Opioid Use in the Context of Polysubstance Use: Research Opportunities for Prevention, Treatment, and Sustained Recovery

Wed, 4/14/2021 - 12:00pm - 6:00pm

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The NIH HEAL InitiativeSM  convened a workshop, Opioid Use in the Context of Polysubstance Use, on April 14, 2021. The workshop’s primary goals were to review current trends, research opportunities, and strategies for treatment for opioid use combined with other substance use (particularly stimulants, such as cocaine or methamphetamine).

The opioid overdose crisis has changed in recent years due to the increasing prevalence of highly potent synthetic opioids, such as fentanyl and fentanyl analogs, often used with other substances such as stimulants (cocaine, methamphetamine), alcohol, and benzodiazepines. Polysubstance use is more common than single substance use, and individuals who use numerous substances are less likely to seek or receive treatment.

Presenters detailed the rise in polysubstance use and drug overdoses, including during the COVID-19 pandemic. This evolving overdose crisis shines a light on the issue of polysubstance use, illuminating a vital frontier for research to address this public health challenge.

Topics Covered

  • During the time of the COVID-19 pandemic, overdose deaths involving stimulants increased: up 28% for overdoses involving cocaine, and up 46% for overdose deaths involving other psychostimulants (mainly methamphetamine).
  • A growing area for research is treating opioid and methamphetamine co-use in community settings.
  • There are no population-level surveys or standardized treatment data to enable researchers to assess the true breadth of polysubstance use.
  • The necessity of low-barrier treatment is becoming clear, particularly after an overdose.

Key Takeaways

  • Contingency management is an increasingly viable option for polysubstance use, particularly when combined with digital therapeutic approaches used along with medications for opioid use disorder.
  • Excluding polysubstance use from clinical trials limits their applicability and adds to the internal stigma participants may feel about having multiple addictions.
  • To better predict trends and inform intervention strategies, alternative sources of data (outside of overdose death data) are needed, including data about regional variation.
  • Treatment needs to be both adequately resourced and adequately reimbursable for participants with insurance.
  • Emerging models of treatment focus on whole-person care and shared decision-making and also take into consideration social determinants of health.

Read the Full Meeting Summary pdf  199.29 KB

Download PDF version of the Polysubstance Use meeting agenda.

Welcome (12:00 – 12:20 pm)

Welcome and Introduction (12:00 – 12:10 pm)

  • Rebecca Baker, PhD, Director, NIH HEAL Initiative

Opening Remarks (12:10 – 12:20 pm)

  • Nora D. Volkow, MD, Director, National Institute on Drug Abuse

Session 1: Current Trends of Opioid Use in the Context of Polysubstance Use (12:20 – 2:10 pm)

Goal: Examine the context of stimulant and fentanyl co-use and the impact on overdose mortality trends.

Introduction (12:20 – 12:25 pm)

  • ModeratorHeather Kimmel, PhD, Director, Population Assessment of Tobacco and Health (PATH) Study, Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse

A Worsening Drug Overdose Crisis: Behind the Numbers (12:25 – 12:45 pm)

  • Grant Baldwin, PhD, MPH, Director, Division Overdose Prevention, Centers for Disease Control and Prevention 

Opioids and Methamphetamine: Patterns of Use and Consequences, Motivations for Use, Interest in Reducing Use, and Services (12:45 – 1:05 pm)

  • Caleb Banta-Green PhD, MPH, MSW, Principal Research Scientist, University of Washington Addictions, Drug, and Alcohol Institute

Pharmaceutical Industry Marketing, Physician Prescribing, and Stimulant Misuse (1:05 – 1:25 pm)

  • Scott Hadland, MD, MPH, MS, Associate Professor of Pediatrics, Boston University School of Medicine 

Tribal Opioid Response Agenda: Healing Our Communities Through Education and Action (1:25 – 1:45 pm)

  • Danica Love Brown, MSW, PHD, Behavioral Health Program Director, Northwest Portland Area Indian Health Board, Indian Extension for Community Healthcare Outcomes (Indian Country ECHO)

Session 1 Discussion (1:45 – 2:05 pm)

BREAK (2:05 – 2:10 pm)

Session 2: Current Treatment Approaches for Patients with OUD and Stimulant Use Disorders – Research Opportunities (2:10 – 4:00 pm)

Goal: Discuss current treatment approaches and modalities and identify research opportunities to expand and improve treatment options for people who misuse both opioids and stimulants.

