Rawson Expert Report Publicly Filed

IN THE CIRCUIT COURT FOR SULLIVAN COUNTY
AT KINGSPORT, TENNESSEE
BARRY STAUBUS, in his official capacity as the District )

Attorney General for the Second Judicial District and on behalf )
of all political subdivisions therein, including SULLIVAN )
COUNTY, CITY OF BLUFF, CITY OF BRISTOL, CITY OF ) JURY DEMAND
KINGSPORT; ) Case No. C-41916
STATE OF TENNESSEE ex rel. BARRY STAUBUS;
TONY CLARK, in his official capacity as the District Attorney
) Division C
General for the First Judicial District and on behalf of all political )
subdivisions therein, including CARTER COUNTY, CITY OF )
ELIZABETHTON, CITY OF WATAUGA, JOHNSON )
COUNTY, CITY OF MOUNTAIN CITY, UNICOI COUNTY, )
TOWN OF UNICOI, TOWN OF ERWIN, WASHINGTON )
COUNTY, CITY OF JOHNSON CITY, TOWN OF )
JONESBOROUGH; )
STATE OF TENNESSEE ex rel. TONY CLARK; )
DAN ARMSTRONG, in his official capacity as the District )
Attorney General for the Third Judicial District and on behalf of
)
all politic al subdivisions therein, including GREENE COUNTY,
CITY OF TUSCULUM, TOWN OF BAILEYTON, TOWN OF
)
GREENVILLE, TOWN OF MOSHEIM, HAMBLEN COUNTY, )
CITY OF MORRISTOWN, HANCOCK COUNTY, TOWN OF )
SNEEDVILLE; HAWKINS COUNTY; CITY OF CHURCH )
HILL; TOWN OF BULLS GAP; TOWN OF MOUNT )
CARMEL, TOWN OF ROGERSVILLE, TOWN OF )
SURGOINSVILLE; )
STATE OF TENNESSEE ex rel. DAN ARMSTRONG; )
and BABY DOE, by and through his Guardian Ad Litem, )
Plaintiffs, )
)
v. )
)
PURDUE PHARMA, L.P.; PURDUE PHARMA, INC.; THE )
PURDUE FREDERICK COMPANY; MALLINCKRODT LLC;
)
ENDO HEALTH SOLUTIONS, INC; ENDO
PHARMACEUTICALS, INC; ELIZABETH ANN BOWERS
)
CAMPBELL; PAMELA MOORE; and ABDELRAHMAN )
HASSABU MOHAMED, )
)
Defendants. )
EXPERT REPORT OF RICHARD A. RAWSON, PH.D.

I. EXECUTIVE SUMMARY
1. I have been retained by the plaintiffs in this litigation to provide my opinion regarding
appropriate and effective programs for treating persons suffering from opioid use disorder
(OUD). I have outlined programs that the State of Vermont has used to expand treatment for
OUD and identified general principles that should inform efforts by Northeast Tennessee
officials to respond to the opioid crisis. As part of my opinion, I have analyzed the likely
prevalence of OUD in Northeast Tennessee and made recommendations about the services
needed to provide needed treatment for individuals with OUD in this area.
II. QUALIFICATIONS
2. I am currently a research professor at the University of Vermont (UVM) and a professor

emeritus in the Department of Biobehavioral Sciences, David Geffen School of Medicine at the
University California at Los Angeles (UCLA). I have a BA (1970) and Ph.D. (1974) in
psychology from UVM. I began my research in the area of drug addiction in 1974 with one of
the first research grants awarded by the National Institute on Drug Abuse (NIDA) to evaluate
naltrexone as a treatment for heroin addiction. Over the next 45 years, I spent 30 years as a
professor at UCLA, the past 4 years with a concurrent appointment at UVM. From 1980-1995, I
founded and directed a non-profit treatment organization with a network of outpatient clinics in
the Los Angeles area. I set up and ran over 20 clinics and during that time developed a widely
used treatment approach for the treatment of individuals with addiction.
3. I have an extensive research portfolio on a broad range of addiction-related topics. I have

done research on specific behavioral and medication treatments, as well as research and
evaluation of treatment networks and treatment systems. I have worked with NIDA, the US
Substance Abuse and Mental Health Agency (SAMHSA), the US State Department, the World
Health Organization, and the United Nations Office of Drugs and Crime on international
substance abuse research and training projects for over 20 years. I have worked extensively in
Africa, the Middle East, and South East Asia. Specific projects include leading the United
Nations Office on Drugs and Crime (UNODC) Treatnet Program, a Fogarty Training grant with
REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

HIGHLY CONFIDENTIAL PAGE 1
Cairo University, a national drug use survey in Iraq, and the Vietnam HIV-Addiction
Technology Transfer Center. I provide training and technical assistance to numerous states with
a focus on service delivery in rural areas (within South Dakota, Wisconsin, West Virginia, and
California) on addiction treatment system development. I am an investigator for the HRSA
Center to Reduce the Impact of the Opioid Epidemic in Rural Communities, recently awarded to
the University of Vermont.
4. When I moved “home” to Vermont in 2015, I was asked by Governor Peter Shumlin and
the Director of the Vermont Department of Health, Harry Chen, to evaluate Vermont’s response
to the opioid crisis. The Vermont Hub and Spoke model (H&S) is an innovative system of
treatment to rapidly expand medication treatment for OUD. In 2017-2018, I visited over 40
clinic sites throughout Vermont and interviewed over 200 individuals in treatment for OUD. I
completed a comprehensive report on this project1 and have published two articles on the results
of the evaluation.2 As a result of this experience I have a thorough understanding of the
treatment services for OUD throughout the state of Vermont.
5. I have published 6 books, 40 book chapters and over 240 professional papers and
annually conduct numerous workshops, paper presentations and training sessions in the US and
internationally. These are listed in my CV, which is included as Attachment A.
6. The present case is the first time I have been paid as an expert witness. The list of
materials I relied upon for this Report is included as Attachment B. My rate for work in this
matter is $300 per hour and $400 per hour of testimony. My compensation does not depend
upon the outcome of this litigation.
1
R. Rawson, “Vermont Hub-and-Spoke Model of Care for Opioid Use Disorders: An Evaluation,” Submitted
December 2017, available at https://www.healthvermont.gov/sites/default/files/documents/pdf/ADAP_Hub_and_
Spoke_Evaluation_2017_1.pdf.
2
R. Rawson et al., “Patient perceptions of treatment with medication treatment for opioid use (MOUD) in the
Vermont hub-and-spoke system,” Preventive Medicine, 2019, pp. 2-6 and R. Rawson et al., “Assessment of
medication for opioid use disorder as delivered within the Vermont hub and spoke system,” Journal of Substance
Abuse Treatment, 97, 2019, pp. 84-90.

III. THE OPIOID EPIDEMIC
7. The United States is currently grappling with an epidemic of opioid abuse and overdose.
Each day, on average, 130 Americans die from an opioid overdose.3 Overdose deaths from
heroin and other opioids have risen sharply over the past decade, now eclipsing deaths from
other external causes, such as gun-inflicted homicides or motor vehicle crashes, and some
experts predict continuing increases in death for the next decade.4 Opioid-related consequences
(e.g., criminality, infectious diseases, overdoses, pre-mature death) have resulted in economic
costs of $56 billion annually.5 The issue of opioid abuse and dependency is so pressing that, in
2017, the Acting HHS Secretary declared a national public health emergency. 6
8. Prescription opioid use is relatively common in the United States. A 2016 survey by
Kaiser Family Foundation and The Washington Post estimated that about 1 in 20 adults in the
United States had recently taken prescription opioids for a period of at least two months, not
including those treated for cancer or terminal illness.7 Among the opioid users surveyed, more
3
Centers for Disease Control and Prevention, “Understanding the Epidemic,” available at https://www.cdc.gov/
drugoverdose/epidemic/index.html.
4
“The Great Opioid Epidemic,” The Washington Post, December 11, 2016, available at
https://www.washingtonpost.com/opinions/the-great-opioid-epidemic/2016/12/11/77bd8998-be4d-11e6-91ee-
1adddfe36cbe_story.html; and M. Blau, “STAT forecast: Opioids could kill nearly 500,000 Americans in the next
decade,” STAT Blog, June 27, 2017, available at https://www.statnews.com/2017/06/27/opioid-deaths-forecast/.
5
W.C. Becker et al., “Non-medical use, abuse and dependence on prescription opioids among U.S. adults:
Psychiatric, medical and substance use correlates,” Drug and Alcohol Dependence, 94, 2008, pp. 38-47; H.G.
Birnhaum et al., “Societal costs of prescription opioid abuse, dependence, and misuse in the United States,” Pain
Medicine, 12, pp. 657-667; T. Clausen et al., “Mortality among opiate users: Opioid maintenance therapy, age and
causes of death,” Addiction, 104, 2009, pp. 1356-1362; C.M. Jones et al., “Vital signs: Demographic and substance
use trends among heroin users: United States, 2002-2013,” Morbidity and Mortality Weekly Report, 64, pp. 719-725;
L.J. Paulozzi, “Prescription drug overdoses: A review,” Journal of Safety Research, 43, 2012, pp. 283-289;
SAMHSA, Opioids, 2016, available at http://www.samhsa.gov/atod/opioids; and A. Wisneiwski et al., “The
epidemiologic association between opioid prescribing, non-medical use, and emergency department visits,” Journal
of Addictive Diseases, 27, 2008, pp. 1-11.
6
U.S. Department of Health & Human Services, “HHS Acting Secretary Declares Public Health Emergency to
Address National Opioid Crisis,” October 26, 2017, available at https://www.hhs.gov/about/news/2017/10/26/hhs-
acting-secretary-declares-public-health-emergency-address-national-opioid-crisis.html.
7
B. DiJulio, B. Wu, and M. Brodie, “The Washington Post/Kaiser Family Foundation Survey of Long-Term
Prescription Painkiller Users and Their Household Members,” Kaiser Family Foundation, December 2016, available
at http://files.kff.org/attachment/Survey-of-Long-Term-Prescription-Painkiller-Users-and-Their-Household-
Members.

than one-third reported being physically dependent or addicted.8 However, household members
of opioid users were much more likely to report issues with addiction or dependence than those
actually using the painkillers, with more than half of household members surveyed saying they
thought the user was addicted or dependent.9
9. It is well understood that opioid dependency can be fatal. The annual number of deaths
from opioid overdose has increased dramatically in the United States over the last two decades.
In particular, the age-adjusted mortality rate from opioid overdose increased more than fourfold
between 1999 and 2017, from 2.9 per 100,000 population in 1999 to 14.9 per 100,000 population
in 2017, with much of this increase occurring over just the last decade (See Figure 1).10 The
problem is so severe that 1 in 5 Americans now say they know someone who has died from a
prescription painkiller overdose.11
8
Ibid, p. 1.
9
Ibid, p. 9.
10
Kaiser Family Foundation analysis of CDC WONDER Database: Kaiser Family Foundation, “Opioid Overdose
Death Rates and All Drug Overdose Death Rates per 100,000 Population (Age-Adjusted),” available at
https://www.kff.org/other/state-indicator/opioid-overdose-death-rates.
11
Kaiser Family Foundation, “1 in 5 Americans Say They Know Someone Who Has Died from Prescription
Painkiller Overdose,” January 18, 2018, available at https://www.kff.org/other/slide/1-in-5-americans-say-they-
know-someone-who-has-died-from-prescription-painkiller-overdose/.

FIGURE 1
OPIOID OVERDOSE DEATH RATES IN TENNESSEE AND THE UNITED STATES
10. The opioid epidemic is even more severe in Tennessee than nationally, with the state’s
overdose death rate rising to 19.3 per 100,000 population in 2017, an eleven-fold increase from
1999 (see Figure 1).12 Furthermore, overdose deaths from opioids are rising faster than for other
drugs. By 2017, opioids were responsible for 71% of all drug overdose deaths in the state, up
from about 50% in 2007.13 More than 1,200 people died from an opioid overdose in Tennessee
in 2017 alone, with only about one-quarter of these deaths including heroin as an underlying
cause.14
11. Figure 2 depicts opioid prescribing rates from 2006-2017 in the United States, Tennessee,
and the nine Tennessee counties involved in this matter, with rates expressed as the number of
12
Kaiser Family Foundation, “Opioid Overdose Death Rates and All Drug Overdose Death Rates per 100,000
Population (Age-Adjusted),” available at https://www.kff.org/other/state-indicator/opioid-overdose-death-rates.
13
Kaiser Family Foundation, “Opioid Overdose Deaths and Opioid Overdose Deaths as a Percent of All Drug
Overdose Deaths,” available at https://www.kff.org/other/state-indicator/opioid-overdose-deaths/.
14
Ibid and Kaiser Family Foundation, “Opioid Overdose Deaths by Type of Opioid,” available at
https://www.kff.org/other/state-indicator/opioid-overdose-deaths-by-type-of-opioid/.

retail prescriptions dispensed per 100 persons. Tennessee’s prescribing rate peaked at 140 per
100 persons in 2010. This means that, in 2010, there were 1.4 opioid prescriptions dispensed in
Tennessee for every person living in Tennessee. While opioid prescribing rates have been
declining steadily in the United States since 2012 and in Tennessee since 2010, Tennessee’s
prescribing rates remain very high as of 2017 (the latest available data). In fact, Tennessee’s
prescribing rate, 94.4 per 100 persons, is the third highest in the country, and is exceeded only by
Alabama and Arkansas, each of which have rates above 105 per 100 persons (see Figure 3).15
FIGURE 2
OPIOID PRESCRIBING RATES IN THE NINE TENNESSEE COUNTIES,
TENNESSEE, AND THE UNITED STATES
15
CDC, “U.S. Opioid Prescribing Rate Maps,” available at https://www.cdc.gov/drugoverdose/maps/rxrate-
maps.html. Data on opioid prescribing rates include prescriptions of “buprenorphine, codeine, fentanyl,
hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, propoxyphene, tapentadol, and
tramadol,” as identified using the National Drug Code. These data do not include: cough and cold formulations
containing opioids; buprenorphine products used to treat opioid use disorder; or methadone dispensed through
methadone maintenance treatment programs. I created one line for the nine Tennessee counties by weighting each
rate by the population for that year. Population data are from: US Census Bureau, “American FactFinder,” available
at https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml.

FIGURE 3
OPIOID PRESCRIBING RATES BY STATE
12. Prescribing rates in the nine Tennessee counties are even higher than the overall
Tennessee rates, and have historically been among the highest in the country. The prescribing
rate in 2009 in the nine Tennessee counties was extraordinarily high, at 191.6 prescriptions
dispensed per 100 persons. By comparison, the average county-level prescribing rate in the
United States was 90 per 100 persons in 2009, among counties for which data are available.
While the prescribing rate in the nine Tennessee counties has also been declining since 2010, it
remains quite high, at 114.9 per 100 persons.
IV. THE PREVALENCE OF OPIOID USE DISORDER (OUD)
13. OUD is described as “a problematic pattern of opioid use that causes clinically significant
impairment or distress.”16 A diagnosis of OUD is based on specific assessment criteria from the
Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5), such as unsuccessful efforts
16
“Substance-Related and Addictive Disorders,” in American Psychiatric Association, Diagnostic and Statistical
Manual of Mental Disorders, 5th edition, DSM Library. Arlington, VA, 2013 (hereafter DSM-5) and CDC,
“Commonly Used Terms,” February 12, 2019, available at https://www.cdc.gov/drugoverdose/opioids/terms.html.

to cut down or control use.17 In 2017, 11.4 million Americans reported that they had misused
opioids in the past year (population-adjusted), while about 2.1 million met the criteria for
OUD.18 These figures are likely to be gross underestimates, a fact I explain in more detail
below.
A. The National Survey on Drug Use and Health (NSDUH) Provides a Gross
Underestimate of the Prevalence of OUD
14. The origins and limitations of the overdose death estimates described in Section III are
generally well understood. For example, not all medical examiners or coroners conduct
extensive drug tests of decedents, not all tests are comprehensive in the opioids they can detect,
and abuse of multiple substances concurrently may complicate cause of death attribution.19
Therefore, rates of involvement of specific drugs, such as prescription opioids or heroin, in
overdose deaths are likely to be underestimated.20 Nonetheless, there is no doubt that the
number of opioid-related deaths has grown rapidly.
15. The accuracy of estimates of the number of individuals with OUD is less clear. The
source typically used to estimate the number of people who use heroin or misuse prescription
opioids in the US is the National Survey on Drug Use and Health (NSDUH), which has been
conducted annually since 2002. The NSDUH interviews approximately 70,000 people per year
ages 12 and older,21 yielding 330,000 unique individuals interviewed between 2011 and 2016 for
17
Ibid.
18
J. Bose et al., “Key Substance Use and Mental Health Indicators in the United States: Results from the 2017
National Survey on Drug Use and Health,” Substance Abuse and Mental Health Services Administration, September
2018, available at https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHFFR2017/
NSDUHFFR2017.pdf.
19
M. Warner, et al., “State variation in certifying manner of death and drugs involved in drug intoxication deaths,”
Academic Forensic Pathology, 3(2), 2013, pp.231-237 and C.J. Ruhm, “Drug poisoning deaths in the United States,
1999–2012: a statistical adjustment analysis,” Population Health Metrics, 14(2), 2016, pp. 1-12.
20
Ruhm, op. cit., pp. 1-2.
21
National Survey on Drug Use and Health, “About the Survey,” available at https://nsduhweb.rti.org/respweb/
about_nsduh.html.

whom survey data are publicly available.22 However, of these 330,000 individuals, only 217
reported using heroin daily or near-daily (DND), yielding an average population-weighted
estimate of 156,000 DND users in the US at any time between 2011 and 2015.23 This estimate is
an extreme underestimate, as substantiated by the extensive array of information below.
16. There are numerous, well documented reasons why the NSDUH severely underestimates
the actual number of opioid users in the US. Reasons include:
• Selective non-response: Of all individuals asked to participate in the NSDUH,

46% refuse.24 While the NSDUH adjusts its survey weights to account for non-
response, these adjustments may not be sufficient to account for differential rates
of heroin use between responders and non-responders.
• Small sample size magnifies the impact of underreporting.
• Sampling frame: The NSDUH does not survey incarcerated or otherwise
institutionalized individuals, military personnel on active duty, or individuals who
are homeless and do not reside in shelters.25 The most significant of these
unrepresented groups is incarcerated individuals. Nearly 2.2 million people are
incarcerated in the United States,26 and 19% reported regularly using opioids prior
to incarceration.27 Since these individuals are not included in the NSDUH, their
high rate of OUD is not captured by the survey.
• Under-reporting: Because of the stigma associated with heroin and other illicit
drug use, respondents may be reluctant to admit their drug use.28
22
I. Binswanger et al., “Release from prison--a high risk of death for former inmates,” New England Journal of
Medicine, 356(2), 2007, pp. 157–165.
23
M. Fendrich, et al., “Validity of drug use reporting in a high-risk community sample: a comparison of cocaine
and heroin survey reports with hair tests,” American Journal of Epidemiology, 149(10), 1999, pp. 955–962.
24
S. Magura, “Validating self-reports of illegal drug use to evaluate National Drug Control Policy: a reanalysis and
critique.” Evaluation and Program Planning, 33(3), 2010, pp. 234-237.
25
Substance Abuse and Mental Health Services Administration, “National Survey on Drug Use and Health,”
available at https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health.
26
D. Kaeble and M. Cowhig, “Correctional Populations in the United States, 2016,” U.S. Department of Justice,
Bureau of Justice Statistics; April 2018, available at https://www.bjs.gov/content/pub/pdf/cpus16.pdf.
27
J. Bronson et al., “Drug Use, Dependence, and Abuse Among State Prisoners and Jail Inmates, 2007- 2009,”
NCJ250546. Washington, DC: Bureau of Justice Statistics, US Department of Justice, 2017.
28
L.D. Harrison et al., “Comparing drug testing and self-report of drug use among youths and young adults in the
general population,” SAMHSA, Office of Applied Studies, May 2007, available at http://buckleysrenewalcenter.
com/wp-content/uploads/2012/02/drugtest.pdf.

17. In addition to the reasons above, the NSDUH does not ask about the use of synthetic
opioids like fentanyl, the leading cause of opioid deaths since 2015 (see Figure 4).29 As a result,
our knowledge of the extent of the opioid problem in 2019 is even further deficient.
FIGURE 4
AGE-ADJUSTED DRUG OVERDOSE DEATHS, BY OPIOID CATEGORY: UNITED STATES 1999-201730
18. Finally, there is direct, incontrovertible evidence that the NSDUH badly underestimates
the number of individuals with OUD. In the most recent state level NSDUH report, the State of
Vermont is estimated to have 6,000 individuals with OUD.31 However, there is excellent
documentation from Medicaid and Vermont’s Department of Health data, that in Vermont in
29
Centers for Disease Control and Prevention, “Understanding the Epidemic,” December 18, 2018, available at
https://www.cdc.gov/drugoverdose/epidemic/index.html.
30
H. Hedegaard, A.M. Minino, and M. Warner, “Drug Overdose Deaths in the United States, 1999-2017,” NCHS
Data Brief, 329, November 2018, available at file:///C:/Users/kdrake/Desktop/db329-h.pdf.
31
SAMHSA, “Behavioral Health Barometer: Vermont, Volume 5,” pp. 1-37 at p. 22, available at
https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/Vermont-BH-BarometerVolume5.pdf.

2018, over 10,000 individuals received treatment for OUD with methadone, buprenorphine and
naltrexone.32 Although the data for 2018 is not yet available, in 2017, Vermont Health
Department records indicate that another 22% (over the number receiving medication treatments)
received treatment for OUD not involving medication.33 Hence 10,000 plus 2,200 = 12,200
people are in treatment for OUD. In addition, there are additional people with OUD in Vermont
who are in treatment at the VA, who receive syringe exchange services and who are incarcerated,
none of whom are counted in the 12,200 number. Further, we have no idea how many
individuals there are who have OUD, who are outside all of these categories and not counted in
any of these groups. So, the number has to be well above 12,200 people with OUD in Vermont.
HOWEVER, THE NSDUH ESTIMATES THAT THERE ARE ONLY 6,000 PEOPLE WITH
OUD TOTAL IN THE STATE OF VERMONT.
19. Therefore, in order to accurately estimate the number of people with OUD in the nine
Tennessee counties, and to estimate the number who will need treatment, NSDUH cannot be
relied upon and other estimation methods are needed.
B. The “True” Prevalence of OUD
20. In view of the limitations of the NSDUH as a method for estimating the number of
individuals with OUD, researchers have searched for alternative estimation methods. The
prestigious group at RAND Corporation have extensively addressed the methods available for
estimating the number of drug users in the US and they maintain that the NSDUH, while a fine
survey on many health issues, badly underestimates the number of heroin and other opioid
uses.34
32
“More Vermonters are Receiving Needed Medication Assisted Treatment,” Vermont Department of Health, July
2019. available at https://www.healthvermont.gov/sites/default/files/documents/pdf/ADAP_Medication%20
Assisted%20Treatment%20for%20Opioid%20Use%20Disorder%20Trends.pdf.
33
This is based on my personal communications with employees of the Vermont Health Department.
34
P. Reuter, J.P. Caulkins, and G. Midgette, “Measuring Problem Heroin use: Misuse of a General Population
Survey,” under review.

