Funded Projects

Despite psychopathology robustly increasing the risk for later substance use disorders (SUD), remarkably few studies have examined the impact of treating psychopathology on reducing rates of opioid use disorder (OUD), nicotine, and SUD. The main aims of this study are to implement a pragmatic set of office-based instrumentation using patient related outcome measures linked to electronic health records (EPIC) for intake and follow-up assessments to evaluate psychopathology, OUD, nicotine use disorder, and other SUDs in young people aged 16-30 years old who are receiving psychopathology treatment as part of routine outpatient clinical care. The study will also examine similar age patients with non-opioid SUD in outpatient SUD treatment settings to examine the impact of treatment in mitigating the development of OUD. Data derived from this study will help inform clinical guidelines and public health policy and provide important secondary outcomes for further work on the prevention of OUD, nicotine use disorder, and other SUDs in relation to early-onset psychopathology.

Drug checking services provide individuals who use drugs with information about the true contents of their purchases, and thus may help prevent overdoses. However, current technologies are either costly, technically complex, and non-portable or subject to false signals and restricted in their detection capabilities. This project will continue development of a new, simple-to-use, point-of-care analytical technology (DoseCheck) that can rapidly detect established drug threats in a sample and recognize newly emerging drugs. The project will also attempt to adapt DoseCheck to provide rapid results in emergency overdose situations and improve the analytical capabilities of medical examiners in under-resourced jurisdictions.

Multiple social determinants affect the health of youth experiencing homelessness. These include a lack of stable safe housing, income, education, food security, restricted access to services, as well as discrimination, victimization, and social isolation. This project will test the use of prevention efforts to address the factors that may be embedded within systems that serve this population, such as drop-in centers. The research will gather generalizable information about helping these youth along with cost estimates to inform future implementation efforts.

Evidence suggests that homeless youth have the highest rates of opioid use among youth subgroups in the country (Brands et al., 2005). Resolution of youth homelessness through housing and prevention services, often referred to as “Housing First”, has great potential to reduce the likelihood for the development of an opioid use disorder as well as other problem behaviors associated with living on the streets. However, only 20 percent to 30 percent of homeless youth samples report ever having stayed at a crisis shelter, 9 percent report having ever accessed mental health services, and 15 percent report ever having received treatment for substance use disorder (Ray, 2006), indicating a need to reach and engage youth in services that are feasible and acceptable. The results of this study will provide essential information for researchers and providers on the efficacy of housing plus opioid and related risk prevention services in a randomized controlled trial on opioid use, how moderators affect the response, and mechanisms underlying change.

This project is focused on identifying the clinical, genetic, and neural characteristics that convey risk for prescription opioid addiction. We will leverage the central biorepository and electronic health record (EHR) database of the Geisinger Health System to conduct large-scale genomics research and phenotype development. Through a collaboration with Regeneron Pharmaceuticals, the Geisinger biobank currently contains DNA samples on about 110,000 participants and includes both Illumina OmniExpressExome genotyping and whole exome sequence data, including common and rare variants, from over 60,000 of these subjects. This discovery cohort contains thousands of chronic musculoskeletal pain patients who have been taking greater than 120 mg equivalents of morphine for more than three months. Using EHR and self-report tools to develop a case definition and quantitative scoring, we will derive a clinical/genetic profile of prescription opioid addiction. This profile will be enhanced via integration of neuroimaging data.

FDA-approved medications for treating opioid use disorder are effective, but there is a significant unmet need for alternatives, especially relapse prevention. NIDA and the FDA have encouraged investigators to expand the range of therapeutic outcomes, beyond measurement of abstinence. Insomnia is a clinically significant, but understudied, correlate/predictor of relapse to substance use. Yet most medications for treating insomnia have limited efficacy and can produce side effects. The orexin (OX) system plays a key role in sleep and substance use, offering a promising avenue for study. This project will address whether OX-1/2 antagonism is a mechanism that can directly improve outpatient opioid abstinence, or whether OX antagonism corrects sleep deficiencies and indirectly improves opioid abstinence. Specific aims are to determine whether nightly treatment with the OX-1/2 antagonist suvorexant, relative to placebo, 1) increases outpatient opioid abstinence and 2) improves sleep efficiency on the residential detoxification unit. The study will also determine 3) whether improved sleep efficiency predicts greater opioid abstinence (regardless of group assignment).

