Researcher William Stoops explores the psychology of drug addiction

Don’t miss the video interview with William Stoops at the end of this blog post.

One undergraduate psychology course changed William Stoops’ life.

Originally, Stoops planned to major in French, but after taking more psychology classes and getting involved in intensive, hands-on research, he decided in his senior year to devote his professional life to the study of the behavioral effects of drugs.

“I was fascinated by the idea that we can rigorously and scientifically study the effects of drugs,” Stoops said. “It’s not as simple as somebody is an addict, or someone has a drug-use disorder…There’s so much more to it, and it’s in that nuance where we can identify treatments and interventions.”

Stoops earned both his master’s and doctoral degree at UK, under the mentorship of Craig Rush, PhD, in the department of behavioral science in the College of Medicine. Most doctoral students go to another institution for postdoctoral work, but Stoops opted to stay at UK to work with Sharon Walsh, PhD, director of UK’s Center on Drug and Alcohol Research on prescription opioids.

Researching a different type of addiction

While there is a national health crisis involving opioid abuse, Stoops focuses his research on cocaine addiction.

“For opioid-use disorder, we have approved medications to treat those problems. We have ways to intervene with an overdose. For cocaine, we don’t have any effective treatments,” Stoops said.

Data suggests that cocaine overdoses in African-Americans are at the same level as opioid overdoses in non-African-Americans.

In clinical and research communities, the only successful treatment of cocaine-use disorder is abstinence from cocaine. “But we don’t have a lot of data to say what the benefits of abstinence are,” Stoops said. “We also don’t have any data to say that reduced use does or does not produce benefits. So the goal is to look at abstinence versus reduction in cocaine use, and look at the broad array of health outcomes.”

This project is funded by a five-year $2.9 million grant from the National Institute on Drug Abuse. Habitual cocaine users experience cardiac and immune system problems. By measuring physiological responses, as well as cognitive and psychological functions, researchers can develop a better data set for those using cocaine in a reduced amount and for those who abstain from cocaine.

Using prior research to improve public health

Stoops’ prior studies informed his current projects. Early in his career, Stoops and his team completed a randomized trial of an intervention called Abstinence Reinforcement that was delivered online to rural smokers.

“How can we reduce the barriers to getting treatment to individuals who really need it?” Stoops said. “We know that smoking rates are high in Kentucky in general, but especially high in Eastern Kentucky. It’s hard to get treatment there, because the nearest clinician or nearest treatment center is miles and miles and hours away. And we proved that it was effective. And it’s been part of a body of literature that spurred more work about mobile health and mobile delivery of treatments for various drug-use disorders.”

Stoops says one of the most rewarding parts of research is working with the National Health Institute on these public health issues, and he imparts that enthusiasm and dedication to the students he mentors.

“At the end of the day, even if we’re doing basic science research, we are contributing information that is going to positively impact the health of the taxpayers and the health of your fellow citizens. And you should enjoy being able to do that work.”

Next steps:

UK, UK HealthCare leaders take case for opioid addiction funding to Washington

Kentucky is among the states most ravaged by opioid abuse and drug addiction.

But the University of Kentucky – with researchers and clinicians working across a number of colleges and disciplines – is on the front lines of finding solutions.

Leaders from UK Research and UK HealthCare – along with some of the institution’s most prolific researchers – took their stories of hope and challenge to Washington, D.C., recently to make the case with some of the country’s top elected officials about the need to continue federal funding to address drug addiction and abuse.

“The scourge of opioid abuse and addiction is wreaking havoc on Kentucky. Addiction is a disease of despair, victimizing individuals and communities when they are most vulnerable. It does not discriminate by ZIP code or neighborhood; race or ethnicity – it affects us all,” said UK President Eli Capilouto, who led the delegation to Washington.

“Universities across the country are locked in a fight against opioid abuse. The University of Kentucky is among the leaders, working in partnership with local, state and federal stakeholders to stem the tide of this insidious menace.”

A group of UK representatives – including Executive Vice President for Health Affairs Mark Newman, College of Medicine Dean Bob DiPaola, Vice President for Research Lisa Cassis and Vice President for University Relations Tom Harris – joined Capilouto in meetings with top elected officials in the country over the course of three days recently. Officials included Senate Majority Leader Mitch McConnell and Sen. Rand Paul as well as U.S. Reps. Hal Rogers, Andy Barr, Brett Guthrie, Thomas Massie, Jamie Comer and John Yarmuth.

