NDRI News

Grant Funded: Development of an Online Best-Practice Resource for Opioid Overdose and HIV/HCV Prevention among Opioid Users in Disaster and Emergency Contexts

April 14, 2017



Disasters place disproportionate stress on disadvantaged populations who more readily experience resource loss and health risks during emergencies. Currently several million Americans misuse prescription opioids and heroin, and that number continues to rise as the U.S. faces one of the worst opioid abuse epidemics in its history. Opioid misusers including more than 400,000 opioid treatment program (OTP) patients receiving medication-assisted therapy (MAT) constitute a particularly vulnerable population, and yet disaster research and planning research has only recently begun to address the considerable public health risks faced by these individuals and their communities when services are disrupted.

Funding will result in an efficient and robust best-practices web-based resource for those at risk for opioid-related overdose, blood-borne infection, or treatment disruption during emergency/disaster situations. Currently, there is no low-threshold or comprehensive resource addressing these timely concerns. The web-site will provide communities with easily accessible best practices guidelines and a resource to help educate substance users and other key stakeholders in disaster preparedness and best-practice responses to high-risk situations.

For more information, contact Andrew Rosenblum


Grant Funded: Migrant Puerto Rican PWID: The Influence Of Acculturation And Enculturation On HIV And HCV Risk Behaviors

March 15, 2017



Reducing HIV and HCV risks among migrant Puerto Rican people who inject drugs (PWID) is critical to reduce new infections, improve health outcomes, and decrease health disparities among PWID. Our goal is to develop a targeted risk-acculturation intervention for a key population contributing to HIV and HCV prevalence in the northeast. Results will be viable for implementation in other U.S. urban areas where this population is present.

For more information, contact Camila Gelpi-Acosta


New Center at NDRI: The Center for Military and Veteran’s Health Research

March 1, 2017



The Center for Military and Veteran’s Health Research (CMVHR) is a collaborative partnership of scientists from the Institute for Biobehavioral Health Research and the Center for Community and Health Disparities Research at the National Development and Research Institutes, Inc. The mission of the Center is to maximize the readiness, health, and well-being of military personnel and the quality-of-life of veterans. Center scientists accomplish this mission through partnerships with industry, the U.S. Department of Defense and Veterans Affairs, veteran service organizations, and veterans themselves to discover promising technologies, organizational policy, community initiatives and therapeutic strategies for our nation’s warfighters. CMVHR scientists, which include decorated military veterans, have conducted research with active duty military members and veterans for over 25 years and have received funding from the National Institutes of Health, U.S. Department of Defense, and American Legacy Foundation.

For more information, contact Keith Haddock


Grant Funded: Understanding the Impact of Abuse on Men's Risk Behavior

October 1, 2016



Childhood sexual abuse (CSA) remains a critical public health issue among Black and Latino sexual minority men, as it is associated with multiple negative outcomes including substance misuse, poor mental health, revictimization, and high-risk sexual behavior. Most CSA research with sexual minority men relies on quantitative assessment that often precludes consideration of cultural variations in how formative sexual experiences are understood, are based on inconsistent or overly restrictive definitions of abuse, and therefore may fail to detect certain abusive experiences (e.g., those involving female perpetrators), which can have harmful health consequences if they remain unrecognized. This mixed-methods study will overcome existing limitations by drawing on perspectives of Black and Latino sexual minority men and relevant service providers to better understand the role of, and need to include, sexual abuse histories in treatment and counseling settings, with the long-term goal of improving assessment and health outcomes.

For more information, contact Ellen Benoit


Grant Funded: Accessible Care Intervention for Engaging People who Inject Illicit Drugs (PWID) in Hepatitis C Care

September 15, 2016



The proposed study will examine the feasibility, acceptability, safety, effectiveness, and cost of an Accessible Care intervention for engaging people who inject illicit drugs in hepatitis C care. Four times as prevalent in the US as HIV infection, hepattis C is already the leading cause of liver failure and liver transplantation, the disease burden and health care costs will continue to rise in the coming decades, and the 1.5-2.0 million people who inject illicit drugs are the most severely affected. If we are to end the hepatitis C epidemic in or country, data are needed on effective methods to provide successful antiviral therapy to the core population affected by the epidemic.

