The Northeast Node of the Clinical Trials Network sponsors an academic bimonthly Science Series on the state of the science on addiction and integrated care models, occurring during the lunch hour from 12:00 to 1:00 PM EST, and is open to all health and mental health professionals. Continuing Education credits are available for medical professionals (1.0 AMA PRA Category 1 Credits approved by Dartmouth-Hitchcock Medical Center) and clinical professionals (1.0 CEU from the Vermont Office of Professional Regulation for allied mental health, substance abuse counselors, social workers) who attend the interactive session.
If you have any questions about the Science Series or how to obtain Continuing Education credits, please email Northeast.Node.CTN@dartmouth.edu.
Opioid use disorder, depression, and suicide
The opioid and opioid overdose epidemic has had a devastating impact in the US. This talk will cover recent research on the intersection of substance use disorders (opioid use disorder in particular), suicide and overdose. It will also describe the potential applications of suicide assessments and interventions in individuals with opioid use disorder.
Dr. Na's research interests are in the intersection of substance use disorders and suicidal behavior. His research focuses on the psychosocial and environmental factors that contribute to the development of addiction and suicidal behavior as well as treatment of individuals with co-occurring substance use disorders and psychiatric disorders.
Injectable XR Buprenorphine: A better mousetrap or a paradigm shift in MOUD?
In this Science Series presentation, Dr. Quirion discusses the science behind extended release (XR) buprenorphine and field experiences in the utilization of XR buprenorphine in a primary care setting. This talk also addresses the ways to bring this medication to patients and discussion of whether this treatment makes financial sense.
Eva Quirion, NP, PhD, is a pain care provider embedded in primary care at St. Joseph Healthcare in Bangor, Maine. Eva has been working with patients to help them manage chronic pain and improve safety related to controlled substances, including compassionate de-prescribing. The St. Joseph’s MOUD program provides XR buprenorphine to over 150 patients, more than any other program in the state of Maine. Dr. Quirion is also part-time faculty at The University of Maine School of Nursing, faculty for the Michigan Center for Clinical Systems Improvement (Mi-CCSI), member of the Co-Occurring Collaborative Serving Maine (CCSME), and serves on the Schmidt Institute’s committee for controlled substance stewardship.
Treating Stimulant use Disorders in the Context of the Opioid Crisis: A Review
In this presentation, Dr. Rush discusses current behavioral interventions used to treat stimulant use disorders, as well as promising pharmacological adjuncts. The efficacy of these interventions in the context of the ongoing opioid crisis is emphasized.
Dr. Rush is a professor in the Department of Behavioral Science at the University of Kentucky, and an Assistant Dean in the College of Medicine (Office of Faculty Affairs). He has tested novel behavioral and pharmacological interventions for stimulant use disorders for nearly 30 years.
Cannabis and Opioids: Promising pharmacology to address the opioid epidemic?
This presentation gives a brief overview of cannabis and the pharmacology of phytocannabinoids. Content focuses on combined evidence from preclinical studies and randomized controlled trials examining the potential for cannabinoids to modulate opioid effects on the following endpoints:
- opioid dependence and withdrawal symptoms,
- opioid abuse liability, and
- opioid analgesia.
At the end of this talk, attendees will understand basic cannabinoid pharmacology and the state of the evidence supporting the utility of cannabinoids for opioid use disorder and as an adjunct to opioids for pain.
Dr. Ziva Cooper, PhD, is the Director of the UCLA Center for Cannabis and Cannabinoids in the Jane and Terry Semel Institute for Neuroscience and Human Behavior and Associate Professor in the UCLA Departments of Psychiatry and Biobehavioral Sciences and Anesthesiology.
Her research involves understanding variables that influence both the therapeutic potential and adverse effects of cannabis and cannabinoids, the chemicals in the cannabis plant.
Dr. Cooper received her PhD from the University of Michigan in Biopsychology in 2007 in the field of preclinical psychopharmacology. Her current projects funded by the NIH and California State include understanding the potential for cannabis constituents to reduce reliance on opioids, differences between men and women in their response to the pain-relieving effects of cannabis, effects of cannabis as a function of age, and therapeutic effects of cannabinoids in patient populations.
Innovation in State-Level Drug Policies: Legalization, Decriminalization, and 24/7 Sobriety
America’s drug policy landscape is changing. More than 40% of the U.S. population lives in states that have passed laws to legalize cannabis production and sales, and Oregon has become the first state in the country to decriminalize the possession of controlled substances (including heroin, methamphetamine, and illegally produced fentanyl) for personal use. But the innovation hasn’t only been in the direction of liberalization, especially when it comes to alcohol. An increasing number of places are implementing 24/7 Sobriety programs to reduce alcohol consumption among justice-involved individuals whose alcohol use has led them to repeatedly threaten public safety. This presentation highlights the research on these efforts and offers ideas to those hoping to learn more about these new approaches.
Beau Kilmer (he/him) is the McCauley Chair in Drug Policy Innovation, director of the RAND Drug Policy Research Center, and a senior policy researcher at the RAND Corporation. His research lies at the intersection of public health and public safety, with special emphasis on crime control, substance use, illegal markets, and public policy. Kilmer's publications have appeared in leading journals such as New England Journal of Medicine and Proceedings of the National Academy of Sciences, and his commentaries have been published by CNN, Los Angeles Times, New York Times, San Francisco Chronicle, USA Today, Wall Street Journal, and other outlets. His coauthored book on cannabis legalization was published by Oxford University Press and his coauthored book on the future of fentanyl and other synthetic opioids was published by RAND. He received his B.A. in international relations from Michigan State University, M.P.P. from UC Berkeley, and Ph.D. in public policy from Harvard University
Injectable Extended-Release Buprenorphine Treatment in the Fentanyl Era
This presentation is a review of:
Substance Use Coercion: Evidence and Implications
It has long been recognized that abuse by an intimate partner can have traumatic substance use and mental health effects. Research has found high rates of both past and current intimate partner violence (IPV) among people in substance use disorder treatment and mental health care settings. A growing body of evidence has found that abuse often targets a partner’s substance use and mental health in deliberate attempts to undermine and control survivors to keep them from achieving their recovery goals. These forms of abuse, known as substance use and mental health coercion, not only jeopardize the well-being of survivors and their children but also compromise the effectiveness of treatment and recovery services. This session will introduce participants to the key features of substance use coercion, provide an overview of the existing research, and highlight implications for practice, policy, and research.
