UK expert recommends medication-assisted treatment for opioid addiction

Dr. Michael Kindred

By Dr. Michael Kindred, assistant professor in the UK College of Medicine.

Of the 20.5 million Americans 12 or older that had a substance-use disorder in 2015, two million had a substance-use disorder involving prescription pain relievers, and more than a half-million more had a substance-use disorder involving heroin, according to the American Society of Addiction Medicine. That’s more than 2.5 million Americans who are in need of assistance treating opioid-use disorder.

One evidence-based treatment option available is medication-assisted treatment (MAT). Like the word assisted in the name suggests, MAT is meant to be provided in conjunction with counseling and other services that aid patients in reducing some of the stressors that can lead to active addiction. Programs like PATHways in the UK College of Nursing are an example of that. In addition to MAT, the program offers counseling, peer support and other healthcare services.

The type of medication commonly used for opioid-use disorder is called buprenorphine. It is provided to patients at intervals that are determined by their doctor. The medication can be delivered as a film placed under the tongue or a pill, but research is being conducted to find alternative delivery routes such as implants or injections.

In order to provide MAT, there are several requirements a physician must meet; those requirements are set by the Drug Enforcement Agency (DEA) and Substance Abuse and Mental Health Services Administration. First, the prescriber must be licensed under state law, they must register with the DEA, and they must complete training and/or certification. Providers must all be able to refer patients to counseling or other services. There are also restrictions on how many patients a doctor can treat using MAT; during the first year of securing the DEA waiver, providers can treat up to 30 patients, after the first year they can apply to treat up to 100 patients, and after the second year they can apply to treat up to 275 patients.

The opioid epidemic has impacted every corner of the United States, especially rural communities that have difficulty accessing medical care, but there are options available for helping those in active addiction enter recovery.


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UK researcher using $2.9M grant to treat cocaine-use disorder

Does reducing the use of cocaine, but not abstaining from the substance entirely, produce health benefits? There’s currently little research available that answers that question.

William Stoops, PhD, professor in the UK College of Medicine and director of regulatory knowledge and support for the UK Center for Clinical and Translational Science, has received a $2.9 million grant from the National Institute on Drug Abuse (NIDA) to find more answers.

Stoops hopes his research will contribute to the evolving knowledge of treatment for cocaine-use disorder (CUD), a substance-use disorder that currently has no well-established treatment methods.

“Facilities treating cocaine-use disorder are doing what they can, but there is no common practice,” Stoops said.

And while medications are available for other common substance-use disorders including opioid-use disorder and alcohol-use disorder, no medication is available to treat CUD.

Finding a more successful treatment model

Another challenge is that under the current model, CUD treatment is considered “successful” only if a patient abstains entirely from using the substance. Stoops points out that although abstinence is the ideal outcome, such a “total” fix is not the same measure of success used in treating other chronic diseases.

“Abstinence may be too high of a bar to set. We don’t do that with other chronic diseases – we focus more on reduction or management, like when treating someone for high blood pressure,” he said.

Stoops, along with interdisciplinary team members from the departments of behavioral science, psychiatry, internal medicine and psychology at UK, hope to determine if reduced cocaine use confers health benefits to individuals with CUD. He hypothesizes that a reduction will lead to improved health, and abstinence will yield even more benefits.

Health and economic benefits

The study will take place over five years and aims to enroll 200 participants (about 40 per year). Participants, who must be between 18 and 65 years old, will be asked to participate in a 12-week intervention. During the intervention, participants will need to be available three days a week for short visits. After the initial 12-week period, there will be long-term follow-up. The clinical component of the study will be conducted through the clinical services unit of the UK Center for Clinical and Translational Science.

In addition to helping people manage and treat their CUD, Stoops and the research team are also aware of the economic benefits to more people entering recovery.

“Substance use disorders in general, and CUD specifically are very expensive to the taxpayer. They lead to billions of dollars in lost productivity and healthcare costs each year,” Stoops said.

“Not having an effective, broadly used treatment, combined with the lack of a strong evidence base about whether reduced cocaine use can confer benefit, hampers our ability to help people with CUD.”

If you are interested in participating in or learning more about the study you can find more information at clinicaltrials.gov.


Next steps:

  • Researchers are working hard to identify new treatments and strategies to improve health, but they need healthy participants and those with medical conditions to participate in clinical studies. Find out how you can participate in clinical research at UK HealthCare.
  • Read how UK researchers are using an NIH grant to fight drug abuse in rural Kentucky.

