Project: Social Networks and HIV Risk among Rural Drug Users

Investigator: Jennifer Havens, PhD

Email: jennifer.havens@uky.edu

Abstract: The overall goal of the study is to examine the prevalence, incidence, and risk factors for HIV and other blood borne infections (BBIs) such as hepatitis B (HBV) and C (HCV) among rural Appalachian drug users using social network analysis and multilevel modeling. HIV continues to be a major public health problem in the United States, especially among drug users. However, little is known about HIV in rural areas in which there are marked health disparities. Therefore, given that studies among urban drug users have found that social network indicators are robust predictors of HIV risk, both social network and individual characteristics will be measured for their association with HIV risk among rural drug users. The specific aims are: 1) To determine the prevalence and incidence of HIV, HCV and HBV among rural injection and non- injection drug users; 2) To examine HIV and other BBI risk among rural injection and non-injection drug users; and 3) To examine longitudinal changes in rural HIV, HCV and HBV risk at 6-months, 12-months and 18- months post-baseline. To meet these aims, a sample 500 rural injection and non-injection drug users will be recruited using respondent driven sampling (RDS). In addition to biologic testing for HIV, HCV and HBV, rural participants will be given an interviewer-administered questionnaire pertaining to their social networks (drug, sexual and support networks), sociodemographics, drug use, HIV risk behaviors, psychiatric diagnoses, intravention and norms. Since individuals will be nested within networks, data will be analyzed using multilevel random effects regression that allows for the simultaneous examination of social network and individual-level risk. Consistent with the priorities of the NIDA AIDS Research Program, this proposal will explore the social network structure in a rural drug using population in order to better understand how network factors may affect HIV risk in rural areas using an innovative multilevel approach. Results from the proposed study will inform the design and implementation of HIV interventions in rural areas and help to determine the appropriate population for which to target such activities in order to reduce the morbidity and mortality associated with HIV and other BBIs.

Project: Barriers to the Adoption of Pharmacotherapies in Publicly Funded Substance Abuse Treatment: Policy Barriers and Access to Physicians

Investigator: Hannah K. Knudsen, PhD

Email: hannah.knudsen@uky.edu

Funding Agency: Robert Wood Johnson Foundation’s Substance Abuse Policy Research Program

Abstract:

Background
Although pharmacotherapies can improve outcomes for individuals being treated for substance abuse, the adoption of medication-assisted treatments by community-based organizations continues to be low, particularly in the publicly funded treatment sector. A key barrier is the lack of physicians in these settings, which may be the result of organization-level factors as well as state policies that regulate and fund these organizations. To date, there are few studies that have considered these issues in the context of publicly funded addiction treatment and it is unclear the relative importance of organizational, environmental, and state policy factors in modeling medication adoption.

Specific Aims
This proposed research has three specific aims. Aim 1 is to measure the availability of medical staff, the adoption of pharmacotherapies, and the relative importance of perceived policy and organizational barriers to medication adoption. The second aim is to estimate models of medication adoption that integrate environmental and organizational measures of perceived policy barriers, medical staff, organizational structure, culture, and resources in order to examine their relative importance as facilitators and barriers to the use of pharmacotherapies in publicly funded treatment organizations. The project’s third aim is to examine the associations between medical staff and both organizational and environmental factors, including organizational structure, culture, resources, perceived state policy barriers (including funding policies and regulations), and perceived availability of medical staff in the local labor market.

Methods

Questionnaires will be mailed to administrators of approximately 318 publicly funded addiction treatment programs. For administrators who do not respond to the questionnaire, telephone contact will be used to encourage recruitment, and then the measures from the questionnaire will be administered as a telephone interview. An 85% response rate is expected, based on prior experience with this type of treatment organization. Measures will include the adoption of pharmacotherapies, the availability of medical staff, and the relative importance of organizational and environmental barriers to adopting medications. Additional measures will include organizational factors (e.g. structure, culture, and resources) and environmental factors (e.g. supportive state policies, use of external information, and availability of medical staff in the local labor market). Data analysis will use statistical techniques that will appropriate for each dependent variable. Logistic regression and multinomial logistic regression models will be used to estimate models of the adoption of pharmacotherapy and availability of medical staff, such as any physicians or any nurses. The independent variables in those models will include organizational, environmental, and state policy measures as independent variables. Negative binomial regression will be used to estimate count data models of the number of medical staff and number of medications adopted, using organizational, environmental, and state policy measures as independent variables.

