Population Health and Health Services
Much emphasis in the field of addiction medicine is placed on the absolutely essential goal of developing and testing treatments for substance use disorder (SUD). Yet, a comprehensive response requires a much broader view. Addiction arises from and is exacerbated by a host of factors involving systems and populations and leads to a wide variety of adverse consequences. For example:
- It may even be that addiction can spread like a contagion through social networks
- Stigma is a profound problem (and intervention target) that involves even those who will never suffer directly from addiction.
- Effective prevention of addiction would obviate the need for treatment entirely.
- Those with addiction cannot be treated if they are not accessing treatment services.
- Intervention services need to be operationalized and comparatively evaluated. How to effectively and efficiently implement services is an enormous knowledge gap in many conditions and is even more complicated in addiction where patient motivation for treatment is uniquely problematic. Moreover, individuals with co-occurring mental health issues tend to be high healthcare utilizers but optimal treatment approaches for this population has received relatively little research attention.
- Policy level intervention can have profound effects (positive or negative) on the prevalence and consequences of addiction.
- Addiction is well-known to cause or worsen a host of co-morbidities (e.g., infectious disease) that in turn require their own prevention, treatment, and policy solutions.
- A full understanding of longitudinal outcomes in health and economic terms can assist with policy development, intervention prioritization, and motivating system change.
The mission of the “Population Health and Health Services (PHHS) Core” of the UC Center for Addiction Research is to conduct the science necessary to place addiction in context, prevent the condition when possible, and limit the consequences of addiction when it does occur. Core investigators multidisciplinary and highly synergistic interests range from surveillance and epidemiology, primary and secondary prevention intervention, operations and implementation, and outcomes assessment. These categories apply both to addiction itself and related co-morbidities.
Dr. Shauna Acquavita is a Professor and MSW Director at the School of Social Work. She has a decade of social work experience working with individuals who have been diagnosed with mental health and substance use disorders. Her research focuses on substance use disorders including tobacco use among vulnerable populations, specifically pregnant women.
Dr. Caroline Freiermuth is an Associate Professor of Emergency Medicine. Her research has focused on managing pain while minimizing risks, including the risk of opioid use disorder. Dr. Freiermuth's expertise in treatment for opioid use disorder and harm reduction has been recognized through her roles on multiple active grants. She serves as a Co-investigator on the NIDA HEALing communities study, acting as a facilitator for implementing new programs for prevention and treatment of opioid use disorder in emergency departments across the state of Ohio. As the principal investigator of the Emergency Department Comprehensive Care grant, awarded by the Ohio Department of Health, Dr. Freiermuth leads the coordination of expanded services for persons with opioid use disorder across local health systems, ensuring that emergency departments are adequately identifying those at risk for the disease and have the needed resources and protocols to treat these patients. Dr. Freiermuth recently enrolled over 1300 hundred patients from three emergency departments into a pharmacogenomics study, funded by the Ohio Attorney General's office. Through this study, she seeks to identify genetic markers associated with opioid use disorder, with the long term goal of running trials to determine if identifying this risk before opioid exposure can decrease the risk of developing opioid use disorder.
HEALing Communities Study
The HEALing Communities Study will determine how to address the opioid epidemic through prevention, treatment and recovery. To assess the effectiveness of different interventions, the study will compare results between communities, and in order to make
these comparisons, participating communities were randomly assigned using a scientific algorithm to start these interventions either in December 2019 (Wave 1) or December 2021 (Wave 2).
- The 9 counties in the first wave are Ashtabula, Athens, Cuyahoga, Darke, Guernsey, Greene, Hamilton, Lucas, Scioto.
- The 9 counties in the second wave are Allen, Brown, Franklin, Huron, Jefferson, Ross, Stark, Williams and Wyandot.
Throughout the project, all participating communities will continue to get all the other treatment and prevention resources and services that they would otherwise receive.
T. John Winhusen, UC professor of psychiatry and behavioral neuroscience, director of the Addiction Sciences Division and principal investigator of the Ohio Valley Node in the NIDA Clinical Trials Network, is serving as a co-principal investigator for the state of Ohio with Dr. Rebecca Jackson, director of the Ohio State University’s Center for Clinical and Translational Science, along with Alisha Nelson of RecoveryOhio, an initiative created by Gov. Mike DeWine. UC, Ohio State and Case Western are coordinating the research study in collaboration with the 19 counties. UC faculty members Jennifer Brown, associate professor of psychiatry in the addiction sciences division, and Dr. Michael Lyons, associate professor of emergency medicine, are leading the statewide effort of intervention implementation across the selected counties.