Introduction (2:10 – 2:15 pm)

  • Moderator – Ivan Montoya, MD, MPH, Deputy Director, Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse

Potential New Pharmacotherapeutic Developments for Opioid and Stimulant Use Disorders (2:15 – 2:35 pm)

  • Christian Heidbreder, PhD, Chief Scientific Officer, Indivior

Psychosocial Treatments for Stimulant Use Disorders (2:35 – 2:55 pm)

  • Stephen T. Higgins, PhD, Professor of Psychiatry and Psychological Science, Director of Vermont Center on Behavior and Health, University of Vermont

Vaccines for Treating Opioid and Stimulant Use (2:55 – 3:15 pm)

  • Sandra D. Comer, PhD, Professor of Neurobiology, Department of Psychiatry, Columbia University and New York State Psychiatric Institute

Digital Therapeutics in the Treatment of Opioid and Stimulant Use Disorders (3:15 – 3:35 pm)

  • Lisa A. Marsch, PhD, Director, Center for Technology and Behavioral Health, Director, Northeast Node of the National Drug Abuse Treatment Clinical Trials Network, Geisel School of Medicine, Dartmouth College

Session 2 Discussion (3:35 – 3:55 pm)

BREAK (3:55 – 4:00 pm)

Session 3: Current Prevention and Treatment Strategies to Sustain Recovery for OUD and Polysubstance Use– Research Opportunities (4:00 – 6:00 pm)

Goal: Discuss current treatment and prevention interventions and identify research opportunities to improve intervention uptake, treatment retention, and sustained recovery tailored to individual and community contexts and needs.

Introduction (4:00 – 4:05 pm)

  • ModeratorRedonna Chandler, PhD, Director, AIDS Research Program and HEALing Communities Study, National Institute on Drug Abuse

Methamphetamine Use Among Persons with Opioid Use Disorder: Implications for Treatment (4:05 – 4:25 pm)

  • Judith Tsui, MD, MPH, Associate Professor, Department of Medicine, University of Washington

Emergency Department Perspective: Access to Care (4:25 – 4:45 pm)

  • Gail D’Onofrio, MD, MS, Professor and founding Chair of the Department of Emergency Medicine, Yale University School of Medicine and Physician-in Chief of the Yale-New Haven Hospital Emergency Department

The Impact of Recent Trends in Polysubstance Use on the HEALing Communities Study (4:45 – 5:05 pm)

  • Rebecca Jackson, MD, Director, OSU Center for Clinical and Translational Science
    Associate Dean for Clinical and Translational Research Professor, Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University Medical Center

Keeping Them in the Boat (5:05 – 5:25 pm)

  • Philip Rutherford, BA, Chief Operating Officer, Faces & Voices of Recovery, Washington, DC

Session 3 Discussion (5:25 – 5:45 pm)

Wrap-up, closing remarks (5:45 – 6:00 pm)

Speaker Bios

Grant Baldwin, Ph.D., MPH
Dr. Grant Baldwin is the Director of the Division of Overdose Prevention at CDC National Center for Injury Prevention and Control. In this role, he is responsible for monitoring trends in the opioid epidemic and other emerging drug threats as well identifying and scaling up prevention activities to address the evolving drug crisis. This includes supporting local drug-free community coalitions too. Prior to this appointment in October 2019, Dr. Baldwin served as the Director of the Division of Unintentional Injury Prevention for 11 years where he helped raise the profile of motor vehicle injury prevention, advanced work in older adult fall prevention and traumatic brain injury prevention, and established the initial CDC response to the prescription opioid overdose epidemic. As the scope, scale, and complexity of America’s drug overdose epidemic changed, the Division of Overdose Prevention was created to serve as a necessary and essential focal point to CDC’s more expansive and diversified work in the area. Dr. Baldwin has been at CDC for 25 years. Dr. Baldwin received his PhD in Health Behavior and Health Education at the University of Michigan. He received a MPH in Behavioral Sciences and Health Education from Emory University, and is currently an affiliated professor at Emory University. Dr. Baldwin has given keynote addresses or provided remarks at over 100 state, national and international conferences and meetings, has authored or coauthored more than 50 peer-reviewed publications, and has received awards of excellence for his leadership and teaching.