21. The consensus among public health officials in Vermont is that, at best, 50% of the OUD
population is in treatment. That would mean there are at least 24,400 people with OUD in the
state of Vermont, which is 4.5% of the Vermont population over age 13.35
22. In a recent article in the highly respected American Journal of Public Health, Barocas
and colleagues performed a very well designed analysis of multiple datasets of Massachusetts
data and applied a multi-sample stratified capture–recapture analysis to estimate OUD
prevalence in Massachusetts.36 This approach, the capture-recapture methodology, is a
“foundational” methodology when estimating the size of a population in a situation where direct
measures of estimation are not possible. The resulting estimates in Massachusetts from 2011,
show a rapidly increasing percentage of the population, such that by 2015, the estimated
prevalence for OUD in Massachusetts was 4.60% of the population over the age of 11.37
C. The Prevalence of OUD in Northeast Tennessee
23. The Appalachian region, including Northeast Tennessee, has been the epicenter of the
opioid epidemic.38 As illustrated in Figure 5, a much higher rate of opioids, more than double,
have been prescribed in the nine Tennessee counties compared to Vermont and Massachusetts.39
35
The 2018 population of Vermont over age 13 was 538,502. US Census Bureau, “American FactFinder,”
available at https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml.
36
J.A. Barocas et al., “Estimated Prevalence of Opioid Use Disorder in Massachusetts, 2011-2015: A Capture-
Recapture Analysis,” American Journal of Public Health, 108(12), 2018, pp. 1675-1681.
37
Ibid., p. 1678.
38
For example, see A.M. Bunting et al., “Clinician identified barriers to treatment for individuals in Appalachia
with opioid use disorder following release from prison: a social ecological approach,” Addiction Science & Clinical
Practice, 13(23), 2018, pp. 2-10.
39
CDC, “U.S. Opioid Prescribing Rate Maps,” available at https://www.cdc.gov/drugoverdose/maps/rxrate-
maps.html. This data includes prescriptions of “buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone,
methadone, morphine, oxycodone, oxymorphone, propoxyphene, tapentadol, and tramadol, were identified using the
National Drug Code. Cough and cold formulations containing opioids and buprenorphine products typically used to
treat opioid use disorder were not included. In addition, methadone dispensed through methadone maintenance
treatment programs is not included in the IQVIA Xponent data.”

FIGURE 5
OPIOID PRESCRIBING RATES IN THE NINE TENNESSEE COUNTIES, MASSACHUSETTS AND VERMONT
24. In addition to a higher rate of prescriptions per person, Tennessee, and Northeast
Tennessee in particular, has consistently had a substantially higher rate of high-risk opioid
prescribing and use than Vermont and Massachusetts.40 Risks of addiction and other adverse
outcomes are dose-responsive, meaning that increased morphine milligram equivalents
(MME) results in increased risks.41 In 2017, Tennessee had the highest mean MME per person
40
L. Schieber et al., “Trends and Patterns of Geographic Variation in Opioid Prescribing Practices by State, United
States, 2006-2017,” JAMA Network Open, 2(3), 2019 pp. 7-9; and J. Baumblatt et al., “High-Risk Use by Patients
Prescribed Opioids for Pain and Its Role in Overdose Deaths,” JAMA Internal Medicine, 174(5), 2014, pp. 796–801.
41
D. Dowell, T. Haegerich, and R. Chou, “CDC Guideline for Prescribing Opioids for Chronic Pain – United
States, 2016,” JAMA, 315(15), 2016, pp.1624-1645; A. Bohnert et al., “Association Between Opioid Prescribing
Patterns and Opioid Overdose-Related Deaths,” JAMA 305(13), 2016, pp. 1315-1321; A. Bohnert et al., “A Detailed
Exploration Into the Association of Prescribed Opioid Dosage and Overdose Deaths Among Patients With Chronic
Pain,” Medical Care, 54(5), 2016, pp. 435–441; T. Gomes et al., “Opioid dose and drug-related mortality in patients
with nonmalignant pain,” Arch Intern Med, 171(7), 2011, pp.686-691; K. Dunn et al., “Opioid prescriptions for
chronic pain and overdose,” Ann Intern Med, 152(2), 2010, pp. 85-92; Y. Liang & B. Turner, “National cohort
study of opioid analgesic dose and risk of future hospitalization,” Journal of Hospital Medicine, 10(7), 2015, pp.
425–431.

in the country.42 A 2015 map published by the CDC, depicted in Figure 6, shows the level of
variation in MME per person by county.43
FIGURE 6
MORPHINE MILLIGRAM EQUIVALENT BY US COUNTY
25. Similarly, the greater the number of days for which opioids are prescribed, the greater the
risks.44 Each additional week of use has been associated with a 20% increased risk for the
development of OUD or occurrence of an overdose.45 The CDC’s 2016 Guideline for
Prescribing Opioid for Chronic Pain urges prescribers to provide the lowest effective dosage and
42
L. Schieber, et al., op. cit.
43
CDC Vital Signs, “Where you live matters,” July 2017, https://www.cdc.gov/vitalsigns/pdf/2017-07-
vitalsigns.pdf.
44
L. Paulozzi et al., “Risk of adverse health outcomes with increasing duration and regularity of opioid therapy,”
J Am Board Fam Med., 27(3), 2014, pp. 329-338; G. Brat et al., “Postsurgical prescriptions for opioid naive patients
and association with overdose and misuse: retrospective cohort study,” BMJ, 2018, 360.
45
M.Edlund et al.,“The role of opioid prescription in incident opioid abuse and dependence among individuals with
chronic noncancer pain: the role of opioid prescription,” Clin J Pain. 30(7), 2014, pp. 557-564; Brat, et al., op. cit.

prescribe “no greater quantity than needed for the expected duration of pain severe enough to
require opioids.”46 Studies have shown increases in the likelihood that opioid use will continue
long-term if opioids are prescribed longer than 5 days and longer than 30 days.47 In 2017,
Tennessee had a higher mean annual duration per prescription than Vermont and Massachusetts
and the second highest number of prescriptions for a duration of 30 days or more in the country,
substantially greater than the rates of Vermont or Massachusetts.25
26. Although the prevalence of OUD in the nine Tennessee counties is unknown, it is very
likely that the prevalence is higher than the 4.5%-4.6% prevalence in Vermont and
Massachusetts.
V. VERMONT’S TREATMENT SYSTEM FOR OPIOID ADDICTION REPRESENTS THE GOLD

STANDARD
27. Over the past decade, as states have attempted to meet the needs of their citizens with
regard to treatment access for individuals with OUD, a number of models have emerged as very
promising. A state model of treatment that has been lauded as one of the most promising
approaches is the Vermont Hub-and-Spoke Model (H&S).
28. Vermont has been significantly impacted by the opioid epidemic. Opioid overdose
deaths in Vermont increased from 43 in 2010 to 114 in 2017.48 Along with the rest of New
England, Vermont has been one of the states most profoundly impacted by the consequences of
the opioid epidemic, fueled by large amounts of prescription opioid misuse and addiction.49 In
46
Dowell, Haegerich, and Chou, op. cit.
47
A. Shah, C. Hayes and B. Martin, “Characteristics of initial prescription episodes and likelihood of long-term
opioid use – United States, 2006-2015,” MMWR Morb Mortal Wkly Rep., 66(10), 2017, pp. 265-269.
48
Kaiser Family Foundation, “Opioid Overdose Deaths and Opioid Overdose Deaths as a Percent of All Drug
Overdose Deaths,” available at https://www.kff.org/other/state-indicator/opioid-overdose-deaths/.
49
Kaiser Family Foundation, “Opioid Overdose Death Rates and All Drug Overdose Death Rates per 100,000
Population (Age-Adjusted),” available at https://www.kff.org/other/state-indicator/opioid-overdose-death-rates; and
Substance Abuse and Mental Health Services Administration, “Behavioral Health Barometer: Vermont, Volume 5:
Indicators as measured through the 2017 National Survey on Drug Use and Health and the National Survey of
Substance Abuse Treatment Services,” HHS Publication No. SMA-19-Baro-17-VT. Rockville, MD: Substance
Abuse and Mental Health Services Administration, 2019.

2014, Vermont’s then-Governor, Peter Shumlin, announced that the state was experiencing an
opioid addiction epidemic, devoting nearly his entire State of the State address to Vermont’s
growing problem of opioid addiction.50
29. Over the past decade, in response to its opioid epidemic, Vermont has developed an
innovative statewide treatment network to expand treatment for individuals with OUD. This
treatment network is the Care Alliance for Opioid Addiction, or the H&S system, which has
expanded since Governor Shumlin’s 2014 address.51 The purpose of the H&S is to provide
comprehensive, integrated care and improved care coordination for people experiencing opioid
dependence and addiction, while expanding access to medications for OUD (MOUD).52
30. In the H&S model, “hubs” and “spokes” are two types of treatment settings that offer
different levels of support to patients with different levels of need (see Figure 753). Each patient
is treated in the least restrictive setting that is clinically appropriate, and may move between
settings, depending on his or her unique care needs.
50
T.A. Simpatico, “Vermont responds to its opioid crisis,” Preventive Medicine, 80, 2015, pp. 10-11 and H. Epp, “5
Years After Gov. Shumlin Called For Action On Opioids In Vermont, What’s Changed?” Vermont Public Radio,
January 7, 2019, available at https://www.vpr.org/post/5-years-after-gov-shumlin-called-action-opioids-vermont-
whats-changed#stream/0.
51
Ibid.
52
State of Vermont, “Hub and Spoke,” 2019, available at https://blueprintforhealth.vermont.gov/about-
blueprint/hub-and-spoke and The Pew Charitable Trusts, “Innovative Approaches Can Help Improve Availability of
Opioid Use Disorder Treatment,” November 2018, available at https://www.pewtrusts.org/-
/media/assets/2018/11/supti_innovative_approaches_to_treating_opioid_use_disorder.pdf.
53
Figure source: State of Vermont, “Hub and Spoke,” 2019, available at https://blueprintforhealth.vermont.gov/
about-blueprint/hub-and-spoke.

FIGURE 7
THE HUB & SPOKE SYSTEM
31. “Hubs” are licensed regional opioid treatment programs (OTPs), which offer intensive
treatment for individuals experiencing complex addictions.54 There are nine hubs in the State of
Vermont, which offer daily support to patients and may dispense methadone and/or
buprenorphine.55 Hubs have an extensive staff of MDs with training and experience in
delivering MOUD, as well as staff physicians, nurses, and counselors, who provide intensive
specialty-care addiction treatment. Behavioral treatment staff include licensed clinical social
workers, alcohol and drug counselors, and case managers. Services include urine drug testing,
pregnancy and infectious disease screening, birth control information, and annual physical
exams.
32. By contrast, “spokes” are primary medical care settings located in communities across
the State of Vermont, which serve as Office Based Opioid Treatment (OBOT) settings. Spokes
integrate care for opioid dependence into more general medical care for patients with less
intensive treatment needs.56 While spokes may administer buprenorphine, they are not
54
Ibid.
55
Ibid.
56
Ibid.

authorized to administer methadone. Spokes are more numerous than hubs; there are more than
100 spokes in Vermont.57 Spokes are staffed by one or more waivered buprenorphine prescribers
and a MOUD team (one full-time equivalent registered nurse (RN) position and one counselor
per 100 patients on MOUD). The embedded RN and counselor help the physician manage
patients, and these MOUD teams can be shared among community physicians, based on the
number of patients per practice. RNs meet with new patients, review treatment contracts and
consents, arrange insurance authorization, conduct urine drug testing, handle random callbacks
for diversion prevention, provide medication refills, and check prescription histories in the
Vermont Prescription Monitoring System. The counselors, or case managers, coordinate
counseling services; manage acute crises; provide supportive counseling or check-ins; help with
housing, insurance, and travel issues; and manage waits for service. The MOUD team regularly
meets with the physician(s) to discuss cases, develop treatment plans, and monitor progress.
33. A primary function of the H&S is to expand access to MOUD, a comprehensive

treatment program that uses medication, such as methadone or buprenorphine, alongside
counseling to treat OUD.58 The empirical support for the use of MOUD is overwhelming.59 As
reflected in the extensive scientific reports supporting MOUD, the use of MOUD dramatically
reduces opioid use and drug injection and overdose and produces many other benefits.60 In the
past three years in the United States, the Department of Health and Human Services has allocated
57
This is based on my personal communications with employees of the Vermont Health Department.
58
State of Vermont, “Hub and Spoke,” 2019, available at https://blueprintforhealth.vermont.gov/about-
blueprint/hub-and-spoke.
59
For example, see: N.D. Volkow, et al., “Medication-Assisted Therapies – Tackling the Opioid-Overdose
Epidemic,” New England Journal of Medicine, 370(22), 2014, pp. 2063-2066; R.P. Schwartz, et al., “Opioid
Agonist Treatments and Heroin Overdose Deaths in Baltimore, Maryland, 1995-2009,” American Journal of Public
Health, 103(5), 2013, pp. 917-922; R.P. Mattick, et al., “Methadone maintenance therapy versus no opioid
replacement therapy for opioid dependence (Review),” Cochrane Database of Systematic Reviews, 2003(2); R.P.
Mattick, et al., “Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence
(Review),” Cochrane Database of Systematic Reviews, 2014(2); and World Health Organization, Guidelines for the
Psychosocially Assisted Pharmacological Treatment of Opioid Dependence, 2009, available at
https://www.who.int/substance_abuse/publications/9789241547543/en/.
60
Rawson, 2017, op cit.

over $3 billion dollars to support increasing access to MOUD.61 At present, the debate about
whether to use MOUD is settled. The question is: how can access to MOUD be rapidly
expanded, in order to quickly reduce the morbidity and mortality associated with OUD.
34. Vermont’s H&S system provides a useful benchmark for other areas. Research in the
peer-reviewed literature has documented the benefits of the H&S in expanding access to MOUD
throughout the State of Vermont.62 For example, in an evaluation of the impact of the H&S,
patients treated with MOUD reported dramatic reductions in opioid and other substance use,
overdose, crime, emergency department visits, and hospital stays.63 In addition, treatment with
MOUD in the H&S system is associated with reductions in symptoms of anxiety, depression, and
family conflict.64 In depth-interviews with individuals in treatment in the H&S system suggest
that the medications and other services provided within the H&S system are viewed as very
valuable to individuals in treatment, and that the services provided in the spokes (primary care
clinics) have been especially helpful in facilitating access to care and reducing stigma.65 And the
H&S system may be cost-saving: an economic analysis documented that those individuals with
OUD who are treated in the H&S have significantly lower healthcare costs than opioid addicted
individuals not in treatment.66
35. The H&S model has been lauded by experts as an innovative and effective model for
expanding access to MOUD. During the past five years, there have been numerous reviews of
strategies for expanding MOUD, and the H&S has been one of a very few approaches that are
61
Bipartisan Policy Center, “Tracking Federal Funding to Combat the Opioid Crisis,” March 2019, available at
https://bipartisanpolicy.org/wp-content/uploads/2019/03/Tracking-Federal-Funding-to-Combat-the-Opioid-
Crisis.pdf.
62
J.R. Brooklyn and S.C. Sigmon, “Vermont Hub-and-Spoke Model of care for opioid use disorder: Development,
implementation, and impact,” Journal of Addiction Medicine, 11(4), 2017, pp. 286-292.
63
R. Rawson, et al., “Assessment of medication for opioid use disorder as delivered within the Vermont hub and
spoke system,” Journal of Substance Abuse Treatment, 97, 2019, pp. 84-90.
64
Ibid, p. 87.
65
Rawson et al. (2019), op. cit.
66
M.K. Mohlman et al., “Impact of medication-assisted treatment for opioid addiction on Medicaid expenditures
and health services utilization rates in Vermont,” Journal of Substance Abuse Treatment, 67, 2016, pp. 9-14.

recommended.67 The Agency for Healthcare Research and Quality (AHRQ), part of HHS tasked
with the responsibility for identifying effective practices, lists the H&S model as a very
promising approach for expanding treatment for OUD.68 As the federal government has
provided new funding for OUD over the past three years, 12 states (and possibly more at this
time) are implementing the H&S model. For example, in 2017, California initiated a $90M
effort to expand the H&S in underserved and rural areas.69 Clearly the H&S model provides a
promising and very credible method for expanding and delivering lifesaving MOUD services.
36. In order to promote communication and cooperation between hubs and spokes, the
Vermont Department of Health and Medicaid office hosts a “Learning Collaborative” (LC) on a
quarterly basis for all staff in the H&S system. These LCs are full-day teaching and group
learning forums, led by addiction experts from Dartmouth and UVM, that are designed to
provide staff with guidance on the best evidence-based treatment. The LCs also provide a forum
for H&S personnel to get to know each other, coordinate patient care, and collectively review
data on H&S performance. In the early years of the H&S, LCs were held at least monthly, and
they are currently held at least quarterly. These meetings appear to have been instrumental to the
success of the H&S system.70
37. In addition to the H&S service system, Vermont has four inpatient treatment facilities,
with a total of 80 beds.71 All of these facilities are integrated with the outpatient H&S network
and deliver MOUD as part of their treatment programs. Other OUD services in Vermont
67
The Pew Charitable Trusts, 2018, op cit.; and D. Raths, “Vermont’s Hub-and-Spoke Approach to Opioid
Treatment Catching On,” Healthcare Innovation, May 22, 2018, available at https://www.hcinnovationgroup.com/
population-health-management/article/13030249/vermonts-hubandspoke-approach-to-opioid-treatment-catching-on.
68
R. Chou, et al., “Medication-Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care
Settings,” Technical Brief No. 28, Prepared by the Pacific Northwest Evidence-based Practice Center under Contract
No. 290-2015-00009-I, AHRQ Publication No. 16(17)-EHC039- EF. Rockville, MD: Agency for Healthcare
Research and Quality, December 2016, available at https://effectivehealthcare.ahrq.gov/sites/
default/files/pdf/opioid-use-disorder_technical-brief.pdf.
69
Miele, et al., op. cit.
70
B.R. Nordstrom, et al., “Using a learning collaborative strategy with office-based practices to increase access and
improve quality of care for patients with opioid use disorders.” Journal of Addiction Medicine, 10(2), 2016, pp. 117–
122.
71
This is one area where Vermont’s treatment capacity has room for improvement.

include: six syringe exchange facilities; an extensive naloxone distribution program; and
recovery coaches, who provide support for MAT initiation and retention. Additionally, in 2017,
Vermont lawmakers passed legislation mandating that all individuals with OUD who are
incarcerated in Vermont are offered access to buprenorphine and naltrexone. Most recently, in
Chittenden County – Vermont’s most populous county, and home of about 30% of the state
population – several “low-barrier” service innovations to expand MOUD for hard-to-reach and
hard-to-engage opioid users have been implemented. These new innovations include:
buprenorphine induction services in the emergency department of the UVM Medical Center in
Burlington, with linkage to the H&S system for ongoing care, and buprenorphine induction and
maintenance services incorporated into Burlington’s syringe exchange. Below, I provide further
detail on these additional treatment facilities and innovations.
Residential care
38. Although the H&S is the centerpiece of the Vermont opioid response, it is not the only
component. There are four residential treatment programs in Vermont, encompassing 80 beds.
These residential beds are needed for individuals who require high levels of support during their
induction period or during their ongoing care on MOUD. Such individuals can include: younger
patients, pregnant women, patients with co-occurring psychiatric or medical disorders, or
patients on MOUD in the H&S system who are struggling with use of non-opioids, including
benzodiazepines, alcohol, or stimulants. For many of these patients, a period of stabilization and
intensive care is necessary to allow them to have an optimal treatment response. All residential
programs are classified as level 3.7 or 4.0 using the American Society of Addiction Medicine
(ASAM) patient placement criteria, reflecting their ability to care for patients requiring high
levels of care intensity,72 and all provide MOUD as part of their care. Residential care settings
emphasize successful transfer to ongoing care in the H&S system upon discharge.
39. A significant number of individuals in Vermont use less intensive residential settings,
including sober living for varying lengths of stay. Because of the informal nature of these
72
American Society of Addiction Medicine, “What are the ASAM Levels of Care?” May 13, 2015, available at
https://www.asamcontinuum.org/knowledgebase/what-are-the-asam-levels-of-care/.

facilities, there are no state data on the number of individuals who use them or the lengths of
stay. Interviews with community resource leaders in Vermont suggest that as many as 10% of
individuals on MOUD are living in these facilities at any point in time.
Syringe exchange services
40. When the opioid epidemic was unfolding in Vermont, and health and policy leaders came
together to discuss service priorities, they decided to focus on reducing overdose deaths and
serious medical consequences from opioid use, including HIV and Hepatitis C. Comprehensive
literature reviews of research inside and outside the US clearly established that syringe exchange
services were among the most effective and cost-efficient methods for reducing the spread of
HIV, Hepatitis C, and other blood-borne diseases, including endocarditis.73 Further, syringe
exchange services were seen both as an outreach opportunity to educate injection drug users
about the benefits of treatment and as an entry point into treatment services in Vermont.
Currently, Vermont has six syringe exchange sites around the state.74
Naloxone distribution
41. As a step in the effort to reduce overdose deaths, in 2013, Vermont implemented an
aggressive program of naloxone distribution.75 During its first year, the effort distributed 1,447
naloxone overdose kits to 1,029 individuals.76 In 2018, this effort has expanded to 7,507 kits to
2,016 individuals.77 Kits and training on their use are dispensed to first responders (i.e., EMTs,
members of fire departments, and police departments), as well as drug users and their family
73
F. Laufer, “Cost Effectiveness of Syringe Exchange as an HIV Prevention Strategy” Journal of Acquired Immune
Deficiency Syndromes, 28, 2001, pp.273-278; D.Vlahov and B. Junge, “The Role of Needle Exchange Programs in
HIV Prevention” Public Health Reports, 113(1), 1998, pp 75-80; F.I Bastos and S.A Strathdee, “Evaluating
Effectiveness of Syringe Exchange Programmes: Current Issues and Future Prospects” Social Science & Medicine,
51, 2000, pp. 1771-1782
74
Personal Communication with Anthony Folland, Vermont Department of Health.
75
Vermont Department of Health, “Naloxone Distribution and Administration in Vermont – Data Brief,” June
2019, available at https://www.healthvermont.gov/sites/default/files/documents/pdf/ADAP_Naloxone_Data
_Brief_1.pdf.
76
Ibid.
77
Ibid.