Project: Smoking Cessation Practices in Community Treatment Programs

Investigator: Hannah K. Knudsen, PhD

Email: hannah.knudsen@uky.edu

Funding Agency: National Institute on Drug Abuse

Abstract:

Background
The delivery of health services to promote smoking cessation may substantially reduce cancer-related morbidity and mortality. However, there has been little research conducted within healthcare settings to measure the delivery of these services, particularly within those organizations that serve client populations with high rates of tobacco use such as individuals with substance use disorders. There are few national studies on the delivery of smoking cessation (and other tobacco use) services in substance abuse treatment settings. Furthermore, there are no data regarding the adoption and implementation of the Public Health Service clinical practice guideline, Treating Tobacco Use and Dependence in these facilities.

Specific Aims
1. To systematically describe the adoption and implementation of the clinical practice guideline, Treating Tobacco Use and Dependence (Fiore et al., 2000) within publicly funded substance abuse treatment centers, privately funded substance abuse treatment centers, and therapeutic communities. 
2. To measure tobacco-related policies, including environmental policies and insurance coverage for smoking cessation among employees, within these three types of substance abuse treatment settings.
3. To examine longitudinally whether pharmacological approaches to smoking cessation have expanded over time.
4. To model the organizational predictors of the adoption and implementation of the three main parts of the clinical practice guideline (i.e. the 5 A’s, pharmacotherapies, and counseling).
5. To examine substance abuse treatment counselor attitudes toward smoking cessation.

Methods
This research has gathered organizational-level and counselor-level data on the adoption and implementation of smoking cessation services in three existing nationally representative samples of substance abuse treatment facilities. Telephone interviews were conducted with program directors of 299 publicly funded specialty substance abuse treatment centers, 321 privately funded centers, and 277 therapeutic communities.  These telephone interviews measured whether centers: 1) had adopted and implemented the guideline, including the 5 A’s, pharmacotherapies, and psycho-social interventions; 2) had adopted environmental tobacco-related policies; and 3) provided insurance coverage for employee smoking cessation. Mail-back questionnaires were distributed to counselors to assess their attitudes toward smoking cessation and the extent to which they deliver these services, resulting in a database of 2,179 counselors. Integration of these data with organization-level information collected from these facilities in 2002-2003 will allow for multivariate modeling of the organizational characteristics associated with guideline adoption and implementation as well as a longitudinal analysis of pharmacotherapy adoption.

Project: Evaluating the uptake of instruction for office-based opioid addiction practices aimed at decreasing and preventing buprenorphine diversion and misuse

Investigator: Michelle Lofwall, MD

Email: michelle.lofwall@uky.edu

Abstract: Opioid addiction is a significant public health problem in the United States, associated with the spread of infectious diseases, crime, premature death, and significant psychiatric and medical comorbidities. In the 2006 National Survey on Drug Use and Health, it was estimated that over 1 million people met Diagnostic and Statistical Manual-IV criteria for prescription opioid dependence. The Office of National Drug Control Policy estimates that there are another 1 million people addicted to heroin. Prior to the Drug Abuse Treatment Act of 2000, opioid pharmacotherapies for opioid addiction treatment were limited to opioid treatment programs, which are heavily regulated, limited in number and often not accessible or unacceptable to patients. The Drug Abuse Treatment Act of 2000 combined with the Food and Drug Administration (FDA) approval of sublingual buprenorphine, a Schedule III controlled substance, for the treatment of opioid addiction have increased the availability of treatment and brought opioid addiction treatment back into mainstream medical practice. However, the increase in buprenorphine availability has also led to an increase in its misuse and diversion. This is not unexpected given it has psychoactive opioid effects, and it is being prescribed to a population that by definition misuses and often diverts opioids. However, it is important that diversion of buprenorphine from physician office-based practices be minimized in order to protect public health and avoid the perception that doctors’ treatment of opioid addiction is a problem. If this is not done, there potentially could be changes in legislation or a re-classification of buprenorphine to a more restrictive drug schedule that would limit its availability in office-based opioid addiction treatment. The specific aim of the present application is to evaluate the uptake of instruction for office-based opioid addiction practices aimed at decreasing and preventing buprenorphine diversion and misuse. This project will be a prospective, longitudinal evaluation of physician office-based buprenorphine treatment practice that employs self-report surveys before and after a continuing medical education (CME) activity in Johnson City, Tennessee. Overall, this project will contribute important information regarding the effectiveness of an educational intervention in impacting physician office-based opioid addiction practices.

