Addiction Research

Embracing Anti-Racism in Addiction Treatment, Research, and Policy Convening

The Substance Use and Anti-racism (SUDA) Research Program launched at the end of spring 2021. It is a community-engaged process to improve addiction treatment for Black patients. The guiding question is, “How can we make addiction treatment more appealing, effective, and equitable for Black patients?” 

In the earliest phase of the project, researchers integrated a range of methods, including focus groups with Black patients who have substance-related problems and live in the neighborhoods surrounding BMC, and six scoping literature reviews to understand key factors that shape Black people’s experiences of addiction treatment. This later led to the next phase funded by the Patient Centered Outcomes Research Institute.

To learn more about this research, click here or contact Daneiris Heredia-Perez at Daneiris.Heredia-Perez@bmc.org.

RESPECT Perinatal Substance Use Research Group

More than 120 babies are born at BMC each year to women with opioid use disorders. Researchers in the Departments of Pediatrics & Obstetrics and Gynecology are busy discovering new and better treatments for these vulnerable infants, many of whom are develop Neonatal Abstinence Syndrome (NAS). All babies born to with in-utero opioid exposure are monitored as inpatients for 5-7 days for symptoms of opioid withdrawal. The most recent available data suggest that twelve percent of all NAS babies in the state are cared for by BMC.

The RESPECT Research Group is learning about the short-term medical and long-term developmental outcomes of treating these newborns with different pharmacologic regimens. The groundbreaking studies conducted by the RESPECT Research Group are resulting in many publications, leading the way to higher quality, more personalized care for babies exposed to opioids during pregnancy.

Recent studies and publications have focused on the impact of buprenorphine or naltrexone treatment on NAS outcomes, the impact of genetic variants on NAS outcomes, the influence of clinical factors such as prematurity and breastfeeding on NAS outcomes, and the importance of non-pharmacologic care on NAS outcomes.

Learn more about RESPECT

Racism, Not Race: a Quantitative Analysis of the Use of “Race” and “Racism” in the Addiction Literature

Racism plays a unique role in the way that substance use and addiction are conceptualized and treated in the United States. Yet it is known from a prior study that medical journals are unlikely to name “racism” even when the same article mentions “race.” We sought to repeat this analysis among addiction medicine journals, hypothesizing that articles in addiction medicine journals would be more likely to discuss both race and racism. Analyzing articles in the past 30 years in five prominent addiction medicine journals, we found that race was mentioned not uncommonly, but that racism was mentioned vanishingly rarely, in less than 1% of articles. In our paper, we argue that this enforced ignorance on the topic of racism in addiction contributes to racialized policies and treatment systems.

Contact Spender Dunleavy, MD, the study principal investigator, at Spencer.Dunleavy@bmc.org for more information.

Harm Reduction Policies and Practice in Massachusetts Homeless Shelters

Overdose remains the leading cause of death among people experiencing homelessness. Harm reduction practices can improve engagement with people who use drugs and decrease chance of fatal overdose, but attitudes and policies regarding substance use can vary widely between shelters. We seek to describe the range of harm reduction policies in place in shelters in Massachusetts by interviewing shelter staff and guests in 4 shelters in 4 communities across the state. We also plan to develop a set of practical harm reduction best practices as well as promising future practices for shelter-based harm reduction based on interviews with staff and guests. 

Contact Avik Chatterjee, MD, the study principal investigator at Avik.Chatterjee@bmc.org for more information.

HEAL Initiative: Preventing Opioid Use Disorder in Older Adolescents and Young Adults Disorders

The HEAL Prevention Cooperative is a multi-site NIH Initiative aiming to make evidence-based preventive intervention services available and accessible to all persons who experience risk for opioid and other substance misuse or disorder. At BMC, in conjunction with MGH, the team is conducting a naturalistic longitudinal observational study assessing the impact of treatment of psychopathology (mental health disorders) on the development of OUD, SUD, and nicotine use disorders in young people (16 to 30 years) who engage in behavioral health treatments.

Contact Adriana Salome at Adriana.Salome@bmc.org for more information.

The SAFEST Choice Learning Collaborative

The SAFEST (SBIRT and FASD Education, Support, and Technical assistance) Choice Learning Collaborative is a national educational program that aims to reduce the incidence of prenatal alcohol exposure (PAE) and improve outcomes in children with suspected or diagnosed fetal alcohol spectrum disorders (FASD). SAFEST Choice uses a Project ECHO virtual education model to train interdisciplinary pediatric and prenatal health care teams on how to screen for and counsel patients about the risks of alcohol use during pregnancy, and how to identify and care for children and adolescents with suspected or diagnosed FASD.

