Substance Abuse and Addiction Commons^™

Hepatitis C Virus Transmission Among People Who Inject Drugs In Rural United States: Mathematical Modeling Study Using Stochastic Agent-Based Network Simulation, Lin Zhu, Jennifer R. Havens, Abby E. Rudolph, April M. Young, Golnaz Eftekhari Yazdi, William W. Thompson, Liesl M. Hagan, Liisa M. Randall, Jianing Wang, Rebecca Earnest, Shayla Nolen, Benjamin P. Linas, Joshua A. Salomon

Center on Drug and Alcohol Research Faculty Publications

People who inject drugs (PWID) account for the majority of hepatitis C virus (HCV) infections in the United States. The injection-equipment-sharing network likely plays an important role in shaping the dynamics of HCV transmission. Recognizing the emerging HCV epidemic in rural communities, we developed an agent-based network simulation model of HCV transmission via injection equipment sharing and used data on rural PWID networks to inform model parameterization and calibration. We then simulated an array of networks that varied key network properties to understand their impact on the magnitude and distribution of HCV incidence. The results show substantial heterogeneity in HCV …

Emergency Department-Initiated Standard Versus High-Dose Buprenorphine Induction (Envision): A Randomised Clinical Trial Protocol, Kathryn Hawk, Andrew Herring, Marek Chawarski, Erik S. Anderson, Michael Baumann, Alyrene Dorey, August F. Holtyn, Christopher Jones, Shara Martel, Patricia Owens, Kaitlin Kmiecik, Tania D. Strout, Peter Taillac, Michelle R. Lofwall, Sharon L. Walsh, Gail D’Onofrio

Center on Drug and Alcohol Research Faculty Publications

Introduction: The initiation of buprenorphine for patients with opioid use disorder (OUD) in the emergency department (ED) has been associated with improved outcomes including reduced ED visits and increased treatment engagement. Though both standard-dose (8 mg buprenorphine equivalent) and high-dose (24 mg buprenorphine equivalent) strategies to initiate buprenorphine have been used in the ED, no prospective trials comparing outcomes among patients receiving these treatments have been reported.

Methods and analysis: This multisite randomised clinical trial is a multisite double-blind, double-dummy, randomised clinical trial enrolling 360 emergency department patients with moderate-to-severe OUD. Enrolled patients will be randomised to one of two …

Facebook As A Strategy To Deliver A Peer Navigation Intervention For Recently Incarcerated Women With Opioid Use Disorder: A Mixed Methods Descriptive Profile, Martha Tillson, Jaxin Annett, Marguerite A. Webster, Amanda Fallin-Bennett, Mandi Webster, Amber Clemons, Cynthia Robinson, Kevin Crabtree, Casey Baker-Romans, Michele Staton

Center on Drug and Alcohol Research Faculty Publications

Recovery support and treatment linkages are critical during transitions from incarceration to community but can be challenging to deliver to hard-to-reach populations. This paper will examine Facebook contacts between peer navigators (PNs) and women with opioid use disorder (OUD) following jail release to explore women’s use of PN services, including purpose and content of Facebook messages. As part of a larger clinical trial under the Justice Community Opioid Innovation Network (JCOIN), PNs provided OUD treatment navigation and recovery support for 12 weeks following women’s release from jail, using remote options such as Facebook. Facebook Messenger transcripts between PNs and participants …

Factors Associated With Opioid-Involved Overdose: Descriptive Data From A Randomized Controlled Trial Evaluating Extended-Release Buprenorphine For Perinatal Opioid Use Disorder, Sara M. Witcraft, Leah Holcomb, Yingjia Wei, Gerald Cochran, John T. Winhusen, Michelle R. Lofwall, Peter R. Martin, Jessica L. Young, Jessica Spinali, Constance Guille

Center on Drug and Alcohol Research Faculty Publications

Background: Opioid use disorder (OUD) during pregnancy is a leading contributor to peripartum morbidity and mortality, with overdose deaths rising significantly in recent years. Despite the identification of various factors associated with overdose events, including social, demographic, psychiatric, and neonatal outcomes, the relative contributions of these factors to peripartum overdose history (or lack thereof) remain unclear. Thus, this study aims to characterize factors associated with lifetime opioid-involved overdose events among currently pregnant individuals receiving buprenorphine (BUP) treatment for OUD.   Methods: Treatment-seeking pregnant individuals with an estimated gestational age of 6 to 30 weeks were enrolled in a large multisite randomized …

Injection-Related Infections And Self-Treatment Practices Among People Who Inject Drugs In Rural Appalachia, Laura C. Fanucchi, Jennifer R. Havens, Matthew Fahmy, April M. Young

Center on Drug and Alcohol Research Faculty Publications

In this study of self-reported serious injection-related infections among people who inject drugs in rural Appalachia (n = 463), 50% reported reusing syringes/needles, 70.6% ever had an injection-site abscess, and 44.4% of those with a recent abscess took nonprescribed antibiotics. The study identifies opportunities to improve harm reduction services.