Carole Warshaw, M.D., is the Director of the National Center on Domestic Violence, Trauma & Mental Health. Dr. Warshaw has been at the forefront of developing collaborative models and building system capacity to address the mental health, substance use and advocacy concerns of survivors of DV and other trauma, and to create accessible, culturally responsive, domestic violence- and trauma-informed services and organizations. She has written and spoken extensively on these topics both nationally and internationally and has served as an advisor to numerous health, mental health and advocacy organizations and federal agencies, including the U.S. Department of Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of the Assistant Secretary for Planning and Evaluation (ASPE). She also served on the National Research Council Committee on the Assessment of Family Violence Interventions. Dr. Warshaw has maintained a private practice in psychiatry since 1989 and is a faculty member in the Department of Psychiatry at the University of Illinois.
Gabriela Zapata-Alma, LCSW, CADC, is the Director of Policy and Practice on Domestic Violence and Substance Use at the National Center on Domestic Violence, Trauma, and Mental Health; as well as faculty at The University of Chicago, where they coordinate the Advanced Alcohol and Other Drug Counselor certification program at the School of Social Service Administration. Gabriela brings over 15 years of experience supporting people impacted by structural and interpersonal violence through leading evidence-based clinical services, housing, and resource advocacy programs. Currently, Gabriela authors best practices, provides trauma-informed policy consultation with a focus on advancing social justice, as well as capacity building related to serving marginalized communities impacted by trauma and other social determinants of health, nationally and internationally.
Stimulant Use – Current Trends, Impact on the Brain, and Implications for Treatment and Recovery
This presentation describes the local and national scope of stimulant use. The acute and chronic mental health and physical health consequences of stimulant use are presented, including information on the impact of stimulant use on memory and cognition. The presentation concludes with a discussion on how to implement effective behavioral treatment interventions with people who use stimulants, and the necessary adaptations needed to engage and retain people in care.
About the Presenters
Thomas E. Freese, PhD, is currently the Co-Director of the UCLA Integrated Substance Abuse Programs (ISAP). Prior to this, Dr. Freese served as ISAP Director of Training for 20 years. Dr. Freese is also Co-Director of the Pacific Southwest (HHS Region 9) Addiction Technology Transfer Center (PSATTC), funded by SAMHSA. He has conducted trainings on addressing the opioid epidemic, medications for addiction assisted treatment, methamphetamine use, culturally responsive care, implementing integrated treatment, and screening and brief interventions for risky substance use.
Beth Rutkowski, MPH, currently serves as the Director of Training and Co-Director of the SAMHSA-supported Pacific Southwest Addiction Technology Transfer Center. The majority of Ms. Rutkowski’s time is focused on the development of synchronous and asynchronous training and intensive technical assistance packages based on evidence-based substance use disorder research and targeted to the community at large. Ms. Rutkowski has co-authored and edited several peer reviewed research articles, book chapters, special issues, and technical reports on a variety of topics related to the treatment of substance use disorders.
RAM: Vermont’s Rapid Access to Medication Assisted Treatment Project
Central Vermont was the pilot site for the Rapid Access to Medication Assisted Treatment (RAM) initiative. This presentation will explore Central Vermont’s readiness for RAM and the person-centered treatment system that was created as a result.
About the Presenters
Javad Mashkuri, MD, is the Medical Director of Emergency Services at Central Vermont Medical Center. Dr. Mashkuri has developed the Central Vermont Medical Center system for buprenorphine induction in the Emergency Department and been a principal architect of Rapid Access to Medicine for OUD in the region.
Robert “Bob” Purvis is the Executive Director of the Turning Point Center of Central Vermont and serves as the treasurer of the Vermont Recovery Network.
Kate Burkholder, LADC, LCMHC, is a dually licensed counselor working with people suffering from both substance use and mental health conditions. Kate currently works for Treatment Associates and is a medication-assisted treatment clinician for the Community Health Team through Central Vermont Medical Center.
Brandon Olson is the Treatment Center Director for Central Vermont Addiction Medicine/BAART Programs, the Medication Assisted Treatment (MAT) “Hub” in Central Vermont.
Medication Formulation and Treatment Model Preferences Among People with Opioid Use Disorder
Treatment for opioid use disorders (OUD) has changed significantly, including the development of long-acting medication for opioid use disorder (MOUD) formulations, and integrated treatment models systematically addressing both behavioral and physical health. More information on patient preference for these innovations is necessary to inform a patient-centered treatment system for OUD. This presentation will review a series of mixed-methods studies using exploring preferences for medication formulation and treatment model among people with OUD.
About the presenter:
Elizabeth Saunders is a Senior Research Scientist at the Center for Technology and Behavioral Health (CTBH). Elizabeth earned her PhD from the Dartmouth Institute (TDI) for Health Policy and Clinical Practice. Her mixed-methods dissertation research examined preferences for medication for opioid use disorder (MOUD) using web-based sampling strategies. Elizabeth’s research interests include the evaluation and implementation of treatment for opioid use disorder (OUD) using qualitative and quantitative methods. In her free time, she enjoys playing music, reading, and spending time outside with her family.
Responding to the Opioid Epidemic's "Ripple Effect" through Integrated Family Care: The Policy and Payment Landscape
In November of 2019, the United Hospital Fund (UHF), an independent nonprofit health care policy organization based in New York, released first-of-its-kind national and state estimates of the toll of the U.S. opioid epidemic on children. In this talk, Suzanne Brundage, director of Children's Health at UHF and principle investigator will:
- describe the estimate impact of the opioid epidemic on New Hampshire's children today and by 2030;
- discuss emerging integrated models of health care that address family addiction and other family-based behavioral health challenges;
- Outline key policy and payment challenges and opportunities for sustaining these new models of care.
