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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 psychologist helps sick kids manage the stress of treatment

Treatment for any serious medical condition can be daunting for even the most fearless adults. But for children who deal with serious illness, fear, anxiety and a lack of understanding can make it difficult for them to cope with their treatment.

Dr. Meghan Marsac, pediatric psychologist and assistant professor in the UK College of Medicine, saw how many parents and children struggled to navigate the stress and logistics of treatment.

“When I was helping kids and parents adjust to what life was like with pediatric cancer, there were a lot of things we were teaching over and over again,” Marsac said. “Parents wouldn’t know these things. You’re not supposed to have a kid with cancer.”

And so Cellie was born. Designed by Marsac during her fellowship at Children’s Hospital of Philadelphia, the Cellie Coping Kit was developed for children ages 6-12, and includes of a plush toy named Cellie, a deck of cards with coping and communication techniques, and a book for caregivers. The first Cellie kit was geared toward children with cancer, but has since been adapted for children with sickle cell disease, traumatic injuries and food allergies. A kit for eosinophilic esophagitis, an allergy condition that causes inflammation of the esophagus, is in the works, as is a kit for the siblings of children with illness or disability.

How Cellie helps

The kit is designed not only to comfort children during their illness, but also to provide them with the tools they need to understand their treatment and communicate their feelings.

The coping cards address various “stressors” children can face, including scary procedures (such as needle sticks), emotional stress and side effects of treatment such as nausea or hair loss. The kit also addresses how to manage situations such as missed school or playing outside. The caregiver book parallels the cards, giving parents the advice on how to address their child’s concerns.

“We reviewed the cards and that helped [our son] understand that some of the feelings he has are similar to other children here,” said one parent. “So he didn’t feel like he was alone.”

For example, the card in the child’s kit that addresses a fear of needle sticks lists several tips, including “squeezing Cellie tight and looking at Cellie until it is over” or “telling your nurse or parent a story.”

“The pain tips help me,” said one child. “The pain thermometer, the faces, and the belly breathing card…that helped me a lot.”

Working together to help families cope

Much of Marsac’s research is centered around developing and evaluating programs designed to help parents and children manage medical conditions and preventing long-term emotional impairment after illness or injury.

Cellie was initially developed to help Marsac’s pediatric cancer patients, but she recognized the need for coping tools for children with a variety of conditions. The Cellie Coping Kit for sickle cell disease shares many components with the cancer kit. The food allergy kit was designed after Marsac’s conversation with one of her students about the dearth of allergy resources for children.

Marsac and her team worked directly with doctors, nurses, psychologists, child-life specialists and families to develop the kit. Extensive research was conducted to determine what was most difficult for families when it came to navigating treatment and what medical teams could do to assist families. Families reported that the kit was a useful tool in promoting conversations about illness in the family.

“[Our daughter] just become more aware about [her condition] by reading the cards and asking a lot of questions,” said one parent. “Some of the things on the cards she didn’t understand before, so she has more of an education now.

“This is all the stuff we’ve been going through.”

Children who learn early how to discuss their illness are better equipped to manage it better as adults, Marsac said.

“We know that physical and emotional health are intertwined,” she said. “Our team’s goal is to support both parts of health, and the kits are designed to walk families through treatment.”


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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.
UK College of Medicine-Northern Kentucky

St. Elizabeth gives $2.5M for UK College of Medicine scholarships

St. Elizabeth Healthcare will provide a gift of $2.5 million to support a tuition scholarship program for the UK College of Medicine-Northern Kentucky campus. Through this gift, scholarships will be awarded to medical students enrolled at the Northern Kentucky campus, which is scheduled to open in the fall of 2019.

The affiliation between UK, Northern Kentucky University and St. Elizabeth Healthcare was announced in February. This scholarship program is the next step in the development of a regional medical college in Northern Kentucky.

“In providing these scholarships, we are making an enormous investment in the future of the health of our community,” said Garren Colvin, St. Elizabeth president and CEO. “With our partnership with the University of Kentucky, we will be able to provide additional benefits to both organizations as well as the region and Commonwealth by directly assisting in medical school support and recruitment for the Northern Kentucky campus.”

These scholarships will be provided to medical students who meet the following criteria:

  • Enrolled as medical students at the UK College of Medicine-Northern Kentucky campus.
  • Meet the college’s financial need requirements.
  • Remain in good academic standing and progress toward completion of the medical degree.
  • Maintain continuous, full-time enrollment at the Northern Kentucky campus

“This scholarship program, seeds sown in ground made fertile by a willingness to care for others, will ripple through many generations of health practitioners,” said UK President Eli Capilouto. “We are grateful to St. Elizabeth’s leadership and the donors who support this remarkable gift, one that will directly support medical students, and ultimately the patients whose names the donors may never know. That is the highest form of giving, and it is the highest honor we can receive as a partner in this endeavor.”