Caleb Banta-Green, MSW, MPH, Ph.D.
Dr. Banta-Green is a Principal Research Scientist at the Addictions, Drug & Alcohol Institute and an Affiliate Associate Professor, School of Public Health at the University of Washington. His researches opioid and stimulant use and use disorders and interventions to support recovery and reduce substance-related harms. He is particularly interested in developing interventions that are accessible to all people, including those who are most marginalized, such as those who are unhoused, utilizing services such as syringe service programs, and/or in the criminal legal system. He has an MSW, an MPH, and a PhD in Health Services Research from the School of Public Health, all from the UW. He serves on local, state, and federal workgroups and committees related to epidemiology, policy, and interventions for illicit substance-related conditions. He is a member of the U.S. Health and Human Service’s Interdepartmental Substance Use Disorders Coordinating Committee.

Danica Brown, MSW, Ph.D.
Danica Love Brown, MSW, CACIII, PhD, is a citizen of the Choctaw Nation of Oklahoma born and raised in Northern New Mexico. Ms. Brown is the Behavioral Health Director at the Northwest Portland Area Indian Health Board, and has worked as a mental health and substance abuse counselor, social worker and youth advocate for over 20 years. She has a history of working in the areas of prevention, drug and alcohol/mental health treatment, community and restorative justice, and sexual health with Native American and adjudicated youth. She specializes in working with culturally and socio-economically diverse populations and Tribal communities. Danica is an Indigenous Wellness Research Institute ISMART fellow alumni, Council of Social Work Education, Minority Fellowship Program fellow alumni and Northwest Native American Research Center for Health, fellow alumni. Her research has focused on Indigenous Ways of Knowing and Decolonizing Methodologies to address historical trauma and health disparities in Tribal communities and she loves puppies.

Sandra Comer, Ph.D.
Sandra Comer PhD is Professor of Neurobiology in the Department of Psychiatry at Columbia University and Research Scientist VI at the New York State Psychiatric Institute. She graduated summa cum laude from Vanderbilt University in 1987. Following PhD studies at the University of Michigan and post-doctoral research at the University of Minnesota, Dr. Comer joined Columbia University in 1993, where her research focus has been on the development and testing of novel approaches to the treatment of opioid use disorders. She is Director of the Opioid Laboratories in the Division on Substance Use Disorders and runs a very active research program devoted to examining various aspects of the abuse liability of opioids. Dr. Comer served on the Institutional Review Board at NYSPI for 10 years, so she is familiar with the regulatory requirements of research with human volunteers. In addition, she is an active member of the College on Problems of Drug Dependence, the longest standing group in the United States addressing problems of drug dependence and abuse. She served as Chair of the Program Committee, was elected President in 2015-2016, and currently serves as the Public Policy Officer of CPDD. She is a member of the World Health Organization Expert Advisory Panel on Drug Dependence, gives lectures and presentations to the U.S. Food and Drug Administration, reviews grant applications for the National Institutes of Health, and mentors both pre- and post-doctoral students. She has published over 170 papers, chapters, and books on issues related to substance use disorders.

Gail D’Onofrio, M.D., MS
Gail D’Onofrio, MD, MS is Professor and Chair of the Department of Emergency Medicine at Yale University and Physician-in Chief of the Emergency Services at Yale-New Haven Hospital. She is internationally known for her work developing and testing interventions for alcohol, opioids and other substance use disorders, serving as PI on several large NIH, SAMSHA, and CDC studies that have changed clinical practice. She is currently the PI on two NIDA Clinical Trial Network grants; the recently funded ED-INNOVATION tests the implementation of ED-initiated buprenorphine in 30 diverse ED across the country and compares different formations of buprenorphine in engaging patients in treatment.