About the Presenter
Suzanne C. Brundage is the director of the United Hospital Fund's Children's Health Initiative, which was established to strengthen health care's focus on health disparities rooted in childhood. Through a dual focus on service delivery and policy, Suzanne has worked on a range of issues including social determinants of health and education; primary care; Medicaid; and substance use disorders. She is a trusted collaborators through partner, and consensus building for many organizations and individuals nationwide focused on strengthening systems for families. She was named the first Patricia S. Levinson Fellow at UHF for her work to improve health care for vulnerable populations. She holds a BA from Bennington College in conflict resolution and international affairs and an MS in health policy and management from the Harvard T.H. Chan School of Public Health.
Vaping in 2020: Old Vices, New Devices
Vaping has been a headline topic for the past year, with arguments, evidence and policies being announced at a dizzying pace. Where are we in February 2020? A brief review of where the science stands at present, where policy stands and changes ahead.
Dr. Susanne Tanski, MD MPH FAAP, is an Associate Professor of Pediatrics at the Geisel School of Medicine at Dartmouth and a practicing primary care pediatrician at the Children’s Hospital at Dartmouth. Working within the Population Sciences Group at the Norris Cotton Cancer Center at Dartmouth and in the Koop Institute, her current research includes a focus on tobacco use among adolescents and young adults and media/marketing influences on adolescent drinking and smoking.
New Hampshire’s Project FIRST (First Responders Initiating Recovery, Support, and Treatment)
NH Project FIRST is a statewide initiative that promotes the understanding of SAMHSA”s Recovery Support Strategic Initiative, which aims to help individuals understand the process of recovery and ensure that proper supports are available to those who need and want them. Key to this program is the use of first responders who conduct nonfatal overdose follow-up visits and train at-risk individuals and their support systems on cardiopulmonary resuscitation, the Good Samaritan law, and naloxone administration. During visits, first responders assess needs, provide a naloxone kit, and treatment and social services resources, and provide connections to treatment and other services. First responders are in a prime position to perform these activities; they are trusted and respected in communities and they see individuals during emergent and non-emergent situations and have insight into living conditions, support systems, and unique patient needs.
Paula Holigan is a Program Manager for the NH Department of Safety, Division of Fire Standards and Training and EMS. She is responsible for managing NH Project FIRST, a first responder mobile integrated healthcare program funded by the Substance Abuse and Mental Health Services Administration’s (SAMHSA) First Responder Comprehensive Addiction and Recovery Act (FR-CARA) grant. Prior to this full-time role, Paula served as the Program Coordinator for Strategy and Planning, Program Coordinator for the Law Enforcement Narcan program, and Program Coordinator for the Pearson VUE Mobile Test Lab. Paula is a graduate of the National Fire Academy’s Managing Officer Program and an active Instructor/Coordinator and educator in several NH Fire and EMS services. She is a retired Lieutenant and remains an active call provider at the Atkinson Fire Departments.
Screening for substance use in primary care: An update on guidelines, screening tools, and strategies for addressing implementation barriers
In August 2019, the United States Preventive Services Task Force (USPSTF) issued a new draft recommendation to screen for drug use in primary care settings. With this new guideline, alcohol and drug screening are both recommended (Grade B) for all adult patients in primary care clinics, provided that capacity exists to deliver or make referrals to appropriate treatment. Screening can be recommended because of the high prevalence of unhealthy alcohol and drug use, its impacts on health, and the potential to effectively treat or prevent substance use disorders and related conditions. Brief, validated screening tools exist that can efficiently identify unhealthy alcohol and drug use and guide clinical care, but they remain underutilized. Screening for alcohol and drug use in primary care settings faces barriers to its implementation, including lack of time, workflow integration, and concerns about its acceptability to patients and providers. Dr. McNeely is Lead Investigator of a NIDA Clinical Trials Network study (CTN-0062 and CTN-0062-A1) that has been working with clinical leaders and providers in three health systems (9 primary care clinics) to define a feasible electronic health record-integrated screening approach, implement it in their practices, and evaluate its impact. In this presentation, she will provide an overview of screening guidelines and available tools, and speak to the challenges and successes of implementing substance use screening in primary care settings.
Jennifer McNeely, MD, MS is Associate Professor at the NYU School of Medicine in the Department of Population Health and Department of Medicine, Division of General Internal Medicine. Dr. McNeely’s research focuses on improving the identification and treatment of addiction in general medical settings. Her NIH/NIDA-funded research focuses on health care contacts as an opportunity to identify and provide effective interventions to address unhealthy substance use, and includes studies of screening instruments, hospital addiction consult services, clinical decision support tools for brief intervention, and collaborative care to prevent opioid use disorder. Her screening tool validation studies provided evidence for the 2019 USPSTF review of screening for illicit drug use. Dr. McNeely’s prior work has included policy research on models of opioid maintenance treatment; clinical research on an HIV prevention intervention in a drug treatment program; and analysis of large public health data sets to describe the health burden of illicit opioid use in New York City. She is a general internist specialized in Addiction Medicine, and currently practices at Bellevue Hospital.
Opioid pharmacotherapies for primary care and criminal justice populations: low threshold, low barrier approaches to naltrexone and buprenorphine treatments
Clinical trials and practice-based research indicates a relatively simple, medical management approaches to opioid use disorder treatments are feasible, effective, and easily disseminated. These 'low threshold' models value wide inclusion criteria, minimal additional mandates for counseling or psychosocial supports, immediate and sustained access to medications, and regular but not intensive follow-up to support medication adherence and good clinical outcomes. We have conducted multiple clinical trials using these low threshold, low barrier packaging of buprenorphine and naltrexone therapies for opioid use disorder in primary care settings, among detox-to-outpatient cohorts, and in jail-to-community and parole/probation populations.
