research and CTP practices (McCarty et al., 2007
). Workforce surveys included 106 of 112 eligible CTN CTPs in order to document characteristics of the counselors, manager-supervisors, medical staff, and support staff as they might influence treatment-related behaviors. The survey found disparate attitudes among the groups, and noted “only modest levels of support” for the use of addiction medications, with less support for buprenorphine than for methadone (28% vs. 35%). The authors noted the need for greater training and promotion of evidence-based treatment practices to overcome resistance toward them found largely among non-degreed staff, which is consistent with previous work on technology transfer (Rogers, 2003
) that has shown the influence of higher levels of education, which predict greater receptivity to new practices. Among strong determinants of attitude and behaviors, the study found that staff who had been involved in buprenorphine protocols was more positive about the future and ongoing use of the medication for their patients.
Fitzgerald and McCarty (2009)
provided additional documentation of the effects of CTN activities on community-based treatment practice. A secondary analysis of data from the CTN treatment unit and workforce surveys examined organizational and practitioner variables that affected utilization of medications. Staff attitudes varied greatly across the 247 clinical settings included in the survey. The variation correlated with clinical practice behaviors regarding use of medications (methadone, buprenorphine, and naltrexone). Several elements of the article's recommended steps to increase implementation of addiction medications are incorporated in ongoing CTN-based dissemination efforts, among them being creation of referral networks for prescribers; educating staff and clients about addiction medications, and enhanced training for all staff about addiction medications.
Echoing what others have noted, we wrote several years ago that “good science alone is no guarantee for successful adoption of a new treatment in the [addiction] field” (Ling, Cunningham, & Rawson, 2004; p 117
). We believe this remains true in the case of buprenorphine. While much effort in medication development has been directed toward changing patients' attitudes and behaviors, the successful implementation of buprenorphine required (and still requires) that efforts be directed to help clinicians change their philosophies and practices (Ling & Compton, 2005
). By bringing together research and practice and reducing the prevailing dichotomy, CTN work has been instrumental in opening minds and improving the treatment of opioid addiction.