members. While certainly an underestimate of the impact of this program, in the first three
months of 2019, 85 overdose reversals were recorded by first responders in Vermont.78 Clearly
this program has saved hundreds, if not thousands, of lives.
Recovery coaches
42. One of the major challenges of creating a strong response to the opioid crisis throughout
the US has been the shortage of personnel trained in delivering care to individuals with OUD.
To help respond to this shortage, Vermont has developed a cadre of “recovery coaches,” who use
lived experience from their own recovery to serve as peer support under the supervision of
licensed professionals.79 Recovery coaches work in hospitals, emergency departments, outpatient
medical clinics and syringe exchanges.80 They provide a level of support and assistance that
greatly expands the impact of the professional addiction treatment and health service systems.
Treatment for incarcerated individuals with OUD
43. In 2018, lawmakers in Vermont passed legislation requiring the Department of

Corrections to make MOUD available to all incarcerated individuals with OUD in Vermont
correctional settings.81 As of 2019, 661 individuals are receiving buprenorphine, naltrexone and
methadone in Vermont correctional settings.82 When individuals complete their incarceration,
they are linked directly into treatment in the Vermont H&S system with other services including
recovery housing and counseling.
78
Ibid.
79
SAMSHA, “Vermont Implements Peer Recovery Structure to Tackle Substance Use,” 2014, available at
https://www.samhsa.gov/homelessness-programs-resources/hpr-resources/vermonts-peer-recovery-structure
80
UVM Medical Center, “Recovery coaching: Peer support for patients with substance use disorder,” July 24, 2019,
available at https://www.burlingtonfreepress.com/story/sponsor-story/uvm-medical-center/2019/07/24/recovery-
coaching-peer-support-patients-substance-use-disorder/1793450001/ ; and Vermont Department of Health, “Peer
Recovery Coaches Provide Support and Assistance in Emergency Departments to Individuals with Substance Use
Disorders,” September 26, 2018, available at https://www.healthvermont.gov/media/newsroom/peer-recovery-
coaches-september-26-2018.
81
M. Faher, “More than 500 Vermont inmates receiving addiction treatment,” VTDigger, January 23, 2009,
available at https://vtdigger.org/2019/01/23/500-vermont-inmates-receiving-addiction-treatment/.
82
Personal Communication with Amy Kelly, Vermont Department of Corrections

A. Growth in Vermont’s Capacity for Treatment
44. The principal strategy in Vermont’s response to the opioid crisis has been to expand
MOUD and harm reduction services with the goal of reducing opioid overdose deaths. In the
graph below, it can be seen that from 2014, when the total number of people to receive MOUD
was 5,335, the number has increased to 10,025, almost a 100% increase. As of 2018, 2.6% of
Vermont’s population are receiving MOUD. This per capita rate is far higher than any other
state in the US. These H&S numbers do not present a complete picture. In addition to the
individuals on MOUD, there are individuals who are in other forms of treatment for OUD. In
2017, there were approximately 20 % of the number on MOUD, who were receiving behavioral
treatment, without MOUD (another 2,000). In addition, there are 661 incarcerated individuals
receiving MOUD in Vermont’s jails and prisons, several hundred in the VA program in White
River Junction and 100-200 in cash clinics that are not part of the Vermont H&S system. In
short, the effort to ramp up treatment using MOUD as the primary approach has been remarkably
successful.
FIGURE 8

B. Vermont’s System is Working
Overdose deaths
45. As described above, the number one priority for policy makers in the State of Vermont as
they developed their response to the opioid crisis was to implement a set of activities that would
result in fewer overdose deaths, with the H&S system as the primary strategy. As presented in
the figure below, relative to the other 5 states in New England, the increased rate of overdose
deaths has been significantly slowed in Vermont. As seen in the figure, in 2013, the rates of 5 of
the NE states were virtually identical (with the exception of Rhode Island, which was higher).
However, starting in 2014 (the first year of the H&S implementation), the overdose death rate in
Vermont has been consistently lower than the other 5 NE states. Using overdose death rates as a
measure, the H&S and related efforts in Vermont have saved lives, when contrasted to the
neighbor states in NE.

FIGURE 9
Effectiveness of MOUD treatment in the H&S
46. In order to determine if patients treated in the Vermont H&S system derived benefits
beyond avoiding overdose death, in October 2016, the Vermont Department of Health awarded
the University of Vermont (UVM) Center for Behavior and Health, in the Department of
Psychiatry, a grant to evaluate the Vermont H&S system for the treatment of OUDs. The primary
objective of the evaluation was to collect data on the impact of participation in the Vermont H&S
system and to assess the usefulness of these services to opioid users.
47. The evaluation report is a 180-page document. In brief the evaluation showed that
individuals treated with MOUD in the Vermont H&S system dramatically reduced their opioid
use. Figure 10 illustrates the magnitude of the reduction in opioid use and injection drug use.
This figure based on a randomly selected group of 80 individuals in treatment in the H&S system
for at least 6 months, shows the change in the number of days of opioid use (and injection) from

the period 90 days before treatment admission, to a 90 day period when the individuals were in
treatment for at least 6 months.
Figure 10
Figure 14: Opioid use of in-treatment participants

(n = 80)
90
80 90 days before treatment
90 days before interview
70
Number of Days of Use
60
50
40
30
20
10
0
Any Opioid Use Prescription Illicit Opioids Opioid Treatment Opioid Injection
Opioids without a Medication,
Doctor's without
Prescription Prescription
48. The data from the evaluation found many other major changes: Reductions in cocaine,
methamphetamine and alcohol use, reductions in arrests, days in jail and self-reported days of
criminal activity and reductions in overdose, visits to the emergency department and overnight
stays in the hospital. In addition, patients reported improvement in depression and anxiety,
family functioning and in overall quality of life. The results of the evaluation were
overwhelmingly supportive of the benefits of treatment within the H&S system and are available
in Rawson et al. (2018).

C. Ongoing Work in Vermont
49. Efforts to address low barrier treatments in Chittenden County include buprenorphine
induction in the emergency department at the UVM Medical Center and buprenorphine induction
and maintenance in the syringe exchange program in Burlington and in the hospital ED.
50. As the overdose death data presented above indicate, as a result of Vermont’s robust
response to the opioid crisis, with the H&S service network and the other elements of treatment
and harm reduction, Vermont’s overdose death rate has remained significantly lower than the
other five New England States. As a result of the success of this innovative effort, many other
states are replicating the work in Vermont.
51. However, as illustrated in the overdose death graph above (Figure 9), despite this effort,
the emergence of fentanyl in 2015 to date, has caused the overdose rate in Vermont to continue
upward (albeit at a slower rate of increase than the other NE states). In response to this
continuing overdose death crisis, in Chittenden County, Vermont’s population center, several
new initiatives were undertaken in 2018 to reduce overdose deaths. These two programs are
considered “low barrier” programs, as they bring access to the addicted individuals who are not
willing or able to enter formal treatment programs. These programs offer immediate induction
onto buprenorphine without waiting at the syringe exchange in Burlington (and patients can
remain in treatment at the syringe exchange or transfer into H&S treatment; and induction onto
buprenorphine in the emergency department at the University of Vermont Medical Center,
without waiting during 21 of the 24 hours per day (3 am to 6 am the induction service is not
available), 7 days per week. By lowering the barrier to buprenorphine induction, the goal is to
bring people into treatment who are not accessing the standard H&S treatment services.
Vermont’s goal, as reflected throughout, is to reduce overdose deaths.
52. Although only one year of data is available, the effort appears to be very promising. In
the figure below, the overdose death rate for the state of Vermont is the top line, reflecting an
upward trend through 2018. The second line reflects the death rate in the 13 counties in
Vermont, except for Chittenden County, an upward trend through 2018. The bottom line in the
graph is the overdose death rate in Chittenden County. As can be seen, the upward trend is

reflected through 2017, but in 2018, the rate significantly declined. In 2017, there were 35
overdose deaths in Chittenden County, but this declined to 17 in 2018 (a reduction of over 50%).
As of July of 2019, the significantly lower rate in Chittenden County appears to be continuing.
53. It is not clear if the reduction in the death rate in Chittenden County can be accounted for
by the development of the low barrier services, but the results look very promising. One fact that
is clear, however, the expanded use of MOUD and other harm reduction services have reduced
the number of people in the State of Vermont who have died from opioid overdose. The primary
priority of the Vermont response to the opioid crisis, initiated in 2013, has been effectively
addressed, although more work is needed.
FIGURE 11

VI. THE NEED FOR INCREASED TREATMENT CAPACITY IN EASTERN TENNESSEE
A. Issues Unique to Northeast Tennessee
54. In addition to the differences in prescribing and high-risk use described in Section IV.C,
Tennessee’s experience with abuse and diversion, which are related to prescribing rates and
patterns, has been different from Vermont’s. This should inform the Northeast Tennessee
response to the opioid epidemic.
55. Over a decade ago, drug dealers began trafficking prescription opioids through Florida
pharmacies or prescribers for diversion into Tennessee communities, on a route that became
known as the “Florida Pipeline” or “Oxy Express,” referring to Interstate 75.83 Northeast
Tennessee’s proximity to I-75 exposed the region to trafficked prescription opioids. Following a
DEA crackdown in Florida, there was a “squeezing the balloon effect,” and pill mills began
migrating to Tennessee, where there were already a significant number of high-volume
prescribers.84 Tennessee’s struggle with high-volume prescribers continues, and multiple
prescribers and pharmacists have been arrested this year.85 The United States Office of Drug
83
G. Allen, “The ‘Oxy Express’: Florida’s Drug Abuse Epidemic,” NPR Morning Edition, March 2, 2011. available
at http://www. npr.org/2011/03/02/134143813/the-oxy-express-floridas-drugabuse-epidemic; “The government’s
struggle to hold opioid manufacturers accountable,” The Washington Post, April 2, 2017, available at
https://www.washingtonpost.com/graphics/investigations/dea-mallinckrodt/?hpid=hp_hp-top-table-main_dea-
645pm%3Ahomepage%2Fstory&utm_term=.600de72194cb.
84
J. Rannazzisi (Deputy Assistant Administrator, Drug Enforcement Administration), Statement before the Caucus
on International Narcotics Control, United States Senate, “Responding to the Prescription Drug Abuse Epidemic”
Hearing, July 18, 2012, p. 6; G. Kerlikowske (Director of National Drug Control Policy), Statement before the
Caucus on International Narcotics Control, United States Senate, “Responding to the Prescription Drug Abuse
Epidemic” Hearing, July 18, 2012, p. 10. (“There have been notable increases in doctors purchasing oxycodone in
Georgia, Tennessee, and Kentucky. Among oxycodone-purchasing doctors, 21 doctors located in Georgia and 11 in
Tennessee are among the top 100.”); C. Ornstein and R.G. Jones, “As Controlled Substance Use Rises in Medicare,
Prolific Prescribers Face More Scrutiny” National Public Radio, Propublica, USA Today, December 15, 2014,
available at https://www.propublica.org/article/as-controlled-substance-use-rises-in-medicare-top-prescribers-face-
scrutiny (stating, “In 2012, 269 providers wrote at least 3,000 prescriptions for Schedule 2 drugs, ProPublica’s
analysis shows. They were concentrated in a handful of states. Florida led the country with 52 prescribers, followed
by Tennessee with 25.”)
85
See e.g., “12 million pills and 700 deaths: How a few pill mills helped fan the U.S. opioid inferno,” The Los
Angeles Times, June 24, 2019, available at https://www.latimes.com/nation/la-na-pol-pill-mills-linked-to-hundreds-
of-deaths-20190614-story.html; Department of Justice, Press Release, “Appalachian Regional Prescription Opioid
(ARPO) Strike Force Takedown Results in Charges Against 60 Individuals, Including 53 Medical Professionals,”

Control Policy has designated Greene, Hamblen, Hawkins, Sullivan, Unicoi and Washington
counties “High Intensity Drug Trafficking Area” counties – “areas within the United States that
exhibited serious drug trafficking problems and harmfully impacted other areas of the country.”86
56. Large numbers of opioids and high dose prescriptions are involved in abuse and
diversion. A drug’s overall availability contributes to its abuse potential.87 When prescription
opioids are sold on the street, higher dosages have a higher monetary value, presenting a
temptation for impoverished individuals living in a high-supply, high-demand area. For example,
prescription opioids are often valued at $1 per milligram when sold illicitly.88 Thus, a 30-
day prescription of 80 mg OxyContin, which typically contains 60 pills, as OxyContin is taken
twice per day, would have a street value of $4,800, while the yearly median income in Kingsport,
Tennessee is $43,516.
57. An analysis using 2011-2015 claims data found the Tri-Cities area among the top 25
cities in the country for opioid abusers per capita.89 The study estimated that 46.7 percent of all
opioid prescriptions are abused in the Tri-Cities.90
B. The Current Treatment System in Eastern Tennessee
58. The Northeast Tennessee region is served by only one OTP – Overmountain Recovery
(“Overmountain”), located in Gray, Tennessee, which has capacity to serve 600 patients and a
current census of approximately 275. TennCare does not currently cover methadone; however,
more importantly, Overmountain is too far away for many Northeast Tennessee residents.
April 17, 2019 available at https://www.justice.gov/opa/pr/appalachian-regional-prescription-opioid-arpo-strike-

force-takedown-results-charges-against.
86
United States Attorney’s Office, Eastern District of Tennessee, “Appalachian High Intensity Drug Trafficking
Area,” available at http://ahidta.org.
87
W. Compton and N. Volkow, “Abuse of prescription drugs and the risk of addiction,” Drug Alcohol Depend,
83(1), 2006.
88
H. Surrat et al., “Street prices of prescription opioids diverted to the illicit market: data from a national
surveillance program” The Journal of Pain, 14(4), 2013, pp. S40
89
Castlight Health, “The opioid crisis in America’s workforce,” available at https://www.ashlandmhrb.org/
upload/the_opioid_crisis_in_americas_workforce.pdf.
90
Ibid.

Studies show that reduced travel times to outpatient treatment settings can significantly improve
rates of service use. 91
59. The Northeast Tennessee treatment landscape presents at least two public health
challenges with regard to buprenorphine: in five rural counties there are insufficient providers, if
any, whereas in in two urban counties buprenorphine is available but often not prescribed
according to best practices that make for sustained effected treatment. For example, there are 34
OBOTs licensed by the Tennessee Department of Mental Health and Substance Abuse Services
in the nine Tennessee counties with Washington and Sullivan Counties containing the majority.92
Carter, Johnson, Unicoi, and Hancock Counties do not have any licensed OBOTs.93 These
smaller, more rural Counties also have many fewer buprenorphine-waivered prescribers
compared to Washington and Sullivan Counties.94 A recent study classified Carter, Hawkins,
and Unicoi Counties as “high-risk” counties, while Johnson and Hancock Counties’ status is
listed as unknown.95
91
J. Fortney et al., “The effects of travel barriers and age on the utilization of alcoholism treatment aftercare,”
American Journal of Drug and Alcohol Abuse, 21, 1995, pp. 391-406; S.K. Schmitt, C.S. Phibbs, J.D. Piette, “The
influence of distance on utilization of outpatient mental health aftercare following inpatient substance abuse
treatment,” Addict Behavior, 28(6), 2003, pp. 1183-92.
92
Tennessee Department of Mental Health and Substance Abuse Services, “Fast Facts: TDMHSAS Licensed Sites”
available at https://www.tn.gov/content/tn/behavioral-health/research/tdmhsas-fast-facts-test-3/fast-facts--tdmhsas-
licensed-sites.html.
93
Ibid.
94
SAMHSA, “Buprenorphine Practitioner Locator” available at https://www.samhsa.gov/medication-assisted-
treatment/practitioner-program-data/treatment-practitioner-locator?field_bup_physician_us_state_value=TN.
95
R.L. Haffajee et al., “Characteristics of US Counties With High Opioid Overdose Mortality and Low Capacity to
Deliver Medications for Opioid Use Disorder,” JAMA Network Open., 2(6), 2019.

60. Buprenorphine diversion is common in the nine Tennessee counties.96 In Washington
and Sullivan Counties, there are regular complaints about cash-only buprenorphine “pill mills.”97
Limited access and capacity could explain the high rates of buprenorphine diversion in the nine
Tennessee counties.98
61. At the present time, the nine Tennesse counties have 3 residential treatment programs that
provide counseling and non-medication treatments with a combined capacity of 131 beds.99 The
Tennessee Department of Mental Health and Substance Abuse Services 2019 Needs Assessment
for Region 1, which encompasses all of the nine counties in Northeast Tennessee except
Hamblen County, stated that there is a need to “[i]ncrease recovery housing to include peer run
recovery residences, halfway houses, and three-quarter housing options to support treatment
adherence and recovery skills.”100 In support, the Needs Assessment stated:
According to the Tennessee Department of Health (DOH), the overdose rates continue to
rise. In FY 2018, Region 1 crisis data indicates that 3,170 individuals presented to area
hospitals for substance use treatment needs. Similarly, residential treatment needs
continue to rise as court referrals are increasing due to diversionary programs through
Office of Criminal Justice Programs (OCJP). As a result, there are limited beds available
96
See e.g.,“Endless prescription: Suboxone, Subutex plaguing region,” Kingsport Times, July 3, 2016, available at
https://www.timesnews.net/Local/2016/07/03/An-endless-prescription-Suboxone-Subutex-becoming-an-epidemic-
in-the-region; Tennessee Department of Mental Health and Substance Abuse Services, “Tennessee Nonresidential
Buprenorphine Treatment Guidelines, Summer 2018 Update,” (stating “In 2017…there was widespread
acknowledgement of the need for these treatment Guidelines due to the growing prevalence of individuals who have
an opioid use disorder, an increased number of individuals using medication-assisted treatment with buprenorphine,
and diversion issues associated with buprenorphine.”); “TennCare Cut Coverage For Suboxone; A Nashville Doctor
Says Aftermath Shows It Was Being Abused,” Nashville Public Radio, August 23, 2016, available at
https://www.nashvillepublicradio.org/post/tenncare-cut-coverage-suboxone-nashville-doctor-says-aftermath-shows-
it-was-being-abused#stream/0; “Heroin, Buprenorphine Drug Busts on the Rise in Tennessee,” February 10, 2016,
https://www.tn.gov/behavioral-health/news/2016/2/10/heroin-buprenorphine-drug-busts-on-the-rise-in-
tennessee.html; “TDH Finds Some Overdose Deaths Associated With Buprenorphine,” January 18, 2018, available
at https://www.tn.gov/health/news/2018/1/8/tdh-finds-some-overdose-deaths-associated-with-buprenorphine.html.
97
“Local addiction treatment facility raided by federal agents,” Johnson City Press, May 2, 2018, available at
https://www.johnsoncitypress.com/law-enforcement/2018/05/02/Local-addiction-treatment-facility-raided-by-
federal-agents-owner-denies-anything-illegal-or-unethical.html.
98
Ibid.
99
Ibid.
100
Tennessee Department of Mental Health and Substance Abuse Service, “Planning and Policy Council 2019
Needs Assessment Summary,” available at
https://www.tn.gov/content/dam/tn/mentalhealth/documents/planning/FINAL%202019%20NA%20Summary.pdf

for the number of individuals needing treatment, and if they are able to receive treatment,
the limited availability of sober-living homes increases the chance of relapse as many of
these individuals do not have sober environments they can return to.101
62. “Expand transitional recovery housing beyond sober living home” was listed in the
agency’s 2018 Needs Assessment as well, stating that “Oxford House is currently the only
transitional recovery option in Region I. While the number of Oxford House beds have increased
in Johnson City, outlying communities such as Greeneville, Bristol, Kingsport, and Rogersville
are still at a deficit.”102
C. Services Needed to Build an Effective Treatment System in Eastern Tennessee
63. In order to meaningfully address the opioid crisis and harms related to the illegal opioid
market in the region, the nine Tennessee counties should implement a coordinated, fully
integrated plan incorporating the following:
• A system of OUD services located throughout Northeast Tennessee, such that
individuals have ready access to care (30 minutes or less from their home); where
they can be admitted within 72 hours of presenting for admission;
• A netork of connections to treatment, referrals, and “warm handoffs” at each point
of care;
• Continuity of care provided by a multidisciplinary team that can facilitate patient
transitions between various health services and higher and lower levels of service
based on patients’ evolving needs and treatment responses;
• Addiction specialists providing expertise, support, and training for other
providers; and
• Care for psychiatric conditions and complex and challenging patients.
64. Elements of Eastern Tennessee’s system should include: Outpatient settings provide
medication treatment for MOUD, primarily buprenorphine treatment (with naltrexone for
patients as clinically indicated). This network of outpatient sites will provide the majority of
101
Ibid.
102
Tennessee Department of Mental Health and Substance Abuse Services, “Planning and Policy Council, 2018
Needs Assessment Summary,” available at https://www.tn.gov/content/dam/tn/mentalhealth/documents/
planning/2018%20NA%20Summary.pdf.