Pledge to quit during the Great American Smokeout on Nov. 16

Audrey K. Darville, PhD, APRN, CTTS

Written by Audrey K. Darville, an associate professor in the UK College of Nursing and a certified tobacco treatment specialist.

Tobacco use continues to take a massive toll on the lives of Kentuckians. Currently, one in four Kentuckians smoke cigarettes, and certain groups, like pregnant women, smoke at even higher rates. Tobacco use also takes an enormous toll on our economy. Each year, Kentucky spends nearly $2 billion treating Kentuckians who get sick from smoking and employers spend $5,816 a year in healthcare costs and lost productivity for every employee who smokes.

Tobacco use is a chronic problem causing serious and severe health conditions and early death. Nicotine is addictive, and users need help to quit. Even after a smoker quits, relapse, or starting to smoke again, is common. Fewer than five out of 100 people who quit cold turkey (without help) succeed.

There are many efforts in place to help reduce smoking in the Commonwealth. The Great American Smokeout, which takes place on the third Thursday in November each year, is the perfect opportunity to talk about new help available to help Kentuckians quit.

Resources for quitting

If you use tobacco, think about quitting and know you don’t have to do it alone. Talk to your healthcare provider, local health department and/or call the quitline (1-800-QUITNOW). If you are a healthcare provider, help your patients quit by offering them proven and affordable treatments. If you are an employer, provide your employees ready access to all of the proven smoking cessation treatments.

For the first time, most Kentucky insurers, including Medicaid, are required to cover all proven smoking cessation treatments without copays. These include:

  • All seven medications (nicotine patch, gum, lozenge, inhaler, nasal spray; bupropion; varenicline).
  • Individual, group and telephone counseling.
  • Services and medications provided with no co-pay or prior authorizations.
  • Coverage for at least two quit attempts per year, with no lifetime limits.

Misconceptions about e-cigarettes

There is a common misconception that electronic cigarettes are a safe alternative to tobacco cigarettes and can be used to quit smoking. Recent studies have shown that the “vapor” from e-cigarettes is actually a toxic aerosol of fine particles that inflames the airways, having effects similar to tobacco smoke. E-cigarettes are not an approved FDA smoking cessation method, and smokers who use e-cigarettes delay quitting and are significantly less likely to quit smoking than smokers who use proven cessation treatments.

The single best thing any tobacco user can do for their health is to quit. So ask for help and become an ex-smoker during the Great American Smokeout on Nov. 16.

For more information, contact BREATHE at the UK College of Nursing: www.breathe.uky.edu


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9 great reasons to quit tobacco now

Quitting smoking is obviously good for your long-term health, but did you know there are immediate benefits? If you quit smoking right now, your health improves within minutes. Here’s a timeline of the positive changes you can look forward to when you quit:

  1. After 20 minutes, your blood pressure, pulse rate and the temperature of your hands and feet return to the normal rate.
  2. After 12 hours, your blood oxygen levels and carbon monoxide levels return to normal.
  3. After 24 hours, you have lowered your chance at having a heart attack.
  4. Within 48 hours, your sense of smell and taste return to normal.
  5. Within 72 hours, breathing becomes easier and your lung function increases.
  6. Within two weeks, blood circulation in your gums and teeth is back to normal.
  7. In 1 to 3 months, your circulation improves, walking is easier and your chronic cough goes away.
  8. In 1-9 months, your lungs are cleaner and your energy level increases.
  9. In one year, your risk of heart disease, heart attack and stroke has dropped in half.

Every minute that you don’t smoke improves your overall health, and the perks to quitting are enormous. Food will taste better, you’ll get sick less often and physical activities will become much easier. Quitting smoking isn’t easy, but you can look forward to many real benefits.

Next Thursday, Nov. 16, is the annual Great American Smokeout sponsored by the American Cancer Society. Communities all over the country will hold rallies, parades and meetings to help people quit smoking. For more information or to get involved, call the American Cancer Society at 800-227-2345 or visit them on the web.


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UK researchers awarded NIH grant to fight drug abuse in rural Kentucky counties

The National Institutes of Health recently awarded the UK Center for Health Services Research (CHSR) funding to study the adoption of syringe exchange programs in rural communities in the Appalachian region of Kentucky.

Rates of opioid use disorder and injection drug use have risen significantly in Kentucky, especially in rural communities. The serious health consequences of injection drug use include the spread of both hepatitis C and HIV. Kentucky is home to eight of the 10 counties in the nation that the Centers for Disease Control and Prevention has identified as most vulnerable to an outbreak of HIV.