Increasing the number of physicians in the Commonwealth will increase healthcare access for residents, which will improve the health of Kentuckians. Kentucky leads the nation in cancer and chronic lower respiratory disease rates and also ranks sixth in heart disease, seventh in diabetes and eighth in stroke.


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UK College of Medicine-Bowling Green

Video: New campus will help shape future of healthcare in Ky.

This time next year, the inaugural class of medical students at the new UK College of Medicine-Bowling Green campus will be attending their first course, kicking off an exciting new opportunity for future Kentucky clinicians.

In June, officials broke ground on a new facility at The Medical Center in Bowling Green, which will be home to the satellite campus. This four-year, regional campus medical school is the first of its kind in Kentucky and is a partnership between UK, The Medical Center at Bowling Green and Western Kentucky University.

The UK College of Medicine-Bowling Green will be a fully functioning campus, using the same curriculum and assessments as UK’s Lexington campus. The on-site faculty will have UK College of Medicine appointments and teach in small groups, and they will provide simulation/standardized patient experiences with lectures delivered from Lexington using educational technology.

For students, the program in Bowling Green offers many benefits: scholarships; smaller class sizes; and the opportunity to live, work and learn in an up-and-coming Kentucky community.

“I think the regional medical campus in Bowling Green offers a really exciting opportunity for a batch of young students to come in and essentially lay the groundwork for everything that campus does going forward,” said Austin Webb, a WKU graduate currently in his third year of medical school at UK. “They are also going to be directly shaping the healthcare in that region for years to come.”

Check out the video below to see how the new campus in Bowling Green will foster a new generation of Kentucky physicians and improve healthcare across the Commonwealth.


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UK HealthCare, The Medical Center and WKU are opening a medical campus in Bowling Green, Ky., to increase access to healthcare for generations to come.

UK celebrates groundbreaking of new College of Medicine-Bowling Green campus

Healthcare leaders from UK, The Medical Center at Bowling Green and Western Kentucky University celebrated on Tuesday the groundbreaking of the new UK College of Medicine-Bowling Green campus.

The four-year, regional campus medical school is the first of its kind in Kentucky and is a partnership between The Medical Center, UK and WKU.

The UK College of Medicine-Bowling Green Campus will be a fully functioning campus, using the same curriculum and assessments as UK’s campus in Lexington. On-site faculty will have UK College of Medicine appointments and teach in small groups and provide simulation/standardized patient experiences with lectures delivered on-site from Lexington using educational technology. Additionally, clinical experiences will occur at The Medical Center at Bowling Green and surrounding community practices.

“At the University of Kentucky, we know that working together – across disciplines and across the Commonwealth – is the best way to ensure real, positive change for those we serve,” UK President Eli Capilouto said. “This collaboration will allow us to effectively and efficiently utilize existing resources throughout the state to meet this important need for more physicians and greater access to healthcare.”

“Through this investment in education, we are continuing to increase access to quality healthcare – and ensuring that we have the physicians available to take care of generations to come,” said Connie Smith, president and chief executive officer of Med Center Health. “We have always had a commitment to bringing the best in healthcare to our communities. This medical school is going to raise the bar even higher as we increase opportunities for research and technology and adhere to the latest in evidence-based practice.”

Basic science and early didactic training will be taught in conjunction with faculty at WKU through both on-site classes and distance education methods in accordance with UK College of Medicine curricular protocols.

“This partnership helps ensure our state will remain competitive as the landscape of healthcare changes,” said Dr. Robert DiPaola, dean of the UK College of Medicine. “It also signals a new beginning in the efforts to train more physicians in Kentucky, for Kentucky, and especially a new beginning for our future students as they embark on this journey and career in medicine. It is an honor to celebrate this milestone with our partners in developing the UK College of Medicine-Bowling Green campus.”

Longtime UK faculty member and administrator Dr. Todd Cheever will serve as the first associate dean for the Bowling Green campus. Dr. Don Brown, a vascular surgeon and Bowling Green physician, who also serves as director of medical education at The Medical Center, has been named assistant dean.

The UK College of Medicine-Bowling Green Campus will host 30 students per year. The facility will be part of a multipurpose building attached to a five-story parking garage constructed on the campus of The Medical Center. Construction is scheduled for completion by the summer of 2018.


