Author: Heather May and Julie Kiefer
As news of the opioid crisis continues to dominate the headlines, reducing the number of deaths from overdose has remained a challenge. The toll is frightening, reaching 47,600 in 2017, the most recent nationwide data on record. Here in Utah, an average of 7 deaths each week are caused either by prescription drugs or heroin.
“We need better alternatives for treating pain and better services to treat patients who have addiction and dependency issues,” says Scott Junkins, MD, chief of the division of pain medicine and member of U of U Health’s opioid taskforce. “U of U Health is being thoughtful about supporting multiple specialties to come up with ways to empower our patients and make their lives better.
To meet these urgent needs, U of U Health is leading research that promises to change the way opioids are prescribed with a goal of reducing harm while still treating pain. Innovative approaches that span disciplines are making these aspirations a reality. From basic biology to population health to community outreach, several projects are described below.
Seeking New Solutions
Answers underwater – Researchers are looking for the next source of non-opioid painkillers in an unexpected place: underwater. A team of biologists, anesthesiologists, pharmacologists, and medicinal chemists have already found potential analgesic properties in venom isolated from Conus regius, a snail common to the Caribbean Sea. The goal is to determine how to synthesize the compounds to make prescription drugs as effective as opioids but without addictive properties. In a separate study, drug screens performed with tropical zebrafish have revealed another compound that reduces opioid-seeking behaviors that could one day do the same in people.
-Baldomero Olivera PhD (Biology); Randall Peterson PhD, Marcus Bortolato MD, PhD, Kristen Keefe PhD (Pharmacology & Toxicology)
Alternative approaches – A number of non-opioid-based strategies tackle low back pain, but \ no magic bullet works for everyone all the time. As part of a large clinical trial, physical therapists, primary care providers, experts in cognitive behavioral therapy and mindfulness, and biostatisticians will examine which approaches benefit which patients the most in an effort to uncover guidelines that aid clinicians in developing personalized treatment plans. In addition, radiologists are investigating the effectiveness of another non-invasive, drug-free, and low-risk treatment: focused ultrasound.
-Julie Fritz PT, PhD (Physical Therapy & Athletic Training); Viola Rieke PhD, Lubda Shah MD (Radiology)
Moms are most vulnerable during the post-partum period after their last check-up with an obstetrician.
-Marcela Smid, MD
Protecting Vulnerable Populations
Pregnancy and post-partum risk — Drug-induced deaths are the leading cause of pregnancy-associated deaths for women in Utah, with more than three-quarters attributed to opioid use. To confront the issue, the Substance Use & Pregnancy—Recovery, Addiction, and Dependence (SUPeRAD) Prenatal Specialty Clinic provides specialized care for pregnant and post-partum women who are using substances or recovering from addiction. Studies carried out by PARCKA faculty (see below) at SUPeRAD are investigating ways to improve care for this population, including determining whether navigators who provide additional patient support will reduce opioid use.
-Marcela Smid MD, MS, MA (Obstetrics & Gynecology); Gerald Cochran, MSW, PhD (Epidemiology)
Improving care for veterans — Recognizing that veterans can be particularly vulnerable to addiction, the PARCKA Vulnerable Veteran—Innovative Patient Aligned Care Team (VIP) Initiative is a clinical and evaluation project that embeds addiction care within primary care. The approach improves acceptance of addiction care among patients who cannot, or will not, seek it through more traditional mental health care settings. The initiative, meant to be a model for other VA facilities, also includes policy analysis, presentation of case studies to providers, and research.
-Adam Gordon, MD, MPH, FACP, DFASM (Epidemiology)
Supporting Sound Decision-making
Careful conversations — While prescription opioids can be an appropriate part of pain management, risks also exist, making it critical to clearly communicate information about safety and expectations prior to, during, and after treatment. As part of a national collaboration, researchers in biomedical informatics are integrating recommendations from the CDC Guideline for Prescribing Opioids for Chronic Pain directly into electronic health records so they are at-the-ready when health care providers and patients are making important decisions.
-Kensaku Kawamoto MD, PhD, MHS (Biomedical Informatics)
Next-gen communications — When a person with an opioid overdose or other poisoning emergency comes to the emergency department, health care providers often rely on poison control to provide accurate information and treatment recommendations. Yet transmitting those critical messages can be a challenge due to missed phone calls and incomplete instructions. To help, nursing, pharmacy, and biomedical informatics are collaborating to develop a next-generation communication system that streamlines the response in Utah’s emergency departments. Software called SNOWHITE enables safe, secure and efficient communication through electronic health records, allowing providers to efficiently treat patients while circumventing the proverbial game of telephone.
-Mollie Cummins PhD, RN, FAAN, FACMI (Nursing)
Empowering Individuals
Community connections — Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA) provides clinical education to undergraduates, graduates, and peers about opioid use disorder and other addiction disorders. But it also reaches the broader community. In collaboration with foundations and agencies, PARCKA leads addiction roundtables in the community at large and provides addiction education to community health providers. PARCKA faculty also lead a number of studies investigating the causes and treatment of opioid use disorder.
-Adam Gordon, MD, MPH, FACP, DFASM (Epidemiology)
At-home disposal — Up to 90 percent of patients don’t finish their opioid prescriptions, and many fail to dispose of their extra medication, posing a real problem that can lead to misuse. A pilot study demonstrated that arming patients with a home disposal kit may help. After patients underwent elective surgery, those given kits were 20 percent more likely to dispose of their excess pills. The team is currently expanding the program to further reduce the amount of opioids in circulation.
-Lyen Huang MD, MPH, FACS; Benjamin Brooke, MD, PhD, FACS (Surgery)