CHSR’s focus on community efforts to end health disparities in underserved areas aligned closely with the NIH funding opportunity to examine drug use interventions.

The two-year National Institute on Drug Abuse-funded study is designed to reach vulnerable injection-drug users in Clark, Knox and Pike counties. The goal is to understand the many barriers that drug users face in accessing syringe exchange programs and to identify priority intervention targets.

The project’s principal investigator, Hilary Surratt, associate professor in the UK College of Medicine, is working closely with the Clark, Knox and Pike county health departments to gather data from drug users, health department staff, treatment providers and law enforcement.

This data will inform changes to policies and practices of syringe exchange programs and develop prevention strategies to enhance access and utilization of these programs in rural areas.


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UK researcher receives $3.1 million grant to fight health disparities in Appalachia

An initiative from the UK Colleges of Medicine and Public Health to educate people in Eastern Kentucky about cancer prevention has been awarded an additional $3.1 million grant to address the diabetes epidemic.

Since 2004, Nancy Schoenberg, the Marion Pearsall Professor of Behavioral Science at the UK College of Medicine, has been principal investigator of a series of projects in Eastern Kentucky collectively called “Faith Moves Mountains.” The project works to build community support for cervical cancer prevention and a wellness and cancer prevention program and to reduce Appalachian health disparities.

Earlier this fall, Schoenberg and her team of community and university researchers from the UK College of Medicine and the UK College of Public Health were awarded a new five-year, $3.1 million grant from the National Institute of Diabetes and Digestive and Kidney Diseases to continue the Faith Moves Mountains initiative and implement a project called “Clinic to Community Navigation to Improve Diabetes Outcomes” in Appalachian communities where diabetes is considered an epidemic.

Faith-based community partnerships

Like the previous projects, researchers aim to target specific health behaviors through faith-based interventions by building relationships with churches in Appalachian communities.

“We have worked over the years with about 60 or 70 churches, faith organizations in general, as well as senior centers, community centers, [and] other environments, to really promote the most scientifically rigorous projects,” Schoenberg said.

“All of my research really focuses on bringing in people from the communities melding their community knowledge and our team’s scientific knowledge to figure out the best interventions and programs to promote health and to decrease health disparities.”

For this project, Schoenberg will continue to draw on existing faith organizations and other partnerships. “We’ll reach out to new churches in new counties and new environments to promote the message of diabetes control,” she said.

Education and self-management

Appalachian Kentucky has rates of diabetes about 46 percent higher than the national average. Even more challenging is that about one-third of those who have diabetes are undiagnosed.

During the project, researchers intend to reduce adverse outcomes by educating people with Type 2 diabetes about self-management and training community-based facilitators to help coordinate healthcare services. To determine the most effective intervention components, researchers will assign participants to one of three groups: a diabetes self-management group, a patient navigation group, or a combined self-management and patient navigation group.

The self-management groups will meet in churches or other community-based venues. In addition, patient navigators will assist with educating and facilitating healthcare appointments at community-based health clinics and check-in with patients to make sure they attend medical appointments and receive adequate follow-up care.

“We want to draw on what we know works to help community members get the diabetes self-management that they need,” Schoenberg said. “Our hope is that at the end of the day, they’re able to take control of their health.”


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Here’s how to improve your everyday memory as you age

Research shows that the human brain starts to shrink with age. When the brain shrinks, your ability to remember things can decline. You can help offset the decline in memory with regular activity that challenges both the mind and the body.

Here are some tips to help minimize age-related changes and improve everyday memory:

Stay active

Cardiovascular activity for 20 to 30 minutes at least three times a week is important for physical and mental health. Try walking, swimming or another activity that you enjoy. Physical activity enlarges the hippocampus (the most vital part of the brain for memory) and improves long-term memory.

Sleep more

It is a common misconception that sleep needs decline with age. What often happens is sleep patterns change. As we age, we spend more time in lighter sleep stages than deeper sleep stages. Try and get as much sleep as it takes for you to feel rested (at least seven to nine hours), and this includes and encourages naps.

Continue to socialize

Being social and getting out improves your memory and your mood.

Be sure you can see and hear well

It is hard to learn new things and remember old things if you can’t see or hear well. Wear your prescription glasses or hearing aids if they are prescribed to you. Have your sight and hearing tested periodically.

Avoid distractions that divert your attention

Distractions can range from trying to do several things at once to loud background noises. Even your own thoughts can distract you. When you’re preoccupied, it’s harder to pay attention. Stay focused on one task at a time so you don’t forget directions or other important information.

