Funded Projects

Numerous harm reduction strategies are available to reduce the harmful consequences of drug use. Examples include syringe services programs that provide sterile syringes, easy access to naloxone, and fentanyl test strips that may help people identify whether the substance(s) they plan to take contain fentanyl. This project aims to evaluate the use and effectiveness of several strategies in an urban environment as well as determine the openness and commitment of providers to offering them. 

Although approximately 80% of people with opioid use disorder smoke cigarettes, tobacco use is rarely addressed in treatment of opioid use disorder. Moreover, smoking cessation interventions that are effective in the general population have been minimally effective among people with opioid use disorder. This project will integrate into methadone treatment programs the Mindfulness-Oriented Recovery Enhancement intervention and motivational interviewing to address use of tobacco and other drugs. This research will determine the value of this intervention compared to attending a support group or receiving motivational interviewing. The project will also examine use of tobacco, opioids, and other drugs, and whether people begin treatment. The research will also study implementation barriers and facilitators to the mindfulness-based approach as well as strategies to enhance its adoption into clinical practice.

Research is needed to better understand how to make life-saving harm reduction services more accessible to populations that are hard to reach. This project will identify the physical and psychological factors that make harm reduction services most effective. The findings will then be used to inform the development, implementation, and testing of an innovative strategy consisting of several internet- and smartphone-based tools designed to improve access to harm reduction services for people who are hard to reach. 

Harm reduction supplies include fentanyl test strips that allow people who use drugs to identify whether the substance(s) they plan to take contain fentanyl and sterile syringes that help to prevent the spread of infectious diseases among people who inject drugs. One potential way to increase access to harm reduction supplies is mail delivery. This project will describe state-level policies that deter the use of mail-based delivery of harm reduction services, examine characteristics of people who use mail-based harm reduction services, and assess individual preferences related to mail-based harm reduction services.

Guidelines published by the Centers for Disease Control and Prevention in 2016 recommended gradual reductions in opioid medication doses (opioid tapering) for people with chronic pain and substance use disorder and recommended that those patients with pain and opioid use disorder should be switched to opioid use disorder medications. Despite wide implementation, little is known about the consequences of opioid tapering among patients with co-occurring chronic pain and substance use disorder. This project will use various databases (Cerner Real-World DataTM, American Hospital Association data, and U.S. Census data) to create a representative electronic health records database. This database will be used to determine the relationship between opioid tapering, multidisciplinary pain treatment, and medications for opioid use disorder – as well as monitor outcomes for patients with chronic pain and co-occurring substance use disorder.

The lack of timely data about drug use and overdose deaths has hindered the ability of communities and state agencies to allocate resources to regions where they are most needed. This project will develop a secure data pool that combines individual and community-level real-time data from multiple sources, including urine drug testing. These data will then be used to model the contribution of opioid, cocaine, and stimulant use to overdoses, overdose deaths, and cases of substance use disorder. This research will also use urine drug testing results and demographic/contextual data to identify populations and subpopulations at highest risk of drug use and overdose. This information will be displayed through a data platform tailored to the needs of end users (e.g., communities or agencies) and with user-friendly tools that help users make informed decisions on where resources are most urgently needed.

Compared to people with stable housing, individuals experiencing homelessness are more likely to use both fentanyl and stimulants and experience drug-related harms. This project will examine fentanyl-stimulant polysubstance use patterns and how they evolve over time in response to changes to housing status. It will also assess use of overdose prevention and substance use disorder treatment interventions in homeless individuals who use both fentanyl and stimulants, including how polysubstance use patterns shape their risk of overdose over time. This research will also interact with community stakeholders toward translating the findings into future research, policy, and program recommendations.

While some people who use drugs do not carry or use naloxone, others respond to multiple overdoses over short periods of time. This project aims to identify characteristics and experiences of these individuals, known as “overdose responders,” toward better understanding barriers to naloxone use. The research will also test interventions to support the well-being of responders and to increase the number of community members ready and willing to give naloxone to reverse overdose. 

Timely and accurate surveillance of fatal and non-fatal overdoses is necessary in light of the worsening overdose crisis, but data is rarely available in real-time. Tracking non-fatal overdoses is especially important because patients who overdose once are likely to experience additional and potentially fatal overdoses. This project aims to increase the quality and timeliness of non-fatal overdose data estimates by analyzing clinicians’ notes rather than clinical codes from emergency department and emergency medical services records. The datasets and models produced from this research will be used to build an interactive dashboard with up-to-date, county-level overdose-surveillance estimates for use by Kentucky first responders to aid in rapid allocation of resources.

Decreasing opioid dosing faster than advised by clinical recommendations often leaves chronic pain unaddressed and may increase the risk of overdose and suicide compared to continuing long-term opioid treatment. This project will compare a patient-centered tapering protocol with or without MORE in primary care offices in New Jersey and Utah. The MORE approach integrates training in mindfulness, reappraisal, and savoring to alter behavior away from valuation of drug rewards and toward natural rewards. This research will also identify practices to use MORE in primary care settings.

Opioid use during pregnancy is associated with harmful health outcomes for infants including preterm birth, neonatal opioid withdrawal syndrome, and brain-related problems. This project will carry out an in-depth investigation of the effects of opioid use during pregnancy including changes to health of the placenta, inflammation in the fetus, as well as behavioral and movement-related outcomes during the first year of life. This research will contribute to fundamental knowledge about how the placenta and brain work together as well as identify new strategies for diagnosing, treating, and preventing opioid harm to the fetus and mother.   

Exposure to prescription opioids during pregnancy can alter growth of the fetus and cause persistent neurological problems during childhood. This project will identify biological underpinnings of oxycodone exposure on health of the placenta, brain development of the fetus, and behavioral problems observed in early infancy. This research will also assess whether melatonin supplementation can limit these harmful outcomes. Overall, the research aims to characterize the health effects of oxycodone used during pregnancy, as well as to point to new tools and molecular indicators (biomarkers) for diagnosing, treating, and preventing opioid harm to the fetus and mother.