Project: Postmarketing abuse surveillance – treatment programs

Investigator: Michelle Lofwall, MD

Email: michelle.lofwall@uky.edu

Abstract: In 2002, the Food and Drug Administration approved two buprenorphine formulations for the treatment of opioid dependence - sublingual tablets containing buprenorphine (Subutex®) and sublingual tablets containing buprenorphine and naloxone (Suboxone®). The FDA approval was granted with the condition that Reckitt Benckiser, the makers of these products, institute a risk management program at the time of product launch. At the same time, the Drug Addiction Treatment Act of 2000 expanded the clinical context of medication-assisted opioid addiction treatment by allowing qualified physicians to dispense or prescribe specifically approved Schedule III, IV, and V narcotic medications for the treatment of opioid addiction in treatment settings other than the traditional Opioid Treatment Program (i.e., methadone clinic). Private practitioners can now be certified by the Department of Health and Human Services Center for Substance Abuse Treatment (CSAT) to prescribe buprenorphine for the treatment of opioid dependence in their private practices.

To meet the condition laid down by the FDA, Reckitt contracted with the Substance Abuse Research Division of CRS Associates for a surveillance mechanism that would permit the company to: monitor the extent of abuse and diversion of its two products; proactively address local, regional, or national trends in abuse and/or diversion; and assess the degree of abuse relative to other drugs with known abuse potential. The current multi-site surveillance project, in which the University of Kentucky is a participating site, is a survey of people seeking treatment at substance abuse treatment and substance abuse research programs (subjects may be treatment or non-treatment seeking). This study will help assess and monitor the extent of abuse and diversion of Suboxone® and Subutex relative to other drugs with known abuse potential.

Project: CJDATS2

Investigator: Carl Leukefeld, DSW

Email: cleukef@uky.edu

Abstract: With 83% of state prisoners reporting drug use (Mumola & Karberg, 2006) and 700,000 prisoners re-entering U.S. communities annually (Glaze & Bonczar, 2006), there is a need for organizational studies on how to design effective systems of continuous care for re-entering offenders. Kentucky provides an ideal setting to study re-entry because Kentucky is ranked in the top 3 states for increases in the number inmates (Harrison & Beck, 2006) as well as the number of parolees (BJS, 2006). This continuation application is submitted by the University of Kentucky to further understand re-entry by continuing the Central States Center in CJ-DATS 2. Our CJ-DATS I Center successes include: Involvement in 7 protocols which exceeded the number by any other Center; Leading the only woman-focused protocol; Developing a true stakeholder-centered infrastructure which resulted in the innovative Kentucky Re-Entry Guidelines; Research activities which produced 26 manuscripts and 16 presentations by our team as well as data to allow other CJ-DATS 1 researchers to publish. CJ-DATS 1 also provided the infrastructure to develop a statewide outcome study and 2 NIDA grant applications. Our Center's innovative vision will uniquely contribute to the scientific knowledge on the organizational and system changes necessary to implement and sustain evidence-based interventions (APA, 2006) across a continuum of care at re-entry in diverse criminal justice and community organizational settings. Our conceptual approach draws upon selected theoretical frameworks of organizational change to implement the Center's vision and our 3 Research Concepts. This application presents 4 established partner-rich Center Committees to: (1) Plan, (2) Implement, (3) Collect/Analyze Data and (4) Develop Publications in concert with our Center Steering Committee and the national CJ-DATS 2 Steering Committee. Letters of commitment include our states' Corrections Commissioner, Director of Substance Abuse, Commissioner of Public Heaith, state substance abuse officials, public safety officials, and treatment organizations which support our innovative vision as well as our rural and urban interests.