Try new things

New experiences, such as going to a new place or even taking a different route to your usual places, can also improve recall. Trying new things activates the part of your brain that turns short-term memory into long-term memory.

Use these memory aids

Despite the best efforts, episodic memory, which captures the “what,” “where,” and “when” of daily life, declines somewhat over time. So does long-term memory. The American Psychological Association offers these suggestions:

  • Make lists of what you want to accomplish and check off items when they are finished. Follow your established routine.
  • Don’t hurry. Take your time learning new information or remembering old information.
  • Stay organized: Keep things you use a lot in the same place each time. Put your keys and other important things somewhere that you walk by frequently.
  • Make visual associations to remember names or places.
  • Keep a calendar or planner of important dates. Check it throughout the day.

How we can help

Normal memory problems should not affect your everyday life. If you occasionally forget where you put things, you might just need to get better organized. However, if you forget how to do something or what to do in certain situations, you should see a health care provider. These memory problems are not a normal part of aging.

The UK Memory Disorders Clinic at the Kentucky Neuroscience Institute offers a variety of services to individuals with memory problems and their families. Patients at the clinic undergo a complete evaluation from our team of experts to diagnose and treat a variety of memory disorders.


Next steps:

  • Alzheimer’s disease is a form of dementia that can affect mental capability and cause memory loss. It usually affects people who are 65 or older, so if there’s a senior in your life, be aware of these signs and symptoms of the disease.
  • Learn more about the UK Memory Disorders Clinic, which provides support to those with memory problems and their families.
teen suicide prevention, Dr. Hatim Omar

Teen suicide is preventable: Here’s how you can help

Dr. Hatim Omar

Dr. Hatim Omar

Written by Dr. Hatim Omar, chief of the UK Adolescent Medicine. Dr. Omar and his team address the unique health concerns faced by teens and young adults.

This Sunday, Sept. 10, is World Suicide Prevention Day, which gives us all an opportunity to think about the ways we can help prevent suicide and show support for the loved ones in our lives.

This is an especially important topic for adolescents, an age group where suicide is a significant cause of death. The statistics are sobering:

  • Suicide is the second-leading cause of death among teenagers ages 15-19.
  • Suicide is at an all-time high among middle schoolers ages 10-14 and has surpassed car crashes as the leading cause of death.
  • Overall, teen suicide has tripled in the last 50 years, killing more teens than all diseases combined.

Why is suicide risk so high among adolescents?

Research shows that there are many factors beyond genetic predisposition and mental illness that influence suicide risk during adolescence.

The adolescent phase is associated with physical, emotional and social changes. Lack of family support, unrealistic expectations, academic pressure, social isolation and victimization can lead to disappointment, depression or simple overreaction that may result in a self-inflicted injury or death.

Other risk factors for teens include:

  • Having access to a firearm.
  • Being a victim of dating violence and/or sexual assault.
  • Being bullied, either at school or cyberbullying.
  • Using or abusing drugs or alcohol.
  • Having a conflict with a parent.
  • Lacking a support system or someone to talk to.

Recognize the warning signs

Be aware of the following warning signs and behaviors that could indicate a teen is at risk for suicide:

  • Talking about wanting to die or about feeling trapped.
  • Acting anxious or agitated.
  • Behaving recklessly.
  • Experiencing changes in mood, diet or sleeping patterns.
  • Becoming socially isolated.
  • Declining school performance.
  • Giving away belongings.
  • Creating poems, essays or drawings that refer to death.
  • Dramatically changing their appearance.
  • Expressing a sense of guilt, shame or rejection.
  • Talking about feeling unbearable pain, or feeling like a burden to others

Understand the common myths about suicide

Myth 1: Asking someone about suicide will cause him to become suicidal. Asking about suicide can actually help prevent it.

Myth 2: Depression causes all suicides. Less than half of teens who commit suicide have a proven diagnosis of depression and only a fraction of depressed teens commit suicide.

Myth 3: Suicides always happen in an impulsive moment. Many teens will plan a suicide for a long time, often seeking help or trying to attract attention before acting.

Myth 4: Young children cannot be suicidal. They can be, and there is evidence of kids as young as 5 committing suicide

Myth 5: We cannot really prevent suicides. If we all work together, we can reduce suicide significantly. Our grassroots program, Stop Youth Suicide Campaign, has helped more than 20,000 teens over the last 18 years.