Joshua D. Lee MD, MSc is an Associate Professor of Population Health and Medicine/General Internal Medicine and Clinical Innovation at the NYU School of Medicine and Director of the NYU Fellowship in Addiction Medicine. He is a clinician researcher focused on addiction pharmacotherapies in primary care as and criminal justice populations. He has conducted multiple NIH clinical trials examining the use of naltrexone and buprenorphine opioid and alcohol treatments in community criminal justice involved adults, at release from jail, and within community primary care settings.
CTN-0068: Accelerated Development of Additive Pharmacotherapy Treatment (ADAPT-2) for Methamphetamine Use Disorder
Dr. Trivedi will present on the Accelerated Development of Additive Pharmacotherapy Treatment (ADAPT-2) for Methamphetamine Use Disorder (CTN-0068) study. This is a double-blind, placebo-controlled, randomized clinical trial with the primary aim of evaluating the efficacy of extended-release naltrexone plus bupropion as a combination pharmacotherapy for methamphetamine use disorder. Secondary objectives include assessing the safety of naltrexone plus bupropion and determining the efficacy of the combination pharmacotherapy on other substance use outcomes, on depression symptom scores, and on quality of life ratings.
About the Presenter
Madhukar H. Trivedi, MD, is Professor, Chief of the Division of Mood Disorders, and Director of the Comprehensive Center for Depression in the Department of Psychiatry at UT Southwestern Medical Center. He is the holder of the Betty Jo Hay Distinguished Chair in Mental Health and is an established efficacy and effectiveness researcher in the treatment of depression. Dr. Trivedi serves as Principal Investigator (PI) of the Texas Node of the NIDA-funded Clinical Trials Network and is the PI of the NIDA-funded “Stimulant Reduction Intervention using Dosed Exercise (STRIDE)” study, which tests the effectiveness of adding exercise to treatment as usual to improve drug treatment outcomes. Dr. Trivedi is and has been the PI in multiple clinical trials funded through the NIMH, the Texas Department of Mental Health, and the Depression Trials Network, and has been a member of several institutional review groups of the NIMH. Further, he has been involved with the National Network of Depression Centers since its inception and is the Co-Chair of its newly formed Biomarker Task Group. Dr. Trivedi has received numerous awards, published over 420 articles and chapters related to the diagnosis and treatment of mood disorders, and is the PI of a NIMH-funded postdoctoral T32 training program.
Using Project ECHO to Address the Opioid Epidemic in Rural Northern New England
Clinicians can often find it both challenging and daunting to identify their role in addressing the epidemics of opioid misuse and drug overdose deaths facing the nation, particularly in the hard-hit area of northern New England. In an effort to engage and support clinicians in these efforts, Maine Quality Counts (QC) and its partners in the Northern New England ECHO (NNE ECHO) initiative have used the proven “Project ECHO” model to provide direct education and support using the ECHO model of web-supported, case-based learning. The NNE ECHO initiative has hosted several opioid-related programs to date, including compassionate tapering of opioids; SUD care through the perinatal period; Medications for Addiction Treatment (MAT); and bringing key community sectors together to decrease drug overdose deaths within local communities. In this session, Jeanne Ryer (NH Citizens Health Initiative at UNH) and Lisa Letourneau (Maine Quality Counts) will provide an introduction to the ECHO model, and describe how their organizations have used ECHO programs to engage and support clinicians and communities in addressing the opioid epidemic.
About the Presenters
Dr. Lisa Letourneau is a physician leader and passionate advocate for health care system delivery change, with a particular interest in advancing primary care and patient engagement efforts. She previously served for as Executive Director of Maine Quality Counts, a regional health improvement collaborative, where she led several quality improvement efforts including the Maine Aligning Forces for Quality initiative and the Maine Patient Centered Medical Home (PCMH) Pilot. Dr. Letourneau is a graduate of Brown University and the Dartmouth-Brown Program in Medicine and is a board-certified internist who practiced emergency medicine for seven years before beginning her work in clinical quality improvement. She holds a master’s degree from the Harvard School of Public Health and has a particular interest in helping to build connections between public health and clinical care, and the role of physicians in helping to develop and lead health improvement efforts.
Jeanne Ryer is the Director of the NH Citizens Health Initiative (NHCHI), a multi-stakeholder statewide effort to create a system of care that promotes health, assures quality and makes care affordable, effective, and accessible to all New Hampshire residents. NHCHI is a project under the NH Institute for Health Policy and Practice.
From 2003 until 2011, Jeanne was Program Director at the Endowment for Health, New Hampshire’s statewide health foundation, where she managed a portfolio of grants, projects, and policy initiatives addressing economic and geographic barriers to health. Her work focused on state and federal health system reforms, safety net health services, and community transportation. She led efforts to develop and implement a Mission Related Investment strategy to create the Safety Net Loan Fund, a working capital loan fund for safety net primary care, mental health, and oral health clinics. Before joining the Endowment, Jeanne served as Senior Program Officer for the New Hampshire Charitable Foundation and served as lead staff for the Lakes Region Charitable Foundation. Prior to that, she was the principal of a consulting firm specializing in community health and human services planning and primary health care access, focusing on the needs of the underserved in rural and remote areas.
Jeanne’s research and professional interests include population perceptions of health and well-being and the use of multi-stakeholder collaboratives in health systems transformation. She is author and co-author of several books, including one of the early guides to the Internet and others on accessing health and medical information online.
Jeanne serves on the Legislative Commission on Primary Care Workforce, the New England Comparative Effectiveness Public Advisory Council, the Board of Trustees of the Foundation for Healthy Communities, and the Steering Committee for ReThink Health of the Upper Connecticut River Valley.
Parental Substance Misuse and Child Trauma
Children exposed to parental substance misuse suffer from high rates of abuse, neglect, traumatic loss and posttraumatic sequelae. Moreover, an estimated 40-80% of families involved with child protection services due to child abuse or neglect involve substance abuse in the home. With the high rates of substance use disorders including opioid use disorders, and rising rates of death from drug overdose, services to meet the needs of the children and youth whose parents are addicted to alcohol, opioids and other drugs are sorely lacking. This talk will provide an overview of the effects of parental substance misuse on children and youth, with special focus on the association between parental substance misuse and child trauma. Models for treating traumatized children that have high relevance and utility for children and youth coming from substance misusing families will be discussed.