For more information, contact Pedro Mateu-Gelabert


Grant Funded: The Staying Safe Intervention: Preventing HCV among Young Opioid Injectors

July 1, 2016



The growing population of young people who inject drugs (PWID) is at extremely high risk for HCV infection through the use of contaminated injection equipment, yet, to date, no behavioral intervention has been sufficiently potent to produce significant reductions in HCV incidence among PWID. To address this critical public health need, our team developed Staying Safe (Ssafe), an innovative, strengths-based, socio-behavioral HCV prevention intervention found in preliminary research to be highly acceptable and feasible, with strong indications of efficacy. The proposed randomized, controlled trial will assess the effectiveness of the Ssafe intervention in reducing both injection-related HCV/HIV risk behavior and HCV incidence among young adults (ages 18-29) who inject opioids (heroin and/or prescription opioids).

For more information, contact Pedro Mateu-Gelabert or Honoria Guarino


Grant Funded by the American Cancer Society: Cancer Risk and the Epidemic of Smokeless Tobacco in the US Fire Service

July 1, 2016



Smokeless tobacco (SLT) use rates within the U.S. Fire Service are substantially higher than those among  other civilian occupations. Fire Service's SLT use has resulted in health disparities, with minority male  firefighters 10 times more likely to use SLT than male minorities in the general population. Given firefighting  alone increases risk for cancers which have been linked to SLT use, it is critical that occupational research  address this preventable cancer risk. Unlike other occupational groups with high SLT use (i.e., the military),  there are no tailored interventions for the fire service. This project will use formative research to examine  firefighters’ occupational norms, attitudes, beliefs/perceptions about cancer and SLT use, examine cultural and  structural barriers to cessation, and ways to motivate firefighters to quit and promote abstinence. This project  will tailor Enough Snuff (a military SLT cessation program), and create one for firefighters (FIRE­SLT). FIRESLT will be beta­tested in order to examine its feasibility prior to implementing the intervention on a larger  scale. 

For more information, contact Nattinee Jitnarin


Supplement Study #2: Opioid Misuse and Overdose Risk Patterns among Recent Veterans

June 1, 2016



This study will conduct a stakeholder analysis of impacts of naloxone training and provision across various institutional settings and treatment/service modalities. The ongoing study in which this supplement will be situated is currently distributing naloxone to at-risk veterans under the auspices of the Opioid Overdose Prevention Program (OOPP) registered by the NY State Department of Health) at NDRI. This supplement aims to expand scientific understanding of naloxone’s impact by: 1) developing preliminary survey instruments for assessing naloxone-related attitudes, and perceived impacts on participants’ ongoing management of opioid use; 2) conducting a stakeholder analysis of opioid users, treatment providers, first-responders and overdose survivors; and 3) collecting follow-up data over a 12-month period from recent overdose survivors whose overdoses were reversed with naloxone.

For more information, contact Alex Bennett


Grant Funded: Mobile Augmented Screening Tool to Increase Adolescent HIV Testing and Linkage to Care

May 19, 2016



Because adolescents and young adults face markedly increased HIV risk yet frequently do not test, we propose to develop a Mobile Augmented Screening (MAS) tool designed to increase HIV testing, and to facilitate linkage to care and ongoing prevention education. This tool will help clinicians address undiagnosed youth HIV, and enable young patients to receive much needed treatment and avoid unknowingly transmitting infection. Our product is designed to help existing program staff reach an increased number of clients; and to improve public health by encouraging reluctant young patients to accept important HIV testing and care they may otherwise decline.

For more information, contact Ian David Aronson


Grant Funded: Community Wise: An Innovative Multi-Level Intervention to Reduce Alcohol and Illegal Drug Use

May 16, 2016



Community Wise is a manualized, multilevel intervention to reduce health inequalities related to alcohol and illicit drug use that was developed and pilot-tested in a distressed community with concentrations of African American residents (DCAA) using community-based participatory research (CBPR) methods. We seek to apply the Multiphase Optimization Strategy (MOST) - an innovative and rigorous framework that employs factorial designs - to identify the most efficient, scalable, and sustainable components of Community Wise. Our innovative and rigorous combination of CBPR and MOST will produce an optimized intervention that is more acceptable to communities, reduces participant burden, and can be adapted and tested to reduce other health inequalities.