OUD treatment in the proposed system of OUD care. Some of these settings will be dedicated to
opioid treatment programs, or they can include primary care and other general medical or mental
health facilities where prescribers can deliver MOUD care with proper support services. Patients
can be transferred between levels of care to reflect their needs and the level of severity of their
OUD and related issues. The system will attempt to provide care for patients in the least
restrictive level of care that is clinically indicated.
Residential and inpatient care
65. Although this network can serve as the centerpiece of the Eastern Tennessee opioid
response, it will be accompanied by other components to meet the diverse needs of individuals. I
estimate that, based on the effort in Vermont’s and in California’s H&S system,103 approximately
10%-15% of the individuals receiving treatment for OUD should reside in residential care and 3-
5% should reside in an inpatient detoxification facility. These beds are needed for individuals
who need high levels of support during their induction period or during their ongoing care on
MOUD. Individuals who may require this care include: individuals under the age of 21,
pregnant women, patients with co-occurring psychiatric or medical disorders, or patients on
MOUD in the H&S system who are struggling with use of non-opioids, including
benzodiazepines, alcohol or stimulants. For many of these patient categories a period of
stabilization and intensive care is necessary to allow them to have an optimal treatment response.
These programs should meet the ASAM criteria as level 3.7 or 4.0, and they will be required to
promote the use of MOUD as part of their inpatient care and continuing outpatient care.
Emphasis on successfully transferring to ongoing care upon discharge.
Housing
66. Less intensive residential settings, including sober living for varying lengths of stay will
also be critical for a significant number of individuals in Eastern Tennessee. Best estimates from
Vermont are that approximately 10% of individuals receiving treatment need a safe and drug free
environment to stabilize their recovery. It will be important for Tennessee to use facilities that
103
In my opinion, both Vermont and California should improve access to these facilities.

are credentialed and have some recovery programming and oversight to be sure the sober living
facilities remain drug-free as advertised.
Recovery coaches
67. Recovery coaches who are using lived experience in their own recovery can provide
valuable peer support under supervision of licensed professionals. Recovery coaches are valuable
personnel to working in hospitals, emergency departments, outpatient medical clinics and
syringe exchanges. With the proper training and supervision (which is critical) they can build
bridges between the addiction service providers and other aspects of the health system.
Treatment for incarcerated individuals with OUD
68. There is a growing literature to document that incarcerated individuals benefit

tremendously from MOUD during and following their incarceration.104 Eastern Tennessee jails
will need the capability of continuing the MOUD treatment of individuals who come into
incarceration already on MOUD; they will need the capability to induct individuals diagnosed
with OUD onto MOUD while incarcerated; and they will need the capability to arrange for
transfer of individuals on MOUD into community care when they are released into the
community. I understand from counsel that the jails may be unwilling to provide oral
buprenorphine because it is considered valuable contraband. For this reason, the recently
approved injectable buprenorphine is a good option105 that, in my opinion, would be preferable to
vivitrol for the large majority of patients and would have a real impact on reducing overdose
deaths upon release.
Buprenorphine induction in emergency departments
69. By lowering the barrier to buprenorphine induction, it is possible to make MOUD

services accessible and acceptable to individuals with OUD, who are unable or unwilling to enter
104
For example, see Zaller et al., “Intitiation of buprenorphine during incarceration and retention in treatment upon
release,” Journal of Substance Abuse Treatment, 45(2), August 2013, pp. 222-226.
105
For example, see C. Moraff, “Pennsylvania DOC to Pilot Injectable Buprenorphine for Detoxing Prisoners,”
available at https://filtermag.org/pennsylvania-doc-to-pilot-injectable-buprenorphine-for-detoxing-prisoners/.

mainstream H&S or other treatment service settings. Buprenorphine induction in the emergency
departments in Eastern Tennessee will greatly increase engagement of individuals with OUD
into treatments. To implement these services, doctors, nurses and other ED personnel will need
training and additional support staff to add this service. Syringe exchanges will need to add the
services of MOUD prescribers and other clinical support staff.
Training and Technical Assistance Services Needed to Build the Eastern Tennessee System
70. To develop the extensive array of services needed in Eastern Tennessee an

implementation plan could be borrowed from a similar effort in California.106 To reduce the
opioid overdose crisis and expand MOUD in California, the California Department of Health
Care Services (DHCS) selected the Hub and Spoke (H&S) model, developed in Vermont,107 to
create a treatment system that expands access to care for OUD.
71. Eastern Tennessee will need a very ambitious implementation plan to scale up the
treatment services rapidly and build treatment capacity. For that purpose it could use the model
described by Miele and colleagues.108 The Eastern Tennessee implementation plan will be
designed to: increase the number and capacity of waivered buprenorphine prescribers; enhance
skills of prescribers and multidisciplinary teams; promote enrollment of individuals with OUD
into treatment and create a coordinated regional system of opioid treatment and support services.
The training and technical assistance activities will include: Buprenorphine waiver trainings and
provider support, a practice facilitator program that will provide mentoring to new prescribers,
Project ECHO sessions and webinars to provide clinical guidance on common clinical challenges
in treating individuals with OUD and in-person clinical skills trainings. In addition, regional
Learning Collaboratives will be created to ensure communication and cooperative relationship
building among the different practitioners and organizations involved in service delivery in
Eastern Tennessee.109 These quarterly regional Learning Collaborative meetings will help
106
Miele et al., op. cit.
107
Simpatico, op. cit.
108
Miele et al., op. cit.
109
Nordstrom et al., op. cit.

promote the development of a coordinated system of care. Engaging an organization like
Groups,110 that sets up buprenorphine clinics that offer extensive clinical services, could also
help to quickly ramp up treatment capacity in the area.
Role of counties and benefits of publicly-funded treatment
72. Tennessee has not expanded Medicaid, which has been an essential component of
Vermont’s progress in combatting the opioid epidemic. The Tennessee agency charged with
addressing substance abuse treatment, the Tennessee Department of Mental Health and
Substance Abuse Services, is under-funded and ill-equipped to facilitate the system
transformation needed to address the crisis in Northeast Tennessee. Publicly-funded programs
present an opportunity to reconfigure and link services so that “systems of care—collections of
services, structures, and processes that are purposively designed and interconnected in order to
treat substance use disorder systematically—can maximize the clinical impact and cost
efficiency of substance use disorder treatment.”111 In the past, these efforts have failed due to
challenges related to planning, logistics, provider resistance, and resource scarcity.112
73. It is well-documented that Northeast Tennessee, like the Appalachian region generally,
has been more severely impacted by the opioid epidemic than other areas, and the nature of the
opioid epidemic in the region presents a unique set of challenges and issues.113 This supports the
need for a region-driven, locally-coordinated response. Data shows that the odds of adopting
pharmacotherapies were significantly greater in government owned programs.114 Studies have
also shown that nonelderly adults with OUD who had Medicaid were significantly more likely to
110
See https://joingroups.com/.
111
H. Padwa et al., “Organizing Publicly Funded Substance Use Disorder Treatment in the United States: Moving
Toward a Service System Approach,” Journal of Substance Abuse Treatment, 69, 2016, pp. 9-18.
112
Ibid.
113
B. Paykamian “Local treatment and prevention expert weighs in on Tennessee opioid statistics,” Johnson City
Press, November 29, 2018, available at https://www.johnsoncitypress.com/Health-Care/2018/11/28/Tennessee-
ranks-first-in-opioid-sales-consumer-report-says
114
H. Knudsen et al., “Facilitating Factors and Barriers to the Use of Medications in Publicly Funded Addiction
Treatment Organizations,” Journal of Addiction Medicine, 4(2), 2010, pp. 99–107.

receive treatment than those with private coverage.115 The use of contracts can affect MOUD
capacity, allowing the funder to dictate types of services covered and how or where the services
can be provided.116 This allows funders to require through contract the provision of MOUD, co-
location of providers, and any performance or outcome measurement data collected.117
Conclusion
74. Dr. Stern has outlined a plan to supplant the existing, fragmented treatment system in
Eastern Tennessee with a county-funded system that is at least partially modeled on Vermont’s
H&S system. Dr. Stern estimates that his system could engage 10,000 patients within five years.
Based on my understanding of the situation in Eastern Tennessee, my experience in Vermont, as
well as my correspondence with Cooper Zelnick of Groups, I believe that Dr. Stern’s estimates
are conservative in the sense that they might be able to scale up treatment capacity even faster.
Richard A. Rawson, Ph.D.
September 20, 2019
115
Henry J. Kaiser Family Foundation, “The Opioid Epidemic and Medicaid’s Role in Facilitating Access to
Treatment,” available at https://www.kff.org/medicaid/issue-brief/the-opioid-epidemic-and-medicaids-role-in-
facilitating-access-to-treatment/.
116
“State and Local Policy Levers for Increasing Treatment and Recovery Capacity to Address the Opioid
Epidemic: Final Report,” available at https://aspe.hhs.gov/system/files/pdf/259511/SLlevers.pdf; Padwa, et al., op.
cit.
117
Ibid.

Attachment A
REPORT OF DR. RICHARD A. RAWSON: OPIOIDS ATTACHMENT A

HIGHLY CONFIDENTIAL
Richard A. Rawson, Ph.D.
Curriculum Vitae
Dec 10, 2018
PERSONAL HISTORY
Address: 1952 Rte 73

Brandon, VT 05733
(310) 951-9091 mobile
rrawson@mednet.ucla.edu
richard.rawson@uvm.edu
Citizenship: United States of America
EDUCATION
1970 University of Vermont, Burlington, Vermont

B.A., Psychology, University of Vermont
1974 University of Vermont, Burlington, Vermont

Ph.D., Psychology
PROFESSIONAL EXPERIENCE
2016 - Present Research Professor, Center for Behavior and Health, Department of Psychiatry, University
of Vermont, Burlington Vermont
2016 - Present Professor Emeritus, Department of Psychiatry and Biobehavioral Sciences, UCLA, Los
Angeles California
2012 – Present Adjunct Clinical Professor, Department of Psychiatry, University of Hawaii, Manoa,
Honolulu, Hawaii
2013 – 2015 Co-Director, UCLA Integrated Substance Abuse Programs (ISAP), UCLA Department of
Psychiatry and Biobehavioral Sciences, Los Angeles, CA.
2006 – 2015 Professor-in-Residence, UCLA Department of Psychiatry and Biobehavioral Science, Los
Angeles, CA.
1995 – 2013 Associate Director, UCLA Integrated Substance Abuse Programs (ISAP),
UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA.
1999 – 2006 Adjunct Associate Professor, UCLA Department of Psychiatry and Biobehavioral Science,
Los Angeles, CA.
1996 – 2001 Director of Research, NIDA Medication Development Unit, Long Beach Veterans Affairs,
Long Beach, CA.
1988 – 1998 Executive Director and Board Member, Matrix Institute on Addictions, Los Angeles, CA.
1984 – 1998 President and Chairman of the Board, Matrix Center, Los Angeles, CA.
1979 – 1984 Director of Operations, Community Health Projects, West Covina, CA.
1978 – 1980 Assistant Research Psychologist, Department of Psychiatry, New York Medical
College, NY.
1974 – 1978 Assistant Research Psychologist, Department of Psychiatry, UCLA, Los
Angeles, CA.
Richard A. Rawson, PhD
PROFESSIONAL ACTIVITIES
Professional Associations and Committee Service

2015 Scientific Committee of the 20th World Congress of the World Federation for Mental
Health (WFMH 2015) in Cairo, Egypt, Oct. 16-19, 2015.
2013 The American Friends of Skoun, Board of Directors
2013 Treatment Research Institute, Policy Advisory Council
2013 – 2015 UCLA Center for World Health, Internal Advisory Committee
2011– 2014 SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) Advisory Committee
2010 – 2013 Betty Ford Institute, Executive Council
2007 – 2010 College on Problems of Drug Dependence (CPDD), Board of Directors
1987 – 2015 American Psychological Association (APA)
2001 – 2013 Advisory Group for Director of California Department of Alcohol and Drug Programs
Editorial Services
2016 – Present Executive Board and Editorial Board, International Addiction Review
2014 – Present Associate Editor, Journal of Studies on Alcohol and Drugs
2009 – Present Editorial Board, Journal of African Behavioral Health
2004 – 2007 Editorial Board, NIDA Science & Practice Perspectives
2001 – 2010 Associate Editor, Journal of Substance Abuse Treatment
Continuous Ad hoc reviewer for numerous journals
2007 Guest Editor for Addiction special issue on Methamphetamine.
2003 Guest Editor for the Journal of Psychoactive Drugs special issue on California Policy Issues
2002 Guest Editor for the Journal of Drug Issues special issue on Practice-Research Integration
2002 Guest Editor for the Journal of Substance Abuse Treatment special issue on Blending Practice
and Research
2002 Guest Editor for the Journal of Addictive Diseases special issue on
Methamphetamine
2000 Guest Editor for the Journal of Psychoactive Drugs special issue on Methamphetamine
1996 – 1999 Member of the Editorial Advisory Board for the CSAT Treatment Improvement Protocol
(TIPs)
1994 – 1998 Editorial Board for Journal of Maintenance in the Addictions
1993 – 1997 Editorial Board of Behavioral Healthcare Management Magazine
International, Federal, and State Agency Activities

Member WHO Working Group on Mental Health Guidelines (ongoing)
Member California Institute for Mental Health Integration Expert Panel, Jan. 9 & 10, 2012
Participant ONDCP/SAMHSA meeting on workforce development, July 2011
Member NIDA Ad Hoc IRG Committees (Multiple Occasions)
Team Member NIDA Site Visit Grant Review (Multiple Occasions)
Chair NIDA Ad Hoc Grant Review Sessions (Multiple Occasions)
Member NIDA Technical Review Sessions, 1991
Consultant NIDA on the Development of Ibogaine, 1993
Participant Expert Panel for the House Committee on Technology Transfer, 1998
Participant First NIDA Conference on Technology Transfer, 1991
Consultant Attorney General Reno and ONDCP on Methamphetamine, 1996-2000
Member CSAT Expert Panels for Treatment Improvement Protocols (TIPS), 1995-2003
Member TIP Editorial Advisory Board to CSAT, 1995-2003
Testified U.S. Senate and House hearings on methamphetamine 2004, 2005, 2006
Speaker U.S. Department of State on methamphetamine. U.S. Embassy, Vienna, Austria,
2005
2
Member SAMHSA-sponsored training team to work with the Iraqi Health Ministry on substance
abuse treatment, Cairo, Egypt, March 2006
Co-Chair Governor’s (California) Commission on Methamphetamine, 2006-2007
HONORS and SPECIAL AWARDS

2013 Dole and Nyswander Career Achievement Award, AATOD
2011 NIDA International 2011 Award of Excellence
2009 UCLA Department of Psychiatry Excellence in Teaching Award
2009 Decade Lecture at the ISAM Annual Meeting in Calgary, Canada
2007-2010 Elected to the Board of Directors of the College on Problems of Drug Dependence
2008 Outstanding Work in the Area of Research, County Alcohol and Drug Administrators’
Association of California
2008 CSAM Vernelle Fox Award Presentation
1998 Friends Research Institute Mentoring Award
CURRENT RESEARCH, TRAINING and EVALUATION GRANTS and CONTRACTS

2018-2020 Co-principal Investigator/Evaluator, Assessment and buprenorphine initiation in the
emergency department of three University of Vermont hospitals. $1,500,000
2017-2020 Principal Investigator, Implementation of the California Hub and Spoke System of Opioid
Treatment. California Department of Health Services. $2,000,000
COMPLETED RESEARCH, TRAINING AND EVALUATION PROJECTS
2016-2017 Principal Investigator, Evaluation of the Vermont Hub-and-Spoke System for the
Treatment of Opioid Use Disorders, Vermont Department of Health. $200,000
2012-2017 Co-principal Investigator, SBIRT for Substance Abuse in Mental Health Treatment
Settings. Funded by National Institute on Drug Abuse, $2,500,000
2014-2017 Principal Investigator, Saudi Addiction Research Program; ongoing variable contract.
Saudi Embassy, Washington, DC
2014-2015 Principal Investigator, Cooperative Agreement for Workforce Development in Vietnam:
HIV-Addiction Technology Transfer Center. $1,050,000
2012-2016 Principal Investigator, UCLA-Cairo University Training Grant, Funded by the NIH
Fogarty Center, $1,100,000
2009-2015 Principal Investigator, Aerobic Exercise to Improve Outcomes for Treatment of
Methamphetamine Dependence. Funded by National Institute on Drug Abuse.
$2,400,000
2012-2015 Co-principal Investigator, Pacific Southwest Technology Transfer Center. $3,000,000.
Funded by SAMHSA.
2012-2015 Principal Investigator, Evaluation of Skoun and Marsa Services in Beirut Lebanon.
Funded by Drosos Foundation, $130,000
2013-2015 Principal Investigator, Iraqi National Drug Survey. Funded by State Department
International Narcotic Liaison, CHS Subcontract $400,000.
2012-2014 Co-principal Investigator, Los Angeles County Evaluation Services, $2,200,000
2013-2014 Principal Investigator, SBIRT in Vietnamese HIV Treatment and Testing Centers.
NIDA Supplement, $100,000
1999-2015 Co-principal Investigator (Walter Ling, PI), Clinical Trials Network UCLA Node.
NIDA Grant to UCLA, $11,200,000.
2011-2014 Principal Investigator, Cooperative Agreement for Workforce Development in Vietnam:
HIV-Addiction Technology Transfer Center. $750,000.
2011-2012 Principal Investigator, Interagency Agreement to Provide Assistance to the Government
of Iraq’s Ministry of Health on Drug Demand Reduction. $1,000,000.
2012-2014 Co-principal Investigator, Evaluation Services and Technical Assistance Contract with
California Department of Alcohol and Drug Programs. $2,400,000
2009-2011 Principal Investigator, Evaluation Services to Enhance the Data Management System in
California. Funded by State of California/DADP. $1,800,000
3
2007-2012 Principal Investigator, NIDA Institutional Training Grant. $1,500,000. National Institute
on Drug Abuse
2008-2010 Principal Investigator, Double-blind, Placebo Controlled Trial of Bupropion for
Methamphetamine Dependence, NIDA Contract, $1,200,000.
2008-2010 Principal Investigator, Evaluation of the Co-occurring Disorders Court. $157,000.
Funded by L.A County Department of Alcohol and Drug Programs.
2008-2009 Principal Investigator, Continuum of Services Redesign. $480,000. Funded by the
State of California.
2007-2008 Co-principal Investigator, Training Contract to Improve Treatment for Individuals with
Co-occurring Disorders $2,250.000. Funded by LA County Department of Mental
Health, Thomas Freese, PI.
2007-2008 Principal Investigator, CARE Evaluation Contract. $250,000. Funded by the State of
California.
2007-2008 Principal Investigator, California Outcomes Measurement System (CalOMS) Evaluation
Contract. Funded by the State of California, $630,000.
2005-2007 Principal Investigator, Double-blind, Placebo Controlled Trial of Modafinil for
Methamphetamine Dependence, NIDA Contract, $575,000.
2007-2011 Principal Investigator, LA County Evaluation System: An Outcomes Reporting Program
(LACES), Phase III. Funded by the County of Los Angeles, California, $980,000.
2005-2007 Principal Investigator, Training and Capacity Building Center for the UNODC Worldwide
Network of Substance Abuse Resource Centers. Funded by the UNODC, $480,000.
2005-2010 Co-principal Investigator, Four Models of Telephone Support for Stimulant Recovery,
$2,585,197, NIDA, David Farabee, PI.
2005-2007 Co-principal Investigator, Children Endangered by Methamphetamine Use and
Manufacture, NIDA, $387, 400, Nena Messina, PI.
2005-2010 Co-principal Investigator, Cognitive Behavioral Therapy for the Republic of South
Africa, NIDA $1,487,500, Donnie Watson, PI.
2005-2009 Principal Investigator, UCLA Access to CARE Project, SAMHSA, $1,500,000.
2003-2005 Principal Investigator, Double-Blind, Placebo Controlled Study of Ondansetron for the
Treatment of Methamphetamine Dependence. UCLA ISAP, NIDA, Methamphetamine
Clinical Trials Group, $500,000.
2002-2005 Principal Investigator, Double-Blind, Placebo Controlled Study of Bupropion for the
Treatment of Methamphetamine Dependence. UCLA ISAP, NIDA, Methamphetamine
Clinical Trials Group; NIDA $2,042,000.
2004-2005 Co-principal Investigator, Using Drug Abuse Research to Build Cooperation in the
Middle East, $45,000, U.S. Institute of Peace, Darren Urada, PI.
2004-2007 Principal Investigator, Los Angeles County Evaluation System (LACES). Contract with
LA County Office of Alcohol and Drug Programs, $950,000.
2003-2008 Principal Investigator, Methamphetamine Clinical Trials Group. A contract with NIDA,
$8,000,000. Walter Ling, PI of Medication Development Services Master Contract.
2002-2003 Principal Investigator, Substance Abuse Research Training in South Africa, NIDA,
$75,000.
2002-2007 Principal Investigator, Pacific Southwest Regional Addiction Technology Transfer
Center (ATTC). Funded by CSAT, $2,200,000.
2002-2004 Principal Investigator, An Expansion of the Drug Abuse Early Warning System to
include Data Collection in Egypt. U.S. Department of State: Middle East Regional
Cooperative Grant to UCLA, $500,000.
2001-2003 Principal Investigator, A Drug Abuse Warning System for Israeli and Palestinian
Communities. U.S. Department of State: Middle East Regional Cooperative Grant to
Friends Research Institute, $500,000.
2001-2004 Co-principal Investigator. (Patricia Marinelli-Casey, PI) CSAT Methamphetamine
Special Studies Contract $5,750,000.
2001-2006 Co-principal Investigator. (Barry Lester, PI) Prenatal Effects of Methamphetamine.
NIDA Grant to Brown University with UCLA serving as a subcontractor for site
coordination and data management. Subcontract, $880,000.
4
2000-2005 Principal Investigator, NIDA Methamphetamine Medication Network. Part of the NIDA
Contract to UCLA Thomas Newton, Contract PI, $10,000,000.
2001-2004 Principal Investigator, CSAT Practice Improvement Collaborative (Phase 2),
$1,042,000.
2000-2001 Co-Principal Investigator, (Natasha Brown, PI.) CSAT Practice Research Collaborative.
(Phase 1) $200,000.
1999-2004 Co-Principal Investigator, (Michael Prendergast, PI) Application of Positive
Contingencies in a Drug Court Setting. NIDA Grant to UCLA, $1,950,000.
1999-2001 Principal Investigator, Factors Influencing the Implementation of Naltrexone for the
Treatment of Alcoholism. Robert Wood Johnson Foundation Grant to Friends Research
Institute, $340,000.
1998-2003 Principal Investigator, Psychosocial Treatment Dose: A Prospective Evaluation. NIDA
Grant to Friends Research Institute, $2,1400,000.
1999-2004 Co-principal Investigator (M.D. Anglin, PI), Los Angeles County Alcohol and Drug
Program Outcome Project. Los Angeles County Contract with UCLA, $1,250,000.
1998-2001 Co-principal Investigator, Coordinating center for methamphetamine treatment project. A
CSAT Grant to UCLA, $2,400,000.
1997-1998 Principal Investigator SCH 39166 for Cocaine Dependence and contract from Schering
Plough awarded to Friends Research Institute, $350,000.
1997-1998 Principal Investigator, The implementation of LAAM: Factors affecting the use of a new
opiate addiction treatment alternative. A Robert Wood Johnson Foundation grant awarded
to Friends Research Institute, $203,906.
1997-2001 Co-principal Investigator, (A. Huber, PI) Medication/behavior therapy for
methamphetamine abuse (1R01 DA10923). NIDA Grant, to Friends Research Institute,
$1,788,253.
1997-1998 Co-principal Investigator, (S. Shoptaw, PI) Acamprosate for alcohol dependence. A contract
from Lipha Pharmaceutical awarded to Friends Research Institute, $250,000.
1996-2000 Co-principal Investigator, (M.D. Anglin, PI) LAAM maintenance: HIV risk reduction
potential and application. NIDA Grant, to UCLA DARC, $2,584,080.
1996-1999 Co-principal Investigator, (S. Shoptaw, PI) Contingency management-tobacco smoking in
opiate addicts NIDA grant, Friends Research Institute, $709,802.
1995-1997 Co-principal Investigator, (S. Shoptaw, PI) A structured treatment manual for HIV+
substance abusers. NIDA, Small Business Innovative Research (SBIR), Phase II Grant to
Matrix Center, $727,069.
1994-1999 Principal Investigator, Behavioral/Cognitive trial for cocaine abuse. NIDA Grant to Friends
Medical Science Research, Inc. $1,939,653.
1993-1998 Co-principal Investigator, (Y. Hser, PI) Drug treatment counselors: Current practices and
effectiveness. NIDA Grant to UCLA, $2,546,347.
1993-1994 Principal Investigator, Ritanserin for alcohol abuse. A contract from Janssen Foundation to
1992-1994 Principal Investigator, Ritanserin for cocaine abuse. A contract from Janssen Foundation to
1993-1994 Co-principal Investigator, (S. Shoptaw, PI) A structured treatment manual for HIV+
Substance Abusers. NIDA, Small Business Innovative Research (SBIR), Phase I Grant to
Matrix Center, Inc. $72,453.
1991-1992 Principal Investigator, A rehabilitative framework for methadone treatment. A contract
from the State of California to Matrix Institute, $125,000.
1991-1996 Co-Principal Investigator, (M D. Anglin, PI), UCLA center on treatment careers. NIDA
Center grant to UCLA, $4,132,063.
1993-1995 Principal Investigator, A structured manual to facilitate naltrexone treatment. NIDA, Small
Business Innovative Research (SBIR), Phase II Grant to Matrix Center, $472,600.
1991-1992 Principal Investigator, A structured manual to facilitate naltrexone treatment. NIDA, Small
Business Innovative Research (SBIR), Phase I Grant to Matrix Center, $38,450.
1991 Principal Investigator, The Matrix model of alcoholism treatment. NIAAA, Small Business
Innovative Research (SBIR), Phase I Grant to Matrix Center, $49,075.
5
1989-1994 Principal Investigator, Treatment of stimulant users to reduce HIV transmission. NIDA
Research Demonstration Project to Friends Medical Research, Inc., $3,102,371.
1990-1992 Principal Investigator, A neurobehavioral model for outpatient cocaine addiction treatment.
NIDA, SBIR Phase 2 Grant to Matrix Center, $499,075.
1988-1989 Principal Investigator, A neurobehavioral model for outpatient cocaine addiction treatment.
NIDA, SBIR Phase 1 Grant to Matrix Center, $49,725.
1988-1991 Co-principal Investigator, (F. Castro, PI) Matches and mismatches in treatment for cocaine
users. NIDA grant to San Diego State University, $450,000.
1985-1986 Principal Investigator, Lofexidine hydrochloride for methadone withdrawal. Merrill-Dow
Contract, $40,000.
1980-1981 Principal Investigator, Clonidine hydrochloride for opiate detoxification. Boeringer
Engelheim Contract, $50,000.
1978-1980 Project Director, Naltrexone and psychotherapy for opiate addiction. (R. Resnick, PI) NIDA
grant to New York Medical College, $120,000.
1978-1981 Co-principal Investigator and Project Director. (R. Coombs, PI) "Social and familial
components of combined use of alcohol and other drugs in a youthful population." State of
California Office of Alcoholism Grant to UCLA, $200,000.
1978-1979 Co-principal Investigator and Project Director, (R. Coombs, PI) Family strengthening to
redirect drug-prone youth. NIDA grant to UCLA, $600,000.
1974-1977 Co-principal Investigator and Project Director, (E.J. Callahan, PI) Heroin antagonist and
learning therapy for opiate addiction. NIDA grant to UCLA, $525,000.
SELECTED LECTURES and PRESENTATIONS (2005–PRESENT)