A second team of UK representatives, led by UK’s Vice President for Administration and External Affairs Mark D. Birdwhistell, included faculty from six different colleges who are engaged in substance abuse and addiction research. The university currently has $22.5 million in research funding around these issues as part of UK’s $330 million research enterprise. UK, in fact, received $11.2 million in research funding from the National Institute on Drug Abuse last year alone.

“The breadth of ongoing research in substance abuse by our faculty led to vibrant discussions with congressional staff,” Cassis said. “Everyone had the same goal, and all agreed that support for substance research is critical.”

UK’s opioid-focused research team in Washington included:

  • Carrie Oser, a sociology professor examining health service utilization, drug treatment outcomes and infectious disease prevention among rural residents and minorities.
  • Donald Helme, an associate professor in the UK Department of Communication who focuses on media- and school-based campaigns designed to prevent risky behaviors.
  • Alison Davis, an agricultural economics extension professor who has facilitated a local substance abuse coalition in Russell County, Ky., that is adopting strategies and policies to reduce substance abuse.
  • Mark Fillmore, a professor of psychology focusing research on acute and chronic effects of abused drugs on mental capacity.
  • Kristin Ashford, an associate professor of nursing and co-creator of the Perinatal Assistance and Treatment Home (PATHways), which is helping pregnant women who use opioids. Since the program launched in 2014, more than 150 women have received treatment through PATHways; of those, 77 percent who were admitted to labor and delivery tested negative for illicit drug use.
  • Jeffery Talbert, a pharmacy professor who focuses his research on the intersection of policy decisions and health outcomes.
  • April Young, an assistant professor of public health who works with the UK Center on Drug and Alcohol Research and is helping lead a $1.16 million cooperative research effort to build community-grounded health responses to combat opioid abuse in Appalachia.

“Their work is making a difference,” Birdwhistell said. “But they will be the first to tell you that progress is not possible without the support they receive from our lawmakers and federal funding for their research efforts. Together, we can turn the tide, if we remain focused.”

Next steps:

New UK clinic provides specialized treatment for opioid abuse

Many people with opioid-use disorder (OUD) come in contact with the healthcare system for issues related to substance use. Often, people present to the emergency room with an opioid overdose or infections from drug injections. These infections can require lengthy hospitalization and surgical intervention.

When patients receive treatment for medical complications related to OUD and injection drug use, they may not receive treatment for the underlying substance-use disorder. By failing to address the underlying cause of the medical complications, patients remain vulnerable to reinfection, readmission or even death.

When the state began looking for ideas to address the opioid epidemic in Kentucky, three experts from UK – Drs. Sharon Walsh, Michelle Lofwall and Laura Fanucchi – submitted a plan to give patients at the hospital better access to treatment specifically for OUD.

Building a partnership to provide strong care

Through the new First Bridge Clinic, located at the UK Center on Drug and Alcohol Research, Walsh, Lofwall and Fanucchi are creating a new setting where patients can receive evidence-based care for OUD. Patients may receive FDA-approved medications for OUD, counseling services, and monitoring aimed to promote remission and recovery.

In partnership with the emergency departments at UK HealthCare and with financial support from the state through the CURES Act, Walsh, Lofwall and Fanucchi are creating a clinical setting where providers in the emergency department can refer patients to receive transitional care for OUD.

“We’re developing a new clinic, and it’s going to partner closely with the ED so when patients are referred they can receive care rapidly and within the same healthcare system with the aid of peer support,” Walsh said.

Collaborating for greater access across the Commonwealth

Additionally, Walsh, Lofwall and Fanucchi will share information with facilitators from the two other sites in the state also awarded funding to create similar clinics.

“The need for this clinic is clear,” Lofwall said. “If the underlying addiction isn’t treated, the person goes back to active addiction and is at very high risk for death and/or reinfection requiring another hospitalization with complicated medical and surgical treatments.”

In creating this new multidisciplinary service, the UK team is hoping to positively impact the opioid epidemic by expanding and improving access to recovery services for patients.