About the Presenters
Kay Jankowski, PhD, is an Assistant Professor in the Department of Psychiatry, and Associate Director of the Dartmouth Trauma Interventions Research Center, Dartmouth-Hitchcock Medical Center. She received her Doctorate in Psychology from the University of Vermont and completed her internship and post-doctoral work at Geisel School of Medicine at Dartmouth. Jankowski has published numerous articles and presented widely in the area of child and adolescent trauma, including developing and testing new treatment interventions, disseminating evidence-based practices into "real world settings", and transforming child serving systems to bring a more trauma-informed approach to care and services for children, youth and their families. Most recently she is the Principal Investigator for the New Hampshire Partners for Change Project, a federally funded (ACF, DHHS) demonstration project to improve the social and emotional well-being of children and youth in child welfare and juvenile justice systems. She is also the Co-Principal Investigator for the federally funded New Hampshire Adoption Preparation and Preservation Project, with a goal of promoting successful adoption by creating a trauma-informed, evidence-based and adoption competent child welfare system. Jankowski also is a certified trainer for Trauma-Focused Cognitive Behavior Therapy (TF-CBT). She provides training and consultation to clinicians across New England in the model, as well as training in trauma-informed care to a range of organizations including mental health agencies, substance abuse treatment centers, organizations that serve homeless populations, and schools, and has expertise in leading learning collaborative models of practice change. In addition, she is an experienced clinical psychologist, and maintains a practice, treating traumatized children, adolescents and adults at Dartmouth-Hitchcock.
Erin Knight, PhD, is a research associate at the Center for Program Design and Evaluation (CPDE) at Dartmouth. In her previous work, she conducted research on the education of students with developmental delays and the effectiveness of academic, social/emotional, and behavioral school-based intervention systems. In her work at CPDE, Erin has been involved with multiple project teams, including those at the Dartmouth Trauma Interventions Research Center, in conducting qualitative and quantitative work.
What’s the Point? Harm Reduction through Syringe Exchange in White River Junction and Springfield, VT
Please note: the first few minutes of the recording have no audio.
Syringe exchange programs are more than just a place to trade in used needles for new ones. These programs offer a variety of services such as HIV and Hepatitis C testing, naloxone and referrals to substance misuse treatment and other services. This talk examined and compared two syringe exchange programs run by the HIV/HCV Resource Center, one at the Good Neighbor Heath Clinic and the other at Springfield Health Center. The talk focused on client demographics, risk behaviors, drug use, Hepatitis C transmission and prevalence and the role of stigma as an impediment to accessing services.
About the Presenter
Laura Byrne is Executive Director of the HIV/HCV Resource Center, an AIDS Service Organization located in Lebanon, NH. She has administered the agency’s White River Junction syringe exchange program since 2010 and the Springfield program since 2017. With degrees from Colby College (BA) and Boston University (MA), she is an anthropologist by training and has also lived and studied abroad. In addition to promoting increased access to services and harm reduction for injection drug users, she is interested in relationships between gender, identity, society and culture.
Opioid Use Disorder and Commonly Co-occurring Conditions: An Infectious Disease Perspective
People with opioid use disorder who inject drugs commonly have co-occurring infectious disease conditions like HIV, viral hepatitis, and infective endocarditis. This presentation will review the epidemiology behind injection drug use (IDU) and infectious diseases, a clinical checklist for key health issues among people who inject drugs (PWID) with a focus on harm reduction and infection prevention, and findings from a recent study of Maine Medical Center patients with IDU-associated infective endocarditis.
About the Presenter
Kinna Thakarar, DO, MPH, is an infectious disease (ID) and addiction medicine physician with a special interest in health services research related to ID/addiction issues. She received a BA in Health and Societies from University of Pennsylvania, DO from Philadelphia College of Osteopathic Medicine, and an MPH from Johns Hopkins Bloomberg School of Public Health.
She completed internal medicine residency at Cambridge Health Alliance and infectious disease fellowship at Boston Medical Center, where she was part of an NIH-funded research training program in HIV/AIDS research for underserved populations, and also completed a fellows immersion training program in addiction medicine research. She is currently an attending physician at InterMed, affiliated investigator at the Center for Outcomes Research and Evaluation in Portland, Maine, and an Assistant Professor of Medicine at Maine Medical Center/Tufts University School of Medicine.
We apologize for the lapse in this video's recording.
Pharmacotherapy for Treating People with Alcohol Use Disorder
Alcohol use disorder is a common chronic condition. Although multiple pharmacotherapies have been shown to reduce drinking in people with this disorder, these important treatment strategies are underutilized. Dr. Brunette will provide an overview of how to conduct assessments and provide evidence-based pharmacologic management for people with alcohol use disorders in primary and specialty care settings.
About the Presenter
Dr. Mary F. Brunette is an Associate Professor of Psychiatry at Geisel School of Medicine at Dartmouth and the Medical Director of the Bureau of Mental Health Services within the New Hampshire Department of Health and Human Services. As a board-certified addiction psychiatrist, she has been involved with research and clinical care of patients with mental illnesses and co-occurring substance use disorders for over 20 years. She has been active with both psychosocial research and clinical trials studying treatments for people with these co-occurring disorders and other disadvantaged populations. In the past few years, she initiated a program of research on smoking cessation for people with mental illnesses, and has been involved in studying the use of technology to increase the efficacy and expand the research of treatments for people with co-occurring disorders, with a focus on people with severe mental illnesses in general and nicotine addiction in particular.