Dr. Rawson has conducted 10–50 presentations and workshops per year since 1985 throughout the United States and
internationally. He also has provided consultation and training to state agencies, county agencies, treatment
organizations, community organizations, public policy groups, and health and social service ministries for numerous
countries. He has testified before the FDA, the California, Hawaii, Washington, Wyoming and Minnesota legislatures,
and for several congressional committees. He is a frequent presenter at CPDD, ASAM, and APA conferences, as well
as at NIDA, CSAT, ONDCP, WHO, and UNODC-sponsored training events. UNODC Treatnet Project: Dr. Rawson
was the principal investigator for the training curriculumcenter for the United Nations Office on Drugs and Crime,
Treatnet resource network. In this role, he was responsible for the design of an extensive package of training materials
to be used as the core curriculum for a worldwide network of addiction training centers.
Selected Presentations
2019 Medication treatment for opioid use disorders, Burlington City Council, Burlington
Vermont, March 2019.
2019 Treatment for opioid addiction. Training seminar for Vermont law enforcement personnel,
March, 2019.
2019 Wisconsin Annual Addictions Conference, Update on Stimulant use trends and treatments.
Green Bay Wisconsin. March 2019.
2019 Expansion of medication assisted treatment for OUD with the Hub and Spoke, Green Bay,
Wisconsin, March 2019.
2019 Treatments for methamphetamine use disorders by men who have sex with men, UVM
Department of Infectious Diseases, Burlington Feb 2019.
2019
2019 Treatment of stimulant use disorders. Webinar for San Francisco Dept of Public Health,
San Francisco Cal
2012–2018 Every year, I conducted 30–50 presentations/training sessions/workshops in the United
States . Topics include research on physical exercise, health system development,
performance measures, cognitive behavioral strategies, use of screening and brief
interventions, addiction medications, methamphetamine, research methods, and
epidemiology of drug use in Iraq.
2018 WHO Regional meeting on treatment systems for SUD, Elements of a Treatment system.
Abu Dhabi, Nov 2018
6
2017 Clinton Foundation Healthcare Summit. Medication-Assisted Treatment for Opioid

Dependence: Rationale and Evidence of Effectiveness. Little Rock, Ark. April, 17, 2017.
2011 CSAM Addiction Medicine State of the Art 2011 conference. Long Beach, CA. “Your
Future Practice: Ingredients of Health Care Reform.” Oct. 12-15.
2011 Substance Use Disorders Treatment under Health Care Reform training. Hayward, CA.
Oct. 3.
2011 CADPAAC Quarterly Meeting. Sacramento, CA. Sept. 28.
2011 National TASC Conference on Drugs and Crime. Denver, CO. “How the Affordable Care
Act will change the Treatment of Substance Use Disorders and How These Efforts will
be Monitored, Measured and Evaluated.” May 4-6.
2011 CADPAAC meeting. Sacramento, CA. “EnCal Pilot Project Update.” March 22.
2011 Behavioral Health conference. Phoenix, AZ. “Developing Addiction Treatment Services
in Asia and the Middle East” and “Integrating Substance Use in Primary Care.” March
16, 19.
2011 Filming of: “Treating and Supervising Methamphetamine Addicts in Your Drug Court.”
Williamsburg, VA. Jan. 23, 24.
2010 CATES Series Training. Alameda County, CA. “Substance Use Disorders Treatment
under Health Care Reform: Welcome to the Health Care System.” Dec. 7.
2010 CATES Series Training. Merced County, CA. “Substance Use Disorders Treatment
under Health Care Reform: Welcome to the Health Care System.” Dec. 1.
2010 CATES Series Training. Tehama County, CA. “Substance Use Disorders Treatment
under Health Care Reform: Welcome to the Health Care System.” Nov. 17.
2010 Addictions 2010 Conference. Arlington, VA. “A Preliminary Examination of Client
Transfers across Alcohol and Drug Treatment Services as a Measure of Provider
Connectedness.” Oct. 30.
2010 ADP Training Conference. “Patient Perspectives on Medication-Assisted Opiate
Addiction Treatment.” Sacramento.
2010 APA 118th Annual Convention. San Diego, CA. “How will Health Care Reform change
Substance Use Disorder Treatment?” Aug.15.
2010 NADCP training. Jackson, MS. “Treating Meth Addicts in Your Drug Court.” Aug. 12,
13.
2010 72nd CPDD Conference. Scottsdale, AZ. “Preliminary Evidence on the Use of Aerobic
Exercise in the Treatment of Methamphetamine Dependence.” June 17.
2010 NADCP 16th Annual Training Conference. Boston, MA. Update on the
Methamphetamine Problem in the US. June 3.
2010 Hawaii Addictions Conference. Honolulu, HA. “A Passport over the Cultural Frontiers of
Addiction” and “Next Journeys in Addiction Research.” March 17-19.
2010 Fresno Pilot Presentation on Addiction as a Chronic Health Problem. Fresno, CA.
“Addiction as a Chronic Disease.” March 8.
2010 Betty Ford Center Grand Rounds “Addiction as a Chronic Disease” training. Rancho
Mirage, CA. Feb. 18.
2010 Kern County Mental Health Conference. Kern County, CA. “Treatment of
Methamphetamine Dependence: Clinical Challenges and Effective Strategies, Meth
Update.” Feb. 1.
2010 CADPAAC. Sacramento, CA. Meeting. “EnCal Pilot Project Update.” Jan. 26-29.
2010 Treatment Strategies in Integrated Mental Health and Primary Care Services. San
Francisco, CA. Jan. 15.
2010 Cedars-Sinai Medical Center. Los Angeles, CA. “Methamphetamine Update: Is the
Epidemic Over?” Jan. 7.
2010 7th Annual Wyoming Methamphetamine and Substance Abuse Conference Agenda.
Casper, WY. “The Brain and Meth.” Jan 7.
2009 Medical University of South Carolina, 2009 AAAP Annual Meeting. Los Angeles, CA.
“Methamphetamine Use Disorders: Associated Symptoms and Treatment Options.” Dec.
6.
2009 8th Annual Conference: Jackson County Courts and Community: Caring for Children and
Families; Families and Substance Abuse: Latest Knowledge and Interventions. Medford,
7
OR. “Methamphetamine: Challenges for Human Service and Criminal Justice

Professionals.” Nov. 20
2009 Treating and Supervising Methamphetamine Addicts in Your Drug Court. Omaha, NE.
“Psychopharmacology; Treatment for Methamphetamine Addicts.” Nov. 10.
2009 Los Angeles Criminal Justice Inn of Court Meeting. Los Angeles, CA. “Addiction
Changes the Brain: Implications for Treatment.” Nov. 4.
2009 2009 Addiction Health Support Research Conference: Health Care Reform, Parity and
Continuing Care Models. San Francisco, CA. “Workshop for Substance Abuse Treatment
Program Providers: Treating Addiction as a Chronic Condition: Rationale and Strategies
to Extended Care.” Oct. 28-30
2009 UCLA’s 14th Annual Review of Psychiatry and Psychopharmacology Update. Los
Angeles, CA. “Interventions for Substance Abuse: How to do them? Do they work?” Oct.
24.
2009 The Science of Drug Abuse in Schools and Colleges. Athens, GA. “Treatment for
Methamphetamine Dependence: Clinical Issues and Treatment Approaches.” Oct. 20.
2009 The University of Georgia. Athens, GA. “A Discussion of the Nation’s Current
Methamphetamine Problems.” Oct. 19
2009 Treating and Supervising Methamphetamine Addicts in Your Drug Court. Seattle, WA.
“Taking a Comprehensive Approach: Defining the Problem; Supervision and Behavior
Modification for Meth Addicts, Manufacturing Trends.” Oct. 13
2009 The Substance Abuse Research Consortium 40 th Semi-Annual Meeting. Sacramento, CA.
“The National Quality Forum Report: The Foundation for Treatment Standards. Sept. 21.
2009 ADP Kick-Off COSSR meeting. Sacramento, CA.” Critical Components to a Continuum
of Care.” Sept. 14.
2009 COSSR Program Presentation Fresno, CA. “Components of a Continuum of Care.” Sept.
1.
2009 Oregon’s Drug and Alcohol Prevention Programs Strategic Planning Meeting. Portland,
OR. “Methamphetamine Dependence: Current Knowledge about Treatment.” Aug. 20.
2009 “Methamphetamine Dependence.” Berkeley, CA. Aug. 1.
2009 2009 Hawaiian Addictions Conference/AAPI Workgroup Scientific Conference on
Addiction and Related Issues. Honolulu, HA. “Building a Treatment System: Elements
and Challenges.” May 11-12.
2009 NPI Clinical Leadership Forum. Los Angeles, CA. “Integrated Treatment of Co-
occurring Disorders.” May 4.
2009 ASAM 40th Annual Medical-Scientific Conference. New Orleans, LA. “Cocaine and
Methamphetamine Addiction: Clinical Update 2009.”April 30-May 2.
2009 ADP Continuum of Services Systems Re-Engineering meeting. “Key Components to a
Continuum of Care.” Sacramento, CA. April 21-24.
2009 SSTAR training. Providence RI. “Methamphetamine Addiction: Basics of Treatment.”
March 26-29.
2009 Region IX Health Care for the Homeless Conference. Los Angeles, CA. “Effective Drug
Treatment Strategies for the Homeless.” Feb. 2.
2009 RPG Conference: Advancing Clinical and Collaborative Practice. Arlington, VA.
“Methamphetamine and other Substances: Latest Knowledge, Latest Treatment.” Jan. 15.
2008 American Public Health Association Annual Meeting: Screening and Brief Intervention
in a Mental Health Clinic: Public Health Agenda or Mental Health Therapy. San Diego,
CA.
2008 SAMHSA: First National TC Conference: Set, Setting, and Dose: Critical Dimensions
for Effective Criminal Justice TC Programs. Denver, CO
2008 SAMHSA: Updates on Methamphetamine: Effective Treatment and Other Hot Topics.
Rockville, MD
2008 ADPA: Prescription Drugs Abuse: What are People Using and How Do You Treat
Them? Alhambra, CA
2008 California Board of Parolee Trainings. Sacramento, Oakland, and Anaheim, CA
8
2008 Treatment of Methamphetamine Dependence: Strategies that Work, for the

Summer Conference for the Northwest Institute of Addiction Studies in Portland,
Oregon
2008 Understanding Methamphetamine Addiction: New Knowledge from the Past
Decade of Research, for the Summer Conference for the Northwest Institute of
Addiction Studies in Portland, Oregon.
2008 CPDD. San Juan, Puerto Rico
2008 The ADP Conference 2008, Implementing a Comprehensive Continuum of Services:
Beyond Tradition - Creating Synergy. Burlingame, CA
2008 Annual Drug Court Conference. Los Angeles, CA
2008 UCSF Department of Psychiatry's New Developments in Substance Abuse Treatment
Grand Rounds. San Francisco, CA
2008 CADPAAC Quarterly Meeting. Sacramento, CA
2008 Methamphetamine: Modifications in Brain Functioning and Mental Health
Implications. Dallas, TX
2008 8th Annual California Information Management Conference and Exposition. Garden
Grove, CA
2008 Medication-Assisted Treatment Training and Educational Symposium. Pleasant Hill, CA
2008 CalSWEC Mental Health Initiative Curriculum Infusion Seminar. Los Angeles, 2008
CCJCC Drug Court Coordinator Committee, Los Angeles, CA
2008 The 2008 Treatment Courts Training Day. Anaheim, CA
2008 MIA-STEP Phoenix House Training, OC (Part II). Santa Ana, CA
2008 The 10th Annual Fundamentals of Addiction Medicine. Seattle, WA
2008 Meth Task Force Meeting. Orange, CA
2008 Meth Task Force Meeting. Long Beach, CA
2008 5th Annual Methamphetamine and Substance Abuse Conference. Casper, Wyoming
2008 Evidence Based Treatments for Methamphetamine Dependence. Washington State
Legislature Event, Olympia, WA
2007 Society of Correctional Physicians (SCP) Meeting. Nashville, TN
2007 National Treatment Accountability for Safer Communities (NTASC) Annual Meeting.
Westminster, CO
2007 State of the Art 2007: Advancing the Clinical Practice of Addiction Treatments: Science
and Methodology, Culture and Society. Universal City, CA
2007 Treatnet: A Program to Increase Addiction Treatment Capacity Worldwide, SSTAR
Treatnet. Providence, Rhode Island.
2006 Methamphetamine in LA County: An Update. Alhambra, California
2006 Treatment for Methamphetamine-Related Disorders. Albuquerque, NM
2006 New Clinical Information Regarding the Treatment of Individuals for Cocaine and
Methamphetamine Dependence (CSAM)
2006 Methamphetamine: New Knowledge about the Epidemic, the Neurobiology and Clinical
Issues. Williamsburg, Virginia
2006 Treatments for Methamphetamine-Related Disorders. Williamsburg, Virginia
2006 Methamphetamine: Clinical Challenges and Critical Populations. Williamsburg, Virginia
2006 Methamphetamine: What Can Brain Imaging Tell Us? Williamsburg, Virginia
2006 Methamphetamine: Clinical Challenges and Critical Populations. Nashville, Tennessee
2006 Methamphetamine: The Nature of the National Epidemic. Nashville, Tennessee,
2006 Addiction as a Brain Disease: Blending Research and Practice to Enhance Prevention and
Treatment in YOUR Community. Sedona, Arizona
2005 Methamphetamine: A focus on women and children. Indianapolis, Indiana,
2005 Methamphetamine: How it influences the brain and behavior of users. Michigan
2005 Treatment for methamphetamine-related disorders: What works. Michigan
2005 Research Efforts in South Africa. UCSF, San Francisco.
2005 Methamphetamine: How it Influences the Brain and Behavior of Methamphetamine
Users. Sioux Falls, South Dakota
2005 Methamphetamine: Brain and Behavior-Research Findings. Sioux Falls, South Dakota
2005 Methamphetamine: A 2005 Update. Miami, Florida
9
SELECTED INTERNATIONAL LECTURES and PRESENTATIONS (1997–PRESENT)

