UMass Amherst Research Aimed at Ending the Opioid Epidemic
A 28-year-old man who had done two tours in Afghanistan started using heroin to “get rid of the ghosts” from being in war. A 33-year-old woman began using Percocet to help her sleep after a horrific sexual assault for which she felt responsible because she “drank too much” at the bar. These are some of the faces of the opioid epidemic.
In 2017, the U.S. Department of Health and Human Services (HHS) declared the opioid epidemic to be a public health emergency. The National Survey on Drug Use and Drug Health reported that in 2019 over 10 million people misused prescription opioids, while 1.6 million people had an opioid use disorder (OUD). Tragically, there were 100,000 overdose deaths in the United States in the 12-month period ending in April 2021, according to the U.S. Centers for Disease Control and Prevention (CDC).
The opioid crisis is a complex problem with multiple root causes, which won’t be fixed by a silver bullet. Just as HHS has outlined a multipronged response, UMass Amherst researchers are working to address the epidemic from several angles in order to prevent overdoses and save lives.
“Stigma is What Kills People”
One of the main barriers to helping people with opioid addiction continues to be the stigma around substance use, said Kim Dion, clinical associate professor in the Elaine Marieb College of Nursing. Patients avoid seeking medical care until they are in crisis because providers often treat their substance use as a choice, and blame them when they relapse.
Since 2015, Dion has implemented a training curriculum designed to reduce substance use stigma for all undergraduate pre-licensure nursing students at UMass Amherst. In 2020, the HHS Substance Abuse and Mental Health Services Administration (SAMHSA) awarded the College of Nursing a two-year grant, with Dion as the principal investigator, to support this work. Dion has refined the curriculum over time: Today it includes training on the physiology of addiction; screening brief intervention and referral to treatment; identifying an opioid overdose and administering intranasal naloxone; harm reduction measures, such as educating patients on safe injection practices and treating abscesses; and trauma-informed care.
“By providing education on addiction and how to treat patients with dignity, students learn to meet patients where they’re at and help them become safer in their drug use to decrease the risk of overdosing,” said Dion.
She also invites people directly affected by addiction, including those with a history of substance use disorder and their loved ones, to share their personal experience with students—deepening students’ understanding of the human side of addiction.
For example, the woman who began using Percocet after being sexually assaulted shared that it was one nurse at the hospital, who treated her as a human being with warmth, that helped her to remain substance free for six months.
“The impact of what one person can do is profound,” said Dion. “This is my take home point to the students: They can be the reason for someone not to get high.”
Dion conducts multiple surveys of students at various points during the training program, which today spans two semesters, and has found significant progressive declines in stigma.
She has distributed the training modules she developed to colleagues at other academic institutions, as well as to nurse educators through social media. She also trains many other students on the UMass campus, including RAs, fraternities, the UMass Amherst Medical Reserve Corps, and off-campus students, and gives educational presentations and trainings to local community groups, area hospitals and healthcare facilities, and marginalized populations, such as sex workers.
Promoting Evidence-Based Solutions
OUD is especially prevalent among people involved with the criminal justice system. Elizabeth Evans, associate professor of health promotion and policy, studies the social determinants of health and the factors that shape use of healthcare among incarcerated populations. She collaborates closely with criminal justice systems and public health groups, and in October 2021 began a five-year term on the Massachusetts Public Health Council (PHC), which advises the commonwealth’s Department of Public Health (DPH) on policy decisions.
According to Evans, there are many interrelated factors that play a role in the ability of formerly incarcerated people to get treatment for opioid use, such as access to housing, employment, and health insurance, particularly Medicaid. Certain groups, such as women who are pregnant or parenting, may be especially fearful of the scrutiny they could face if they seek care. Evans conducts much of her research in Massachusetts, which she said has been a trailblazer in public health promotion in general, and in using evidence-based solutions to address the opioid epidemic. By studying the effectiveness of programs and policies in the state, including conducting cost-benefit analyses, she hopes to find solutions that can ultimately be adopted in other places.
