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.
Throughout his academic career, Dr. Lyons has worked to reduce fragmentation in systems and mission that separates public health and other healthcare entities. The emergency department setting is a compelling platform for launching this focus given its role as a safety net provider, remarkably high prevalence of substance use, mental health, and infectious disorders, and its frequent interaction with virtually all aspects of the healthcare, public health, and social service systems.
Dr. Lyons has led the University of Cincinnati’s Early Intervention Program (EIP) and Department of Emergency Medicine Division of Public Health and Health Services Research since 2002. The EIP is an ever-expanding collection of clinical prevention initiatives that has been continuously funded for over two decades by a variety of public health, community, healthcare, and industry sponsors. The program augments and directly modifies existing emergency care and other healthcare services, as well as providing services in community settings in partnership with public health agencies and community-based organizations. Approximately 100 nurses, physicians, researchers, and other allied health professionals began their initial career development as EIP service providers. This body of clinical and administrative work directly informs Dr. Lyons’ research which has been variously funded by NIH, CDC, AHRQ, EMF, and SAMHSA. Most recently he is serving as co-lead of the “Intervention Core” for the Ohio portion of the massive NIH/SAMHSA HEALing Communities Study, which will engage 19 counties throughout Ohio in comprehensive and rapid reduction of untreated opioid use disorder and related overdose mortality.
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.
Theresa 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. Acquavita’s research has focused on the area of substance use disorders, maternal and child health, and interprofessional education and collaboration. She has a decade of social work experience working with individuals who have been diagnosed with mental health and substance use disorders. She has been the recipient of federal, state and local grants focusing on behavioral health workforce development. Her research contributes to best practices in training allied health students in addressing alcohol, tobacco and other drug use in patients.
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. Clark’s research has included the development of multiple educational interventions to support harm reduction efforts related to the opioid epidemic, reduce stigma against persons with substance use disorders, and increase knowledge and implementation of evidence-based best practices for substance abuse treatment – all in an effort to save lives and turn the tide on the epidemic. Dr. Clark’s original iBooks include: CARRY Narcan©, Evidence Based Treatment for Opioid Use Disorders, Be-SAFE©, and STOMP out Opioid Diversion©. Dr. Clark is a member of the Board of Directors at a regional substance use disorder treatment facility and Co-Chair of The Association for Multidisciplinary Education and Research in Substance Use and Addiction Nursing Special Interest Group. Dr. Clark is the Executive Director of the Undergraduate and Prelicensure Nursing Programs in the College of Nursing.
Dr. Caroline Freiermuth is an emergency physician interested in pain management, and the determinants of health that impact development of chronic pain and opioid use disorder. She has recently been awarded a multi-million-dollar grant from the Ohio Attorney General's office to study the pharmacogenomics of OUD. She has also been instrumental in evaluating harm reduction measures such as naloxone distribution and provider attitudes towards patients with and interventions for OUD.
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. Punches is a doctorally-prepared nurse scientist and emergency care researcher with significant experience in emergency department (ED) clinical operations, perceptions of ED care, and qualitative methods. Her research is focused on 1) addressing the complex phenomenon of trauma recovery, acute pain management, and substance use disorders, 2) understanding patient, nurse, and provider interactions and experiences in episodic, acute care environments such as the ED and 2) translating that understanding into effective health services and behavioral interventions that are demonstrated to improve health outcomes.
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. She 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.