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Dr. Matthew Bush

Dr. Matthew Bush honored for work to improve hearing healthcare

Dr. Matthew Bush, a clinician and researcher at UK Otolaryngology, Head & Neck Surgery, was recently awarded a prestigious fellowship for his research related to improving hearing healthcare in underserved rural areas.

Bush is a doctoral candidate in the Department of Behavioral Science at UK. He is one of only 10 recipients nationwide to receive the $10,000 2017 Dissertation Fellowship from The Honor Society of Phi Kappa Phi, the nation’s oldest and most selective collegiate honor society for all disciplines.

His research investigates hearing healthcare disparities in underserved rural populations with a goal to develop and implement innovative interventions that improve the diagnosis and treatment of hearing loss. The fellowship award will be applied toward 12 months of dissertation writing.

Bush received extensive medical training at Marshall University and UK. He studied hearing healthcare, ear surgery and innovative technologies including cochlear implants. He completed his fellowship at the Ohio State University, where he began to develop research on hearing healthcare in rural populations.


Next steps:

  • Get to know Dr. Bush in our Making the Rounds interview. He tells us what his ideal weekend looks like and how he gives the gift of hearing, here and around the world.
  • Learn more about cochlear implants, including who is a candidate for the device and how they’re different from hearing aids.
Dr. Scottie Day

Meet pediatrician Scottie Day: ‘Caring for the sickest of the sick’

Making the RoundsDr. Scottie Day, associate chief medical officer at Kentucky Children’s Hospital, is the featured physician in this week’s Making the RoundsA graduate of the UK College of Medicine, Dr. Day worked in Indiana, Ohio and Hawaii before returning to Lexington in 2011. He now works at KCH in the Pediatric Intensive Care Unit (PICU).

When did you know you wanted to be a physician?

As a child growing up in Eastern Kentucky, I always wanted to be a physician. And I held true to that. I think that I always felt like I wanted to be in some type of servant position.

Why did you choose pediatrics as your specialty?

I originally couldn’t decide on a specialty and wanted to take care of children and adults, which led me to do my residency in internal medicine and pediatrics. However, as I went through residency, I realized I wanted to take care of the sickest of sick of children.

Working in the PICU gave me a chance to take care of small babies all the way up to older teenagers and even some young adults with childhood diseases. It took my internal medicine-pediatrics resident training and allowed me to use this knowledge to take care of the most critically ill. There is nothing more rewarding.

What makes you want to come to work every day?

As a PICU physician, each morning I do what I love most: take care of the sickest children and their families with an amazing team and fulfill my calling and talents that I have been blessed with. The stresses are high, but the rewards are priceless.

How would your friends describe you? 

Easygoing, friendly, talkative. Conscientious about others’ feelings, wanting to do every single thing, never saying no.

Do you have any guilty musical pleasures?

I listen to all music. I play music myself; I’ve played since I was 5 years old. Piano, guitar, mandolin, ukulele, drums. I listen to every single type of music.

What is your favorite aspect about living in Lexington? 

It’s got the small-town community feel, but it still has some big city pleasures. I’m originally from Kentucky, and when I moved back to Lexington, I liked being in a college town. I feel like there’s a huge sense of community here.


Watch our video interview with Dr. Scottie Day, where he talks about his patient care philosophy.


Next Steps

  • Experts at the KCH PICU take care of critically ill children with a range of medical issues, including burns, trauma injuries, and cardiovascular and neurological concerns. Learn more about our state-of-the-art services.
  • When your child is sick or hurt, you want the best care possible. That’s exactly what you get at Kentucky Children’s Hospital. Learn more about KCH.
UK College of Medicine Professor Stefan Stamm has identified how alternative splicing in RNA may point to new ways to treat obesity and cancer.

UK research could yield treatment for cancer, obesity

UK College of Medicine Professor Stefan Stamm has identified a previously-unknown function of small nucleolar RNAs (snoRNAs): regulating a fundamental cellular process called alternative splicing. His findings point to new ways to treat obesity and cancer.

“Alternative splicing allows cells to make multiple proteins out of a single gene,” Stamm explains.

What is alternative splicing?

In alternative splicing, the molecule being spliced – a form of RNA known as precursor messenger RNA (pre-mRNA) – is an intermediate species between the DNA template that contains the instructions to make a protein and the protein product that is ultimately generated by following those instructions. During this process, the cell’s splicing machinery cuts out segments of the pre-mRNA. It then splices the remaining pieces together to create the mature mRNA that will be used to make a protein. Many pre-mRNAs can be spliced in different ways, and the disparate mRNAs that result are used to produce unique variants of the corresponding proteins.