Project: Prescription Drug Use and Eastern Kentucky

Investigator: Carl Leukefeld, DSW

Email: cleukef@uky.edu

Abstract: The overall purpose of this application is to develop an understanding of prescription drug use and abuse among active drug users in selected rural and urban Kentucky settings. For example, this project will examine the history of prescription drug use/abuse, present drug use/abuse patterns, and route of administration of prescription and illicit drugs.

In order to help improve the health and well-being of socioeconomically disadvantaged pregnant and postpartum women (PPW) in Kentucky, Mountain Comprehensive Care Center (MCCC) was awarded funding by the Substance Abuse Mental Health Services Administration (SAMHSA) Center on Substance Abuse Treatment (CSAT) to expand and enhance comprehensive substance use treatment services. 

Although MCCC provides services across Kentucky, women and children residing in rural counties located in Central Appalachia are able to receive services as a result of this PPW SAMHSA grant. The PPW grant spans five years (2022 - 2027), with a final target enrollment of 120 women. Women eligible to receive MCCC PPW services include adult women who are pregnant or who have had a child within the past year, and who also have a substance use disorder or co-occurring substance use and mental health disorders. Serenity House in Inez, Kentucky provides and/or coordinates all MCCC PPW services. MCCC has partnered with the University of Kentucky’s Center on Drug and Alcohol Research (CDAR) to collect and examine PPW participant information relevant to understanding client changes pre- and post-treatment and determining if project goals have been sufficiently addressed.

Staff:
Megan Dickson, PhD, Evaluator
Sophia Shalash, MSW, Project Director
Misty Boyington, Data Coordinator Sr.
Nina Monticello, Data Coordinator Sr.

With funding from the Substance Abuse Mental Health Services Administration (SAMHSA) Center on Substance Abuse Treatment (CSAT), Chrysalis House implemented an enhanced biopsychosocial model of treatment services for pregnant and postpartum women (PPW) on Sept. 30, 2022. The PPW grant spans five years (2022 - 2027), with a final target enrollment of 250 women. Chrysalis House’s comprehensive treatment program addresses the multiple needs PPW who use substances, and with new funding from CSAT, expanded their services to include children and families in a holistic manner. Chrysalis House has partnered with the University of Kentucky’s Center on Drug and Alcohol Research (CDAR) to collect and examine PPW participant information relevant to understanding client changes pre- and post-treatment and determining if project goals have been sufficiently addressed.

Staff:

Megan Dickson, PhD, Evaluator
Sophia Shalash, MSW, Project Director
Hope Tevis, Administrative Research Assistant Pr.
Nina Monticello, Data Coordinator Sr.

With funding from the Substance Abuse Mental Health Services Administration (SAMHSA) Center on Substance Abuse Treatment (CSAT), the Hope Center continued medication-assisted treatment (MAT) in combination with psychosocial services to treat opioid use disorder (OUD) beginning on Sept. 30, 2021. Hope Center’s comprehensive treatment program addresses the multiple needs of substance-using populations, and with new funding from CSAT, has continued to expand their services to include extended-release naltrexone (Vivitrol) injections for clients diagnosed with OUD. With funding from CSAT, Hope Center partnered with Bluegrass Community Health Center (BCHC) to provide MAT in combination with residential recovery services, primary healthcare, and behavioral healthcare, providing a comprehensive and integrated program for the highly vulnerable reentering and/or homeless population that is served. The Hope Center has partnered with the University of Kentucky’s Center on Drug and Alcohol Research (CDAR) to collect and examine MAT participant information relevant to understanding client changes pre- and post-treatment and determining if project goals have been sufficiently addressed.

Staff:

Michele Staton, PhD, MSW, Co-Evaluator
Megan Dickson, PhD, Co-Evaluator
Sophia Shalash, MSW, Project Director
Hope Tevis, Administrative Research Assistant Pr.
Nina Monticello, Data Coordinator Sr.
Madeline DeJesus, Data Coordinator Sr.

This project involves a partnership between the University of Kentucky Center on Drug and Alcohol Research and Mountain Comprehensive Care Center (MCCC) on a Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Prevention (CSAP) grant focused on Strategic Prevention Framework-Partnerships for Success (Short Title: SPF-PFS). The purpose of this program is to address underage drinking and substance use among persons ages 9 to 20. SAMHSA expects this program will prevent the onset and reduce the progression of substance abuse and its related problems while strengthening the prevention capacity and infrastructure at the community level. MCCC contracted UK BSC/CDAR to conduct the required evaluation if they receive a grant award.