Social determinants of health are individual and environmental factors that affect health, the ability to function, and quality of life. This project will study the impact of the family-focused Families Actively Improving Relationships (FAIR) prevention intervention currently offered in rural Oregon counties to parents experiencing substance use and mental health challenges. Through the FAIR program, participants receive substance use treatment services; mental health treatment services; parent management training; and support to access employment, housing, education or to mitigate exposure to violence and discrimination. This research will examine how the FAIR intervention affects substance use and societal determinants of health, toward informing payors and decision makers about the cost and value of FAIR prevention services in rural communities.

This proposal aims to test the impact of an empirically derived implementation strategy—under real-world conditions and across multiple child service systems—on successful adoption and sustainment of two evidence-based programs that address adolescent substance abuse: Treatment Foster Care Oregon (TFCO; formerly Multidimensional Treatment Foster Care) and Multidimensional Family Therapy (MDFT). The overarching goal of this proposal is to evaluate whether the integration of implementation fidelity (fidelity to the implementation process) with intervention fidelity (fidelity to the clinical intervention) can increase the probability that a new organizational site not only successfully adopts a program but develops the infrastructure to ensure it can sustain. This study will (a) evaluate the effect of stages of implementation completion coaching strategy (SIC-CS) on outcomes of program adoption and sustainment, (b) extend the SIC to include measurement of sustainment, and (c) examine cost and resource patterns most likely to yield sustainable programs.

Justice-involved young adults are one of the highest-risk populations for the development of opioid use disorder (OUD) and other significant public health problems, but they usually lack access to evidence-based practices that could potentially prevent this trajectory. The risk of unintentional death and other deleterious outcomes and long-term costs for opioid misuse for young adults, their communities and society (costs estimated at more than $115 billion annually) make this a priority, with rural areas in need of the most attention and assistance. The overriding purpose of the proposed pilot study is to prevent the onset of OUD by improving young adult offenders’ access to evidence-based risk reduction interventions, like contingency management (CM), by testing whether officers in the adult probation and parole setting can deliver such an intervention to their young adult substance using probationers who have not yet developed OUD. The primary motivation for this pilot is the clear public health need for improving and expanding delivery of substance use risk reduction interventions for young adults in the justice system. The ultimate outcome would be prevention of OUD in this high-risk population.

The project will address gaps in both risk identification and clinical management by utilizing comprehensive clinical data from a mature health information exchange containing more than 2.3 million patients across the spectrum of clinical care (hospitals, primary care, specialty care, community health centers, urgent care) to develop a statistically robust method to measure suicide risk associated with prescription opioid use. First, the team will couple data fusion techniques with machine learning-based approaches in identifying the clinical and demographic characteristics associated with elevated risk of suicidal behavior among prescription opioid users. Second, the team will develop clinical profiles of patients with higher risk of suicidal behavior associated with prescription opioids, and to incorporate these profiles in a clinical decision support platform that can be used for identification and intervention at the point of care. The clinical decision support tool developed under this proposal will provide a generalizable platform that could be extended to other more conventional opioid related outcomes such as OUD and overdose.

New Hampshire can anticipate as many as 1,000 infants born with prenatal opioid exposure each year. Pain management is complicated for pregnant women with opioid use disorder (OUD), and undermanagement of pain is a strong risk factor for relapse. Contemplative interventions, such as yoga and mindfulness, may reduce risks for relapse for pregnant and parenting women with OUD. This project represents a partnership with New Hampshire stakeholders to develop and pilot evaluation of a trauma-informed yoga and mindfulness relapse prevention intervention (Mindful Moms in Recovery: MMORE). It aims to: 1) identify needs and areas of adaptation of trauma-informed yoga and mindfulness-based relapse prevention protocols through formative work with pregnant and parenting woman; 2) develop an integrated 10-session intervention protocol with iterative feedback from client stakeholders; and 3) evaluate feasibility, acceptability, and efficacy trends of MMORE in a pre-post pilot with pregnant women.

This study proposes to test the delivery of a comprehensive cognitive behavioral therapy, reSET, to determine whether it can improve treatment adherence and long-term outcome among patients with opioid use disorder initiating medication-assisted treatment within a community-based"Hub and Spoke” Model of buprenorphine maintenance in central Pennsylvania. reSET (Pear Therapeutics, Inc.) is a commercially available version of the web-based Therapeutic Education System (TES) delivered as a mobile app and recently approved by the FDA as the first digital therapeutic adjunct for the treatment of substance use disorders. Through a series of interactive therapy lessons, the program teaches patients cognitive-behavioral coping skills to resist drug use and to address factors such as craving, depression, and other mood problems and relationship issues that are associated with risk of relapse. The CM component provides concrete rewards contingent on performance of key target behaviors.