Funded Projects

Buprenorphine (BUP) is an FDA-approved medication-assisted therapy (MAT) that improves outcomes and saves lives in patients with opioid use disorder (OUD). It is available in multiple dosage forms and routes of administration, including daily sublingual (SL) and buccal tablets and films, a monthly subcutaneous (SC) injectable, and a 6-month SC implant; however, these forms leave many patients untreated or undertreated. This product, in a partnership with Lyndra Therapeutics, aims to develop a once-weekly oral BUP dosage form for maintenance therapy for OUD, using a new oral dosage formulation developed by Lyndra. A long-acting oral BUP may address important limitations of current MATs by providing improved PK with less euphoria than SL, a patient- and provider-preferred route of administration, and an optimal dosing interval for improved patient adherence with the potential for cost-effective direct observed therapy.

With nearly 116 million people suffering from chronic pain in the United States, there is a need for new analgesics without the risks posed by opioids. Antagonists acting at TRPV1 receptor have long been recognized as one of the most promising novel classes of non-opioid analgesics. Initial tests in humans have confirmed that this class of drugs produces analgesia and is safe and well-tolerated, but side effects include hyperthermia and partial loss of heat sensitivity, leading to most research being halted. This project will conduct a set of preclinical proof-of-concept studies in rats to support the claims that, at doses that have minimal, clinically acceptable, or negligible impact on cardiovascular function, a2 adrenoceptor agonists can diminish thermoregulatory effects of TRPV1 receptor antagonists.

This study will (1) test pharmacologic and behavioral strategies to improve OUD pharmacotherapy treatment retention and to improve outcomes among patients who have been successfully stabilized on OUD medications and want to stop medication and (2) identify predictors of successful outcome and develop a stage model of relapse risk.

The HEALthy Brain and Child Development National Consortium (HBCD-NC) will establish a normative model of developmental trajectories over the first 10 years of life. All sites in the HBCD-NC will carry out a common research protocol and will assemble and distribute a comprehensive research dataset to the scientific community. The HBCD-NC will collect neural, behavioral, physiological, and psychological measures, as well as biospecimens, to characterize neurodevelopmental trajectories. Most participants will be recruited in the second trimester of pregnancy, with a smaller subset recruited at birth, and followed for the first 10 years of life. The University of Florida study site will recruit a diverse group of mother-infant pairs from urban and rural communities in North Central Florida.

Novel treatments for opioid use disorder are critically needed as the addiction and overdose crises continue. Neuromodulation is a promising supplemental treatment to standard care. The overarching project seeks to evaluate low-intensity focused ultrasound that targets the nucleus accumbens, a primary component of the brain’s reward neurocircuitry. This supplement will expand the number of participants in part of the study and will increase the project’s overall impact consistent with the original objectives and aims of the parent grant.

EicOsis is developing a first-in-class analgesic with efficacy against neuropathic pain that will reduce or replace the need for opioids and thus potentially prevent opioid use disorder (OUD). The target of the small molecule inhibitor EC5026 is the soluble epoxide hydrolase, a master regulatory enzyme that modulates the activity of endogenous bioactive lipids. The study will reach the next steps in clinical human clinical trials with EC5026 through additional preclinical studies to expand the efficacy into models of chronic pain conditions. Additionally, detailed pharmacokinetic, metabolism, and distribution studies are proposed that will provide the required information to optimize drug formulation and for advanced clinical trials examining efficacy in humans. EicOsis is meeting current development goals, and EC5026 is well positioned to meet the urgent need of reducing opioid use.

Although there are effective prevention and treatment programs and services to address opioid misuse, opioid use disorder (OUD), and overdose, gaps remain between those needing and those receiving prevention and treatment, in part because of a need to better understand how to make these programs and services most effective at a local level. The National Institutes of Health (NIH) and the Substance Abuse and Mental Health Services Administration (SAMHSA) launched the HEALing Communities Study to generate evidence about how tools for preventing and treating opioid misuse and OUD are most effective at the local level. This multisite implementation research study will test the impact of an integrated set of evidence-based practices across health care, behavioral health, justice, and other community-based settings. The goal of the study is to reduce opioid-related overdose deaths by 40 percent over three years. Boston Medical Center is partnering with academic institutions in three other states to study the impact of these efforts in 67 highly affected communities. The study will also look at the effectiveness of coordinated systems of care designed to increase the number of individuals receiving medication to treat OUD, increase the distribution of naloxone, and reduce high-risk opioid prescribing.