Staff:

Megan Dickson, PhD, Evaluator
Erika Pike, PhD, Project Director
Nina Monticello, Data Coordinator Sr.

With funding from the Substance Abuse Mental Health Services Administration (SAMHSA) Center on Substance Abuse Treatment (CSAT), Hope Center and Chrysalis House implemented an enhanced psychosocial model of treatment services for reentering female offenders beginning on Jan. 15, 2020. Hope Center and Chrysalis House’s comprehensive treatment programs address the multiple needs of substance-using populations. With the new CSAT funding, they were able to increase the number of reentering female offenders served. Both agencies emphasize comprehensive and integrated programs and services associated with successful treatment outcomes for areas including employment, family support, and integrated treatment for co-occurring disorders. The Hope Center has partnered with the University of Kentucky’s Center on Drug and Alcohol Research (CDAR) to conduct an evaluation for this project. The evaluation has three primary objectives: (1) To describe client characteristics at treatment entry into the CSAT funded project; (2) To examine short-term project outcomes based on intensity and duration of treatment; and (3) To complete a process evaluation.

Staff:

Michele Staton, PhD, MSW, Evaluator
Sophia Shalash, MSW, Project Director
Hope Tevis, Administrative Research Assistant Pr.
Nina Monticello, Data Coordinator Sr.
Madeline DeJesus, Data Coordinator Sr.

The Criminal Justice Kentucky Treatment Outcome Study (CJKTOS) was implemented in April 2005 to examine the effectiveness of corrections-based substance use treatment programs. CJKTOS includes baseline information collected from clients when they enter treatment and follow-up data one year after release from the correctional facility. This study compares client self-report information from the two data collections.

Staff:

Michele Staton, PhD, MSW, Evaluator
Anastasia Dunn, Administrative Research Assistant Principal
Amber Herrington, Data Coordinator Sr. 
Chelsea Cook, Data Coordinator Sr.
Bethany Booth, Data Coordinator Sr. 
Casey Baker, Data Support Specialist
Martha Tillson, Research Scientist III
Erin Winston, Project Management Director

The Kentucky Women’s Justice Community Opioid Innovation Network (W-JCOIN) aims to increase initiation and maintenance of medication for opioid use disorder (MOUD) among high-risk justice-involved women in the transition from jail to the community to reduce opioid relapse and overdose. As part of a NIH collaborative network, the W-JCOIN leads a type 1 hybrid effectiveness and implementation trial to examine an innovative MOUD pre-treatment model using telehealth (alone and in combination with peer navigators) for justice-involved women in transition from jail to the community in 6 experimental and 3 comparison (Services as Usual-SAU) sites. The following aims guide the study: (1) Compare the effectiveness of MOUD Pre-Treatment Telehealth (alone versus in combination with Peer Navigators) to increase MOUD initiation and maintenance among high- risk, justice-involved women in the community after release relative to services as usual (SAU). (2) Estimate the incremental cost and cost effectiveness of MOUD Pre-Treatment Telehealth (alone and in combination with Peer Navigators) relative to SAU for high-risk justice involved women with OUD in achieving desired changes in clinical, public health, and public safety outcomes over one-year post-release. (3) Examine temporal changes in key implementation constructs hypothesized by the EPIS framework to influence successful innovation implementation. 

Staff:

Michele Staton, Principal Investigator
Brittany Anderson, Administrative Research Assistant Principal
Jaxin Annett, Temporary Technical/Paraprofessional
Casey Baker, Data Support Specialist
Sarah Despain, Administrative Research Assistant Principal
Sarah Engle, Administrative Research Assistant Principal
Kathy Frost, Administrative Research Assistant Principal
Olivia Jones, Administrative Research Assistant Principal
Mary Levi, Graduate Research Assistant
Stephanie Litteral, Administrative Research Assistant Principal
Shelley Owsley, Administrative Research Assistant Principal
Martha Tillson, Research Scientist III
Erin Winston, Project Management Director