Learn more about the SAFEST Choice Learning Collaborative or contact Jackie German at Jacqueline.German@bmc.org for more information.

Impact of Initial Buprenorphine Prescribing Strategies on Retention in Care for Patients with Opioid Use Disorder

Treatment of opioid use disorder with the medication buprenorphine reduces risk of opioid overdose mortality, but poor retention in care limits this medication’s protective effect. This proposal will use large observational data to examine the relationship between buprenorphine dosage strategies and retention by: 1) describing current buprenorphine dosage practices in terms of dosage trajectories, 2) comparing the effect of two distinct buprenorphine dosage strategies on retention, and 3) estimating the impact of improved buprenorphine dosage practices on retention and overdose for the state of Massachusetts. This proposal has the potential to identify improved buprenorphine dosage strategies that increase retention in care, a key pillar in reversing the opioid overdose epidemic. 

Contact Ally Cogan at Ally.Cogan@bmc.org for more information.

Substance Use Prevention for Recently Displaced Adults (SUPRA)

The war in Ukraine has triggered the world’s largest current humanitarian displacement, forcing over 13 million people from their homes. While conflict can worsen substance use, little is known about its incidence and prevalence in countries affected by war, like Ukraine, making it difficult to design effective prevention efforts for displaced populations.

To close this gap, our team will partner with Ukrainian experts and communities to survey displaced Ukrainians and, based on the findings, develop and test a prevention program using acceptance and commitment therapy (ACT). We aim to create an effective, scalable approach to support mental health and prevent substance use disorders in humanitarian settings.

Contact Ve Truong at Ve.Truong@bmc.org for more information.

Tuberculosis, Alcohol, and Lung Comorbidities (TALC)

Our TALC study investigates hazardous alcohol use as a modifiable risk factor for post-tuberculosis (TB) lung disease in people with HIV (PWH). This 18-month observational study will follow 200 patients completing TB treatment in Mbarara, Uganda. In a two-part approach, we will first assess the relationship between alcohol use and post-TB lung disease and then explore how to tailor alcohol and smoking interventions for patients undergoing TB treatment.

Learn more about TALC here or contact Lydia Carlson, MPH, at Lydia.Carlson@bmc.org for more information.

Gabapentin to Reduce Alcohol and Improve Viral Load Suppression (GRAIL)

Ending the HIV epidemic depends on helping people with HIV (PWH) reach and maintain an undetectable HIV viral load. Unhealthy alcohol use is a common barrier that affects every step of HIV care, lowering antiretroviral therapy (ART) adherence and reducing the success of treatment as prevention (TasP). Addressing alcohol use is essential to helping PWH stay engaged in care and achieve viral suppression.

The Gabapentin to Reduce Alcohol and Improve Viral Load Suppression (GRAIL) trial will test whether gabapentin can help PWH who drink heavily and continue to have unsuppressed HIV at least six months after diagnosis. The goal is to determine if reducing alcohol use with gabapentin can improve HIV care engagement, boost ART adherence, and ultimately achieve viral load suppression.

Enrollment for this study is currently open. Learn more about GRAIL here or contact Ve Truong at Ve.Truong@bmc.org for more information.

The Alcohol Disorder Hospital Treatment (ADOPT) Study

The ADOPT study is a randomized controlled trial comparing the effectiveness of extended-release injectable naltrexone to oral naltrexone initiated at the time of hospital discharge for reducing heavy drinking among general medical inpatients with alcohol use disorder.

Information on the study can be found here, in addition to the following publications:

• Cannabis and Cocaine Use, Drinking Outcomes, and Quality of Life in General Hospital Inpatients with Alcohol use Disorder
• Correlates of Post-hospitalization Naltrexone Adherence for Alcohol Use Disorder
• Oral vs Extended-Release Injectable Naltrexone for Hospitalized Patients With Alcohol Use Disorder

Contact Kara Magane at maganek@bu.edu for further information.

Supporting the Implementation of a Parenting Intervention for Mothers with Substance Use Disorder in the Pediatric Medical Home

Children of mothers with substance use disorder (SUD) constitute a growing and highly vulnerable population. The SOFAR pediatric medical home for families and children impacted by SUDs, with integrated behavioral health (IBH), provides an opportune setting for addressing the needs of mothers and children impacted by SUDs. While many families are thriving in the program, there is a strong unmet need for evidence-based parent-training interventions, particularly during the preschool period.  