Scott Hadland, M.D., MPH, MS
Scott Hadland is pediatrician and addiction specialist at Boston Medical Center and Boston University School of Medicine. He holds triple board certification in General Pediatrics, Adolescent Medicine, and Addiction Medicine. Dr. Hadland's clinical and research interests focus on adolescent and young adult substance use disorder prevention and treatment, and on improving care for youth and families affected by substance use. As part of these efforts, he seeks to improve education on addiction to pediatricians in the US and beyond. Dr. Hadland has also studied the potential influence of the pharmaceutical industry in physician prescribing of opioids and stimulants. He was the 2020 recipient of the Emerging Leader Award in Adolescent Health from the American Academy of Pediatrics. Dr. Hadland’s work has been funded by the National Institute on Drug Abuse, American Heart Association, Thrasher Pediatric Fund, Academic Pediatric Association, and the Society for Adolescent Health and Medicine.

Christian Heidbreder, MA, Ph.D.
Dr. Christian Heidbreder combines 30 years’ leadership experience in the neurosciences spanning the academic, governmental, and industrial sectors across Europe and the US. For 10 years prior to crossing into industry, Christian made a strong mark in the halls of academia and research, specifically at the University of Louvain (UCL) in Belgium, at the National Institute on Drug Abuse (NIDA) in Baltimore, and at the Swiss Federal Institute of Technology in Zürich (ETH) in Switzerland. He authored and co-authored over 450 peer-reviewed scientific publications, reviews and published conference proceedings with more than 10,000 citations. For the last 20 years, Christian held positions of increasing responsibility at SmithKline-Beecham’s Neuroscience Department in the UK, GSK’s R&D Centre of Excellence for Drug Discovery in Psychiatry in Italy, Altria’s Health Sciences Department in the US, and Reckitt Benckiser in the US and the UK. Following the demerger of the Pharmaceuticals component of Reckitt Benckiser, Christian joined Indivior as Chief Scientific Officer to provide strategic global leadership for worldwide R&D operations including nonclinical and clinical development, regulatory affairs, chemistry, manufacturing & controls, and portfolio management. Christian holds BA, MA, and PhD degrees from the University of Louvain and a Certificate in Strategic Innovation from the Wharton Business School. He is an Affiliate Professor in the Department of Pharmacology & Toxicology of the Virginia Commonwealth University School of Medicine and a Governance Fellow of the National Association of Corporate Directors (NACD). Christian also serves as a member of the National Advisory Council on Drug Abuse (NACDA) and a member of the National Institutes of Health (NIH) Helping to End Addiction Long-term (HEAL) Multi-Disciplinary Working Group (MDWG).

Stephen Higgins, Ph.D.
Stephen T. Higgins, Ph.D., is Director of the University of Vermont’s Center on Behavior and Health, and Principle Investigator on multiple NIH grants on the general topic of behavior and health, including two center grants and an institutional training award. He is the Virginia H. Donaldson Endowed Professor of Translational Science in the Departments of Psychiatry and Psychological Science and serves as Vice Chair of Psychiatry. He has held many national scientific leadership positions, including terms as President of the College on Problems of Drug Dependence and the American Psychological Association’s Division on Psychopharmacology and Substance Abuse. He is the author of more than 400 journal articles and invited book chapters and editor of a dozen volumes and therapist manuals in the area of behavior and health.