Initiating Treatment for Opioid Use Disorder in the Emergency Department
The Emergency Department (ED) is a critical venue to initiate SUD interventions. ED patients have a disproportionately high prevalence of SUD, are at an elevated risk of overdose, and many do not access healthcare elsewhere. Despite this, SUD interventions are rarely initiated in EDs. Drs. Hawk and McCormack will review common barriers to initiating treatment in the ED, including stigma, lack of resources, and perceptions of SUD as chronic, non-emergent conditions more appropriately addressed elsewhere. Drawing on recent and ongoing research, they will describe best practices for the treatment of opioid use disorder and alcohol use disorder in the ED. Interventions to be discussed include ED-initiated buprenorphine, extended-release naltrexone, and naloxone distribution.
About the Presenters
Ryan McCormack, MD, MS, is an Assistant Professor of Emergency Medicine at New York University, School of Medicine. He graduated from Jefferson Medical College in 2000, and earned a MS in Clinical Investigation with a focus on comparative effectiveness research from New York University in 2015. Dr. McCormack was awarded a NIAAA K23 for his research focusing on efficacious pharmacotherapy (extended-release naltrexone) to a multidisciplinary care management model targeting medically disengaged frequent users of the ED with severe alcohol use disorders. He is a practicing emergency medicine clinician with a broad clinical background in Emergency, Internal and Addiction Medicine. His research focuses on using collaborative strategies to practically and sustainably integrate substance use interventions in the emergency department (ED) to enhance healthcare quality. He is currently Co-Investigator for the NIDA R01 randomized trial “Comparing Interventions for Opioid Dependent Patients in Medical EDs”. Dr. McCormack has been a member of the NIDA CTN since 2009. He was the Bellevue Site PI of CTN-0047 (SMART-ED), currently serves on the executive committee for CTN-0069 (Project ED Health) and is Lead Investigator for CTN-0079 (ED Connection to Care with Buprenorphine for Opioid Use Disorder in Urban and Rural Settings).
Kathryn Hawk, MD, MHS, is an Assistant Professor of Emergency Medicine at Yale University and works as an attending physician at Yale-New Haven Hospital. She graduated from Drexel University, College of Medicine in 2010. She completed a research fellowship as part of Yale’s Interdisciplinary Drug Use, Addiction, and HIV Research Scholar (DAHRS) NIDA career development award. Dr. Hawk completed a Master of Health Science from Yale University in 2016. Her research focuses on overdose prevention in high-risk populations and ED-initiated buprenorphine and linkage to treatment for substance use disorders. She currently serves on the executive committee for CTN-0069 (Project ED Health), is a Co-Investigator for Connecticut’s Centers for Disease Control prescription drug overdose Prevention for States grant, and is the PI of an Emergency Medicine Foundation project “Developing an Emergency Department Based Intervention to Prevent Opioid Overdose: Listening to Patient Voices”. Dr. Hawk is Co-Investigator on CTN-0079 (ED Connection to Care with Buprenorphine for Opioid Use Disorder in Urban and Rural Settings).
What’s age got to do with it? Addressing smoking in young adults with comorbidity
Smoking in young adults is prevalent. In recent years, ad campaigns have touted the importance of quitting or abstaining from tobacco; while those ads have been effective for some, large groups of young adults continue to smoke. In this presentation, Dr. Brunette will discuss the prevalence of smoking in young people, how smoking is linked with comorbid mental illness and addiction, and effective strategies to help young people quit smoking, thus preventing the development of smoking-related disease and early mortality.
About the Presenter
Dr. Mary F. Brunette is an Associate Professor of Psychiatry at Geisel School of Medicine at Dartmouth and the Medical Director of the Bureau of Mental Health Services within the New Hampshire Department of Health and Human Services. As a board-certified addiction psychiatrist, she has been involved with research and clinical care of patients with mental illnesses and co-occurring substance use disorders for over 20 years. She has been active with both psychosocial research and clinical trials studying treatments for people with these co-occurring disorders and other disadvantaged populations. In the past few years, she initiated a program of research on smoking cessation for people with mental illnesses, and has been involved in studying the use of technology to increase the efficacy and expand the research of treatments for people with co-occurring disorders, with a focus on people with severe mental illnesses in general and nicotine addiction in particular. You can read her full biography here.
Please note: Due to technical issues, this presentation did not record. A PDF of Dr. Brunette's slideshow is available here: NE Node Science Series_Brunette
Behavioral Sensing: An enabling technology for mobile health research
Low-cost wireless wearable biosensors paired with powerful mobile phone and cloud computing structures have the potential to transform healthcare management and research by providing an unprecedented and comprehensive view of a person’s health status and behavior patterns. Mobile sensor technologies can also facilitate prevention of chronic diseases and support adoption of a healthy lifestyle through just-in-time interventions to promote healthy behavior patterns. However, there still exist many challenges to implementing mobile health systems. Wearable sensors have to be designed to blend into people's daily life routine while providing information on physiology and behavior. Sensors deployed in the field environment provide large, noisy, complex data streams about the many facets of daily life and health. However, further advances in computational algorithms are required to transform sensor data into set of useful bio-markers readily interpretable by researchers. This talk will describe our recent work in wearable sensing and computing to address these challenges, including behavior inference from multi-mode physiological sensors, models of stress condition, and pairing rich probabilistic models with novel wearable sensor designs to dramatically expand the scale of physiological data we can obtain in the field while minimizing the burden to participants.
About the Presenter
Emre Ertin is an Associate Professor with the Department of Electrical and Computer engineering and a principal investigator with the Dorothy M. Davis Heart and Lung Research Institute at The Ohio State University.
He is currently serving as the Sensor Technology Lead for the NIH Center of Excellence in Mobile Sensor Data-to-Knowledge (MD2K) that develops big data solutions to quantify physical, biological, behavioral, social, and environmental factors that contribute to health and wellness in daily life. Dr. Ertin received his BS degree in Electrical Engineering and Physics from Bogazici University, MSc degree in Signal Processing from Imperial College, and PhD degree in Electrical Engineering from The Ohio State University. Before joining Ohio State in 2003, he served as the technical lead of smart sensor development at the Core Technology Group of Battelle Memorial Institute. At OSU he served as a principal investigator on NSF, AFOSR, ARO, AFRL, ARL, DARPA, and NIH funded projects on novel sensor concepts and associated data analytic techniques. In addition, Dr. Ertin is a co-investigator on the Northeast Node-led CTN-0073-Ot, "Towards Detecting Cocaine Use Using Smartwatches in the NIDA Clinical Trials Network."