For more information, contact Ellen Benoit


Grant Funded: Mobile Intervention Kit to Increase HIV/HCV Testing and Overdose Prevention Training

May 15, 2016



Because many people who inject drugs (PWID) do not receive adequate information about: HIV or HCV testing and prevention, or overdose prevention and response training, we propose to develop a Mobile Intervention Kit to deliver technology-based interventions from a library of theory-guided video content. The first iteration will address overdose prevention and response training, as well as HIV/HCV prevention education. Subsequent iterations will expand the content library to include additional subjects. The Substance Abuse and Mental Health Services Administration lists HIV, HCV, and overdose prevention/response as current priorities. The Centers for Disease Control and Prevention similarly note the importance of addressing HIV and HCV when providing services to PWID. However, program staff may not always be fully knowledgeable about all topics, and may not explain details in ways PWID can fully understand.

Our proposed Mobile Intervention Kit (MIK) will address this unmet need for services, while creating value for program staff and administrators. An easy to use menu will enable client organizations to configure each tablet to present brief videos (approximately 2 minutes each) on: overdose prevention and response; the proper use of naloxone; HIV/HCV prevention; and the specifics of HIV and HCV test processes. These videos can be offered individually or in any combination. After a participant has viewed the materials, the MIK will automatically send a completion report to an off- site, password protected database maintained by Digital Health Empowerment, the SBC submitting the current proposal. De-identified data from these reports will be provided to client organizations, which can then share details with current and potential funders to document the services they provide. Digital Health Empowerment will charge a sliding fee to use the MIK, and will collect additional fees for each report.

Our project team has created NIH-funded technology-based interventions to facilitate substance use reporting and increase HIV testing among patients in high volume, urban emergency departments. Patients, including those who initially declined testing, cited the privacy and clarity of our technology-based approach as reasons they ultimately accepted HIV testing and more honestly reported substance use. Our team also has experience delivering services to high-need PWID in various clinical and non-clinical outreach settings. Additionally, Digital Health Empowerment principals So-Young Oh and Ian David Aronson, Ph.D. have more than 10 years experience collaboratively developing technology products, including video-based health interventions and other digital content, for clients in non-profit, commercial, and universiy settings. We plan to build upon this expertise to: develop videos and software to facilitate venue appropriate video selection and presentation, along with a backend system to collect data and generate automated completion reports; and conduct a preliminary feasibility trial (n=30) at a program serving PWID.

For more information, contact Ian David Aronson


Supplement Study: Challenges to Opioid Treatment Programs after Hurricane Sandy

October 1, 2015



This supplemental project will expand and extend the original aim and protocol of our study by conducting a national survey of at least 50 opioid treatment programs (OTPs). (Our current sample includes 9 OTPs that were affected by Hurricane Sandy.) The supplemental project sample will be stratified by region and urbanicity (rural, suburban, urban); and OTPs would be oversampled in areas that have a history of natural disasters to determine their disaster planning and recovery resources and needs. We also plan to interview state and federal officials to learn more about how key government agencies can help OTPs prepare for and respond to emergencies such as hurricanes, other weather-related events, terrorist attacks, and power and internet outages. Based on the current parent ASPR Sandy project (HITEP140014), we have already identified significant consequences of inadequate OTP preparation including increased injecting behavior, relapse to illicit opioid use, involuntary reductions in methadone dosage and suspension or termination of psychotherapeutic medications. These negative outcomes appear to be associated with incomplete continuity of operation plans (COOPs), particularly in the domains of transportation and communication, and the absence of relationships with alternative treatment programs. By conducting a nationwide survey we would be able to collect a robust, representative array of data to assure that findings are generalizable across the United States. We will disseminate our results to OTPs – as policy recommendations and as a model COOP – through AATOD, State Opioid Treatment Authorities, social media, and peer reviewed publications.

Abstract for parent project

For more information, contact Andrew Rosenblum


Grant Funded: Facilitating MAT Acceptance & Implementation in Problem Solving & Felony Courts

September 30, 2015



Despite the high prevalence of opioid addiction among persons under criminal justice supervision there has been very limited penetration of medication assisted treatment (MAT; methadone, buprenorphine, and extended-release naltrexone); an intervention that has a very strong evidence base. To spur implementation of MAT, we propose a Stage I study to develop and assess the feasibility, acceptability, utility and sustainability of an interactive eLearning modality and an eLearning + an organizational approach (Technology Transfer [TT] model) to advance knowledge and facilitate inclusion of MAT in drug and felony courts. We expect this development/pilot project to lead to a protocol that will be tested in a larger-scale efficacy trial to implement evidenced-based therapy for opioid-addicted criminal justice clients.