Residual Next-Day Effects Of Alprazolam On Psychomotor Performance And Simulated Driving In Healthy Normal Adults, Stevie C. Roszkowski, Shanna Babalonis, Marion A. Coe, Paul Nuzzo, Michelle R. Lofwall, Laura C. Fanucchi, Sharon L. Walsh

Center on Drug and Alcohol Research Faculty Publications

The prevalence of drugged driving has increased in the United States. Some drugged driving may be unintentional as prescription medications used as sleeping aids, like zolpidem, cause impairment after the predicted duration of therapeutic action has elapsed. The aim of this study was to determine if nighttime administration of alprazolam, a drug commonly prescribed off-label as a sleeping aid, impacts driving performance the following day. Participants were healthy adults (n = 15) who completed a double-blind, double-dummy, within-subjects inpatient study examining the effects of nighttime administration of alprazolam (0.5, 1, and 2 mg), zolpidem (10 mg), and placebo on driving …

Lessons Learned From Developing Dashboards To Support Decision-Making For Community Opioid Response By Community Stakeholders: Mixed Methods And Multisite Study., Naleef Fareed, Ramona G. Olvera, Yiting Wang, Michael Hayes, Elizabeth Liz Larimore, Peter Balvanz, Ronald Langley, Corinna A. Noel, Peter J. Rock, Daniel Redmond, Jessica Neufeld, Sarah Kosakowski, Daniel R. Harris, Marc Larochelle, Timothy R. Huerta, Lashawn Glasgow, Emmanuel Oga, Jennifer Villani, Elwin Wu

Center on Drug and Alcohol Research Faculty Publications

BACKGROUND: Data dashboards are published tools that present visualizations; they are increasingly used to display data about behavioral health, social determinants of health, and chronic and infectious disease risks to inform or support public health endeavors. Dashboards can be an evidence-based approach used by communities to influence decision-making in health care for specific populations. Despite widespread use, evidence on how to best design and use dashboards in the public health realm is limited. There is also a notable dearth of studies that examine and document the complexity and heterogeneity of dashboards in community settings.

OBJECTIVE: Community stakeholders engaged in the …

Potential Impact Of Curative And Preventive Interventions Toward Hepatitis C Elimination In People Who Inject Drugs-A Network Modeling Study., Lin Zhu, William W. Thompson, Liesl Hagan, Liisa M. Randall, Abby E. Rudolph, April M. Young, Jennifer R. Havens, Joshua A. Salomon, Benjamin P. Linas

Center on Drug and Alcohol Research Faculty Publications

BACKGROUND: Injection-equipment-sharing networks play an important role in hepatitis C virus (HCV) transmission among people who inject drugs (PWID). Direct-acting antiviral (DAA) treatments for HCV infection and interventions to prevent HCV transmission are critical components of an overall hepatitis C elimination strategy, but how they contribute to the elimination outcomes in different PWID network settings are unclear.

METHODS: We developed an agent-based network model of HCV transmission through the sharing of injection equipment among PWID and parameterized and calibrated the model with rural PWID data in the United States. We modeled curative and preventive interventions at annual coverage levels of …

Buprenorphine Prescribing Characteristics Following Relaxation Of X-Waiver Training Requirements., Paul J. Christine, Rouba A. Chahine, Simeon D. Kimmel, Nicole Mack, Christian Douglas, Thomas J. Stopka, Katherine Calver, Laura C. Fanucchi, Svetla Slavova, Michelle R. Lofwall, Daniel J. Feaster, Michael Lyons, Jerel M. Ezell, Marc R. Larochelle

Center on Drug and Alcohol Research Faculty Publications

IMPORTANCE: Local-level data are needed to understand whether the relaxation of X-waiver training requirements for prescribing buprenorphine in April 2021 translated to increased buprenorphine treatment.