SBIRT in Primary Care Pediatrics: Lessons and Opportunities Beyond Implementation
Addressing substance use among adolescents early presents unique opportunities to identify and potentially head off preventable risky behaviors. However, despite recent recommendations from the American Academy of Pediatrics and other professional organizations to implement SBIRT (Screening, Brief Intervention, referral to Treatment) for adolescents, implementation among primary care practices has been challenging and slow. In this presentation, Dr. Chapman will discuss implementation keys and approaches of bringing SBIRT to pediatric primary care practices, including the use of electronic medical records and tablet questionnaires. He will also discuss opportunities that emerge beyond implementation.
About the Presenter
Steven H. Chapman, MD, is a general pediatrician with 20 years of experience, currently practicing at the Children's Hospital at Dartmouth (CHaD) and teaching at Geisel School of Medicine at Dartmouth. He served four years in the National Health Service Corp and is currently the Director of the Boyle Community Pediatrics Program as well as President of the New Hampshire Pediatric Society. He also serves on the Board of New Hampshire Kids Count/Children's Alliance of New Hampshire, and is the school physician for his local Dresden School District. He has particular interest in integrated behavioral health in primary care, Screening, Brief Intervention, and Referral to Treatment (SBIRT) in primary care, and support of parents in recovery who are raising young children.
The Voices of New Hampshire Young Adults
The NH Bureau of Drug and Alcohol Services and it’s contracted evaluation entity, The Center of Excellence conducted an assessment of the risk perceptions, behaviors, and attitudes as they relate to binge drinking and the non-medical use of prescription drugs including opioids and illicit opioids. The assessment consisted of a mixed methodology using focus groups and an online survey. The net result was the State was able to conduct 57 focus groups with 366 participants and the online line survey was answered by over 4,000 NH residents and represented individuals within this age group who are enrolled in college, not enrolled in college, working, and not-working. The presentation will focus on the key themes that emerged and it’s implication for prevention programming.
About the Presenters
Jill Burke, MPA, Chief of Prevention and Education Services, NH-DHHS-Bureau of Drug and Alcohol Services BDAS. Ms. Burke has over 20 years of experience working in the public health sector. In her current capacity with the BDAS she overs a number of federal and state grants and provides training and technical assistance to service providers, the public, and other program professionals on evidence-based approaches and policies to reduce substance misuse across the life-span.
Rachel Kohn, MSW, MPH, has worked in public health for over 18 years and has extensive experience with federal, state and local agencies providing a full array of technical assistance and evaluation services for programs targeting prevention of substance use among youth, smoking cessation, prisoner reentry programs, juvenile court diversion, adult and juvenile treatment drug court programs. Most recently, Ms. Kohn has overseen the development of the New Hampshire Juvenile Court Diversion Center for Excellence which strives to enhance the NH Diversion Network capacity to provide evidence-based diversion programs, expand the reach of diversion services into underserved areas of the state and develop a long-term sustainability plan. She has also been working extensively with federally-funded reentry programs and adult treatment courts in several New Hampshire counties to research and establish standards and best practices, and to support the implementation of evidence-based drug courts as defined by the National Association of Drug Court Professionals.
Harnessing Digital Technologies in the Treatment of Substance Use Disorders
A growing line of research has highlighted the promising role that interactive technologies (e.g., web, mobile devices) may play in the assessment, prevention, treatment, and recovery management of substance use disorders. In this presentation, Dr. Marsch will provide an overview of the state of the science in the development, evaluation, and implementation of technology-based therapeutic interventions for substance use disorders. This research underscores the role that technology may play in improving treatment for substance use disorders in a manner that increases access to care, is cost-effective, ensures fidelity, and enables the rapid diffusion and widespread adoption of science-based interventions.
About the Presenter
Dr. Lisa A. Marsch is the Director of the Dartmouth Center for Technology and Behavioral Health, a designated “Center of Excellence” supported by the National Institute on Drug Abuse at the National Institutes of Health.
She is also the Director of the Northeast Node of the National Drug Abuse Clinical Trials Network based out of Dartmouth, and the Andrew G. Wallace Professor within the Department of Psychiatry at the Geisel School of Medicine at Dartmouth College.
You can read her full biography here.
The Safe Station Project
An overview of the Safe Station program run by Manchester Fire Department and the partners involved. The history, how it came to be, and identifying key components and concepts involved with the process. You will be able to identify the key factors in your community to be able to start the discussion of whether or not the Safe Station Project is something your community can execute and what resources are needed to move the mission forward.
About the Presenter
Chris is a certified career Firefighter I/II since 2004 and Nationally Registered Paramedic since 2000. Currently, he is a full time Firefighter Paramedic with the Lexington MA Fire Department and a fulltime Firefighter and EMS Officer for the Manchester NH Fire Department. Prior to coming to the Manchester Fire Department, Chris was a field paramedic, Field Supervisor, and Station Manager for Rockingham regional Ambulance and then American Medical Response. Happily married to his wife of 17 years Melissa, his family resides in Merrimack NH with their two boys Gavin (9) and Seamus (6) and their 5 year old boxer Bailey. In his spare time, he coaches Merrimack Youth Lacrosse and plays video games with his sons.
Perinatal Substance Use Disorders: Rationale for Integrated Care
Perinatal substance use disorders are a public health problem of increasing severity in northern New England, straining the capacity of the maternity care system. Providing adequate and effective services for this vulnerable population requires an understanding of their complex needs. Because pregnancy is a time of high motivation for self-care, women often seek treatment for substance use disorders for the first time after conception. Integrating addiction treatment with maternity care provides a unique opportunity to increase access, address co-morbid conditions, and improve perinatal outcomes.