Rebecca Jackson, M.D.
Rebecca D. Jackson, MD, is the Max Morehouse Chair of Cancer Research, founding Director of the Ohio State University Center for Clinical and Translational Science, Associate Dean for Clinical and Translational Research, and Professor of Internal Medicine at The Ohio State University. Her research is concentrated in the area of women’s health with a specific focus on defining clinical factors, biomarkers and genetic associations for diseases that disproportionately affect women as well as characterizing the effects of environmental factors such as physical activity, dietary factors and medication exposure that modify disease risk. She brought together a research team across 6 Ohio academic centers, 19 community partners and RecoveryOhio to participate in the HEALing Communities Study and more recently, used a similar community-based participatory research model to address health inequities in COVID-19 testing through RADx-UP. Her laboratory has had continuous NIH support for more than 3 decades and she has authored or co-authored more than 300 peer-reviewed manuscripts. Dr. Jackson is also a nationally recognized leader in in supporting education and training of translational scientists. She has been the recipient of numerous awards including the Kellogg National Fellowship, the Ohio Women’s Hall of Fame, the AACR Team Science Award, the ACTS Team Science Award and the Barry Coller Distinguished Service Award from ACTS. In 2008, she was elected as a Fellow of the American Association for the Advancement of Science and in 2015, she received the OSU Distinguished Scholar Award, one of the University’s highest research honors.

Lisa Marsch, Ph.D.
Lisa A. Marsch, PhD is the Director of the Center for Technology and Behavioral Health (CTBH), the Director of the Northeast Node of the National Drug Abuse Treatment Clinical Trials Network, and the Andrew G. Wallace Professor within the Geisel School of Medicine at Dartmouth College. CTBH is an interdisciplinary “Center of Excellence”, supported by the U.S. National Institute on Drug Abuse, that uses science to inform the development, evaluation, and sustainable implementation of digital therapeutics (that leverage web, mobile, sensing and/or social media approaches) in the treatment of persons with substance use disorders and other behavioral health challenges. These tools are designed to deliver engaging, effective, and widely accessible health monitoring and health behavior interventions to collectively lead to transformations in the delivery of science-based substance use disorder treatment.

Philip Rutherford
Philip Rutherford is the Chief Operating Officer at Faces & Voices of Recovery. He is a recovery coach, a passionate member of the Recovery Community and possesses a self-described Doctorate from the school of Hard Knocks. As COO, he is responsible for multiple lines of business within the Faces & Voices ecosystem. Phil is credited with a significant role in conception, design, launch and facilitation of the Recovery Data Platform (RDP). This cloud-based platform is the first of its kind and has quickly become a valuable asset in longitudinal data collection for Peer-Based Services. Phil has a BA in Psychology with a specialization in Substance Use Disorders. Phil's prior experience as Director at a Recovery Community Organization offered front-row seat into the world of Peer Based Recovery Supports. Prior to that, he spent most of his career in corporate sales, marketing, and management at Microsoft, Micron Electronics, and companies within the Taylor Corporation. Phil is an active member of the Recovery community and has considerable experience in the areas of Substance Use Disorders, Recovery, Reentry, and Cultural Competency.

Judith Tsui, M.D. MPH
Dr. Judith Tsui is an Associate Professor of Medicine at the University of Washington, based at Harborview Medical Center and Evergreen Treatment Services in Seattle, WA. She is an Addiction Medicine physician, providing buprenorphine and hepatitis C treatment in primary care and opioid treatment program settings. Her NIH-funded research is focused on improving care delivery and health outcomes for persons with substance use disorders. Current NIH/NIDA funded PI projects include developing a community pharmacy model for medications for persons who inject drugs (R34DA047660) and an mHealth intervention to improve adherence to buprenorphine and methadone (R44DA044053; R41DA053081). She serves as co-PI for the data coordinating center supporting the “Rural Opioid Initiative” (U24DA048538). Dr. Tsui is committed to educating the next generation of Addiction Medicine physician researchers as the PI/Director of the NIDA R25 funded UW Medical Students Addiction Research (“MedStAR”) program and Associate Director of the UW Addiction Medicine fellowship.

Soundbites From the Event

Dr. Caleb Banta-Green on Shared Decision-Making for Treating Polysubstance Use

Dr. Lisa A. Marsch: The Value of Digital Therapeutics for Substance Use Disorders

NIDA Director Dr. Nora Volkow on the Need for Better Data

Watch Full Videos From the Event

Session 1: Current Trends of Opioid Use in the Context of Polysubstance Use

Session 2: Current Treatment Approaches for Patients with OUD and Stimulant Use Disorders – Research Opportunities

Session 3: Current Prevention and Treatment Strategies to Sustain Recovery for OUD and Polysubstance Use – Research Opportunities

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