How you can help

We all, regardless of our education level or profession, can help prevent and reduce teen suicide. Here’s how:

  • Talk to your teens on regular basis. Ask them about their feelings, their conflicts, possible bullying and anything else going on in their lives.
  • Make sure there are no means of suicide available at home, especially firearms. Having a firearm at home, even with no other risk factors, increases suicide risk fivefold.
  • Show love and support, not punishment or ignorance, when your teen shares something with you.
  • Assure your teen that you are always there for them and listen to their issues.

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men's health month

Men, now’s the time to fine-tune your health

June is Men’s Health Month, which means it’s the perfect time to take a look at what men of all ages can do to live a heathier lifestyle.

From keeping your heart healthy to being proactive about cancer screenings, here’s what you can do to be the healthiest version of yourself:

  • Know your family’s medical history. Knowing your family’s health story can give you insight into what preventive actions you can take in order to stay healthy. Genetics can play a role in your risk for heart disease, Alzheimer’s, some cancers and osteoporosis. Check out a blog by UK Gill Heart & Vascular Institute’s Dr. Gretchen Wells for more about the benefits of knowing your family’s health history.
  • Be proactive about cancer screening. Regular cancer screenings can help catch early signs of the disease and find treatment options. The American Cancer Society recommends most men get regular screenings for prostate, lung and colon cancers at age 50. If you have a family history of cancer, talk with your healthcare provider about when you should start regular screenings.
  • Exercise regularly. Staying active will help to maintain a healthy weight, and it can also help reduce high blood pressure, high blood sugar and cholesterol. Aim for 30 minutes of moderate activity five times a week. Something as simple as a brisk walk or bike ride with a friend will work wonders for your overall health. Don’t know where to start? Check out our five-step guide to beginning a new exercise routine.
  • Stop smoking. Toxins in cigarettes can damage your lungs and can lead to lung cancer. Your heart takes a beating, too. If you do smoke, now’s the time to quit. Check out our guide for finally kicking your smoking addiction.
  • Talk to someone. Depression affects more than 6 million men in the U.S. Men are less likely to talk about how they are feeling, but it is important to know warning signs of depression and ways to find help and treatment. Learn more about the symptoms of depression and what you can do if you or a loved one needs help.
  • Don’t put off regular healthcare visits. You may feel perfectly healthy and not see the need to go to the doctor, but it is important to make sure you see a healthcare provider regularly. Some medical issues, like high blood sugar and high cholesterol, may not have any early symptoms, but a physician can provide diagnosis and treatment.
  • Stay social. If you’re having trouble sticking to a health regimen or just want some help in staying healthy, ask your friends and family join in on your new journey to a healthier life. You’re more likely to stick to your healthy lifestyle if you have support and others that can hold you accountable for your actions.

Although June is Men’s Health Month, it is important to remember that your health matters all year long. By making these simple lifestyle changes, you can have a lasting, positive impact on your health.


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UK brings expertise to national summit on opioid drug crisis

Addiction researchers, clinicians, intervention coordinators and health policy leaders from UK and UK HealthCare are taking part in a national conversation this week focused on combating the opioid drug crisis.

The National Rx Drug Abuse and Heroin Summit, taking place April 17-20 in Atlanta, is the largest national collaboration of professionals from local, state and federal agencies, business, academia, treatment providers, and allied communities impacted by prescription drug abuse and heroin use. It was introduced in 2012 under the leadership of Operation UNITE and U.S. Rep. Harold “Hal” Rogers (KY-5th) with the purpose of alleviating the burden of illegal substance abuse through comprehensive approaches. In this regard, UK leads the way.

Last year alone, investigators in the UK Center on Drug and Alcohol Research received $9.6 million for projects dedicated to substance abuse and addiction. Since 2010, the National Institute on Drug Abuse has awarded more than $92 million to UK research projects. UK HealthCare is proud to support the summit through sponsorship.

“UK is uniquely positioned to confront these questions because of its multidisciplinary research endeavors, leading academic medical center and regional referral network deployed to confront the scourge of opioids. We’re committed to working in – and with – communities to help navigate the complex nature of critical policy changes and effective healthcare implementation,” UK President Eli Capilouto said.

Kentucky’s rate of opioid overdose death remains above the national average, with the Centers for Disease Control and Prevention reporting 1,273 Kentucky overdose deaths in 2015.

“The opioid epidemic is far-reaching and multifaceted, leaving a void in each family and community it scars,” Capilouto said. “Kentucky families and communities throughout Appalachia know the devastation and havoc of addiction. That’s why this question is critical to UK researchers who lead the research, healthcare and policy questions surrounding opioid abuse.”


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