About the Presenter
Daisy Goodman is a certified nurse midwife in clinical practice at Dartmouth Hitchcock Medical Center, and an Instructor in Obstetrics and Gynecology at the Geisel School of Medicine at Dartmouth. She received a certificate in nurse-midwifery and women’s health at the Frontier Nursing University, a Masters in Public Health from the Dartmouth Institute for Health Policy and Clinical Practice, and a Doctorate in Nursing Practice at the Massachusetts General Hospital Institute of Health Professions. Her area of clinical and research interest is focused on improving access to care for pregnant women with opioid use disorders, and on the intersection of trauma and substance use in women’s lives. Dr. Goodman currently practices at Dartmouth-Hitchcock Medical Center in the Department of Obstetrics and Gynecology, and is part of the treatment team at the DHMC Perinatal Addiction Treatment Program. She is currently involved in the development of a toolkit to help standardize practice among maternity and addiction treatment providers caring for pregnant women with substance use disorders. Prior to coming to Dartmouth-Hitchcock in 2013, she worked in the community hospital setting in Maine where she led implementation of a screening and brief intervention program in maternity care and participated in a workgroup sponsored by Maine CDC which developed state guidelines for the management of perinatal substance use.
Why Strategies to Integrate Behavioral Health in Primary Care Are Unsuccessful and What Can Be Done About It?
With the Affordable Care Act and Mental Health and Addiction Parity Act, it is widely assumed that behavioral health care is in the midst of enormous transformation. Epidemiological studies and health services research document the high prevalence of behavioral health conditions in primary medical care settings, and the significant costs associated with not addressing psychiatric and substance use disorders. A variety of behavioral health interventions, both pharmacological and psychosocial, have been developed and studied in primary care situations. Examples of evidence-based interventions include the Collaborative Care Model for Depression, SBIRT for high risk alcohol use, and medication-assisted treatment (MAT) for opioid use disorders. Although these treatments have consistently been found to pass efficacy and effectiveness trials, they are not widely implemented—in fact few if any are sustained beyond the funded research time frame. Implementation science provides systematic insight into the barriers and facilitators of evidence-based practice adoption and reach in routine practice settings and health care systems. In this presentation, the challenge of implementing and sustaining integrated behavioral health in primary care will be analyzed using a pragmatic research framework. Solutions are proposed that consider policy and financing; unified trans-diagnostic approaches to typical and complex behavioral health conditions (psychiatric and substance-related); optimization of care of individual providers and teams; and, the role of technology-based platforms to enhance the quality of behavioral health care, reduce practice variation, and empower patients and families.
About the Presenter
Dr. Mark McGovern is a Professor of Psychiatry, of Community & Family Medicine, and of The Dartmouth Institute of Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth in Lebanon New Hampshire USA. His clinical practice is based at the Hanover Psychiatry, and his scientific program is focused on behavioral health services and implementation research. Read his full biography here.
The Changing Landscape of Marijuana (Cannabis): What's Real and What's Not
Perceptions about cannabis are changing. This webinar discusses the potential impact of changes in cannabis laws and regulations, limitations of the evidence for cannabis as a therapeutic substance, and concerns related to adolescents’ use of cannabis and prevention messaging, and how the changing landscape interacts with these issues.
About the Presenter
Dr. Budney is a Professor at the Geisel School of Medicine at Dartmouth, Co-Director of the Addiction and Health Research Laboratory, and Director of the Treatment Development and Evaluation Core of the Center for Technology and Behavioral Health. Read his full biography here.
Interfaces of Pain & Addiction: Phenomenology, Clinical Care & Open Questions
As opioid prescribing for pain treatment increased over the past two decades, prescription opioid overdose deaths and demand for treatment of opioid addiction increased in parallel. More recently, cheap and abundant heroin and street fentanyl have been associated with a surge in opioid-related harm. While opioids remain the most powerful analgesic medications available, pain is an experience with sometimes complex biopsychosocial components that that may respond to diverse other treatments. This webinar will explore the phenomenology of pain, clinical management options for pain-with and without co-occurring addictive disorders, and the roles and liabilities of opioids in treatment of pain and opioid use disorders. The evolution of the current opioid epidemic and the contributions of prescribed and illicit opioid sources will be considered.
About the Presenter
Dr. Seddon Savage is a clinician, educator, and advocate in the fields of addiction medicine and pain medicine. She is Medical Director of the Chronic Pain and Recovery Center at Silver Hill Hospital in Connecticut and served as Director of the Dartmouth Center on Addiction Recovery and Education from 2004 through 2015. She is an Associate Professor of Anesthesiology on the adjunct faculty of the Geisel School of Medicine at Dartmouth and is currently working with Dartmouth-Hitchcock to support substance-related education and practice improvement. She earned a BA in Art History from Barnard College, an MS in Human Nutrition from the Columbia University College of Physicians and Surgeons, and her MD from Dartmouth Medical School. She earned a certificate of added qualifications in Pain Management from the American Board of Anesthesiology in 1984 and is certified in Pain Medicine by the American Board of Pain Medicine. Dr. Savage is certified in Addiction Medicine by the American Board of Addiction Medicine and is an elected fellow of American Society of Addiction Medicine.
Pharmacotherapy for Opioid Use Disorder
Opiate addiction continues to spread and plague our communities, raising concerns about both public health and widespread suffering. Unlike other addictions, opiates are unique in both their persistence and lack of response to traditional abstinence-based therapies. This webinar will provide a brief overview of current prevalence, natural history, and an introduction to available pharmacotherapy treatment options.
About the Presenter
Dr. Tod Miller was educated at Reed College (BA) and Oregon Health & Sciences University (MD). He completed his residency in psychiatry at the University of Vermont. Dr. Miller spent several years doing outpatient addictions work at Oregon Health & Sciences University in Portland, Oregon before moving east to work at the Brattleboro Retreat and Baystate Franklin Medical Center. For the past five years, he has been the Medical Director for Behavioral Health at Springfield Medical Care Systems, an unusual and innovative Federally Qualified Health Center that includes a critical access hospital with a dedicated 10-bed psych unit, the Windham Center. Their focus is providing behavioral health services that are fully integrated within primary care clinics, exploring a new model of community based care.