OBJECTIVE: To assess whether relaxation of X-waiver training requirements was associated with changes in the number of clinicians waivered to and who prescribe buprenorphine for opioid use disorder and the number of patients receiving treatment.

DESIGN, SETTING, AND PARTICIPANTS: This serial cross-sectional study uses an interrupted time series analysis of 2020-2022 data from the HEALing Communities Study (HCS), a cluster-randomized, wait-list-controlled trial. Urban and rural communities in 4 states (Kentucky, Massachusetts, New York, and Ohio) …

Rural And Urban Clinician Views On Covid- 19’S Impact On Substance Use Treatment For Individuals On Community Supervision In Kentucky, Carrie B. Oser, Maria Rockett, Sebastian Otero, Evan Batty, Marisa Booty, Rachel Gressick, Michele Staton, Hannah K. Knudsen

Center on Drug and Alcohol Research Faculty Publications

Background The COVID-19 pandemic produced system-level changes within the criminal legal system and community-based substance use disorder (SUD) treatment system with impacts on recovery efforts. This study examines rural and urban clinicians’ perspectives of COVID-19 on SUD treatment delivery for people on community supervision.

Methods Virtual qualitative interviews were conducted between April and October 2020 with 25 community supervision clinicians employed by Kentucky’s Department of Corrections (DOC), who conduct assessments and facilitate community-based treatment linkages for individuals on probation or parole. Transcripts were analyzed in NVivo using directed content analysis methods.

Results Clinicians were predominantly white (92%) and female (88%) …

Scales For Participant Alliance With Recovery Coach (Sparc): Initial Development And Pilot Test, Amanda Fallin-Bennett, Martha Tillson, J. Matthew Webster, Carrie B. Oser, Jennifer Edwards Becan, Kevin Knight, Jeremy Byard, Michele Staton

Center on Drug and Alcohol Research Faculty Publications

Recovery coaches are individuals with lived experience with recovery from substance use disorder who typically engender a greater sense of trust than found with other types of healthcare providers. However, there currently are no validated tools that measure the connection between recovery coaches and their participants. The purpose of this study was to describe the initial development of the Scales for Participant Alliance with Recovery Coach (SPARC) to measure recovery coach connection or alliance, including initial psychometric analyses. Measurement development began with five scales of the Client Evaluation of Self Treatment (treatment participation, treatment satisfaction, rapport, peer support, and social …

Rapid Jail-Based Implementation Of Overdose Education And Naloxone Distribution In Response To The Covid-19 Pandemic, Carrie B. Oser, Margaret J. Mcgladrey, Marisa Booty, Hilary L. Surratt, Hannah K. Knudsen, Patricia R. Freeman, Danelle Stevens-Watkins, Monica F. Roberts, Michele Staton, April M. Young, Emma Draper, Sharon L. Walsh

Center on Drug and Alcohol Research Faculty Publications

Background People incarcerated in jails are highly impacted by the opioid epidemic, and overdose education and naloxone distribution (OEND) is an effective strategy to reduce opioid overdose deaths. This study examines barriers and facilitators of fast-track OEND implementation within the jails in the Wave 1 Kentucky counties of the HEALing Communities Study during the COVID-19 pandemic.

Methods Meeting minutes with jail stakeholders were qualitatively coded using the Practical, Robust Implementation and Sustainability Model (PRISM) as the coding framework. The analysis highlighted the top barriers and facilitators to fast-track OEND implementation within the PRISM framework.

Results Space and staffing shortages related …

Get It In Writing: How To Make Medications For Opioid Use Disorder Available During Incarceration, Margaret J. Mcgladrey, Jordan Kelsch, Michelle R. Lofwall, Laura C. Fanucchi, Sharon L. Walsh, Carrie B. Oser

Center on Drug and Alcohol Research Faculty Publications

In a case example from the Kentucky HEALing Communities Study, extensive resources were deployed to address structural barriers and facilitate the provision of medication for opioid use disorder (OUD) in an urban county jail. However, implementation was unsuccessful, and this case example emphasizes the importance of including evidence-based medication for OUD (MOUD) treatment in the scope of work of jails’ contracted medical providers. The privatization of correctional health care services allows local governments with opioid abatement funds to incorporate requirements into medical provider contracts to screen all people entering jails for OUD and to offer MOUD at intake, throughout incarceration, …