The HEALing Communities Study is funded and supported by the National Institute on Drug Abuse, part of the National Institutes of Health, in partnership with the Substance Abuse and Mental Health Services Administration.
Population Health and Health Services Faculty
Dr. Blackard currently directs a translational research laboratory which focuses on human and mechanistic studies to understand the interactions between various viral pathogens. At present, laboratory studies involve hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis E virus (HEV), pegiviruses (HPgV; GBV-C), BK polyomavirus, and HIV and include international collaborations in South Africa, Botswana, India, Mozambique, Nigeria, and Ghana. My NIDA-funded research focuses on the impact of synthetic opioids such as fentanyl on HIV disease. In addition to my research responsibilities, I currently serve as the Co-Director for the NIH-funded KL2 Scholars Program that is responsible for mentoring junior faculty and facilitating their transition to independent research careers.
Dr. Brown is an Associate Professor in the Department of Psychiatry & Behavioral Neuroscience at the University of Cincinnati College of Medicine. She is an affiliated faculty member in the Department of Psychology at the University of Cincinnati. Dr. Brown’s research has been funded by NIH (NIMH, NIAAA, NIDA), CDC, SAMHSA, the Bill & Melinda Gates Foundation, among others. Her research focuses on: a.) the development of interventions to prevent HIV/AIDS and improve reproductive health outcomes among vulnerable populations; b.) the development of interventions to address the intersection between substance use and infectious diseases; and c.) implementation science approaches to improve substance use, reproductive health, and HIV outcomes. Her research is conducted both domestically and globally, with current global studies in Russia and South Africa.
Dr. Brubaker researches the barriers and facilitators to substance abuse treatment, with a focus on interprofessional workforce development. As a community-engaged researcher, he has secured over $3.9 million in federal funding ($1.6 million as PI, $2.3 million as CoI) to expand the mental health and substance abuse treatment workforce through innovative education and trainings. In addition, his published addictions research includes exploring substance abuse and treatment stigma, as well as LGBTQ+ populations and those experiencing homelessness.
Dr. Manchak’s work examines the effectiveness of programs and policies for individuals in the criminal justice system who have mental illness and/or substance use disorder. Since 2012, she has been an external evaluator (PI) on several different projects that focus on justice-involved individuals with opioid addiction, specifically. This includes 4 evaluations of SAMHSA-funded programs affiliated with the local drug court, 2 evaluations of the Hamilton County Quick Response Team, and 1 evaluation of the Hamilton County Law Enforcement Assisted Diversion (LEAD) program. In her own investigator-led research that focuses more specifically on serious mental illness (schizophrenia, bipolar disorder, major depression), she examines the influence of substance use on clinical and criminal outcomes. She has also conducted a study of practitioners in Hamilton County (EMS, treatment, law enforcement/corrections) to examine the personal and professional impact of the opioid crisis.
Dr. Ashley Merianos has extensive training and experience in the epidemiology and prevention of substance use with an emphasis on tobacco, quantitative statistical methods, and clinical and translational research in the pediatric healthcare setting. She is a Certified Health Education Specialist and Tobacco Treatment Specialist. The National Institutes of Health (NIH) has successfully funded Dr. Merianos’ research as a Principal Investigator (K01DA044313 and R21ES032161). Her current K01 project measures the health and economic burden of child tobacco smoke exposure including secondhand and thirdhand smoke on the acute healthcare setting and creates an implementation plan to reduce exposure in a future trial. Dr. Merianos' current R21 project examines the prevalence, contributions, and health risks of exposure to tobacco smoke and electronic cigarette aerosol among children nationwide. She serves as a Co-Investigator on two active NIH research projects (R01ES027815 and R01ES030743) that focus on parental tobacco cessation and child tobacco smoke exposure reduction in the acute healthcare and inpatient settings, and assessment of complex tobacco smoke toxicant mixtures within microenvironments (e.g., homes). Dr. Merianos’ research program has contributed to the tobacco control field by identifying the multiple pathways through which nonsmoking children are exposed to tobacco smoke and evaluating policies aimed at protecting this highly vulnerable population from related harmful effects.
