UK experts share their work in the field of opioid use disorder research at 2022 Rx Summit

University of Kentucky experts on the front lines of the nation's opioid and addiction crises will share their work in the field of opioid use disorder research, treatment and prevention this week at the 2022 Rx Drug Abuse & Heroin Summit in Atlanta April 18-22.

The Rx Summit is the nation's largest annual gathering focused on combating the opioid epidemic and returns to an in-person format this year after being held virtually the last two years due to the COVID-19 pandemic.

A UK delegation including President Eli Capilouto and experts across multiple disciplines will collaborate with a global community of stakeholders who come together annually at the event to share best practices and strategies for prevention, treatment and recovery.

The meeting takes place at a critical time, with U.S. overdose rates at record highs and deaths due to drug overdose topping 1 million for the first time since the Centers for Disease Control and Prevention (CDC) began collecting data on the problem more than two decades ago.

With Kentucky among the states hardest hit by the nation's opioid epidemic, UK experts tackling the crisis in the Commonwealth are at the forefront of the national effort to cultivate change and develop sustainable solutions.

HEALing communities study

On Tuesday, April 19 at 2:15 p.m., UK experts will present "HEALing Communities Study: Deploying Evidence-Based Practices to Reduce Opioid Overdose Deaths Through Community Engagement and Partnerships." Presenters are UK Center on Drug and Alcohol Research Director Sharon Walsh, Ph.D.; UK College of Arts & Sciences Professor of Sociology Carrie Oser, Ph.D.; UK College of Nursing Assistant Professor and Voices of Hope Program Director Amanda Fallin-Bennett, Ph.D.; and Jennifer Gulley with the Clark County Health Department.

In 2019, UK researchers spanning seven colleges, in partnership with state leaders, launched a project through the NIH's HEALing (Helping End Addiction Long Term) Communities Study aimed at reducing opioid overdose deaths.

The four-year, $87 million study is the largest research grant ever received by UK and leverages existing resources and initiatives, in partnership with communities, to implement various evidence-based strategies to reduce opioid deaths across Kentucky.

The randomized study includes 16 Kentucky counties impacted by opioids and is broken down into two waves of eight counties each. With project activities for the first wave of eight counties – Boyd, Boyle, Clark, Fayette, Floyd, Franklin, Kenton and Madison, collectively known as WAVE 1 – nearly complete, UK experts will highlight the community engagement, criminal justice and peer support roles of the study.

UK's HEALing Communities Study has established partnerships with behavioral/health care and criminal justice agencies in counties to expand capacity for medication treatment for opioid use disorder (MOUD), link and retain clients on MOUD, provide overdose education and distribute naloxone, a lifesaving medication that can immediately reverse the effects of opioids.

The presentation will highlight strategies used for community-level decision making around evidence-based practices for opioid use disorder, explore the barriers to and opportunities for expanding care to those suffering from opioid use disorder in criminal justice settings and examine the important role of peer support specialists and recovery coaches in linking people to care and helping retain them in treatment.

The HEALing Communities Study team, in partnership with many state and community partners, is implementing evidence-based practices and removing barriers to care and recovery to turn the tide on the impact of opioid use in the Commonwealth. With WAVE 1 of the study nearly complete, the summit provides an opportunity for our team to share best practices, successes and challenges with other experts working to develop sustainable solutions for the opioid epidemic. The hope is that what we have implemented can become a national model for reducing opioid overdose deaths."

Sharon Walsh, PhD, Study Principal Investigator, University of Kentucky

Insights from state data on overdose deaths

On Wednesday, April 20 at 4:30 p.m., UK experts will present "Insights From State Data Into Deaths Related to Fentanyl, Fentanyl Analogs, Psychostimulants, and Novel Psychoactive Substances." UK College of Pharmacy Professor Chris Delcher, Ph.D., and UK College of Public Health Assistant Professor Dana Quesinberry, J.D., D.P.H., will be joined by Jessica Bitting with the Centers for Disease Control and Prevention (CDC)/National Network of Public Health Institutes (NNPHI); Bruce A. Goldberger, Ph.D., with the University of Florida's College of Medicine; and Michael B. Meit from East Tennessee State University's Center for Rural Health Research.