But most RNAs are not used to make proteins. Among these so-called non-coding RNAs are small nucleolar RNAs (snoRNAs), which guide certain RNA-modifying proteins to their job sites. Curiously, the absence of some snoRNAs is tied to diseases, including certain cancers and Prader-Willi syndrome, a genetic form of obesity. These links indicate that snoRNAs do more than direct RNA modification.

Collaboration leads to new insights

In collaboration with Professor Ruth Sperling of the Hebrew University of Jerusalem, Stamm’s laboratory found that some snoRNAs engage with newfound cellular partners to regulate alternative splicing. Since alternative splicing can regulate protein function, the researchers suspect that this role of snoRNAs might explain why the absence of certain snoRNAs is associated with disease.

If missing snoRNAs are a cause of some diseases, Stamm hypothesized, then replacing the missing snoRNAs with synthetic surrogates should be effective in treating those diseases. To test this hypothesis, Stamm collaborated with Professor Ronald Emeson of Vanderbilt University.

Stamm’s previous work had revealed that SNORD115, a snoRNA that is not produced in people with Prader-Willi syndrome, regulates the alternative splicing of serotonin 2C receptor’s pre-mRNA. Since this receptor is involved in controlling appetite and food consumption, Stamm’s observations suggested that alternative splicing-induced changes in its function may contribute to the drive of people with Prader-Willi syndrome to overeat. He collaborated with Emeson to determine whether a synthetic replacement for SNORD115 might be successful in treating this condition.

Alternative splicing shows promise for treatment

“In order to stop these patients from overeating, we looked for a way to substitute this snoRNA,” said Stamm. “We identified an oligonucleotide – a short strand of RNA – that could mimic the effect of the naturally-occurring snoRNA.”

When the researchers tested the oligonucleotide in animal models, they found that the group who received the oligonucleotide ate less food than did the control groups.

“This shows that food consumption is regulated at the level of alternative splicing,” said Stamm, “and that we can interfere with this system using an RNA oligonucleotide.”

While the missing snoRNA in Prader-Willi syndrome may have inspired the design of this new treatment strategy, the implications extend beyond the rare genetic disorder.

“What’s fascinating is that, because Prader-Willi syndrome is a genetic disease, it’s basically an exaggeration of normal obesity,” said Stamm. “From this, we can learn new ways to treat obesity in the general population.”


To see Stamm discuss his new findings,check out this video.


Next Steps

Make sure to dispose of expired medications

Written by Dr. Amy Meadows, assistant professor of pediatrics and psychiatry in UK’s College of Medicine.

Dr. Amy Meadows

Dr. Amy Meadows

When was the last time you cleaned out your medicine cabinet? Unlike a messy refrigerator, there’s nothing in your medicine cabinet to send a scented reminder that you need to throw out old bottles of ibuprofen and pain killers from your oral surgery two years ago.

Not only is this unsafe because medications should not be consumed past their expiration date, but they also have the potential for abuse. According to the 2014 National Survey on Drug Use and Health, the most commonly abused medications are opiates and other pain relievers, which is consistent with information from other sources.

Many medications have the potential to be misused, which includes both prescribed and over-the-counter medications. There are multiple ways drugs can be used incorrectly, or in some cases, illegally: they can be misused (used in ways other than recommended), abused (used for nonmedical reasons) or diverted (given/sold/bartered to people other than the intended patients).

When taken as directed and in the recommended amounts, over-the-counter medicines are generally very safe. However, those same medications can present a significant danger in overdose. Even over-the-counter analgesics like acetaminophen (Tylenol) or ibuprofen (Motrin) can cause organ damage or even death in some situations. It’s incredibly important that medications are taken as directed on labels or by a physician.

Children are especially at risk for abusing medications, either because they do not recognize medication as a danger or because of the impulsivity and risk-taking common in adolescents. It is recommended that medications be stored out of reach, such as in a medication lock box, to reduce to risk of misuse.

Medications should not, under any circumstance, be saved and used for future issues or ailments. This can be especially dangerous for antibiotics, which should be taken as directed until the full course of medication is completed. Other medications can become ineffective or potentially dangerous after their expiration. It is far safer to be evaluated by a medical professional to diagnose and treat a newly occurring issue rather than relying on old or expired medications.

Everyone can and should periodically dispose of old, unused and expired medications. In Lexington there are several options for safe disposal, including units at the Lexington Police Department and Fayette County Sheriff’s Office or on medication take-back days. Some pharmacies are also able to offer safe disposal of unused medication. Alternatively, if people are unable to access medication take-back programs, it is recommended that medications be placed in a sealable container or bag and mixed with kitty litter, dirt or coffee grounds before being thrown away.


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