Next steps:

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.

Next steps:

College of Nursing faculty member receives grant to fight opioid abuse among pregnant women

Kristin Ashford, PhD, APRN, WHNP-BC, FAAN, associate professor and associate dean of Undergraduate Faculty Affairs in the UK College of Nursing, has been awarded the Hillman Innovations in Care Program grant from the Rita & Alex Hillman Foundation for her work in addressing the opioid epidemic and its impact on maternal-fetal health.

The $600,000 award will enable Ashford to continue to expand both the Perinatal Assistance and Treatment Home (PATHways) and Beyond Birth programs. The PATHways program integrates evidence-based knowledge through a comprehensive approach to perinatal opioid use disorder, offering buprenorphine maintenance treatment for both opioid use disorder and neonatal abstinence syndrome, peer support and education, legal support, prenatal and postnatal health services for mother and baby, and health system navigation during delivery.

PATHways has been expanded to include the Beyond Birth program, which provides wraparound services and access to resources to aid in maintaining recovery in the two years following delivery. 

“After women give birth, they experience the highest amount of stress in their lifetime, and this is when they need the most support in their recovery,” said Ashford.

The grant will be used to expand access to the program in communities that may not have the resources available to provide this type of multidisciplinary care to mothers with opioid use disorder. The grant will also be used to provide training to clinicians in high-need low-resource communities including Hazard and Morehead.

“The most important part of this program is helping mothers be the parents that they want to be,” Ashford said. “The Hillman Innovations in Care Program grant will enable the team to reach and help more women.”

Next steps:

Kip Guy malaria research

Listen: College of Pharmacy dean discusses fighting Kentucky health disparities with practical research

UK College of Pharmacy Dean Kip Guy’s research focuses on drug discovery and development for neglected diseases, particularly those that affect pediatric patients. Coming to UK from St. Jude Children’s Research Hospital, much of his work has focused on fighting malaria, a major killer of children, as well as pediatric cancers including ependymoma, leukemia and medulloblastoma.

Though it was initially the “neat solutions” that attracted him to the field, he quickly learned that not even science provides easy black-and-white answers. While researchers may have expectations of how an experiment may play out, they often learn more from the failures than if it had unfolded as planned.

“You’ve put in all this time and effort because your model told you ‘X’ was going to happen, and then you run the experiment and what you wind up with is something completely different,” he said. “These are the moments in science that are the most fun. It’s when you break your own model and learn something fundamentally new.”

As his research projects grew larger and more intensive over the years, Guy was looking specifically for a place where he could take a larger administrative role and begin mentoring the next generation of scientists. Guy says he found “a perfect storm” in the University of Kentucky, a place known nationally for its research excellence, top-ranked College of Pharmacy and local population in need of therapeutic intervention for a variety of serious health disparities.

“It’s an incredible place, with amazing faculty and a long, rich and successful history of positively affecting clinical practice and the research world. It’s about being in a place where I can work the way I want to work, with the kind of people who are here, and focusing on problems that are really serving unmet needs.”

“We’re not just about working in the lab or the clinic,” Guy said. “We’re also about living in this community and doing well by it.”

In this podcast, Guy shares his own research, his major goals for the College of Pharmacy, and how pharmacy researchers are addressing the opioid epidemic.

Next steps:

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.

Next steps:

opioid research

UK partners with Ky. counties to fight back against opioid epidemic

A UK College of Public Health researcher is using a $1.16 million grant to pursue effective interventions in the fight against opioid addiction in communities across 12 Eastern Kentucky counties.

The grant is a cooperative agreement from the Centers for Disease Control and Prevention, National Institute on Drug Abuse, Substance Abuse and Mental Health Services Administration, and the Appalachian Regional Commission, and will be led by April Young, a researcher at the UK Center on Drug and Alcohol Research and the College of Public Health, and a co-principal investigator at Emory University.

From the start, the research team knew that success of the project would rely on the involvement of the communities where the research will take place. As Young and her co-principal investigator began to draft the research proposal, they sought support from organizations that operate in the region and leaders such as U.S. Rep. Hal Rogers, who drafted a letter of support for the grant application.

