Substance-use research at UK aims to slash ODs, quash hepatitis C, help pregnant and incarcerated women, and much more

By Melissa Patrick
Kentucky Health News

Research about substance abuse has become a major enterprise at the University of Kentucky, legislators heard last week as they got an update on UK research projects, including one that aims to cut overdose deaths 40 percent in 16 counties and another that aims to eliminate hepatitis C in a county. 

UK Vice President for Research Lisa Cassis told the Substance Use Recovery Task Force Aug. 11 that since substance -use research was added as one of UK's six institutional research priorities in 2018, it has experienced the largest growth in grants and contracts, increasing from 75 projects in 2018 to 105 in 2019, with a 151% increase in funding, to more than $75 million.

Sharon Walsh, director of UK's Center on Drug and Alcohol Research, reviewed a few projects, starting with one that has the largest grant ever awarded to UK: the $87 million, four-year HEALing Communities Study, which has a goal of reducing opioid-overdose deaths by 40 percent in 16 counties that represent more than a third of the state's population.  

Photos are from PowerPoint presentation to the Substance Abuse Recovery Task Force

The 16 counties are Jefferson, Fayette, Jessamine, Clark, Franklin, Boyle, Madison, Bourbon, Kenton, Campbell, Mason, Greenup, Carter, Boyd, Floyd and Knox. 

The grant is part of a larger National Institute on Health initiative called HEAL, which stands for  Helping to End Addiction Long-term. 

Walsh said the UK project is moving into its implementation phase, which involves communication efforts to increase demand for medication for opioid use disorder (MOUD) and naloxone, which negates overdoses; increase MOUD prescribing; increase access to naloxone; and reduce high-risk prescribing. The campaign will also work to decrease the stigma of substance-use disorder. 

She also pointed to an $8 million grant-funded project, Justice Community Opioid Innovation Network, which is working to increase initiation and maintenance of MOUD to reduce relapse and overdose among women who are in transition from jail to the community. This program will involve about 900 women across nine Kentucky jail sites. It is part of the HEAL initiative. 

Walsh said that in the fiscal year ended June 30, UK had about 133 projects related to substance use, with 69 principal investigators, or head researchers.

One is funded by a a $15 million, five-year grant to treat every resident of Perry County who is chronically infected with hepatitis C, in order to examine the concept of "treatment as prevention." This project, called KeY Treat, not only provides hep-C treatment and training for providers to deliver it, but substance-use-disorder treatment and case management, and harm-reduction services such as a syringe exchange if needed. Intravenous drug users are especially vulnerable to hepatitis C and can spark outbreaks of it.

KeY Treat is led by Jennifer Havens at the UK Center on Drug and Alcohol Research. It builds on her ongoing research project that has followed, for over 10 years, more than 500 people who use drugs in Appalachia. In 2008-10 her research shows 42.9% of those who injected drugs had hepatitis C; that increased to 65.8% in 2018, Walsh said.

She said 151 people had enrolled in the KeY Treat program, and 97% had started medication to treat their hepatitis C. Among those, 83% have completed treatment, and 97% of them are considered cured. Only about half of those enrolled in treatment are actively using drugs, she said.

As part of the National Rural Opioid Initiative, Walsh said, the CARE2HOPE project has partnered with residents of the 12 counties in the Gateway Health District and Kentucky River Health District to build evidence-based, community-rooted public health responses to the opioid epidemic, overdoses, hepatitis C and HIV. It is funded by a $5.4 million grant.  

Walsh said several of UK's projects fall under the Kentucky Opioid Response Effort, or KORE, which is designed to support services that address the opioid crisis, rather than to drive research. She said KORE currently provides support for 61 different entities across the state and UK is just one of them. 

One of the KORE-funded projects at UK is the First Bridge Clinic, which provides "on-demand" treatment access for those suffering with opioid-use disorder. From its opening in January 2018 to present, this clinic has seen 1,111 patients, and 450 of them began medication to treat their opioid-use disorder, Walsh said.

She said KORE has expanded its model to St. Elizabeth Healthcare, University of Louisville Hospital, the Appalachian Regional Healthcare System, Baptist Health in Lexington and Corbin, and Norton Healthcare in Louisville. 

Another KORE-funded program is the Addiction Consult and Education Services program (ACES) that provides a way for UK hospital patients to get an addiction consultation while hospitalized. It also provides education services for providers. Walsh said this program has done 1,314 consults since October 2018. Of those, 702 initiated medication-assisted treatment while in the hospital. After they were discharged, ACES referred 373 to the First Bridge Clinic, and 190 kept their first appointment. 

The PATHways program was available before KORE funding was available, but has since gotten support from it. The Perinatal Assistance and Treatment Home program works to expand opioid-use disorder treatment access to women immediately before and after giving birth. Since August 2018, 306 mothers have enrolled in PATHways and 251, or 82% of them, initiated MOUD.

Another KORE-funded program, Beyond Birth, provides opioid use disorder treatment to postpartum women, along with comprehensive, wraparound services in coordination with social workers in the Kentucky Department for Community Based Services. 

Walsh also mentioned several other KORE-funded programs, including one that works to increase pharmacists' capacity to administer Vivitrol, a medication for opioid-use disorder; one that trains students in evidence-based practices for opioid-use disorder; one that provides psychiatric care for people who have opioid-use disorders; one that provides treatment for infectious diseases associated with intravenous drug use; and another that is working to build a substance-use-disorder workforce in the Appalachian region.