Kevin S. Irwin
Yale University
Network
Latest external collaboration on country level. Dive into details by clicking on the dots.
Publication
Featured researches published by Kevin S. Irwin.
Journal of General Internal Medicine | 2009
Declan T. Barry; Kevin S. Irwin; Emlyn S. Jones; William C. Becker; Jeanette M. Tetrault; Lynn E. Sullivan; Helena Hansen; Patrick G. O’Connor; Richard S. Schottenfeld; David A. Fiellin
BACKGROUNDDespite the availability and demonstrated effectiveness of office-based buprenorphine maintenance treatment (BMT), the systematic examination of physicians’ attitudes towards this new medical practice has been largely neglected.OBJECTIVETo identify facilitators and barriers to the potential or actual implementation of BMT by office-based medical providers.DESIGNQualitative study using individual and group semi-structured interviews.PARTICIPANTSTwenty-three practicing office-based physicians in New England.APPROACHInterviews were audiotaped, transcribed, and entered into a qualitative software program. The transcripts were thematically coded using the constant comparative method by a multidisciplinary team.RESULTSEighty percent of the physicians were white; 55% were women. The mean number of years since graduating medical school was 14 (SD = 10). The primary areas of clinical specialization were internal medicine (50%), infectious disease (20%), and addiction medicine (15%). Physicians identified physician, patient, and logistical factors that would either facilitate or serve as a barrier to their integration of BMT into clinical practice. Physician facilitators included promoting continuity of patient care, positive perceptions of BMT, and viewing BMT as a positive alternative to methadone maintenance. Physician barriers included competing activities, lack of interest, and lack of expertise in addiction treatment. Physicians’ perceptions of patient-related barriers included concerns about confidentiality and cost, and low motivation for treatment. Perceived logistical barriers included lack of remuneration for BMT, limited ancillary support for physicians, not enough time, and a perceived low prevalence of opioid dependence in physicians’ practices.CONCLUSIONSAddressing physicians’ perceptions of facilitators and barriers to BMT is crucial to supporting the further expansion of BMT into primary care and office-based practices.
Journal of General Internal Medicine | 2006
Margaret A. Drickamer; Becca R. Levy; Kevin S. Irwin; Robert M. Rohrbaugh
CONTEXT: Traditional methods of setting curricular guidelines using experts or consensus panels may miss important areas of knowledge, skills, and attitudes that need to be addressed in the training of medical students and residents.OBJECTIVE: To seek input from medical students and internal medicine residents (“trainees”) on their perception of their needs for training in Geriatrics.DESIGN: Two assessment methods were used (1) focus groups with students and residents were conducted by professional facilitators and the transcripts analyzed for areas of agreement and divergence and (2) geriatric medicine experts and ward attendings were surveyed to examine training gaps raised by trainees during Geriatric Guest Attending Rounds.RESULTS: Trainees perceived training gaps in caring for elderly patients in the areas of (1) recognizing and addressing the complex, multifactorial nature of illness; (2) setting priorities and goals for workup and intervention; (3) communication with families and with patients with cognitive disorders; (4) assessment of a patient for discharge from the hospital and the services at different sites in which patients may receive care. They recounted feeling overwhelmed by complex patients and social situations while acknowledging the special aspects of connecting with older patients. The gaps identified by trainees differ from and complement the curriculum guidelines set by expert recommendations.CONCLUSION: Trainees identified gaps in skills and knowledge leading to trainee frustration and potentially adverse outcomes in caring for elderly patients. Development of curriculum guidelines should include assessment of trainees’ perceived learning needs.
Substance Use & Misuse | 2006
Kevin S. Irwin; Evgeni Karchevsky; Robert Heimer; Larissa Badrieva
Effective prevention of syringe-borne transmission of HIV and the hepatitis viruses can be undermined if contact between injection drug users and the staff of prevention programs is impeded by police harassment, limited program resources, and the absence of an open “drug scene.” All these are commonplace in the Russian Federation. In response, “Project Renewal,” the harm reduction program of the AIDS Prevention and Control Center of the Tatarstan Ministry of Health in Kazan, has created a hybrid syringe exchange program that as its primary focus recruited and trained volunteers to provide secondary syringe exchange. To compensate for operational barriers, the program staff identified private venues and trained responsible individuals to work through their own and related networks of injectors to provide clean syringes, other harm reduction supplies, and educational materials, while facilitating the collection and removal of used and potentially contaminated syringes. Program staff developed a detailed set of tracking instruments to monitor, on a daily and weekly basis, the locations and types of contacts and the dissemination of trainings and materials to ensure that the secondary distribution network reaches its target audience. Data show that these secondary exchange sites have proven more productive than the primary mobile and fixed-site syringe exchanges in Kazan. Beginning in 2001, Project Renewal has trained other harm reduction programs in the Russian Federation to use this model of reaching injectors, identifying and training volunteers, and monitoring results of secondary syringe exchange.
Archive | 2006
Robert Heimer; Robert E. Booth; Kevin S. Irwin; Michael H. Merson
The twin epidemics of drug addiction and HIV simultaneously emerged in the Eurasia region in the late 1990s. Both were unanticipated by health establishments. Failure to act slowed the collection of detailed data and effective responses. In this chapter, we report on our observations and on those of our colleagues. To provide a proper sense of the problem created by the slow response of most of the governments in the region, this chapter combines a description of our experiences with the limited data available from scholarly sources.