2012–Present Each year, I deliver 20–30 lectures, presentations, training sessions, workshops, etc., in
UAE, Egypt, Vietnam, Saudi Arabia, Morocco, Iraq, and Iran. Topics include research
on physical exercise, health system development, performance measures, cognitive
behavioral strategies, use of screening and brief interventions, addiction medications,
methamphetamine, research methods, and epidemiology of drug use in Iraq.
2019 Cairo University Annual Psychiatric Conference, Treatments for opioid dependence integrated into
general medical settings. Feb, 2019.
2013 Panel Chair, Addiction Service System Developments in Vietnam, International Society
of Addiction Medicine, Kuala Lumpur, Malaysia, Nov 23.
2013 Invited Speaker, Methamphetamine, Pharmacology and Treatment, Training for
Government Psychiatrists, arranged by U.S. Embassy, Ho Chi Minh Vietnam, April 8-9.
2013 Invited Speaker, Methamphetamine, Pharmacology and Treatment, Vietnamese National
Institute of Mental Health, Hanoi, Vietnam, April 11-12.
2013 Invited Speaker, Methamphetamine Treatment and Treatment Priorities, NIDA SE Asia
International Research Meeting, Taipei, Taiwan, April 17.
2013 Invited Speaker, Methamphetamine: Current Update on Research, Belgrade and
Kraljevo, Serbia, April 23 and 27.
2013 Invited Speaker, Performance Measures in Addiction Treatment, Staffs of Skoun and
Marsa organizations, Beirut, Lebanon, May 2.
2012 Co-Chair of Panel on Addiction Research from the Middle East, ISAM Annual Meeting,
Geneva, Switzerland, Oct 14
2012 Invited Speaker, Current Research on Smoking Cessation, Jedda, Saudi Arabia, Oct 10
2012 Invited Speaker, Performance and Outcomes Measurement, Qassim Treatment Center,
Qassim, Saudi Arabia, Oct 9
2012 Invited Speaker, Contingency Management, Dammam Treatment Center, Dammam,
Saudi Arabia, Oct 6
2012 Invited Speaker, Development of a Program of Research on Addiction, Jazan University,
Jazan, Saudi Arabia, Oct 2.
2012 Invited Speaker, Performance and Outcomes Measurement, National Rehabilitation
Center, Abu Dhabi, UAE, Sept 25
2012 Grand Rounds, Baghdad Medical University, Baghdad, Iraq, May 11
2012 Member of the organizing committee and speaker at the Inaugural CEWG Meeting,
Baghdad, Iraq, May 8,9
2012 Invited Speaker, Matrix Model of Outpatient Treatment, National Rehabilitation Center,
Abu Dhabi, UAE April 29
2012 Lead Trainer, Iraqi Demand Reduction Project Clinical Training, Beirut, Lebanon, April
14-28
2012 Invited Speaker, First Annual Addictions Conference, Hanoi, Vietnam. March 7-12
2012 Invited Speaker, Cognitive Behavioral Therapy, Al Amal Hospital, Riyadh, Saudi Arabia,
Feb 25
2012 Member of Research Committee, Substance Abuse Research Center, Jazan University,
Jazan, Saudi Arabia, Feb 27-28.
2012 Lead Trainer, Iraqi Demand Reduction Project Clinical Training, Cairo Egypt Feb 1-21.
2011 Invited Speaker and faculty member at Cairo University Addiction Training Program,
Cairo, Egypt. Kasr Al-Ainy Conference. Cairo, Egypt. May 29-June 2
2011 Participant in UNODC Regional Meeting on ATS, Kumming, China
2011 Participant in Planning Meeting for first Vietnamese Annual Addiction Meeting, Hanoi,
Vietnam. April 13-22.
2011 Invited Speaker, 1st International Psychiatry Symposium. Riyadh, Saudi Arabia. Oct. 19-
20.
2010 ISAM 10th Annual Conference. Milan, Italy. “Dissemination and Implementation of
Cognitive Behavioural Therapy for Stimulant Dependence: A Comparison of Three
Approaches.” Oct. 2-5.
2010 Invited Speaker, Methamphetamine Treatment XXVII CINP Congress. Hong Kong.
10
June 6-10
2010 Invited Speaker, Kasr Al-Ainy International Psychiatry Conference. Cairo, Egypt.
“Licensing Counselors and Psychotherapists in Egypt.” Feb. 20-27.
2009 Invited Speaker, Society for the Study of Addiction Annual Symposium. York, United
Kingdom. “Treatment Policy.” Nov. 12.
2009 Invited Plenary Speaker, The International Society of Addiction Medication Anniversary
meeting. Calgary, Alberta, Canada. “An Update on the Biopsychological Management of
Stimulant Dependence.” Sept. 23-27
2009 Lead Trainer, UNODC: Drug Dependence Treatment and Care: Master Trainers
Workshop. Vienna, Austria. May 24-28.
2009 Consultant, 4th Sino-US Training Program of Psychological Counseling and Therapy on
Substance Dependence. Shanghai, China. April 4-12.
2009 Consultant, National Rehabilitation Center and International Society of Medicine. Abu
Dhabi, UAE, and Cairo, Egypt. Feb. 10-23.
2009 Training Expert for Vietnamese Ministry of Health, Hanoi, Vietnam
2008 International Society of Addiction Medicine: Meth: New Knowledge. Cape Town, South
Africa.
2008 International Society of Addiction Medicine Pre-Conference: Meth Treatment. Cape
Town, South Africa
2008 First International Global Institute on Methamphetamine, Prague, Czech Republic
2008 Cracked but Not Broken Conference, Vancouver, BC
2008 Invited Speaker, International Society of Addiction Medicine, Cape Town, South Africa.
2008 Invited Speaker, World Methamphetamine Conference, Prague, Czech Republic.
2007 Conference Chair. Delivery Systems for Substance Abuse Treatment: Integration with
Primary Care and Mental Health and Social Services, Istanbul, Turkey Sept 3-6.
2007 Invited Speaker, Recent Advances in Methamphetamine Treatment, Vancouver, Canada.
2006 Invited Speaker: Bridges Have Been Built: Is Anyone Using Them? Amsterdam,
Netherlands
2006 Chair for the UNODC Treatnet Orientation, Cairo, Egypt.
2006 Invited Speaker, Advances in Addiction Treatment, Jeddah, Saudi Arabia.
2006 Methamphetamine and the Brain: New Knowledge; New Treatments, (US Embassy),
Vienna, Austria
2006 Invited Speaker, International Conference of Counselors in Addiction, Edinburgh,
Scotland.
2005 Invited Speaker, Methamphetamine: New Knowledge, United Nations Office of Drugs and
Crime, Vienna, Austria.
2005 Invited Speaker, Innovations in Substance Abuse Treatment, Beirut, Lebanon
2005 Invited Speaker, Recent Advances in the Integration of Substance Abuse Research and
Practice in the U.S. Radboud University, Nijmegen, Netherlands.
2005 Invited Speaker, Ministry of Health, Muscat, Oman.
2005 Methamphetamine: Brain and Behavior-Research Findings, Treatments for
Methamphetamine, Saskatoon, Saskatchewan
2004 Speaker at World Psychiatry Association Conference, Cairo, Egypt.
2004 Invited Speaker, Substance Abuse and Culture Conference, Vienna, Austria.
2004 Invited Speaker, World Health Organization, North Africa Region, Cairo, Egypt.
2004 Invited Speaker, United Nations Office on Drugs and Crime, Middle East Region, Cairo,
Egypt.
2004 Speaker at Grand Rounds, Ain Shams University, Cairo, Egypt
2004 Co-chair and Speaker, Delivery Systems for Substance Abuse Treatment conference,
Istanbul, Turkey.
2004 Invited Speaker, ISAM meeting, Helsinki, Finland.
2004 Invited Speaker, Ministry of Health, Bratislava, Slovakia.
2004 Speaker at Grand Rounds, Department of Psychiatry, University of Cairo, Egypt.
2004 Invited Speaker, First African Conference on Social Psychiatry, Johannesburg,
South Africa.
2003 Speaker at Grand Rounds, Department of Psychiatry, University of Cairo, Cairo, Egypt.
11
2003 Speaker at Grand Rounds, Department of Psychiatry, University of the Free State,
Bloemfountain, Republic of South Africa.
2003 Invited Speaker to the Israeli Society of Addiction Medicine, Tel Aviv, Israel.
2002 Invited Speaker to Addictions 2002 Conference in Amsterdam, Netherlands.
2002 Invited Speaker to the International Society of Addiction Medicine Meeting, Reykjavik,
Iceland.
2000, 2001 Trainer for U.S. Dept. of State on Stimulant Abuse Treatment, Bangkok, Thailand.
2000 Invited Speaker for the NIDA Conference on Methamphetamine, Budapest, Hungary.
2000 Invited Speaker on Addiction Pharmacotherapies, Amsterdam, Netherlands.
2000 Trainer for U.S. Department of State on Stimulant Abuse Treatment, Tijuana, Guadalajara,
and Mexico City.
1999, 2001 Invited Speaker at the U.S.-Mexico Bi-national Conferences on
Substance Abuse Treatment, Mexico City, Mexico.
1999 Keynote Speaker on Research to Practice Issues, International Congress
on Substance Abuse, Vienna, Austria.
1999 Invited Representative for NIDA on Substance Abuse Treatment at the
U.S.-Netherlands Bi-National Substance Abuse Program. Amsterdam,
Netherlands.
1997, 1998 Consultant to the Economic Cooperation Foundation (Oslo Peace
Accord Organizers) on Addiction Training in West Bank and Gaza,
Palestinian Authority, weeklong addiction training at Al Quds University,
Ramallah, Palestinian Authority.
1997 Consultant to Swiss Government on Psychosocial Treatment Issues for
Substance Abuse Disorders, Thun, Switzerland.
1997 Invited Speaker. Addiction and Society, Presented for the Palestinian Authority Health
Committee, Arafat Health Center, Khan Younis, Gaza, November
1997 Keynote Speaker for Palestinian and Israeli People Against Substance
Use, Beersheva, Israel, November
BIBLIOGRAPHY
RESEARCH PAPERS
A. RESEARCH PAPERS – PEER REVIEWED

