A number of University of Kentucky experts will be giving presentations on their work in the field of opioid use disorder research, treatment and prevention this week at the 2021 Rx Drug Abuse and Heroin Summit, held virtually this year due to the ongoing pandemic.

Addiction Consult and Education Service (ACES)

On Tuesday, April 6 at 3:30 p.m., UK addiction experts will present, “Addiction Medicine Consultation and Education in the Hospital: The University of Kentucky Experience.” Presenters are UK Center on Drug and Alcohol Research Director Sharon Walsh, Ph.D., UK HealthCare physicians Dr. Laura Fanucchi and Dr. Devin Oller, and UK HealthCare Assistant Chief Nurse Executive Brandy Mathews.

Patients who have substance use disorders may end up in the hospital due to other serious health issues caused or exacerbated by their addiction. Once these patients are hospitalized, they tend to remain as inpatients for a long time. At UK HealthCare, the major referral center for complex health care issues in Central and Eastern Kentucky, this means treating patients with advanced infections and other complications.

“We see a ton of patients coming into UK Chandler Hospital and Good Samaritan Hospital struggling with complications stemming from their opioid use disorder,” said Dr. Devin Oller, assistant professor in the UK College of Medicine Division of Internal Medicine and addiction medicine specialist. “Because patients struggle with access getting the care they need for their substance use disorders, we’re often seeing that disease at its extreme.”

Launched in October 2018 as a small pilot program, UK’s Addiction Consult and Education Service (ACES) has grown to a robust multidisciplinary team of physicians, advanced practice providers, nurses, social workers and peer support specialists who provide comprehensive substance use disorder treatment for patients in the hospital while supporting the patients’ other care teams in ensuring that all medical issues are addressed. Funding for both ACES and UK’s First Bridge Clinic comes in part from the Kentucky Opioid Response Effort (KORE).

“The ACES program, along with the First Bridge Clinic, are the result of a wonderful and fruitful partnership between the state, UK HealthCare and the University of Kentucky,” said Sharon Walsh, Ph.D., director of the UK Center on Drug and Alcohol Research.

The ACES team is led by Dr. Laura Fanucchi, associate professor in the UK College of Medicine Division of Infectious Disease and addiction medicine specialist.

“We regularly have a census of 40 to 60 patients, which I think demonstrates the need,” Fanucchi said. “We’ve gotten a lot of positive feedback from our colleagues who say they feel it really helps support both the patient and the other medical teams in providing evidence-based treatment for substance use disorders in the inpatient setting.”

While addiction consult service programs are more common in urban areas, they’re still a fairly new development in the world of addiction medicine.

“It’s been a relatively recent phenomenon in medical centers over the last five to 10 years,” Fanucchi said. “But with the opioid epidemic, there are increasing rates of hospitalizations due to complications of substance use disorders, and what became clear was that people with these severe complications weren’t getting evidence-based treatment for the underlying reasons they were hospitalized.”

Fanucchi also points out that addiction medicine has historically not had a large focus in medical education, leading to healthcare providers feeling “unequipped” to address underlying substance use disorders in some patients. Addressing that deficit head-on is especially important for UK HealthCare Assistant Chief Nurse Executive Brandy Mathews, who serves as the liaison between the ACES team and nursing.

“Our nurses really need to understand the disease process,” Mathews said. “They need to understand and appreciate the struggles that patients are going through. They need to understand the evidence and how medications can be used to treat the disease. I feel both a personal responsibility – and as a nurse leader – a responsibility to help our nurses take the best care of patients that they can.”

But care for a patient with substance use disorder doesn’t end when that patient leaves the hospital – an important part of ACES is to help link that patient with continued treatment once they’re discharged.

“Linking patients to evidence-based treatments and to medications to treat their addiction has to be the priority,” Mathews said. “For example, linking them to a clinic in their community, but also helping find ways they can have other resources, like financial help. For some patients, simply getting transportation to the clinic is one of their main barriers to success in recovery.”

These types of socioeconomic barriers have been exacerbated by the COVID-19 pandemic, says Oller.

“[Another challenge] is really the urgency of some of the social needs that our patients face, especially during the COVID-19 pandemic,” Oller said. “Transportation barriers, financial barriers, limited social support – patients are feeling isolated and need that additional support, and we really need to take a more multidisciplinary approach to what we’re dealing with.”