“The more we learn about drug abuse and addiction, the more we can thoughtfully and strategically intervene to save lives and change the trajectory for families across Eastern Kentucky,” said Rogers, the co-chair of the Congressional Caucus on Prescription Drug Abuse.

“I applaud the University of Kentucky for utilizing its powerful research resources to pinpoint the challenges we face in combatting opioid abuse in an effort to implement effective, lifesaving programs that can be sustained in our communities for generations to come.”

Understanding the opioid epidemic

The project, titled Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic (CARE2HOPE), includes both epidemiological and qualitative research that will be conducted by Young and her colleagues in the UK Center on Drug and Alcohol Research, Emory University and other partnering institutions.

The first two years of the five-year project will focus on better understanding opioid use and its context in the 12-county area that comprises Bath, Rowan, Elliott, Menifee, Morgan, Wolfe, Lee, Owsley, Leslie, Perry, Knot and Letcher counties.

Through interviews and surveys with the community, the team will collect information about resources and factors that impact access to treatment for opioid-use disorder as well as risks for related harm such as overdose, hepatitis C and HIV.

This collaborative effort is vital to developing intervention strategies, as those who live in these communities are the best source for identifying resources and factors that impede access to treatment and contribute to risk. During the first two years, the team will also work with communities to identify evidence-based community-response projects that meet their needs.

Pursuing long-term solutions

The final three years of funding, which is estimated to total about $3.25 million, is contingent on meeting milestones in the first two years. During the three-year intervention phase, the team will work with the community to implement and evaluate the evidence-based community-response projects.

Sustainability is at the forefront of the team’s efforts. The primary goal is to give communities the tools to continue programs that are implemented long after the research has been completed. After completing its data collection, the team will work with communities to identify and apply for additional funding to maintain programming.

A key strength of this initiative is the collaboration with other institutions, including the Harm Reduction Coalition, Kentucky Department for Public Health and other state departments and agencies, Boston University, the Gateway and Kentucky River District Health Departments, AIDS Volunteers, Inc., and other community leaders and organizations.

“It benefits these communities to have experts from across the country working to address the opioid epidemic,” Young said.

The power of collaboration

Hannah Cooper, associate professor in the Rollins School of Public Health at Emory University and co-principal investigator, is familiar with Kentucky, having worked with Young on another project focused in and around Morehead, Ky. That project was her first opportunity to visit Eastern Kentucky.

“On my first trip, I was struck by both the devastating consequences of the local opioid epidemic and by the local community’s fierce commitment to stopping it,” Cooper said. “Whenever two institutions collaborate, you end up with a proposal that is stronger than it would have been with just a single institution.”

The UK team members for this project include Sharon Walsh, Jennifer Havens, Carrie Oser, Michele Staton and Michelle Lofwall, all faculty associates in the UK Center on Drug and Alcohol Research. The team has more than 40 years of combined experience in research on rural drug use, including in substance use disorder treatment, hepatitis C and HIV risk reduction and intervention in criminal justice settings.

UK team members were among the first to document the rise in opioid injection in Appalachia and have a history of highly productive collaborations with federal, state and local stakeholders in Appalachian Kentucky communities.

Next steps:

opioid overdose

Do you know what to do in an opioid overdose emergency?

Dr. Raeford Brown

Dr. Raeford Brown

Written by Dr. Raeford Brown, a pediatric anesthesiologist at UK HealthCare and the chair of the FDA Advisory Committee on Analgesics and Anesthetics.

It’s a terrifying scenario that’s become all too real in the age of the opioid epidemic: a person lying lifeless, not breathing, because of an opioid overdose.

According to the Kentucky Office of Drug Control Policy, the rates of opioid overdose deaths continue to rise in Kentucky. More than 1,400 people in the state died of a drug overdose in 2016, and the largest group of people affected were between the ages of 35 and 44.

No one wants to encounter someone on the brink of death because of an opioid overdose. But many spouses, roommates, caregivers, parents and safety officials will come across an unconscious person and need to know life-saving measures.

Naloxone is a therapeutic drug that reverses the effects of opioid overdose and allows us to save the lives of those experiencing an emergency. Like learning CPR skills and having an AED on hand, knowing how to administer naloxone can give someone another chance at life. Anyone in regular contact with a person using opioids, whether for legitimate medical or non-medical purposes, should know how to access a naloxone kit and how to dispense the drug in an overdose emergency.