Homeless youth have high rates of alcohol and drug use, comorbid mental health conditions, and are at high risk for suicide. However, few preventive interventions have been proven for reducing substance use or addressing suicide among homeless youth. Resolution of youth homelessness through housing and prevention services, often referred to as ?Housing First? (HF), will be tested in the HOME (Housing, Opportunities, Motivation and Engagement) study, which aims to reduce opioid use and progression to opioid use disorder (OUD). This study will include suicide screening, treatment, education and prevention (STEP) to the model to examine whether HF provides secondary benefits for reducing suicidal ideation and behaviors among high risk homeless youth. STEP includes ongoing suicide screening procedures and Cognitive Therapy for Suicide Prevention (CTSP) for those at high risk for suicide. Youth (N=240) will be randomly assigned to receive HF + STEP + opioid and related risk prevention services (strengths-based outreach and advocacy; HIV Prevention; and motivational Interviewing) or to receive STEP + opioid and related risk prevention services, alone. Results from this study will inform the design and implementation of other national models of HF to address prevention of substance use and suicidal ideation and behaviors among homeless youth.

People who take medications for opioid use disorder as part of their recovery pathway need to take these medications for extended periods of time to reduce risk of overdose. Recovery community centers, which provide a range of recovery-oriented and peer-delivered services in a welcoming environment, may be an important asset for these individuals. This project joins two recovery community centers that serve Black communities with an academic research team to inform the design of a rigorous, large-scale clinical trial to determine if clinical referral to recovery community centers improves long-term recovery outcomes.

The opioid crisis continues its highly negative impact, with more than 49,000 opioid-related overdose deaths in 2017. In 2016, the Centers for Disease Control and Prevention (CDC) issued guidelines for opioid prescribing that included opioid dosing and risk mitigation strategies, and health systems implemented similar initiatives even earlier. This has resulted in a quickly changing and more conservative prescribing environment. National data indicate the number of prescriptions has fallen between 2013 and 2016. Registries and electronic health record (EHR) data are increasingly cited as valuable resources to address critical research questions on opioid use with high efficiency. To our knowledge, no investigators have established an EHR-based prescription opioid registry across several diverse health systems with common data algorithms with the flexibility to address multiple questions. The goal of the proposed research is to develop a prescription opioid registry across 10 diverse health systems with harmonized EHR data from years 2012-2018 and leverage it to answer several key “next-step” research questions in response to the opioid crisis. The registry will include medications prescribed for treatment of OUD, including buprenorphine products.

The overarching goal of the Greater Southern California Node (GSCN) of the National Drug Abuse Treatment Clinical Trials Network (CTN) is to expand access to and improve outcomes of treatments for substance use disorders (SUDs)—with a special emphasis on opioid use disorder (OUD). The specific aims of GSCN include the development of new research protocols, support of multi-site CTN projects, and dissemination of research findings. The GSCN research agenda includes four priority areas: (1) developing and testing effective interventions for OUD and related comorbidities, (2) applying implementation science to deliver and expand OUD treatment, (3) leveraging electronic health record systems and data science generation of innovative approaches to improve treatment for OUD, and (4) expanding OUD treatment access and utilization through mHealth and other technologies. The GSCN research agenda reflects its capacity to collaboratively expand CTN efforts to develop and implement innovative approaches to improve treatment for OUD.

Chronic pain and opioid use disorder often occur together, but there are a striking lack of integrated treatments accessible to people in need, particularly Black and Hispanic individuals living and seeking care in under resourced settings. This research will examine multi-modal, evidence-based practices in diverse health care settings and among diverse populations with both chronic pain and opioid misuse/disorder. The first project will examine the effects of yoga and physical therapy onsite at methadone opioid treatment clinics. The second project will test Acceptance and Commitment Therapy and a care-management smartphone app for individuals in primary-care based buprenorphine treatment. The third project will compare microdosing versus standard doses/timing of buprenorphine for hospitalized patients. All three projects will improve access to care for Black and Hispanic individuals in under resourced settings by bringing integrated treatments to them. The interventions have high potential to be used broadly.

To respond quickly and effectively to the constantly changing dynamics of the opioid crisis, public health agencies and organizations need timely state and local data to make critical decisions about where to allocate resources and target responses. This project creates the Rapid Actionable Data for Opioid Response in Kentucky system, a near real-time statewide surveillance system. This resource will combine data from multiple state agencies to provide actionable and timely information to support opioid overdose prevention, harm reduction, evidence-based treatment, and recovery services. The project will also develop user-driven reporting and visualization tools (mobile and web-based apps) that provide immediate access to near real-time community or state level data, reports, and visual analytics.