Quesinberry will share findings from Kentucky state data on overdose deaths related to fentanyl and other psychoactive substances including methamphetamine and discuss how this data is shared with the community to inform prevention and response efforts.

Delcher will also present data showing shifts in the proportional impacts of these substances in geography, time, and periods relative to other policy and societal changes including the COVID-19 pandemic.

The Kentucky Injury Prevention and Research Center (KIPRC), an agent for the Kentucky Department for Public Health located at UK's College of Public Health, publishes annual drug overdose reports based on data collected from the Kentucky Office of State Medical Examiner's Office and county coroner offices and placed in the Kentucky Drug Overdose Fatality Surveillance System (DOFSS) with other data.

The DOFSS's inclusion of multiple data sources provides additional case-level information about drug overdose deaths that can better inform state and local prevention and response efforts, Quesinberry said.

"The overdose death investigation process is actually very complicated, with data from many sources including the coroner, medical examiner and toxicology labs. Pulling all of this information into one single database gives a more comprehensive picture about what has happened in an event that has caused a fatality," Quesinberry said.

The toxicology data in DOFSS is also helping experts understand how the opioid epidemic is evolving. Once mostly caused by prescription opioids like oxycodone and later heroin, drug overdose deaths in Kentucky are now driven by the synthetic opioid fentanyl. From 2019 to 2020, Kentucky overdose deaths that included fentanyl in toxicology reports nearly doubled, with most being linked to illicitly manufactured fentanyl.

While fentanyl is the most commonly found drug in toxicology reports, data is also starting to show increasing co-involvement with methamphetamine and cocaine. Quesinberry says these new trends warrant further investigation to better understand why this is happening. Delcher and Quesinberry were awarded a grant called STIMuLINK from the CDC to investigate stimulant-related overdoses in Kentucky.

Launched in 2017, DOFSS is now developed as part of KIPRC's implementation of the CDC's Overdose Data to Action surveillance strategies to reduce the burden of substance use disorders and drug overdoses in Kentucky.

Policy, prescribing and clinical practice: lessons from recent evaluations in Kentucky

On Thursday, April 21 at 11:15 a.m., UK experts will present "Policy, Prescribing, and Clinical Practice: Lessons From Recent Evaluations in Kentucky." Presenters are UK College of Pharmacy Professor Trish Freeman, Ph.D.; UK College of Medicine Professor Michelle Lofwall, M.D.; and UK College of Public Health Associate Professor Svetla Slavova, Ph.D. They will be joined by the CDC's Kristin Holland, Ph.D.

The presentation will highlight three recent UK-led studies on opioid policy prescribing and clinical practice:

• Kentucky's All Schedule Prescription Electronic Reporting (KASPER) prescription drug monitoring program is designed to be a source of information to assist practitioners and pharmacists with providing patient care using controlled substance medications. In 2018, a new Kentucky law mandated that patient drug conviction data be made available to prescribers and pharmacists on KASPER. A UK research team developed a continuing education program to inform prescribers and dispensing pharmacists on how to interpret this newly available data in the context of patient care. Lofwall will share insights gained about the usefulness of criminal drug records for prescribing and dispensing decisions.
• Slavova will present a study examining the utilization of buprenorphine, a medication used for the treatment of opioid use disorder (MOUD), during the initial weeks of the COVID-19 pandemic. Findings show that buprenorphine treatment increased during the pandemic after the initial interruption from March to April of 2020. Slavova says that future studies are needed to examine treatment retention for individuals initiated on buprenorphine via telemedicine, and there is also a need to assess the association between the drop in individuals on MOUD and the increase in opioid overdose deaths during the initial weeks of the COVID-19 pandemic.
• The "days' supply" is a key number that allows pharmacists to calculate average daily doses for opioid prescriptions. Since days' supply isn't always included on a prescription, it is often up to pharmacists to make the calculation and interpret the doctor's instructions. Freeman will share a study examining the overall accuracy of opioid days' supply in Kentucky pharmacies. Results show that the calculation is influenced by a variety of factors such as special instructions to the pharmacy, 'as-needed' directions, and payer source and suggest that these factors should be accounted for in research studies that depend on days' supply for data.