Addictive Behaviors | 2012
Robert Heimer; Nabarun Dasgupta; Kevin S. Irwin; Mark Kinzly; Alison Phinney Harvey; Anthony Givens; Lauretta E. Grau
BACKGROUND Few studies have examined the relationship between chronic pain and opioid abuse in non-clinical populations. We sought to investigate this in a street-recruited sample of active opioid abusers in Cumberland County, Maine, USA, a locale that had experienced substantial increases in opioid abuse. METHODS A community-based sample was recruited using respondent-driven sampling. Participants were screened to identify those who had consumed illicit opioids in the prior month and administered a structured survey that included the Addiction Severity Index (ASI) and Brief Pain Inventory® (BPI). RESULTS More than 40% of the 237 individuals reported recurring pain that interfered with daily living. For more than three-quarters of those reporting chronic pain, opioid misuse preceded the onset of chronic pain. The order of onset was not associated with differences in sociodemographic, current levels of drug misuse, or ASI and BPI scores. BPI scores were associated with medical and psychological ASI domains. Compared to those not reporting chronic pain, those doing so were more likely to have a regular physician but were more likely to report difficulty gaining admission to substance abuse treatment programs. CONCLUSION Chronic pain was a common co-occurring condition among individuals misusing opioids. Better efforts are needed to integrate pain management and substance abuse treatment for this population.
Addiction | 2009
Craig L. Fry; Kevin S. Irwin
Don Weatherburn’s debate piece [1] considers how we should respond to dilemmas in harm minimization policy and practice—a question of central importance. Until recently, however, it has occupied less attention than matters of evidence and the quest for measurable outcomes in this field. The author highlights dilemmas including: ‘Whose harm should we try to minimize and how do we compare qualitatively different types of harm?’ . . . ‘When reducing the harm suffered by users increases the harm suffered by everyone else, whose interests should prevail?’ and ‘What principle should we adopt to make such decisions?’ [1]. Weatherburn argues that such dilemmas are encountered in harm minimization because of: (i) the co-occurrence of harms and benefits in most harm minimization interventions; (ii) difficulties in measuring and comparing harms and benefits; and (iii) the ‘irreducibly political’ nature of judgements about which harms matter most. We support Weatherburn’s aim of exploring the implications of these normative questions. Our concern however is that the author fails to consider how greater engagement with value positions and related ethical frameworks might benefit drug policy and the harm minimization project generally. For Weatherburn, ‘decisions about what policy to adopt invariably come down to political (value) judgements about what risks, harms and benefits (i.e. outcomes) matter the most’. Rather than seeing this as an opportunity, he dismisses value judgements as ‘not a job for researchers . . . [but] . . . a job for politicians and the public at large’. This is surprising, given the distinctly normative nature of the dilemmas Weatherburn identifies as requiring greater scholarly attention. In essence, the author argues that normative dilemmas in harm minimization are best addressed through greater precision in how we define drug problems, rather than examining the value positions which inform this process. Implicit in this stance is the idea that ‘objective’ researcher–scientists ought not to enter the ‘subjective’ world of political value-based judgements, treating ‘facts’ and values as distinct. Weatherburn proposes that we should ‘abandon the idea of an overarching goal’ (i.e. harm minimization as a drug policy goal) [1]. The author’s argument that the measurement problems in harm minimization render it ineffective as a guiding principle for drug policy relies heavily upon his ‘goal-oriented’ version of harm minimization that is rooted in (or requiring) empirical outcomes. But why should the principle of harm minimization be relevant only to quantifiable outcomes? Weatherburn argues that instead of adopting general principles, such as harm minimization, we should ‘try to reach agreement on the specific drug problems we want to reduce and make their reduction the goal of illicit drug policy’ [1]. He claims this will ‘stimulate a more open and frank debate about what problems matter the most’ and in turn help ‘to identify the points where compromises must be made in the achievement of drug policy goals’. What is unclear is how Weatherburn’s assumed agreement on a specific set of harm minimization problems and goals could ever be reached without examining ‘political value-based judgements’. Consider just one of Weatherburn’s examples, ‘encourage more injecting drug users into treatment’. There is a multitude of ethical issues to be addressed here, for instance questions of autonomy and choice, whether treatment is coerced or mandated, treatment access inequalities and whether limited resources should be used for new treatments or to improve existing options. A range of value positions are possible on these issues. Why would the positions taken on such normative issues not influence the new process Weatherburn proposes? How would an ‘open and frank’ debate occur if the core values underpinning how we define such ‘drug problems’ and potential responses remain hidden or dismissed as too difficult or ‘irreducible’? Why would the same measurement (and indeed epistemological) problems around ‘harm’ and ‘benefit’ comparisons not exist here? Fortunately, increasing efforts are under way to clarify the place of differing values and ethical considerations in harm minimization. This work has shown that a range of applied ethical frameworks are available which can help to clarify value positions, and guide us in making ethical decisions where dilemmas exist in drug policy and practice [2–5]. Explicit ‘values-based’ approaches are now being recognized for their potential contributions (alongside ‘evidence-based’ tools) to the design, guidance and evaluation of harm minimization initiatives [3,4]. Usefully, Weatherburn highlights some pressing normative dilemmas in harm minimization. He addresses
Journal of General Internal Medicine | 2006
William C. Chou; Mary E. Tinetti; Mary B. King; Kevin S. Irwin; Richard H. Fortinsky
American Journal on Addictions | 2007
Lauretta E. Grau; Nabarun Dasgupta; Alison Phinney Harvey; Kevin S. Irwin; Anthony Givens; Mark Kinzly; Robert Heimer
The Journal of Pain | 2010
Declan T. Barry; Kevin S. Irwin; Emlyn S. Jones; William C. Becker; Jeanette M. Tetrault; Lynn E. Sullivan; Helena Hansen; Patrick G. O'Connor; Richard S. Schottenfeld; David A. Fiellin
International Journal of Drug Policy | 2007
Kevin S. Irwin; Craig L. Fry