The Development Of A Recovery Coaching Training Curriculum To Facilitate Linkage To And Increase Retention On Medications For Opioid Use Disorder, Trevor Moffitt, Amanda Fallin-Bennett, Laura Fanucchi, Sharon L. Walsh, Christopher Cook, Devin Oller, Anna Ross, Molly Gallivan, John Lauckner, Jeremy Byard, Phoebe Wheeler-Crum, Michelle R. Lofwall

Center on Drug and Alcohol Research Faculty Publications

Introduction: Medication treatment for opioid use disorder (MOUD) decreases opioid overdose risk and is the standard of care for persons with opioid use disorder (OUD). Recovery coach (RC)-led programs and associated training curriculums to improve outcomes around MOUD are limited. We describe our comprehensive training curriculum including instruction and pedagogy for novel RC-led MOUD linkage and retention programs and report on its feasibility.

Methods–pedagogy and training development: The Kentucky HEALing (Helping to End Addiction Long-termSM) Communities Study (HCS) created the Linkage and Retention RC Programs with a local recovery community organization, Voices of Hope-Lexington. RCs worked to reduce participant barriers …

Early Emergency Department Experience With 7-Day Extended-Release Injectable Buprenorphine For Opioid Use Disorder., Gail D'Onofrio, Jeanmarie Perrone, Kathryn F. Hawk, Ethan Cowan, Ryan Mccormack, Edouard Coupet, Patricia H. Owens, Shara H. Martel, Kristen Huntley, Sharon L. Walsh, Michelle R. Lofwall, Andrew Herring, The Ed-Innovation Investigators

Center on Drug and Alcohol Research Faculty Publications

As the opioid overdose epidemic escalates, there is an urgent need for treatment innovations to address both patient and clinician barriers when initiating buprenorphine in the emergency department (ED). These include insurance status, logistical challenges such as the ability to fill a prescription and transportation, concerns regarding diversion, and availability of urgent referral sites. Extended-release buprenorphine (XR-BUP) preparations such as a new 7-day injectable could potentially solve some of these issues. We describe the pharmacokinetics of a new 7-day XR-BUP formulation and the feasibility of its use in the ED setting. We report our early experiences with this medication (investigational …

Cannabinoid Poisoning-Related Emergency Department Visits And Inpatient Hospitalizations In Kentucky, 2017 To 2019, Stevie C. Britch, Sharon L. Walsh, Rachel Vickers-Smith, Shanna Babalonis, Svetla Slavova

Center on Drug and Alcohol Research Faculty Publications

Background and objectives: Cannabis is the most used federally illicit substance. Due to widespread medicinal use and state-level legalization, public perceptions of cannabis have shifted toward the assumption that cannabis is safe. However, cannabinoids can cause adverse medical complications that may lead people to seek treatment. This study characterized cannabinoid poisoning-related medical encounters, poisoning involving cannabinoids and other psychoactive substances, and cannabinoid poisoning-related cardiac complications. Methods: Administrative billing data for emergency department visits and inpatient hospitalizations in acute care facilities with a discharge date from January 1, 2017 to December 31, 2019 were used to characterize cannabinoid poisoning events in …

A Model For Rigorously Applying The Exploration, Preparation, Implementation, Sustainment (Epis) Framework In The Design And Measurement Of A Large Scale Collaborative Multi-Site Study, Jennifer E. Becan, John P. Bartkowski, Danica K. Knight, Tisha R. A. Wiley, Ralph Diclemente, Lori Ducharme, Wayne N. Welsh, Diana Bowser, Kathryn Mccollister, Matthew Hiller, Anne C. Spaulding, Patrick M. Flynn, Andrea Swartzendruber, Megan F. Dickson, Jacqueline Horan Fisher, Gregory A. Aarons

Center on Drug and Alcohol Research Faculty Publications

Background

This paper describes the means by which a United States National Institute on Drug Abuse (NIDA)-funded cooperative, Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS), utilized an established implementation science framework in conducting a multi-site, multi-research center implementation intervention initiative. The initiative aimed to bolster the ability of juvenile justice agencies to address unmet client needs related to substance use while enhancing inter-organizational relationships between juvenile justice and local behavioral health partners.