The current study aims to evaluate the implementation of a brief, parent child interaction therapy (PCIT)-based intervention, entitled THRIVE, that will be offered in the SOFAR Clinic at Boston Medical Center. THRIVE is a safe, six-session telehealth intervention that has been tested in pediatric and community-based settings. 

This study is currently enrolling participants. Please contact Mei Elansary at Mei.Elansary@bmc.org for more information.

PRONTO Stimulants

PRONTO Stimulants aims to develop an effective toolkit of adaptations to help post-overdose programs better identify and engage with people who use cocaine or methamphetamine. The project focuses on Native, Black, Latino, Hispanic, and youth populations because those populations are disproportionately affected by cocaine or methamphetamine-involved overdose deaths in the United States and are not historically reached by outreach programs. 

Frontline staff members of the eleven POST programs funded by the Massachusetts Department of Public Health, met in focus groups to develop this toolkit, which has more than 20 adaptations. Following toolkit dissemination and implementation, we conducted qualitative interviews and distributed surveys to assess the effectiveness of these toolkit items and their implementation. The findings of this study from this study are ongoing.

Please visit our website or contact Ally Cogan at Ally.Cogan@bmc.org for more information.

Office-Based Methadone Versus Buprenorphine to Address Retention in Medication for Opioid Use Disorder Treatment – A Randomized Pragmatic Hybrid Effectiveness/Implementation Trial

This randomized clinical trial aims determine whether office-based methadone with pharmacy administration and/or dispensing or office-based buprenorphine results in greater treatment retention in approximately 600 patients with opioid use disorder. This trial will also identify implementation barriers, facilitators and acceptability at the patient, provider and health systems level for office-based methadone with pharmacy administration and/or dispensing. BMC has been selected as one of the six sites and the project is being implemented in our office based addiction treatment clinic.

Please visit our website or contact EMBOOS@bmc.org for more information.

Sustaining Recovery for People on Opioid Agonist Treatment with Conversational Agents

Almost half of all people receiving buprenorphine for opioid use disorder discontinue treatment within the first year, due to substance use and medication stigma and other recovery challenges such as stress, emotional dysregulation, and social isolation. This study aims to improve retention in buprenorphine treatment through a smartphone-delivered, stigma-informed recovery support intervention that uses embodied conversational agents (ECA), i.e., animated computer agents that simulate natural and intuitive face-to-face conversations.

The ECA will deliver an acceptance-based intervention originating in cognitive-behavioral therapy to help participants overcome negative thoughts and emotions related to internalized substance use and intervention stigma. Intervention group participants will be engaged in ECA use with different strategies to maximize uptake and compared to 25 control participants receiving usual care at the BMC office–based addiction treatment clinic. 

By addressing stigma and recovery challenges, this intervention can help improve buprenorphine treatment retention and support long-term recovery from opioid-use disorder.

For more information, call 857.895.6486 or email SARA@bmc.org. 

Repeated-dose Behavioral Intervention to Reduce Opioid Overdose: A Two-Site Randomized-Controlled Efficacy Trial (REBOOT)

REBOOT is a longitudinal study aimed at determining the efficacy of a motivational interviewing behavioral intervention to reduce opioid overdoses rates for survivors of overdoses.

Contact Sarah Kosakowski at Sarah.Kosakowski@bmc.org for more information.

RETAIN Pilot

RETAIN is a longitudinal study evaluating an adapted intervention of recovery management checkups for patients with serious infections from injecting drugs. Participants in the intervention receive motivational interviewing and connections to desired care services for six months after discharge from the hospital.

This study is currently enrolling participants. Contact Andrew Rolles at Andrew.Rolles@bmc.org for more information.

Youth Empowerment Study

The Youth Empowerment Study aims to understand the perceptions of overdose risk among youth, families, and youth providers. Specifically, we are looking at how overdose risk is affected by the changing drug supply and how youth use drugs (including intentional or unintentional fentanyl use), and how to adapt or develop overdose prevention strategies for youth.

This study is currently enrolling participants. Contact Ally Cogan at Ally.Cogan@bmc.org for more information.

A Universal Primary Care Based Intervention to Reduce Youth Overdose Risk

This study aims to develop and evaluate an overdose prevention intervention for youth that will increase:

• Awareness of the risks of fentanyl and the drug supply
• Knowledge of strategies to reduce overdose risk
• Recognition and awareness of how to respond to an overdose

We will develop the intervention with the help of a community advisory board, then evaluate through a randomized control trial with four providers and 20 youth recruited from BMC Family Medicine and Pediatrics.

Contact Ally Cogan at Ally.Cogan@bmc.org for more information.