Why it’s so hard to break an opioid addiction
The University of Kentucky has been awarded an $87 million federal grant, the largest in its history, to reduce opioid deaths by 40 percent in 16 counties around the state.
The four-year grant is one of four announced Thursday by the National Institutes of Health that total $350 million. Other agencies receiving a HEALing (Helping End Addiction Long-Term) Communities Study grant are the Boston Medical Center in Massachusetts, Columbia University in New York City and Ohio State University.
Each site will partner with at least 15 communities to measure the impact of prevention, treatment and recovery interventions in hospitals, behavioral health programs, and the criminal justice system. The study will track outcomes of strategies such as providing prisoners more treatment for opioid use disorder, allowing more providers to prescribe medication-based treatment for opioid addiction, and expanding the distribution of naloxone, a medication that reverses opioid overdoses.
The idea is to save lives while giving researchers valuable data about best practices for dealing with one of the country’s worst health crises.
In Kentucky, the grant’s principal investigator will be Sharon Walsh, director of the UK Center on Drug and Alcohol Research, who will partner with the Cabinet for Health and Family Services and the Justice and Public Safety Cabinet to lead a team of 20 researchers and community partners. The 16 Kentucky counties are concentrated in central, northern and eastern portions of the state: Fayette, Bourbon, Franklin, Jessamine, Clark, Madison, Boyle, Jefferson, Knox, Floyd, Carter, Boyd, Greenup, Mason, Campbell and Kenton.
These counties aren’t necessarily the worst hit by the crisis, but each had to meet certain criteria, which included having a jail, at least 25 opioid overdose deaths per 100,000 population, a needle exchange program, and one or more providers who offer medication assisted therapy, such as buprenorphine, for opioid addiction.
Combined, the 16 rural and metropolitan counties had 764 opioid overdose deaths in 2017, with two-thirds of them involving fentanyl, UK officials said. They also represent about 40 percent of the state’s overall population of more than 4 million people.
“The goal is to show meaningful change in the overdose death rate in a short period of time and to do so in a way that can reveal what evidence-based interventions are effective in the community,” Walsh said. “’What will work? Is it distributing more naloxone? Is it educating people better about evidence-based treatment? Is it expanding access to treatment and decreasing barriers? For example, if we pay for someone to have transportation to get to their treatment program will that help them stay in treatment?
State health officials have tried to increase the amount of medication assisted therapy available for opioid addiction, but it is not standard practice in numerous treatment centers or hospitals. Drugs such as buprenorphine can satisfy the addictive cravings of opioid use disorders, but they also can be abused or resold on the street.
NIH officials visited UK in February to assess UK’s grant application.
Research data from all four sites will be analyzed throughout the span of the grant. In Kentucky, Walsh said, the grant will begin with listening sessions to hear from local organizations about what help they need most, “so that we can understand how to help.”
That information will help set up a “care navigation system” that will look different from county to county. For example, in some places, the grant might help pay for more methadone treatment, which is not covered by Medicaid, while in others it might set up better transportation for people in recovery. Walsh said she also hopes to have someone in every jail in each of the counties because people in the criminal justice system are often at high risk for overdoses.
“The evidence generated through the HEALing Communities Study will help communities nationwide address the opioid crisis at the local level,” said Nora D. Volkow, M.D., director of National Institute on Drug Abuse (NIDA). “By testing and evaluating interventions where they are needed the most, we hope to show how researchers, providers, and communities can come together and finally bring an end to this devastating public health crisis.”
U.S. Senate Majority Leader Mitch McConnell and U.S. Reps. Hal Rogers and Andy Barr all supported UK’s application for the grant.
“Kentuckians in both rural and urban communities continue to endure the serious damage of substance abuse,” McConnell said in a statement. “Unfortunately, Kentucky is one of the hardest hit states, but we’re also on the forefront of the national response.”
UK President Eli Capilouto, who attended Thursday’s news conference in Washington D.C. with Gov. Matt Bevin, thanked state and federal politicians for their support. In particular, he named Kentucky Senate President Robert Stivers for pushing lawmakers to fund the Kentucky Healthy Research Building, which he said will be instrumental for researching problems like opioid abuse. The $265 million building on Virginia Street opened last fall with more than $132 million in funding from the General Assembly.
“Working in partnership at the state and federal levels, we have developed the intellectual talent and infrastructure to attack this challenge,” Capilouto said. “Together with the state, we have the reach and partnerships at the local level across our commonwealth to develop and seek community-based solutions to a widespread and deadly challenge. Now is the time to lead. Now is the time to act.”
The university’s largest previous grant was a $25 million award for math and science education in Appalachia.
Also attending the Washington D.C. press conference was Alex Elswick, a 28-year-old Lexington resident in recovery from heroin addiction who recently started Voices of Hope, a non-profit that helps people with opioid use disorder. Elswick said in his long journey to recovery he was never offered medication assisted therapy. He added that at 28, he’s attended more funerals than weddings and will be headed to a classmate’s burial on Friday.
“HEAL came too late for him but it’s just in time for the thousands of lives it’s going to save,” he said.