Methods

The EPIS (Exploration, Preparation, Implementation, Sustainment) framework was selected and utilized as the guiding model from inception through project completion; including the …

A Qualitative Analysis Of Gabapentin Misuse And Diversion Among People Who Use Drugs In Appalachian Kentucky, Rachel Vickers Smith, Elaine M. Boland, April M. Young, Michelle R. Lofwall, Alexa Quiroz, Michele Staton, Jennifer R. Havens

Center on Drug and Alcohol Research Faculty Publications

Gabapentin, an anticonvulsant and analgesic for postherpetic neuralgia, has been thought to have no abuse potential despite numerous published reports to the contrary. Gabapentin has been linked with impaired driving and opioid use, highlighting the need to more fully understand its risk profile. Thirty-three individuals reporting recent nonmedical use of gabapentin were recruited from two ongoing longitudinal studies of drug users in Appalachian Kentucky to participate in focus groups. Four sessions were held (two in the community and two in jail settings), during which participants responded to questions regarding their personal experiences with gabapentin misuse. Focus group participants were similar …

A Phase Iii, Randomized, Multi-Center, Double Blind, Placebo Controlled Study Of Safety And Efficacy Of Lofexidine For Relief Of Symptoms In Individuals Undergoing Inpatient Opioid Withdrawal, Charles W. Gorodetzky, Sharon L. Walsh, Peter R. Martin, Andrew J. Saxon, Kristen L. Gullo, Kousick Biswas

Center on Drug and Alcohol Research Faculty Publications

Background: Lofexidine is an alpha-2-adrenergic receptor agonist approved in the United Kingdom (UK) for the treatment of opioid withdrawal symptoms. Lofexidine has demonstrated better efficacy than placebo for reducing opioid withdrawal symptoms in patients undergoing opioid withdrawal with less reported hypotension than clonidine.

Methods: Designed as an FDA registration trial, this 8-day, randomized, double-blind, placebo-controlled, parallel-group study in 264 patients dependent on short-acting opioids evaluated the efficacy of lofexidine hydrochloride in reducing withdrawal symptoms in patients undergoing opioid withdrawal. The primary efficacy measures were SOWS-Gossop on Day 3 and time-to-dropout. Secondary endpoints included the proportion of participants who were completers; …

Comparing Adult Cannabis Treatment-Seekers Enrolled In A Clinical Trial With National Samples Of Cannabis Users In The United States, Erin A. Mcclure, Jacqueline S. King, Aimee Wahle, Abigail G. Matthews, Susan C. Sonne, Michelle R. Lofwall, Aimee L. Mcrae-Clark, Udi E. Ghitza, Melissa Martinez, Kasie Cloud, Harvir S. Virk, Kevin M. Gray

Center on Drug and Alcohol Research Faculty Publications

Background—Cannabis use rates are increasing among adults in the United States (US) while the perception of harm is declining. This may result in an increased prevalence of cannabis use disorder and the need for more clinical trials to evaluate efficacious treatment strategies. Clinical trials are the gold standard for evaluating treatment, yet study samples are rarely representative of the target population. This finding has not yet been established for cannabis treatment trials. This study compared demographic and cannabis use characteristics of a cannabis cessation clinical trial sample (run through National Drug Abuse Treatment Clinical Trials Network) with three nationally …

Age Of First Arrest, Sex, And Drug Use As Correlates Of Adult Risk Behaviors Among Rural Women In Jails, Martha Tillson, Justin C. Strickland, Michele Staton

Center on Drug and Alcohol Research Faculty Publications

Incarcerated women frequently report initiation of substance use and sexual encounters at an early age, and often engage in high-risk drug use and sexual behaviors as adults. This study examined the timing of first sex, drug use, and arrest, as well as their unique influences on specific risky behaviors in adulthood, among a high-risk population of rural women recruited from jails. Ages of initiation were all positively and significantly correlated, and each independently increased the likelihood of several risky behaviors in adulthood. Implications are discussed for screening, intervention, and treatment targeting high-risk women and girls in rural areas, particularly within …

Young People's Blood Alcohol Concentration And The Alcohol Consumption City Law, Brazil, Raquel De Boni, Carl G. Leukefeld, Flavio Pechansky

Center on Drug and Alcohol Research Faculty Publications

The paper assesses blood alcohol concentration and risk behaviors for traffic accidents before and after the implementation of a law which prohibits the use of alcoholic beverages on city gas stations. In Porto Alegre, Southern Brazil, young people go out at night and drive to gas station convenience stores to buy alcoholic beverages which are consumed on the premises of parking lots in gas stations. Data were obtained from self-administered questionnaires and breath analyzers in two cross-sectional collections with purposive samples of youngsters in May and July 2006 (n=62, and n=50, respectively). There were no significant differences between the groups …