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TRI April Newsletter

TRI Approved for $13 Million Research Funding Award by the U.S. Patient-Centered Outcomes Research Institute

The Treatment Research Institute (TRI) has been approved for a five-year, $13 million funding award by the Patient-Centered Outcomes Research Institute (PCORI) to study patient-centered care for opioid use disorders (OUD) in Federally Qualified Health Centers.

In response to the U.S. opioid epidemic, TRI has designed a holistic, flexible and patient-centered approach to treating opioid use disorder. This new approach, the Personalized Addiction Treatment to Health Model (PATH), will be integrated into existing primary care systems as part of the study. OUD patients from two large Federally Qualified Health Centers (FQHCs) in Philadelphia and two in Washington D.C. will receive either standard care referral to a local community treatment program, or the PATH program, with onsite, integrated OUD treatment.

TRI’s study was selected for funding through PCORI’s Pragmatic Clinical Studies Initiative, an effort to produce results that are broadly applicable to a diverse range of patients and care situations and can be more quickly taken up in routine clinical practice. Many clinical studies test whether a treatment works under ideal conditions in specialized research centers, but health care is rarely delivered in such idealized situations and settings.

Read more about this funding award here.

New Intervention to Engage Drug Court Participants in Preventive Healthcare

Although drug courts have been shown to be extremely effective at treating addiction and reducing criminal behavior, they generally do not address the medical needs of the individuals they serve. This is particularly problematic because chronic drug use increases a person’s susceptibility to a wide range of medical problems. In addition, because the majority of drug court clients do not use primary or preventive healthcare, individuals often rely on the emergency room for treatment when medical problems have escalated and are more difficult and expensive to treat. Fortunately, brief motivational interventions and health navigators have been shown to help patients obtain medical treatment for a number of health-related issues.

TRI researchers have begun phase two of a study to develop and pilot test a health promotion intervention designed to help this population connect with primary care providers to receive preventive health evaluations. Having completed the development in collaboration with both drug court clients and experts in the field, the team has begun the two-group randomized controlled pilot study to examine the acceptability, feasibility and preliminary efficacy of the intervention. Addressing drug court clients’ unmet healthcare needs will allow drug courts to expand their impact at both an individual and societal level. This is the first study of its kind to test such interventions with medically vulnerable drug court clients. The study is funded by the Commonwealth of Pennsylvania Department of Health.

Evaluating the Efficacy of Providing Extended Release Naltrexone in North Carolina

Residents of North Carolina have been hit especially hard by the opioid epidemic. It is estimated that there are 97 prescriptions for painkillers for every 100 people in the state. According to a recent Centers for Disease Control report, the state experienced a 46% increase in the number heroin-related deaths and a 41% increase in prescription opioid deaths from 2014 to 2015.

As a part of a larger strategy to address the opioid epidemic, the state passed legislation on July 14, 2016 to develop a medication-assisted treatment pilot program that will evaluate the effectiveness of providing extended release naltrexone, a non-narcotic non-addictive opioid blocker, to patients in Federally Qualified Health Centers (FQHC). The North Carolina Department of Health and Human Services is funding a randomized controlled efficacy trial that will be conducted by TRI.

The two-group study will compare rates of abstinence, both during the six-month intervention period and at 12 and 18 months post-study entry, among individuals who are assigned to receive either extended release naltrexone at the FQHC or treatment as usual, which is typically referral to community-based treatment. In addition, the team will evaluate cost effectiveness of the intervention.

Discussing the Concept of Marijuana as a Solution to the Opioid Epidemic

TRI is committed to relying on scientifically-derived evidence and sound medical research to help guide effective treatment for substance use disorders. Until there is research that deems safe and successful outcomes for the use of FDA-approved, marijuana-derivative medications to treat a substance use disorder, it does not align with the currently available FDA-approved Medication Assisted Treatments for Opioid Use Disorders. While it is possible that marijuana could be useful, it has been very difficult to research the positive therapeutic effects.
TRI supports the efforts of researchers, including those funded by the National Institutes of Health (NIH), that are exploring possible uses of THC and CBD for medical treatment that may help to reduce things like pain, inflammation, controlling seizures, etc. This research needs to be done in a robust fashion, in randomized controlled trials.

Related conversations can be found in recent news articles in The New York Times, The Guardian and Rolling Stone.