During the pandemic, Mathews says patients with substance use disorder ending up in the emergency department has been “amplified” and notes that this has become an important factor in the continuum of care.

“For some, the pandemic has limited their access to resources,” she said. “So I think we have a responsibility to try to link patients to treatment directly from our emergency department, and that’s something we’re also working on.”

The team collectively agrees that during the pandemic, the rise of telehealth as an option for patients was a positive step. Having the ability to attend group therapy and counseling sessions virtually also proved helpful for many patients who may have otherwise struggled to attend in-person sessions, and seeing patients in their own homes provided some extra feedback that the providers wouldn’t otherwise get.

“I noticed that a lot of times when I’m seeing patients via telemedicine, they’re more relaxed,” Oller said. “They’re in their home environment and they’re able to share about some of their struggles and challenges in a really genuine way.”

Moving forward beyond the pandemic, the team hopes to keep some of the beneficial changes that have developed recently – like telemedicine – while continuing to push for changes that will benefit patients most, like increasing access to life-saving medications for opioid use disorder. A one-size-fits-all approach doesn’t work when treating patients with substance use disorder, Fanucchi says.

“Unfortunately, the treatment system has historically been set up in a very structured way that doesn’t always fit the need of the patient,” Fanucchi said. “So one of the things we’re working on moving forward with is using our treatment approaches as models and having the treatment fit the patient.”

Svetla Slavova, Ph.D., and Doug Oyler, PharmD, discuss their study on using prescription data to inform overdose prevention.

Using Prescription Data to Inform Drug Overdose Prevention

On Tuesday, April 6 at 4:45 p.m., two UK faculty will present “Using Prescription Data to Initiate Targeted Education and Information Prevention Efforts: Perspectives from Two Bureau of Justice Assistance Grantees.” UK College of Pharmacy Assistant Professor Doug Oyler, PharmD, and UK College of Public Health Associate Professor Svetla Slavova, Ph.D., will be joined by the Utah Department of Health’s Anna Fondario in this presentation.

While working as a clinical pharmacist in UK HealthCare’s trauma and surgical ICUs, Doug Oyler noticed a pattern emerge among the patient population: many patients were otherwise healthy people who had suffered a traumatic experience, and some were experiencing a serious hospital visit for the first time. Patients could leave the hospital with a host of medications, but not necessarily a plan for weaning off them in the future.

His experiences motivated him to find ways to “intervene upstream” and prevent problems with opioid use before they begin, with a specific focus on safe opioid prescribing. Now the director of the UK HealthCare Office of Opioid Safety, Oyler and biostatistics expert Svetla Slavova, Ph.D. will present preliminary results from their study that links the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system and UK HealthCare patient data to help healthcare providers identify and intervene with at-risk patients. The team has years of data that can alert providers about patients who come to UK HealthCare with a history of potentially harmful opioid use. Oyler, physicians in the study, and the Office of Opioid Safety can then work with providers to look at what and how much medication is being prescribed and provide educational interventions to help these patients understand their risk of developing an opioid use disorder.

“We were able to establish a data use agreement with the Kentucky Cabinet for Health and Family Services that allowed us to link data for all UK HealthCare inpatient and outpatient patients treated between 2017 until December 2020 to their KASPER record,” Slavova said. “We have built this impressive analytical data set that can then allow us to identify the patient's pattern of opioid use and co-use with other controlled substances prior to admission and after discharge, including the critical time after discharge when care transitions from UK HealthCare practitioners to the local community.”

Slavova describes this as going from a “reactive” to “proactive” mode of analyzing data to inform drug overdose prevention.

“Historically, we have been using data to analyze past events to look at risk and prevention factors to inform policy development,” Slavova said. “[Public health surveillance] has started using new data sources – near real-time data sources when available – to employ statistical algorithms to monitor trends, identify outbreaks, and issue alerts to stakeholders who have the power to act.”

The Rx Summit is a chance for thousands of experts from across the country to share their experiences – the good and the bad – with their colleagues, all in the hopes of reducing harms and mortalities associated with substance use disorders. For Oyler, Kentucky’s long history with the opioid crisis is additional motivation to work in this field and push out their latest findings.

“There’s a perspective of Kentucky in general as an epicenter for the opioid crisis,” he said. “So I think it’s as or more important that we – the state and the university – are seen as a critical player in the response to the opioid epidemic, and that we can lead ourselves back out of this crisis.”