Grayken Center for Addiction

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.

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 "Targeting Effective Analgesia in Clinics for HIV" (TEACH) Study RCT tested whether a collaborative care intervention for physicians improves the delivery of chronic opioid therapy for HIV-infected persons.

Learn more about TEACH

The St PETER HIV trial compared the effects of two nicotinic receptor partial agonists, varenicline and cytisine, on alcohol consumption, alcohol craving, smoking, inflammation, CHD risk and mortality risk.

Learn more about St PETER, read our publication on the study, or contact Natalia Gnatienko, MPH at Natalia.Gnatienko@bmc.org for more information.

THAU 50/50 was an observational, cross-sectional study that examined key differences between 50 people with HIV (PWH) without a history of tuberculosis (TB) to 50 participants from our tuberculosis, alcohol, and lung comorbidities (TALC) study who have a history of TB and have HIV. The study explored how alcohol use, aging, and TB impact frailty and social vulnerability in people with HIV, with an aim of better understanding the care needs and health priorities of both groups in order to more effectively support them.

Learn more about THAU 50/50 here or contact Lydia Carlson, MPH, at Lydia.Carlson@bmc.org for more information.

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.

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.

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.

THAU 50/50 was an observational, cross-sectional study that examined key differences between 50 people with HIV (PWH) without a history of tuberculosis (TB) to 50 participants from our tuberculosis, alcohol, and lung comorbidities (TALC) study who have a history of TB and have HIV. The study explored how alcohol use, aging, and TB impact frailty and social vulnerability in people with HIV, with an aim of better understanding the care needs and health priorities of both groups in order to more effectively support them.

Learn more about THAU 50/50 here or contact Lydia Carlson, MPH, at Lydia.Carlson@bmc.org for more information.

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.

BMC has the distinction of being the recipient of the largest grant awarded by the US government to combat the opioid epidemic.  Scientists from the nation's leading health agencies and four major academic institutions partnered with communities in four states to test a set of interventions to combat the opioid crisis. The Massachusetts team was led by Grayken faculty member Dr. Jeffrey Samet, Chief of BMC's Section of General Internal Medicine. The study website shows the communities that partnered with BMC to implement measures that are aimed at drastically cutting deaths from opioid overdose in the next few years.

Learn more about the HEALing Communities Study or contact Natalia Gnatienko, MPH at Natalia.Gnatienko@bmc.org for more information.

Opioid overdose deaths continue to accelerate with a disproportionate rise among individuals from historically marginalized groups, especially individuals who are Black, Latino or Indigenous. In addition, these groups exhibit lower receipt of buprenorphine, a key medication in the treatment of opioid use disorder (OUD), relative to white individuals. Similar patterns emerge at the neighborhood-level. For example, research has identified associations between neighborhood-level race, ethnicity, and income with rates of treatment with buprenorphine and other medications for OUD (MOUD).

This study leveraged the Data 4 Equity (D4E) platform, an effort by the BU CTSI Biomedical Informatics Core to strengthen geo-spatial and health disparities research at BUMC, with the aim to describe individual and neighborhood-level disparities in buprenorphine receipt for BMC patients using D4E. It generated the preliminary work needed for a larger proposal involving more robust geo-spatial analyses of disparities in buprenorphine treatment at BMC.  

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

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.

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.

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

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.

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.

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.

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.