Dr. Nidey is a maternal and child health epidemiologist, grounded in social epidemiology with a commitment to improving the health and life outcomes for underserved and at-risk families. Her research is focused on understanding the intergenerational effects of maternal adverse childhood events, perinatal mental health and maternal substance use. In 2019, Dr. Nidey started the EMPOWER (empowering mothers, providers and others to weigh in as experts in research) Project. The mission of the project is to improve care, health outcomes and wellbeing for pregnant women with or a history of substance use and their children through collaborating with patient, community, clinical, and academic stakeholders and co-designing and co-leading research initiatives. To support this work, Dr. Nidey has received funding from the CCTST and PCORI.
Dr. Schultz has conducted NIH/NIDA-, AHA- and PhRMA Foundation-funded studies, spanning 15+ years, focused on the cardiovascular outcomes of acute or chronic opioid/opiate use. She and her PhD graduate mentor are acknowledged as the pioneers in the field of acute opioid use in cardiac ischemia-reperfusion injury, which has resulted multiple “therapeutic use” patents and consulting opportunities. Dr. Schultz’s research has contributed to our understanding of the effects of opioid/opiate use and use disorder in ischemic heart disease or heart failure outcomes.
Kenneth Sherman, MD, PhD is a hepatologist and virologist with a diverse research agenda focused on viral hepatitis natural history, immunology, diagnostics, prevention, and treatment. Much of his work involves immunosuppressed, at-risk populations with HIV. He has been continuously funded by NIH and other federal agencies since the 1990s and has held leadership positions in the NIAID AIDS Clinical Trials Group (ACTG), the American Gastroenterological Association and the American Association for the Study of Liver Disease. Dr. Sherman’s research effort has helped define the significance and management of viral liver disease in persons living with HIV and provided the groundwork for current public health screening measures for viral hepatitis in the U.S. and worldwide.
Dr. Wexelblatt is a pediatrician and researcher focused on improving perinatal health outcomes in regional populations. He is currently the Regional Director of Newborn Services for Cincinnati Children's Hospital Medical Center (CCHMC) Perinatal Institute, which serves eight level 2 hospitals and three level 1 nurseries in our region. As the regional faculty representative for the Ohio Children’s Hospital Association (OCHA) subcommittee on Neonatal Abstinence Syndrome (NAS), he helped establish a protocol for NAS for twenty Ohio children’s and maternity hospitals. He led in the reporting of key findings from OCHA demonstrating that improved outcomes for NAS following an infant’s in-utero exposure to opioids could be achieved through the utilization of standard treatment protocols with stringent weaning guidelines. Subsequently, he co-led the analysis and writing of a follow-up study reporting improvement in NAS outcomes after adoption of the collaborative guidelines. Building upon his work with the OCHA collaborative, he served as a primary or co-investigator in several additional regional analyses designed to provide evidence for further optimizing NAS guidelines. Analyses of outcomes following methadone versus buprenorphine weaning and a comparative effectiveness evaluation of conventional methadone weaning versus weaning with a pharmacokinetic modeled methadone protocol were published. He is currently participating as a faculty member of the Ohio Perinatal Quality Collaboration (OPQC) disseminating our findings to 53 delivery hospitals in Ohio to improve the care of the opioid exposed infant. Through their statewide collaborations of OCHA and OPQC, they have created a standardized protocol to safely decrease the length of stay. They have also showed that a pharmacokinetic modeled taper reduced length of stay by three days, and that buprenorphine may be a safe and more effective option for pharmacologic treatment in the setting of NAS.
Dr. Wilder is an Associate Professor at the University of Cincinnati Department of Psychiatry and Behavioral Neuroscience and Medical Director of the Addiction Sciences Division at UC Health. She is board certified in General and Addiction Psychiatry. Her current research interests are the treatment of pregnant and postpartum women with opioid use disorder and the prevention of opioid overdose. She is a site PI for the Clinical Trials Network study: Medication Treatment for Opioid-dependent Expecting Mothers: A Pragmatic Randomized Trial Comparing Two Buprenorphine Formulations. She is also active in the Cincinnati community as a member of the Hamilton County Mental Health and Recovery Services Board.
Dr. Winhusen has conducted NIDA-funded clinical trials for the past 20 years devoted to improving the treatment of substance use disorders including opioid, cocaine, and tobacco use disorders. He is one of the foremost experts in conducting multi-site addiction trials in clinical settings, having served as the national PI for six National Drug Abuse Clinical Trials Network trials. Dr. Winhusen’s research has contributed to our understanding of co-occurring disorders (e.g., tobacco use disorder with ADHD and with stimulant use disorders), the treatment of pregnant substance abusers, and the neurocognitive functioning of individuals with stimulant use disorders.