1. Leitenberg, H., Rawson, R.A., & Bath, K. (1970). Reinforcement of competing behavior during extinction.
Science, 169, 301-303.
2. Joffe, J.M., Rawson, R.A., Mulick, J.A., & Ley, K.F. (1972). Effects of adrenalectomy on open field behavior in
rats. Hormones and Behavior, 3, 87-96.
3. Rawson, R.A., & Leitenberg, H. (1973). Reinforced alternative behavior during punishment and extinction with
rats. Journal of Comparative and Physiological Psychology, 85, 593-600.
4. Leitenberg, H., Rawson, R.A., & Mulick, J.A. (1975). Extinction and reinforcement of alternative behavior.
Journal of Comparative and Physiological Psychology, 88, 640-652.
5. Callahan, E.J., Rawson, R.A., Glazer, M., McLeave, B., & Arias, R. (1976). Comparison of two naltrexone
treatment programs: Naltrexone alone versus naltrexone plus behavior therapy. In D. Julius & P. Renault (Eds.),
Narcotic antagonist: Naltrexone progress report. NIDA Research Monograph, 150-157.
6. Mulick, J.A., Leitenberg, H., & Rawson, R.A. (1976). Alternative response training, Differential reinforcement of
other behavior and extinction in squirrel monkeys. Journal of the Experimental Analysis of Behavior, 25, 311-320.
7. Rawson, R.A. Leitenberg, H., Mulick, J.A., & Lefebvre, M.F. (1977). Recovery of extinction responding in rats
following discontinuation of reinforcement of alternative behavior: A test of two explanations. Animal Learning
and Behavior, 5, 415-420.
12
8. Joffe, J.M., Mulick, J.A., Ley, K.F., & Rawson, R.A. (1978). Effects of prenatal stress procedures on maternal
corticosterone levels and behavior during gestation. Bulletin of the Psychonomic Society, 11(2), 93-96.
9. Joffe, J.M., Rawson, R.A., & Mulick, J.A. (1973). Control of their environment reduces emotionality in rats.
Science, 180, 1383-1384.
10. Washton, A.M., Resnick, R.B., & Rawson, R.A. (1979). Clonidine Hydrochloride: A non-opiate treatment for
opiate withdrawal. Proceedings of the Committee on Problems of Drug Dependence. NIDA Research Monograph,
27, 233-239.
11. Rawson, R.A., Glazer, M., Callahan, E.J., & Liberman, R.B. (1979). Naltrexone and behavior therapy for heroin
addiction. In N. Krasnegor (Ed.), Behavioral approaches to analysis and treatment of substance abuse. NIDA
Research Monograph, June (25), 26-43.
12. Callahan, E.J., Rawson, R.A., McCleave, B., Arias, R., Glazer, M., & Liberman, R.P. (1980). The treatment of
heroin addiction: Naltrexone alone and with behavior therapy. The International Journal of the Addictions, 15(6),
795-807.
13. Tennant, F.S., & Rawson, R.A. (1980). Heroin detoxification, Nurse Practitioner, 5, 35-39.
14. Washton, A.M., Resnick, R.B., & Rawson, R.A. (1980). Clonidine for opiate detoxification. Communication to
Lancet, 1(8177), 1078-1079.
15. Tennant, F.S., Rawson, R.A., & McCann, M.J. (1981). Withdrawal from chronic phencyclidine (PCP) dependence
with desipramine. American Journal of Psychiatry, 138, 845-847.
16. Tennant, F.S., & Rawson, R.A. (1981). Propoxyphene napsylate maintenance treatment for narcotic dependence:
A non-methadone model. Drug and Alcohol Dependence, 8, 79-83.
17. Rawson, R.A., Tennant, F.S., & McCann, M.J. (1981). Characteristics of 68 chronic phencyclidine abusers who
sought treatment. Drug and Alcohol Dependence, 8, 223-227.
18. Rawson, R.A., Mann, A.J., Tennant, F.S., & Clabough, D. (1982). Efficacy of psychotherapeutic counseling during
21 day ambulatory detoxification. Proceedings of the Committee on Problems of Drug Dependence. NIDA
Research Monograph, 43, 310-314.
19. Tennant, F.S., & Rawson, R.A. (1982). Cocaine and amphetamine dependence treated with Desipramine.
Proceedings of the Committee on Problems of Drug Dependence. NIDA Research Monograph, 43, 351-355.
20. Tennant, F.S., & Rawson, R.A. (1982). Outpatient treatment of prescription opioid dependence: Comparison of
two methods. Archives of Internal Medicine, 142, 1845-1847.
21. Tennant, F.S., Rawson, R.A., Cohen, A.M., Tarver, A., & Clabough, D. (1983). Methadone plasma levels and
persistent drug abuse in high dose maintenance patients. Substance and Alcohol Actions/Misuse, 4, 369-374.
22. Tennant, F.S., & Rawson, R.A. (1983). Guanabenz Acetate: A new long acting alpha-two adrenergic agonist for
opioid withdrawal. Proceedings of the Committee on Problems of Drug Dependence. NIDA Research Monograph,
49, 338-343.
23. Rawson, R.A., Mann, A.J., Tennant, F.S., & Clabough, D. (1983). Efficacy of psychotherapeutic counseling during
21-day ambulatory heroin detoxification. Drug and Alcohol Dependence, 12, 197-200.
24. Tennant, F.S., Tarver, A., & Rawson, R.A. (1983). Clinical evaluation of mecamylamine for withdrawal from
nicotine dependence. Proceedings of the Committee on Problems of Drug Dependence. NIDA Research
Monograph, 49, 239-246.
25. Rawson, R.A., & Tennant, F.S. (1983). Five year follow-up of opiate addicts with naltrexone and behavior therapy.
Proceedings of the Committee on Problems of Drug Dependence. NIDA Research Monograph, 49, 289-295.
26. Tennant, F.S., Rawson, R.A., Miranda, L., & Obert, J. (1983). Outpatient treatment of prescription opioid
dependence: Comparison of two methods. Proceedings of the Committee on Problems of Drug Dependence.
NIDA Research Monograph, 43, 315-321.
13
27. Tennant, F.S., Rawson, R.A., Cohen, A.M., Tarver, A., & Clabough, D. (1984). Methadone plasma levels and
persistent drug abuse in high dose maintenance patients. Proceedings of the Committee on Problems of Drug
Dependence. NIDA Research Monograph, 49, 262-265.
28. Rawson, R.A., Washton, A.M., Resnick, R.B., & Tennant, F.S. (1984). Clonidine hydrochloride detoxification
from methadone treatment: The value of naltrexone aftercare. Advances in Drug and Alcohol Dependence, 3, 41-
49.
29. Tennant, F.S., Rawson, R.A., Cohen, A.M., & Mann, A.J. (1984). Clinical experience with naltrexone in suburban
opioid addicts. Journal of Clinical Psychiatry, 45, 42-45.
30. Rawson, R.A., Obert, J.L., McCann, M.J., & Mann, A.J. (1985). Cocaine treatment outcome: Cocaine use
following inpatient, outpatient, and no treatment. Proceedings of the Committee on Problems of Drug Dependence.
NIDA Research Monograph, 67, 271-277.
31. Rawson, R.A. (1986). Relapse prevention programming in the treatment of opioid users. Substance Abuse Bulletin,
2, 1-5.
32. Tennant, F.S., Rawson, R.A., Pumphrey, E.A., & Secoff, R. (1986). Clinical experiences with 959 opioid-
dependent patients treated with levo-alpha-acetylmethadol (LAAM). Journal of Substance Abuse Treatment, 3,
195-202.
33. Baxter, L.R., Schwartz, J.M., Phelps, M.E., Mazziotta, J.C., Barrio, J., Rawson, R.A., Engel, J., Guze, B.H., Selin,
C., & Sumida, R. (1988). Localization of the neurochemical effects of cocaine and other stimulants in the human
brain. Journal of Clinical Psychiatry, 49, 23-26.
34. Rawson, R.A., Obert, J.L., McCann, M.J., Smith, D.P., & Ling, W. (1990). Neurobehavioral treatment for cocaine
dependency. Journal of Psychoactive Drugs, 22(2),159-171.
35. Rawson, R.A. (1990). Cut the crack: The policymakers guide to cocaine treatment. Policy Review Journal, 51, 10-
19.
36. Rawson, R.A., Obert, J.L., McCann, M.J., Castro, F.G., & Ling, W. (1991). Cocaine abuse treatment: A review of
current strategies. Journal of Substance Abuse, 3, 457-491.
37. Rawson, R.A., Obert, J.L., McCann, M.J., & Ling, W. (1991). Psychological approaches for the treatment of
cocaine dependence: A neurobehavioral approach. Journal of Addictive Diseases, 11(2), 97-119.
38. Rawson, R.A., & Ling, W. (1991). Opiate addiction treatment modalities and some guidelines for their optimal use.
Journal of Psychoactive Drugs, 23(2), 151-163.
39. Rawson, R.A., Obert, J.L., McCann, M.J., Marinelli-Casey, P., & Suti, E. (1991). Outpatient chemical dependency
treatment and the managed care system: An unrealized symbiosis. Journal of Ambulatory Care Management,
14(4), 48-59.
40. Rawson, R.A. (1990-1991). Chemical dependency treatment: The integration of the alcoholism and drug
addiction/use systems. International Journal of the Addictions, 25(12A), 1515-1536.
41. Castro, F.G., Sharp, E.V., Barrington, E.H., Walton, M., & Rawson, R.A. (1991). Drug abuse and identity in
Mexican Americans: Theoretical and empirical considerations. Hispanic Journal of Behavioral Sciences, 13(2),
209-225.
42. Castro, F.G., Barrington, E.H., Sharp, E.V., Dial, L.S., Wang, B., & Rawson, R.A. (1992). Behavioral and
psychological profiles of cocaine users upon treatment entry: Ethnic comparison. Drugs and Society, 6, 231-251.
43. Ling, W., & Rawson, R.A. (1993). American opiate substitution treatment programs: From methadone to LAAM
and Buprenorphine. Proceedings of the Swiss Services Project for the Medical Prescription of Narcotics. Thun,
Switzerland.
44. Rawson, R.A., Obert, J.L., McCann, M.J., & Marinelli-Casey, P. (1993). Relapse prevention models for substance
abuse treatment. Psychotherapy, 30(2), 284-298.
45. Rawson, R.A., Obert, J.L., McCann, M.J., & Marinelli-Casey, P. (1993). Relapse prevention strategies in outpatient
substance abuse treatment. Psychology of Addictive Behaviors, 7(2), 85-95.
14
46. Rawson, R.A., Obert, J.L., McCann, M.J., & Ling, W. (1993). Neurobehavioral treatment for cocaine dependency:
A preliminary evaluation. NIDA Research Monograph, 135, 92-115.
47. Harvey, E.M., Rawson, R.A., & Obert, J.L. (1994). History of sexual assault and the treatment of substance abuse
disorders. Journal of Psychoactive Drugs, 26(4), 361-367.
48. Shoptaw, S., Rawson, R.A., McCann, M.J., & Obert, J.L. (1994). The Matrix Model of outpatient stimulant abuse
treatment: Evidence of efficacy. Journal of Addictive Diseases, 13(4), 129-141.
49. Harvey, E.M., Rawson, R.A., Alexander, E., & Bacher, K. (1994). Binge eating in males: A sample description
and treatment outcomes study. Eating disorders: Journal of Treatment and Prevention, 2(3), 215-230.
50. Grella, C.E., Anglin, M.D., Wugalter, S.E., Rawson, R.A., & Hasson, A. (1994). Reasons for discharge from
methadone maintenance for addicts at high risk of HIV infection or transmission. Journal of Psychoactive Drugs,
26(2), 223-232.
51. Ling, W., Rawson, R.A., & Compton, M.A. (1994). Substitution pharmacotherapies for opiate addiction: From
methadone to LAAM and buprenorphine. Journal of Psychoactive Drugs, 26(2), 119-127.
52. Rawson, R.A., McCann, M.J., Hasson, A., & Ling, W. (1994). Cocaine abuse among methadone maintenance
patients: Are there effective treatment strategies? Journal of Psychoactive Drugs, 26(2), 129-136.
53. Hasson, A.L., Grella, C.E., & Rawson, R.A. (1994). Case management within a methadone maintenance program:
A research demonstration project for HIV risk reduction. Journal of Case Management, 3(4), 167-172.
54. Rawson, R.A., Shoptaw, S.J., Obert, J.L., McCann, M.J., Hasson, A.L., Marinelli-Casey, P.J., Brethen, P.R., &
Ling, W. (1995). An intensive outpatient approach for cocaine abuse treatment: The Matrix Model. The Journal
of Substance Abuse Treatment, 12(2), 117-127
55. Frosch, D., Shoptaw, S., Huber, A., Rawson, R.A., & Ling, W. (1996). Sexual HIV risk among gay and bisexual
male methamphetamine users. Journal of Substance Abuse Treatment, 13(6), 483-486. PMID: 9219145
56. McCann, M.J., Miotto, K., Rawson, R.A., Huber, A., Shoptaw, S., & Ling, W. (1996). Outpatient non-opioid
detoxification for opioid withdrawal: Who is likely to benefit? American Journal on Addictions, 6(3), 218-223.
57. Shoptaw, S., Jarvik, M.E., Ling, W., & Rawson, R.A. (1996). Contingency management for tobacco smoking in
methadone maintained opiate addicts. Addictive Behaviors, 21(3), 409-412.
58. Grella, C.E., Anglin, A.D., Rawson, R.A., Crowley, R., & Hasson, A. (1996). What happens when a demonstration
project ends: Consequences for a clinic and its clients. Journal of Substance Abuse Treatment, 13(3), 249-256.
59. Johnson, B.A., Jasinski, D.R., Galloway, G., Kranzler, H., Weinrieb, R., Anton, R.F., Mason, B.J., Bohn, M.J.,
Pettinatti, H.M., Rawson, R.A., & Clyde, C. (1996). Ritanserin in the treatment of alcohol dependence: A multi-
center clinical trial. Psychopharmacology, 128, 206-215.
60. Shoptaw, S., Frosch, D., Rawson, R.A., & Ling, W. (1997). Cocaine abuse counseling as HIV prevention. AIDS
Education and Prevention, 9(6), 511-520. PMID 9451479
61. Obert, J.L., Rawson, R.A., & Miotto, K. (1997). Substance abuse treatment for "hazardous users": An early
intervention. Journal of Psychoactive Drugs, 29, 291-298.
62. Miotto K., McCann M.J., Rawson R.A., Frosch D., Ling W. (1997). Overdose, suicide attempts and death among
a cohort of naltrexone-treated opioid addicts. Drug and Alcohol Dependence, 45, 131-134.
63. Huber, A., Ling, W.L., Shoptaw, S., Gulati, V., Brethen, P, & Rawson, R. (1997). Integrating treatments for
methamphetamine abuse: A psychosocial perspective. Journal of Addictive Diseases, 16(4), 41-50.
64. Frosch D., Shoptaw, S., Jarvik, M.E., Rawson, R.A., & Ling, W. (1998). Interest in smoking cessation among
methadone maintained outpatients. Journal of Addictive Diseases, 17(2), 9-19.
65. Ling, W., Shoptaw, S., Wesson, D., Rawson, R.A., Compton, M., & Klett, C.J. (1998). Treatment effectiveness
score as an outcome measure in clinical trials. NIDA Research Monograph, 175, 208-220.
66. Rawson, R., Hasson, A., Huber, A., McCann, M., & Ling, W. (1998). A 3-year progress report on the
implementation of LAAM in the United States. Addiction, 93(4), 533-540.
15
67. Shoptaw, S., Reback, C.J., Frosch, D.L., & Rawson, R.A. (1998). Stimulant abuse treatment as HIV prevention.
Journal of Addictive Diseases, 17(4), 19-32.
68. Gonzalez Castro, F., Barrington, E.H., Walton, M.A. & Rawson, R.A. (2000). Cocaine and methamphetamine:
Differential addiction rates. Psychology of Addictive Behaviors, 14(4), 390-396.
69. Rawson, R.A., McCann, M.J., Hasson, A., & Ling, W. (2000). Addiction pharmacotherapy 2000: New options
and new challenges. Journal of Psychoactive Drugs, 32, 371-378.
70. Domier, C.P., Simon, S.L., Rawson, R.A., Huber, A., & Ling, W. (2000). A comparison of injecting non-
injecting methamphetamine users. Journal of Psychoactive Drugs, 32, 229-232.
71. Huber, A., Lord, R., Gulati, V., Marinelli-Casey, P., Rawson, R. & Ling, W. (2000). The CSAT
Methamphetamine Treatment Project: Research design accommodations for “real world” application. Journal
of Psychoactive Drugs, 32, 149-156.
72. Rawson, R.A., Huber, A., Brethen, P.B., Obert, J.L., Gulati, V., Shoptaw, S., & Ling,W. (2000).
Methamphetamine and cocaine users: Differences in characteristics and treatment retention. Journal of
Psychoactive Drugs, 32, 233-238.
73. Anglin, M.D., & Rawson, R.A. (2000). The CSAT Methamphetamine Treatment Project: What are we trying to
accomplish? Journal of Psychoactive Drugs, 32, 209-210.
74. Rawson, R.A., McCann, M.J, Huber, A., Marinelli-Casey, P., & Williams, L. (2000). Moving research into
community settings in the CSAT Methamphetamine Treatment Project: The coordinating center perspective.
Journal of Psychoactive Drugs, 32(2), 201-208.
75. Shoptaw, S., Stein, J., & Rawson, R.A. (2000). Burnout in substance abuse counselors: Impact of environment,
attitudes and clients with HIV. Journal of Substance Abuse Treatment, 19, 117-126.
76. Obert, J.L., McCann, M.J., Marinelli-Casey, P., Weiner, A., Minsky, S., Brethen, P., & Rawson, R.A. (2000).
The Matrix Model of outpatient substance abuse treatment: History and description. Journal of Psychoactive
Drugs, 32(2), 157-164.
77. Simon, S.L., Domier, C., Carnell, J., Brethen, P., Rawson, R.A., & Ling, W. (2000). Cognitive impairment in
individuals currently using methamphetamine. American Journal on Addictions, 9(3), 222-231.
78. Blackwell, B., Nace, D., Rawson, R., Greenberg, P., Shaffer, I., Rofman, E.S., Callahan, J., Mee-Lee, D., Kasser,
C., Miller, M.M., & Radcliffe, A. (2000.) Practice guidelines: An ASAM-AMBHA joint statement. Journal of
Addictive Diseases, 19(2), 117-119.
79. Anglin, M.D., & Rawson, R.A. (Eds.) (2000). The CSAT Methamphetamine Treatment Project: Moving
research into the “real world.” Journal of Psychoactive Drugs, 32(2), 135-136.
80. Rawson, R.A., McCann, M.J., Shoptaw, S., Miotto, K., Frosch, D.L., Obert, J.L., & Ling, W. (2001). Naltrexone
for opiate addiction: Evaluation of a manualized psychosocial protocol to enhance treatment response. Drug and
Alcohol Review, 20, 67-80.
81. Ling, W., Huber, A., & Rawson, R.A. (2001). New trends in opiate pharmacotherapy: A review. . Drug and
Alcohol Review, 20, 51-68.
82. Isralowitz, R., Sussman, G., Afifi, M. Rawson, R., Babor, T., & Monteiro, M. (2001). Substance abuse policy
and peace in the Middle East: A Palestinian and Israeli Partnership. Addiction, 96, 973-980
83. Burden, W., Prendergast, M., Roll, J., & Rawson, R.A. (2001). The role of contingency management in drug
courts. Journal of Drug Issues, 31, 73-90.
84. Sim, T., Simon, S., Domier, C.P., Richardson, K., Rawson, R.A., & Ling, W. (2002). Cognitive deficits among
methamphetamine users with attention deficit hyperactivity disorder symptomatology. Journal of Addictive
Diseases, 21(1), 75-89.
85. Simon, S.L., Richardson, K., Dacey, J., Glynn, S., Domier, C., Rawson, R.A., & Ling, W. (2002). A comparison
of patterns of methamphetamine and cocaine use. Journal of Addictive Diseases, 21(1), 35-44.
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86. Rawson, R.A., Huber, A., Brethen, P., Obert, J.L., Gulati, V., Shoptaw, S., & Ling, W. (2002). Status of
methamphetamine users 2-5 years after outpatient treatment. Journal of Addictive Diseases 21, 107-119.
87. Rawson, R.A., Anglin, M.D., & Ling, W. (2002). Will the methamphetamine problem go away? Journal of
Addictive Diseases 21, 5-19.
88. Miotto, K., McCann, M.J., Basch, J., Rawson, R.A., & Ling, W. (2002) Naltrexone and dysphoria: Fact or
myth? American Journal on Addictions, 11(2), 151-160.
89. Marinelli-Casey, P.J., Domier, C. & Rawson, R.A. (2002). The gap between research and practice in substance
abuse treatment. Psychiatric Services 53(8), 984-987.
90. Rawson, R.A., Washton, A.M., Domier, C.P., & Reiber, C. (2002). Drugs and sexual effects: Role of drug type
and gender. Journal of Substance Abuse Treatment 22(2), 103-108.
91. Shoptaw, S., Rotheram-Fuller, E., Yang, X., Frosch, D., Nahom, D., Jarvik, M.E., Rawson, R.A., & Ling, W.
(2002). Smoking cessation in methadone maintenance. Addiction, 97(10), 1317-1328.
92. Reiber, C., Ramirez, A., Parent, D., & Rawson, R.A. (2002). Predicting treatment success at multiple timepoints
in diverse patient populations of cocaine dependent individuals. Drug and Alcohol Dependence, 68, 35-48.
93. McNeese-Smith, D., Crook M.W., Marinelli-Casey, P., Williams, L., & Rawson, R. (2002). Benefit
determination under managed care for substance abuse treatment clients. Care Management Journals, 3, 55-62.
94. Rawson, R.A., Marinelli-Casey, P., & Ling, W. (2002). Dancing with strangers: Will U.S. substance abuse
practice and research organizations build mutually productive relationships? Addictive Behaviors, 27(6), 941-
950.
95. Rawson, R.A., Gonzales, R.G., & Brethen, P. (2002). Methamphetamine: Current research findings and clinical
challenges. Journal of Substance Abuse Treatment 23, 145-150.
96. Rawson, R.A., & Stein, J. (2002). Blending clinical practice and research: Forging partnerships to enhance drug
addiction treatment. Journal of Substance Abuse Treatment, 23, 67-68.
97. Spear, S., & Rawson, R.A. (2002). Linking substance abuse researchers and practitioners in the substance abuse
field: Perspectives of two bridgers. Journal of Drug Issues, 32, 881-892.
98. Rawson, R.A. & Branch, C. (2002). Connecting substance abuse treatment and research: “Let’s make a deal.”
Journal of Drug Issues, 32, 769-782.
99. Crevecoeur, D., Finnerty, B., & Rawson, R. (2002) The Los Angeles County Evaluation System (LACES): A
large scale substance abuse treatment system evaluation program. Journal of Drug Issues, 32, 865-880.
100. Spear, S.A., & Rawson, R.A. (2002). Preface: Perspectives from the conference, “Common Ground, Common
Goals, Common Language: Bringing Substance Abuse Practice and Research Together. Journal of Drug
Issues, 32, 751-756.
101. Obert, J.L., London, E.D., & Rawson, R.A (2002). Incorporating brain research findings into standard treatment:
An example using the Matrix Model. Journal of Substance Abuse Treatment, 23, 107-114.
102. Foreman, R., Dackis, C., & Rawson, R. (2002). Substance abuse: Twelve principles to more effective outpatient
treatment. Current Psychiatry, 1, 16-24.
103. Rawson, R.A., Marinelli-Casey, P., & Huber, A. (2002). Treating methamphetamine dependence in adults. In
R. Straw & J.M. Herrell (Eds.), Conducting multiple site evaluations in real world settings. New Directions in
Evaluation, 94, 73-87.
104. Farabee, D., Rawson, R.A., & McCann, M. (2002). Adoption of drug avoidance activities among patients in
contingency management and cognitive-behavioral treatments. Journal of Substance Abuse Treatment, 23, 343-
350.
105. Rawson, R.A., Huber, A., McCann, M.J, Shoptaw, S., Farabee, D., Reiber, C., & Ling, W. (2002). A comparison
of contingency management and cognitive-behavioral approaches during methadone maintenance treatment for
cocaine dependence. Archives of General Psychiatry, 59(9), 817-824.
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106. Miotto, K., Darakjian, J., Basch, J., Murray, S., Zogg, J., & Rawson, R.A. (2002). Gamma-hydroxybutric Acid
(GHB): Patterns of use, effects and withdrawal. American Journal on Addictions, 10(3), 232-241.
107. Stizer, M.L., Owen, P.L., Hall, S.M., Rawson, R.A., & Petry, N.M. (2003). CPDD policy statement. Standards
for drug abuse treatment providers. Drug and Alcohol Dependence, 71, 213-215.
108. Messina, N., Farabee, D., & Rawson, R. (2003). Treatment responsivity of cocaine-dependent patients with
antisocial personality disorder in cognitive behavioral and contingency management interventions. Journal of
Consulting and Clinical Psychology, 71,320-329.
109. McNeese-Smith, D.K., Crook, M.W., Marinelli-Casey, P., & Rawson, R.A. (2003). Processes and outcomes of
substance abuse treatment within managed care: A preliminary report. Journal of Addictions Nursing, 14, 65-
73.
110. Ling, W., Rawson, R.A., & Compton, M. (2003). Clinical treatment of opioid addiction and dependence.
Methods in Molecular Medicine, 84, 285-295.
111. Watson, D.W., Rawson, R.A., Rataemane, S., Shafer, M.S., Obert, J.L., Bisesi, L., Tanamly, S. (2004). A
distance education model for teaching substance abuse providers in cognitive behavioral therapy. Journal of
Teaching in the Addictions, 2, 45-57.
112. Simon, S.L., Dacey, J., Glynn, S. , Rawson, R.A., & Ling, W. (2004). The effect of relapse on cognition in
abstinent methamphetamine users. Journal of Substance Abuse Treatment, 27, 59-66.
113. Rawson, R.A., Marinelli-Casey, P., Anglin, M.D., Dickow, A., Frazier, Y., Gallagher, C., Galloway, G.P.,
Herrell, J., Huber, A., McCann, M.J., Obert, J., Pennell, S., Reiber, C., Vandersloot, D., Zweben, J., and the
Methamphetamine Treatment Project Corporate Authors. (2004). A multi-site comparison of psychosocial
approaches for the treatment of methamphetamine dependence. Addiction, 99, 708-717.
114. Ling, W., Cunningham-Rathner, J., & Rawson, R.A. (2004). Diffusion of substance abuse treatment: Will
buprenorphine be a success? Journal of Psychoactive Drugs, May(Suppl. 2), 115-117.
115. London, E.D., Simon, S.L., Berman, S.M., Mandelkern, M.A., Lichtman, A.M., Bramen, J., Shinn, A.K., Miotto,
K., Learn, J., Dong, Y., Matochik, J.A., Kurian, V., Newton, T., Woods, R., Rawson, R.A., & Ling, W.L. (2004).
Mood disturbances and regional cerebral metabolic abnormalities in recently abstinent methamphetamine
abusers. Archives of General Psychiatry, 61,73-84.
116. Shoptaw, S., Watson, D.W., Reiber, C., Rawson, R.A., Montgomery, M.A., Majewska, M.D., & Ling, W.
(2005). Randomized controlled pilot trial of cabergoline, hydergine and levodopa/carbidopa: Los Angeles
Cocaine Rapid Efficacy Screening Trial (CREST). Addiction, 100(Suppl. 1), 78-90.
117. Brown, A.H., Domier, C., & Rawson, R. (2005). Stimulants, sex, and gender. Sexual Addiction and
Compulsivity, 12, 169-180.
118. Longshore, D., Anglin, D., Annon, J., & Rawson, R.A. (2005). Levo-alpha-acetylmethyadol (LAAM) vs
methadone: Treatment retention and opiate use. Addiction. 100, 1131-1139
119. London, E.D., Berman, S., Voytek, B., Simon, S.L., Mandelkern, M.A., Monterrosso, J., Thompson, P., Brody,
A., Gaega, J., Hong, M., Hayashi, K., Rawson, R.A., & Ling, W. (2005). Cerebral metabolic dysfunction and
impaired vigilance in recently abstinent methamphetamine users. Biological Psychiatry, 58, 770-778.
120. Spear, S., Hamilton, A., & Rawson, RA. (2005). Painting a picture of the client: Implementing the ASI in
community treatment programs. Journal of Substance Abuse Treatment, 29, 277-282.
121. Rawson, R.A., Gonzales, R., Obert, J.L., McCann, M.J., & Brethen, P. (2005). Methamphetamine use among
treatment-seeking adolescents in Southern California: Participant characteristics and treatment response.
Journal of Substance Abuse Treatment, 29(2), 67-74.
122. Rawson, R.A., McCann, M.J., Flammino, F., Shoptaw, S., Miotto, K., Reiber, C., & Ling, W. (2006). A
comparison of contingency management and cognitive-behavioral approaches for stimulant-dependent
individuals. Addiction, 101(2), 267-74.
123. Hser, Y.I., Stark, M.E., Paredes, A., Huang, D., Anglin, M.D., & Rawson, R.A. (2006). A 12-year follow-up of
a treated cocaine-dependent sample. Journal of Substance Abuse Treatment, 30, 219-226.
18
124. Isralowitz, R., & Rawson, R. (2006). Gender differences in prevalence of drug use among high risk adolescents
in Israel. Addictive Behaviors, 31, 355-358.
125. Rawson, R.A., Gonzales, R., & Ling, W. (2006) Methamphetamine abuse and dependence: An update. New
Directions in Psychiatry, 26, 221-236.
126. Gonzales, R.G., Marinelli-Casey, P.M., Shoptaw, S., Ang, A., & Rawson, R.A. (2006). Hepatitis C virus
infection among methamphetamine dependent individuals in outpatient treatment. Journal of Substance Abuse
Treatment, 31, 195-202.
127. Venneman, S., Leuchter, A., Bartzokis, G., Beckson, M., Simon, S.L., Schaefer, M., Rawson, R., Newton, T.,
Cook, I.A., Uijtdehaage, S., & Ling W. (2006). Variation in neurophysiological function and evidence of
quantitative electroencephalogram discordance: Predicting cocaine-dependent treatment attrition. Journal of
Neuropsychiatry and Clinical Neuroscience, 18, 208-216.
128. Ling, W., Rawson, R.A., & Shoptaw, S. (2006) Management of methamphetamine abuse and dependence.
Current Psychiatry Reports, 8, 345-354.
129. Anglin, M.D., Urada, D., Brecht, M.L., Hawken, A., Rawson, R., & Longshore, D. (2007). Criminal justice
treatment admissions for methamphetamine use in California: A focus on Proposition 36. Journal of
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130. Castro, F., Rawson, R.A., & Stamper, E. (2007). Response: TIPsters weigh in: Putting good science to work.
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200. Hser, Y.-I., Chang, L., Wang, G.-J., Li, M.D., Rawson, R., Shoptaw, S., Normand, J., & Tai, B. (2013).
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24
218. Glasner-Edwards, S., Mooney, L., Ang., A., Garneau, H.C., Hartwell, E.E., Brecht, M.-L., Rawson, R.A.
(2015). Mindfulness based relapse prevention improves stimulant use among adults with major depression and
generalized anxiety disorder. Drug and Alcohol Dependence, 156, e80. doi:
http://dx.doi.org/10.1016/j.drugalcdep.2015.07.1135
219. Bart, G., Le, G.M., Nguyen, H., Tran, H., Rieckmann, T.R., Nguyen, S., Darfler, K., & Rawson, R.A. (2015).
Alcohol and drug use among patients receiving HIV services in Hanoi, Vietnam. Alcohol and Drug
Dependence, 156, e16.
220. Robertson, C.L., Ishibashi, K., Chudzynski, J., Mooney, L.J., Rawson, R.A., Dolezal, B.A., Cooper, C.B.,
Brown, A.K., Mandelkern, M.A., & London, E.D. (2016). Effect of exercise training on striatal dopamine
D2/D3 receptors in methamphetamine users during behavioral treatment. Neuropsychopharmacology, 41(6),
1629-1636. doi: 10.1038/npp.2015.331. PMCID: PMC4832026 [Available May 1, 2017]
221. Cousins, S.J. , Denering, L., Crèvecoeur-MacPhail, D., Viernes, J., Sugita, W., Barger, J., Kim, T., Weismann,
S., & Rawson, R.A. (2016). A demonstration project implementing extended-release naltrexone in Los
Angeles County. Substance Abuse, 37(1), 54-62. DOI: 10.1080/08897077.2015.1052868
222. Cousins, S.J., Radfar, S.R., Crèvecoeur-MacPhail, D., Ang, A., Darfler K., & Rawson, R.A. (2016). Predictors
of continued use of extended-release naltrexone (SR-NTX) for opioid dependence: An analysis of heroin and
non-heroin opioid users in Los Angeles County. Journal of Substance Abuse Treatment, 63, 66–71.
doi: http://dx.doi.org/10.1016/j.jsat.2015.12.004
223. Kohno, M., Okita, K., Morales, A.M., Robertson, C.L., Dean, A.C., Ghahremani, D.G., Saab, F.W., Rawson,
R.A., Mandelkern, M.A., Bilder, R.M., & London, E.D. (2016). Midbrain functional connectivity and ventral
striatal dopamine D2-type receptors: Link to impulsivity in methamphetamine users. Molecular Psychiatry.
doi: 10.1038/mp.2015.223 [Epub ahead of print]. PMCID: PMC4970974
224. Radfar, S.R., Cousins, S.J., Shariatirad, S., Noroozi, A., & Rawson, R.A. (2016). Methamphetamine use among
patients undergoing methadone maintenance treatment in Iran; a threat for harm reduction and treatment
strategies: A qualitative study. International Journal of High Risk Behaviors & Addiction.
doi: 10.5812/ijhrba.30327 [Epub ahead of print].
225. Glasner-Edwards, S., Patrick, K., Ybarra, M., Reback, C.J., Rawson, R.A, Chokron Garneau, H, Chavez, K., &
Venegas, A. (2016). A cognitive behavioral therapy-based text messaging intervention versus medical
management for HIV-infected substance users: Study protocol for a pilot randomized trial. JMIR Research
Protocols, 5(2), e131. PMCID: 4938885 doi: 10.2196/resprot.5407
226. Padwa, H., Urada, D., Gauthier, P., Rieckmann, T., Hurley, B., Crèvecoeur-MacPhail, D., & Rawson, R.A.
(2016). Organizing publicly funded substance use disorder treatment in the United States: Moving toward a
service system approach. Journal of Substance Abuse Treatment, 69, 9-18.
doi: http://dx.doi.org/10.1016/j.jsat.2016.06.010
227. Glasner-Edwards, S., Hartwell, E.E., Mooney, L., Ang, A., Garneau, H.C., Brecht, M.-L., & Rawson, R.A.
(2016). Changes in stress reactivity among stimulant dependent adults after treatment with mindfulness based
relapse prevention: Results from a pilot randomized clinical trial. Journal of Addiction Research & Therapy,
7:298. doi:10.4172/2155-6105.1000298
228. Miotto, K., Cho, A.K., Khalil, M.A., Blanco, K., Sasaki, J.D., & Rawson, R.A. (2017). Trends in tramadol:
Pharmacology, metabolism, and misuse. Anesthesia & Analgesia, 124(1), 44-51. doi:
10.1213/ANE.0000000000001683
229. Glasner-Edwards, S., Mooney, L.J., Ang, A., Garneau, H.C., Hartwell, E., Brecht, M.-L., & Rawson, R. A.
(2017). Mindfulness based relapse prevention for stimulant dependent adults: A pilot randomized clinical trial.
Mindfulness, 8(1), 126-135. doi:10.1007/s12671-016-0586-9. PMCID: PMC5300086 (Available Feb. 1,
2018).
230. Al-Hemiery, N., Dabbagh, R., Hashim, M.T., Al-Hasnawi, S., Abutiheen, A., Abdulghani, E.A., Al-Diwan,
J.K., Kak, N., Al Mossawi, H., Maxwell, J.C., Brecht, M.-L., Antonini, V., Hasson, A., & Rawson, R.A.
(2017). Self-reported substance use in Iraq: Findings from the Iraqi National Household Survey on Alcohol
and Drug Use, 2014. Addiction. [Epub ahead of print] doi: 10.1111/add.13800
25
231. Rawson, R.A., & Clark, N. (2017). Interventions for the management of substance use disorders: An overview.
Eastern Mediterranean Health Journal, 23(3), 214-221.
232. Elkashef, A., Alhyas, L., Al Hashmi, H., Mohammed, D., Gonzalez, A., Paul, R., Wanigaratne, S., Gawad, T.,
Rawson, R., Al Marzooqi, A., & Al Ghaferi, H. (2017). National Rehabilitation Center programme
performance measures in the United Arab Emirates, 2013. Eastern Mediterranean Health Journal, 23(3), 182-
188.
233. Rawson, R.A., Mooney, L.J., Glasner, S., & Gonzales, R. (2017). Innovations in behavioral treatments for
substance use disorders. International Addiction Review, 1(1), 14-21.
234. Cousins, S.J., Crèvecoeur-MacPhail, D., Kim, T., & Rawson, R.A. (2018). The Los Angeles County hub-and-
provider network for promoting the sustained use of extended-release naltrexone (XR-NTX) in Los Angeles
County (2010-2015). Journal of Substance Abuse Treatment, 85, 78-83. doi: 10.1016/j.jsat.2017.02.011.
235. Garneau, H.C., Venegas, A., Rawson, R.A., Ray, L.A., & Glasner, S. (2018). Barriers to initiation of extended
release naltrexone among HIV-infected adults with alcohol use disorders. Journal of Substance Abuse
Treatment, 85, 34-37.
236. Crèvecoeur-MacPhail, D., Cousins, S.J., Denering, L., Kim, T., & Rawson, R.A. (2018). Effectiveness of
extended release naltrexone to reduce alcohol cravings and use behaviors during treatment and at follow-up.
Journal of Substance Abuse Treatment, 85, 105-108.
237. Krebs, E., Enns, B., Evans, E., Urada, D., Anglin, M.D., Rawson, R.A., Hser, Y.-I., & Nosyk, B. (2018). Cost-
effectiveness of publicly funded treatment for opioid use disorders in California. Annals of Internal Medicine,
168(1), 10-19. doi: 10.7326/M17-0611
238. Wolitzky-Taylor, K., Drazdowski, T.K., Niles, A., Roy-Byrne, P., Ries, R., Rawson, R., & Craske, M.G.
(2018). Change in anxiety sensitivity and substance use coping motives as putative mediators of treatment
efficacy among substance users. Behaviour Research and Therapy, 107, 34-41.
239. Wolitzky-Taylor, K., Niles, A.N., Ries, R., Krull, J.L., Rawson, R., Roy-Byrne, P., & Craske, M. (2018). Who
needs more than standard care? Treatment moderators in a randomized clinical trial comparing addiction
treatment alone to addiction treatment plus anxiety disorder treatment for comorbid anxiety and substance use
disorders. Behaviour Research and Therapy, 107, 1-9.
240. Wolitzky-Taylor, K., Krull, J., Rawson, R., Roy-Byrne, P., Ries, R., & Craske, M.G. (2018). Randomized
clinical trial evaluating the preliminary effectiveness of an integrated anxiety disorder treatment in substance
use disorder specialty clinics. Journal of Consulting and Clinical Psychology, 86(1), 81-88.
241. .El Magd, S.A., Khalil, M.A., Gohar, S.M., Enaba, D., Abdelgawad, T.M.S., Hasan, N.M., Miotto, K., &
Rawson, R.A. (2018). Tramadol misuse and dependence in Egypt and the UAE: User characteristics and drug-
use patterns. International Addiction Review, 2, 6-13.
242. Rawson, R.A., Cousins, S.C., McCann, M. J., Pearce, R., Van Donsel, A. (2019) Assessment of medication
for opioid use disorder as delivered within the Vermont hub and spoke system. Journal of Substance Abuse
Treatment. 97, 84-90.
243. Wolitzky-Taylor, K., Rawson, R., Ries, R., Roy-Byrne, P. & Craske, M.G. (in press). Adaptation of
Coordinated Anxiety Learning and Management (CALM) for comorbid anxiety and substance use disorders:
Delivery of evidence-based treatment for anxiety in addictions treatment centers. Implementation Science
(Suppl).
RESEARCH PAPERS – PEER REVIEWED (IN PRESS).