Evans is especially interested in understanding how medications approved by the FDA to reduce opioid cravings and withdrawal symptoms can become the standard of care for OUD—both while people are incarcerated and after release. She is co-principal investigator, along with Dr. Peter Friedmann, associate dean of research at UMass Chan Medical School-Baystate and chief research officer at Baystate Health, on a project examining a pilot opioid treatment program for jail detainees in seven Massachusetts counties. With funding by a $10 million grant from the National Institute of Health’s (NIH) National Institute on Drug Abuse, the researchers will study outcomes for formerly incarcerated people with OUD who receive methadone, extended-release naltrexone, buprenorphine/naloxone, or no medication through a community-based, follow-up care program. The research is part of the NIH’s Justice Community Opioid Innovation Network (JCOIN), an ambitious, $155 million effort involving scientists at dozens of institutions nationwide to improve opioid addiction treatment in criminal justice settings.
Evans is conducting another research project, funded in September 2021 by a five-year, $2.6 million grant from SAMHSA, examining treatment of trauma, a common underlying cause of addiction, for people released from the Franklin County jail. She is also collaborating with the Opioid Task Force of Franklin County and the North Quabbin Region on a post-overdose intervention program, and with the Holyoke District court on the Holyoke Early Access to Recovery and Treatment (HEART) program, which provides same-day access to medications and other treatment for OUD for individuals who appear before the court. About half a dozen of Evans’ undergraduate and graduate students have interned through the HEART program, gaining valuable real-world experience working on public health interventions.
In engaging people with OUD in any form of treatment, Evans acknowledged the challenges posed by persistent stigma associated with drug use. “I want people to feel positive about accessing care,” she said.
What if a common smart watch could help patients who are prescribed opioid medications avoid developing dependence on them, and promote long-term recovery of those with OUD?
As a “problem-driven researcher,” Tauhidur Rahman, assistant professor in the Manning College of Information & Computer Sciences, aims to address some of society’s most intractable problems through his work developing mobile sensing systems for health and behavior in the MOSAIC lab he co-directs. Knowing about the dire effects of opioid addiction for individuals and society, he was drawn to create wearable sensor systems that could detect both use and craving of opioids.
In recent years, Rahman and his PhD student Bhanu Teja Gullapalli have published research on the use of cardiac and respiratory signals to sense cocaine craving, euphoria, and drug seeking behavior, as well as a study on tracking opioid use with a wearable device and developing predictive models using machine learning. In both cases, predictions were made with greater than 80 percent accuracy. The lab recently received a $1.1 million grant from the National Science Foundation’s (NSF) Smart and Connected Health Program to advance its research. With this support, Rahman and Gullapalli aim to develop a robust and reliable detector for opioid cravings and associated stress, as well as a system that recommends a personalized mindfulness-based intervention at craving moments to help the individual avoid using drugs.
The system would use machine learning to improve its recommendations over time, similar to technology used by companies like Netflix or Amazon to recommend movies and products.
“If we can identify those opportunistic moments by detecting craving, we can help people practice just-in-time mindfulness interventions to help them move away from risky consumption,” said Rahman.
He notes the machine learning algorithms used by Netflix and Amazon are based on massive data sets. The researchers plan to build up such a data set for the behavior and physiological signals of those with substance use disorders. They are collaborating with Stephanie Carreiro at UMass Chan Medical School and researchers at SUNY Upstate and Yale medical schools to gather data on the physiological signals associated with stress and cravings—including changes in heart rate, interbeat interval, galvanic skin response (changes in sweat gland activity), and skin temperature.
With the NSF grant, Rahman also hopes to foster additional collaborations with community organizations that support individuals struggling with opioid addiction, in order to build understanding and translate the tools they’re developing to the real world.
This story was originally published in January 2022.