Overdose victims cannot help themselves when they are incapacitated – they need a rescuer. Here are a few facts about naloxone and how to administer the medication during an overdose:

What does naloxone do?

Naloxone blocks the effects of opiates on the respiratory system, allowing the victim to breathe again. Naloxone doesn’t prevent other medications from working. You cannot abuse naloxone, and its effects wear off in about 20 minutes.

Who can get a naloxone kit?

Anyone with a history of opioid poisoning or opioid abuse, a person receiving a first-time methadone prescription, or a person on a high-dose opioid prescription can receive a naloxone kit. Additionally, any person or agency can voluntarily request a kit. Pharmacists will train recipients to administer the drug safely.

What are the signs of opioid overdose?

A person experiencing an opioid overdose will be completely unconscious or unresponsive. They will be limp and unable to talk. People with lighter skin will turn a bluish-purple color, and people with darker skin will turn ash-gray. Their breathing will be shallow, erratic or stopped completely.

What should I do in an overdose emergency?

Before you administer naloxone, call 911.

Naloxone is given as a nasal spray. Spray it directly in the nostrils of the victim and repeat every 30 to 45 seconds, alternating nostrils.

For the prefilled syringe version of naloxone, assemble the syringe and spray half the formula in one nostril and half the formula in the other nostril. The intramuscular form of naloxone should be administered in the thigh. Talk with a pharmacist about specific instructions for giving this form of the medication.

If you are interested in more information about naloxone, sign up for community training available through the Kentucky Harm Reduction Coalition.

Next steps:

UK HealthCare anesthesiologist Dr. Rae Brown has led the FDA advisory committee since last year, providing expert recommendations on opioid regulation.

UK anesthesiologist brings expertise to FDA’s opioid review committee

Raeford E. Brown Jr., MD, FAAP

UK HealthCare anesthesiologist and professor Dr. Rae Brown has led the Food and Drug Administration (FDA) advisory committee since last year, providing expert recommendations on opioid regulation and developing strategies to mitigate opioid risks in society.

In July 2016, Brown was named chair of the FDA Advisory Committee on Analgesics and Anesthetics. He was nominated to serve on the committee by the Commissioner of FDA in 2015 and served on the committee for a year prior to being named chair.

The committee is composed of physicians and scientists from across the nation with expertise in anesthesiology, opioid pharmacology, clinical research and epidemiology. The advisory committee meets monthly at FDA headquarters in Silver Spring, Maryland.

Tackling the opioid crisis

During the past year, the committee has reviewed risk mitigation strategies that serve as a major agency response to the current opioid crisis. In addition, the committee has evaluated 10 abuse deterrent formulations of opioids, discussed the risks and benefits of increasing the availability of naloxone – a drug to treat opioid overdose – and reviewed the risks of codeine in the pediatric population. Brown said the committee is cautious and deliberate in scrutinizing every product reviewed for the market, as the availability of new opioids can make the ongoing epidemic in America much worse.

“My first question is, ‘Is it safe?’” Brown said of reviewing opioid deterrents presented to the committee. “Is it a safe medication for the group it is marketed to, and is it effective? My second question is, ‘Do the data support whether or not it has a real deterrent properties that are going to stand up to all the chemists in the U.S.?’ ”

Developing new clinical trials for pediatric patients

In September 2016, Brown served as the chair of an FDA symposium on the lack of clinical trials demonstrating the safety and effectiveness of opioids in infants, especially the premature. Brown, a professor of pediatric anesthesiology, is now involved in the development of an international consortium designed to provide large numbers of pediatric patients for unique safety trials.

Brown will serve as the chair of this committee for three more years. He also currently serves as the chair-elect of the Section on Anesthesiology and Pain Medicine of the American Academy of Pediatrics and will be appointed chair in November of 2017.

Next steps:

  • At the National Rx Drug Abuse and Heroin Summit in Atlanta, UK clinicians, researchers and health policy leaders led discussions on how to combat the opioid drug crisis.
  • Surgical procedures, both major and minor, require pain management. UK Anesthesiology & Pain Management provides comprehensive anesthesiology services following surgeries, as well as for chronic and cancer-related symptoms.