1. Rawson, R.A., Rieckmann, T, Cousins, S, McCann, M. Pearce, R. (In press) Patient perceptions of
treatment with medication treatment for opioid use disorder (MOUD) in the Vermont hub-and-spoke
system Preventive Medicine.
2. Miele, GM, Caton, L, Freese, TE, McGovern, M, Darfler, K, Antonini, VP, Perez, M, & Rawson, R.
Implementation of the hub and spoke model for opioid use disorders in California: Rationale, design and
anticipated impact. Journal of Substance Abuse Treatment.
26
3. Preliminary Efficacy of a Cognitive Behavioral Therapy Text Messaging Intervention Targeting

Alcohol Use and Antiretroviral Therapy Adherence
Dr Suzette Glasner
LETTERS TO THE EDITOR

1. Al Hemiary, N., Al-Diwan, J., Hasson, A., Rawson, R.A. (2012). Report on drug and alcohol use in Iraq: The
inaugural meeting of the Community Epidemiology Work Group. International Psychiatry, 9(4), 102.
2. Gonzales, R., Marinelli-Casey, P., Hillhouse, M., Hunter, J., Rawson, R.A., Mooney, L., & Ang, A. (2008).
Hepatitis A and B infection among methamphetamine-dependent users. Journal of Substance Abuse Treatment,
35(3), 351-352 [Letter to the Editor]. PMID: 18640808
BOOKS AND MANUALS

1. Rawson, R.A., Obert, J.L., McCann, M.J., Smith, D.P., & Scheffey, E.H. (1989). The neurobehavioral
treatment manual. Beverly Hills, CA: Matrix.
2. Rawson, R.A., Obert, J.L., McCann, M.J., & Ling, W. (1991). The Matrix Model of outpatient treatment for
alcohol abuse and dependency. Beverly Hills, CA: Matrix.
3. McCann, M.J., Rawson, R.A., Obert, J.L., & Hasson, A.J. (1992). Treatment of opiate addiction using
methadone: A counselor manual. CSAT TAP #7. Rockville, MD: U.S. Department of Health and Human
Services.
4. Rawson, R.A., Obert, J.L., McCann, M.J., & Ling, W. (1992). The Matrix Model for the treatment of opiate
addiction with naltrexone. Beverly Hills, CA: Matrix.
5. Shoptaw, S., Rawson, R.A., Blum, M., & Obert, J.L. (1994). Outpatient drug treatment manual for HIV-positive
substance abusers. Beverly Hills, CA: Matrix Institute on Addictions.
6. Rawson, R.A. (1999). TIP 33: Treatment for stimulant abuse disorders: Treatment Improvement Protocol (TIP)
Series 33. Center for Substance Abuse Treatment (CSAT). (Chair, CSAT Consensus panel). Rockville, MD:
U.S. Department of Health and Human Services.
7. Sorensen, J.L., Rawson, R., Guydish, J., & Zweben, J. (Eds.) (2002). Drug abuse treatment through
collaboration. Washington, DC: American Psychological Association
8. Isralowitz, R. Afifi, M., & Rawson, R. (Eds.) (2002). Drug problems: Cross-cultural policy and program
development. Westport, CT: Greenwood Publishing.
9. McCann, M.J., Obert, J.L., Marinelli-Casey, P., & Rawson, R.A. (2005) Meth: The basics. Center City, MN:
Hazelden.
10. Rawson, R.A. (2006). Methamphetamine: New knowledge, new treatments. Center City, MN: Hazelden.
11. Roll, J., Rawson, R.A, Shoptaw, S., & Ling, W. (Eds.) (2009). Methamphetamine addiction: From basic
science to treatment. New York: Guilford Press.
27
BOOKS and MANUALS (IN PRESS)
BOOK CHAPTERS
1. Callahan, E.J., & Rawson, R.A. (1978). Outcome behavioral assessment of narcotic addiction. In M. Sobell &
L. Sobell (Eds.) Current evaluation of alcohol and drug treatment. New York: Pergammon Press.
2. Callahan, E.J., & Rawson, R.A. (1979). Preserving the rights of narcotic addict clients. In J.T. Hannah, H.P.
Clark & W.P. Christian (Eds.), Preservation of clients rights: Systems for the treatment and protection of persons
receiving psychological, medical and educational services. New York, Free Press.
3. Rawson, R.A. (1995). Is psychotherapy effective for substance abuse? In A.M. Washton (Ed.), Psychotherapy
and substance abuse: A practitioner’s handbook (pp. 55-75). New York: Guilford Press.
4. Ling, W., Compton, M., Rawson, R.A., & Wesson, D. (1996). Neuropsychiatry of alcohol and drug abuse. In
B.S. Fogel & R.B. Schiffer (Eds.), Neuropsychiatry: A comprehensive textbook. Baltimore, MD: Williams &
Wilkins.
5. Washton, A.M., & Rawson, R.A. (1998). Substance abuse treatment under managed care. In M. Galanter &
H. Kleber (Eds.), Textbook of substance abuse treatment. Washington DC: APA Press.
6. Rawson, R.A., McCann M.J., Huber A., & Shoptaw, S. (1999). Contingency management and relapse
prevention as stimulant abuse interventions. In S.T. Higgins & K. Silverman (Eds.), Motivating behavior
change among illicit-drug abusers: Contemporary research on contingency management interventions (pp. 57-
74). Washington DC: APA Press.
7. Rawson, R.A., & Obert, J.L. (2002). Relapse prevention groups. In D.W. Brook & H.I. Spitz (Eds.), Group
psychotherapy of substance abuse. Washington, DC: APA Press.
8. Obert, J., Borkin, S., Degani, H., & Rawson, R.A. (2002). Outpatient substance abuse treatment using
scientifically supported treatment manuals: Implementation in the Palestinian Authority and Israel. In R.
Isralowitz, M. Afifi, & R. Rawson (Eds.), Drug problems: Cross-cultural policy and program development.
Westport, CT: Greenwood Publishing.
9. Isralowitz, R., Afifi, M., & Rawson, R. (2002). Overview of cooperative substance abuse activities in the
Middle East. In R. Isralowitz & R. Rawson (Eds.), Drug problems: Cross-cultural policy and program
development. Westport, CT: Greenwood Publishing.
10. Rawson, R., Hasson, A. Afifi, M., & Isralowitz, R. (2002). Middle East Drug Use Watch (MEDUW): A tri-
lateral system to measure the type and extent of psychoactive substance use in Palestinian and Israeli
communities. In R. Isralowitz, M. Afifi & R. Rawson (Eds.), Drug problems: Cross-cultural policy and
program development. Westport, CT: Greenwood Publishing.
11. Rawson, R.A., & Obert, J.L. (2002). The substance abuse treatment system in the US. What is it? What does
it do? Myths and misconceptions. In J.E. Zweben & S. Lambert (Eds.), Occupational medicine: A state of
the art review (pp. 1-21). Philadelphia, PA: Hanley and Belfus.
12. Castro, F.G., Obert, J.L., Rawson, R.A., Valdez, C., & Denne, R. (2002). Toward the development of culturally
competent treatments. In G. Bernal, J.E. Trimble, A.K. Burlew & F.T.L. Leong (Eds.), Handbook of racial
and ethnic minority psychology. Thousand Oaks, CA: Sage.
13. Sorensen, J.L., Guydish, J., Rawson, R., & Zweben, J. (2003). Introduction: The need for research-practice
collaboration. In J. Sorensen, R.A. Rawson, J. Guydish & J. Zweben (Eds.), Drug abuse treatment through
collaboration: Practice and research partnerships that work. Washington, DC: American Psychological
Association.
14. Ling, W., Rawson, R.A., Anglin, M..D. (2003). Agonist pharmacotherapies for opiate dependence: Comparing
the development and implementation of methadone and LAAM. In J. Sorensen, R.A. Rawson, J. Guydishc &
J. Zweben (Eds.), Drug abuse treatment through collaboration: Practice and research collaborations that
work. Washington, DC: American Psychological Association.
28
15. Rawson, R.A., Sodano, R., & Marinelli-Casey, P. (2003). Alcohol use and the workplace. In B. Johnson, P.
Ruiz, & M. Galanter (Eds.), Handbook of alcoholism treatment. New York: Lippincott.
16. Obert, J.L., Weiner, A., Stimpson, J., & Rawson, R.A. (2004). Treating substance use disorders. In R. Coombs
(Ed.), Handbook of addictive disorders (pp. 94-125). Hoboken, NJ: John Wiley & Sons.
17. Rawson, R.A., Sodano, R., & Hillhouse, M. (2005). Assessment of amphetamine use disorders. In D.M.
Donovan & G.A. Marlatt (Eds.), Assessment of addictive behaviors (pp. 185-214). New York: Guilford.
18. Jaffe, J.A., Rawson, R.A., & Ling, W.L. (2005). Cocaine. In B.J. Sadock & V.A. Sadock (Eds.), Kaplan and
Sadock’s comprehensive textbook of psychiatry (pp. 1220-1237). Baltimore, MD: Lippincott.
19. Jaffe, J.A., Ling, W., & Rawson, R.A. (2005). Amphetamines. In B.J. Sadock & V.A. Sadock (Eds.), Kaplan
and Sadock’s comprehensive textbook of psychiatry (pp.1188-1200). Baltimore, MD: Lippincott.
20. Carroll, K.M., & Rawson, R.A. (2005). Relapse prevention approaches for stimulant dependent individuals. In
G.A. Marlatt & D. Donovan (Eds.), Relapse prevention approaches for the treatment of substance use
disorders. New York: Guilford.
21. Rawson, R.A. (2006). Research strategies to test behavioral/psychotherapy treatments for substance use
disorders: Several examples. In N. Loza & A. El-Dosoky (Eds.), Current addiction treatment issues in the
Middle East. Cairo, Egypt: United Nations Office of Drugs and Crime Regional Office Publication.
22. Rawson, R.A. (2006). Intensive outpatient treatment for substance use disorders: The Matrix Model. In N.
Loza & A. El-Dosoky (Eds.), Current addiction treatment issues in the Middle East. Cairo, Egypt: United
Nations Office of Drugs and Crime Regional Office Publication.
23. Rawson, R.A. (2006). Naltrexone for the treatment of opiate addiction. In N. Loza & A. El-Dosoky (Eds.),
Current addiction treatment issues in the Middle East. Cairo, Egypt: United Nations Office of Drugs and Crime
Regional Office Publication.
24. Rawson, R.A. (2006). The Matrix Model: An intensive structured outpatient approach. In S. Trad (Ed.),
Proceedings of the Conference in Beirut Lebanon titled “New Perspectives on the Prevention and Treatment
of Addictions.” Beirut, Lebanon: Skoun.
25. Maxwell, J.C., Rutkowski, B.A., & Rawson, R.A. (2007). Substance abuse epidemiology in the United States:
A review of indicator data. In A. Kalechstein & W.G. van Gorp (Eds.), Neuropsychology and substance use:
State-of-the-art and future directions (pp.1-39). New York: Taylor & Francis.
26. Rawson, R.A., & Ling, W.L. (2008). Methamphetamine abuse and dependence: Current treatments. In M.
Galanter & H. Kleber (Eds.), Textbook of substance abuse treatment. Arlington, VA: American Psychiatric
Association Press.
27. Mooney, L.J., Glasner-Edwards, S., Rawson, R.A., & Ling, W. (2009) Medical effects of methamphetamine
use. In J.M. Roll, R.A. Rawson, W. Ling, & S. Shoptaw (Eds.), Methamphetamine addiction: From basic
science to treatment (pp. 117-142). New York: Guilford Press.
28. Roll, J., Rawson, R., Shoptaw, S., & Ling, W. (2009). Introduction. In J.M. Roll, R.A. Rawson, W. Ling, & S.
Shoptaw (Eds.), Methamphetamine addiction: From basic science to treatment (pp. 1-5). New York: Guilford
Press.
29. Shoptaw, S., Rawson, R.A., Worley, M., Lefkowith, S., & Roll, J.M. (2009). Psychosocial and behavioral
treatment of methamphetamine dependence. In J.M. Roll, R.A. Rawson, W. Ling, & S. Shoptaw (Eds.),
Methamphetamine addiction: From basic science to treatment (pp. 185–201). New York: Guilford Press.
30. Rawson, R.A. (2009). Treatments for methamphetamine dependence: Contingency management and the
Matrix Model. In R. Pates & D. Riley (Eds.), Interventions for amphetamine misuse (pp. 83-100). Oxford,
UK. Wiley Blackwell.
31. Rawson, R.A. (2011, September). Building an addiction workforce in the Middle East: A counselor training
program partnership between Kasr Al-Ainy and UCLA. In Public Health in the Middle East: Building a
Healthy Future (pp. 21-25). Washington, DC: Middle East Institute.
29
32. Rawson, R.A., Gonzales, R., & Ling, W. (2011). Clinical aspects of methamphetamine. In B.A. Johnson (Ed.),
Addiction medicine: Science and Practice (Vol. 1, pp. 495-510). New York: Springer.
33. Ling, W., Mooney, L., & Rawson, R.A. (2013). Amphetamine-type stimulants. In B.S. McCrady & E.E.
Epstein (Eds.), Addictions: A comprehensive guidebook (2nd Edition, Chapter 8). New York: Oxford University
Press.
34. Gonzales, R., Brecht, L., & Rawson, R.A. (2013). Adolescent substance abuse treatment outcomes. In R.
Rosner (Ed.), Clinical handbook of adolescent addiction (pp. 267-271). Oxford, UK: Wiley-Blackwell.
35. Rawson, R.A., Ling, W., & Mooney, L.J. (2015). Clinical management: Methamphetamine. In Galanter, M.,
Kleber, H.D., & Brady, K. (Eds.), The American Psychiatric Publishing textbook of substance abuse
treatment (5th Edition). Arlington, VA: American Psychiatric Publishing.
36. Momtazi, S., Noroozi, A., & Rawson, R.A. (2015). An overview of Iran drug treatment and harm reduction
programs. In N. el-Guebaly, G. Carrà, & M. Galanter (Eds.), Textbook of addiction treatment: International
perspectives (pp. 543-554). Milan: Springer.
37. Farabee, D., Rawson, R.A., & Gawad, T.A. (2015). Treatment in criminal justice settings. In N. el-Guebaly, G.
Carrà, & M. Galanter (Eds.), Textbook of addiction treatment: International perspectives (pp. 1129-1144).
Milan: Springer.
38. Rawson, R.A., Rieckmann, T., & Capoccia, V. (2015). Opportunities for addiction service system development:
Case studies from Vietnam, Lebanon and United Arab Emirates. In N. el-Guebaly, G. Carrà, & M. Galanter
(Eds.), Textbook of addiction treatment: International perspectives (pp. 1189-1197). Milan: Springer.
39. Obert, J., McCann, M., & Rawson, R.A. (2015). Development and dissemination of the Matrix Model of
intensive outpatient treatment. In N. el-Guebaly, G. Carrà, & M. Galanter (Eds.), Textbook of addiction
treatment: International perspectives (pp. 691-971). Milan: Springer.
40. Mooney, L.J., Cooper, C.B., London, E.D., Chudzynski, J., & Rawson, R.A. (2015). Exercise for substance use
disorders. In N. el-Guebaly, G. Carrà, & M. Galanter (Eds.), Textbook of addiction treatment: International
perspectives (pp. 973-986). Milan: Springer.
41. Rawson, R.A., & Galanter, M. (2015). Behavioural approaches: An introduction. In N. el-Guebaly, G. Carrà,
& M. Galanter (Eds.), Textbook of addiction treatment: International perspectives (pp. 775-778). Milan:
Springer.
42. Nathan, P.E., Zweben, J.E., & Rawson, R.A. (2016). Substance use disorders. In J.C. Norcross, G.R.
VandenBos, D.K. Freedheim, & N. Pole (Eds.), APA handbook of clinical psychology: Psychopathology and
health (Vol. 4, pp. 295-320). Washington, DC: American Psychological Association.
DVDs
A. EDUCATIONAL and DOCUMENTARY DVDs

1. Freese, T. (Principle Investigator), Rawson, R (Project Advisor). (2008). Meth Inside Out DVD Series. United
States: Eyes of the World Media Group.
2. Rawson, R. (Expert Panel). (2006) “Understanding Relapse” HBO: Addiction. United States: Home Box Office
Incorporated.
30
Attachment B
REPORT OF DR. RICHARD A. RAWSON: OPIOIDS ATTACHMENT B

HIGHLY CONFIDENTIAL
Attachment B: Materials Relied Upon
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Allen, G., “The ‘Oxy Express’: Florida’s Drug Abuse Epidemic,” NPR Morning Edition, March
2, 2011, available at http://www. npr.org/2011/03/02/134143813/the-oxy-express-floridas
drugabuse-epidemic.
American Society of Addiction Medicine, “What are the ASAM Levels of Care?” May 13, 2015,
available at https://www.asamcontinuum.org/knowledgebase/what-are-the-asam-levels-
of-care/.
Barocas, J.A., et al., “Estimated Prevalence of Opioid Use Disorder in Massachusetts, 2011-
2015: A Capture-Recapture Analysis,” American Journal of Public Health, 108(12),
2018, pp. 1675-1681.
Bastos, F.I and S.A. Strathdee, “Evaluating Effectiveness of Syringe Exchange Programmes:
Current Issues and Future Prospects” Social Science & Medicine, 51, 2000, pp. 1771-
1782.
Baumblatt, J., et al., “High-Risk Use by Patients Prescribed Opioids for Pain and Its Role in
Overdose Deaths,” JAMA Intern Medicine, 174(5), 2014, pp. 796–801.
Becker, W.C., et al., “Non-medical use, abuse and dependence on prescription opioids
among U.S. adults: Psychiatric, medical and substance use correlates,” Drug and Alcohol
Dependence, 94, 2008, pp. 38-47.
Binswanger, I., et al., “Release from prison--a high risk of death for former inmates,” New
England Journal of Medicine, 356(2), 2007, pp. 157–165.
Bipartisan Policy Center, “Tracking Federal Funding to Combat the Opioid Crisis,” March 2019,
available at https://bipartisanpolicy.org/wp-content/uploads/2019/03/Tracking-Federal-
Funding-to-Combat-the-Opioid-Crisis.pdf.
Birnhaum H.G., et al., “Societal costs of prescription opioid abuse, dependence, and misuse in
the United States,” Pain Medicine, 12, 2012, pp. 657-667.
Bohnert, A., et al., “A Detailed Exploration into the Association of Prescribed Opioid Dosage
and Overdose Deaths Among Patients With Chronic Pain,” Medical Care, 54(5), 2016,
pp. 435–441.
Bohnert, A., et al., “Association Between Opioid Prescribing Patterns and Opioid Overdose-
Related Deaths,” JAMA, 305(13), 2016, pp. 1315-1321.
Bose, J., et al., “Key Substance Use and Mental Health Indicators in the United States: Results
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IN THE CIRCUIT COURT FOR SULLIVAN COUNTY

BARRY STAUBUS, in his official capacity as the District )

EXPERT REPORT OF RICHARD A. RAWSON, PH.D.

2. I am currently a research professor at the University of Vermont (UVM) and a professor

3. I have an extensive research portfolio on a broad range of addiction-related topics. I have

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

IV. THE PREVALENCE OF OPIOID USE DISORDER (OUD)

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

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• Selective non-response: Of all individuals asked to participate in the NSDUH,

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

B. The “True” Prevalence of OUD

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C. The Prevalence of OUD in Northeast Tennessee

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REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

V. VERMONT’S TREATMENT SYSTEM FOR OPIOID ADDICTION REPRESENTS THE GOLD

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

33. A primary function of the H&S is to expand access to MOUD, a comprehensive

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

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Syringe exchange services

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

Treatment for incarcerated individuals with OUD

43. In 2018, lawmakers in Vermont passed legislation requiring the Department of

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

Effectiveness of MOUD treatment in the H&S

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

Figure 14: Opioid use of in-treatment participants

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

A. Issues Unique to Northeast Tennessee

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

B. The Current Treatment System in Eastern Tennessee

April 17, 2019 available at https://www.justice.gov/opa/pr/appalachian-regional-prescription-opioid-arpo-strike-

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

C. Services Needed to Build an Effective Treatment System in Eastern Tennessee

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

Residential and inpatient care

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

Treatment for incarcerated individuals with OUD

68. There is a growing literature to document that incarcerated individuals benefit

Buprenorphine induction in emergency departments

69. By lowering the barrier to buprenorphine induction, it is possible to make MOUD

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

70. To develop the extensive array of services needed in Eastern Tennessee an

REPORT OF DR. RICHARD A. RAWSON: OPIOIDS

Role of counties and benefits of publicly-funded treatment