Abstract

For more information, contact Andrew Rosenblum


Grant Funded: Culture and HIV risk in a diverse population

September 25, 2015



Despite considerable attention to the sexual health of young men who have sex with men (YMSM), new HIV and STD infections are rapidly increasing among this population. A critical aspect of sexual behavior among YMSM is the process by which they receive cultural scenarios from external sources, interpret them and enact them with sexual partners. To understand this phenomenon and inform the development of more effective interventions for YMSM, the proposed study will conduct mixed-methods interviews with an ethnically diverse sample of 160 urban YMSM (33% Black, 33% Latino, 33% White; of whom 50% within each racial/ethnic group will be ages 16-20 and 50% will be ages 21-25).

Abstract

For more information, contact Ellen Benoit


Grant Funded: A Clinic and Tech-Based Diet and Fitness Intervention for Volunteer Firefighters

September 15, 2015



The US fire service serves as the front line of defense against any domestic emergency and volunteer firefighters (VFF) comprise the majority of firefighters. Unfortunately rates of overweight and obesity are at epidemic proportions among VFFs and cardiovascular disease remains the leading cause of line of duty deaths. Moreover few resources tailored to the unique culture and needs of firefighters are available to help occupational medicine physicians who provide their fitness for duty examinations. This project will engage firefighters and occupational medicine clinicians in tailoring an internet/mobile intervention and pilot test the program with a sample of VFFs with the goal to prepare and launch a national randomized clinical trial.

For more information, contact Sarah Anne Jahnke


Supplement Study: Opioid Misuse and Overdose Risk Patterns among Recent Veterans

September 1, 2015



New standing orders in the state of New York related to the distribution of the life-saving opioid antagonist, naloxone (Narcan™) have created an opportunity for the parent grant’s managerial staff to distribute the drug directly to veterans who are at high risk of opioid-related overdose. This supplementary research project (R01DA036754-01S1) will achieve the following aims: 1) Train opioid-using veterans in the administration of naloxone to reverse an opioid-related overdose and assess their retention of knowledge provided in an educational video. 2) Assess the uses of and experiences of having naloxone kits among recently returned veterans over a period of one year. 3) Evaluate the potential for personal possession of naloxone to impact overdose risk behaviors.

Abstract for parent project

For more information, contact Alex Bennett


Grant Funded: Evaluation of the National Fallen Firefighters Foundation's (NFFF) Behavioral Health Stress First Aid Intervention

August 20, 2015



Behavioral health interventions implemented to mitigate negative outcomes linked to trauma in the fire service have had limited or iatrogenic effects on firefighters. The National Fallen Firefighters Foundation (NFFF) and the national fire service community have invested considerable resources developing a new behavioral health model to address exposure to traumatic events. The proposed randomized controlled trial will be the first to determine the efficacy of the NFFF’s Consensus Protocol on Firefighter Behavioral Health Stress First Aid Intervention (SFAI), as well as evaluating its implementation and acceptability.

For more information, contact Sara Anne Jahnke


Beyond Addiction Book Available for a $25 or more Contribution to NDRI

August 13, 2015



NDRI Board member, Dr. Jeff Foote, along with co-authors Drs. Nicole Kosanke (former NDRI employee) and Carrie Wilkens win 2015 CPDD/NIDA Media Award for their book Beyond Addiction: How Science and Kindness Help People Change, a practical guide for families dealing with addiction and substance misuse.

Click HERE for more information and to receive a copy of Beyond Addiction.


NDRI is Registered as an Opioid Overdose Prevention Program

May 8, 2015


Andrew Burton/Getty Images

Overdoses involving opioids are preventable and reversible. Across the nation, community-based organizations, as well as state and local agencies, have focused much effort on the prevention of drug overdose. As many states are now doing, New York State recently passed a bill related to the distribution of the life-saving opioid receptor antagonist, naloxone/Narcan™.

This public health statute allows for the prescribing, dispensing and distribution of naloxone by a non-patient specific order. Lay persons can now prescribe naloxone acting under the auspices of a registered Opioid Overdose Prevention Program (OOPP), with no civil and criminal liability for prescribers and lay administration. Those with naloxone can use their naloxone upon others without fear of reprisals. Community-based organizations, drug treatment programs, institutes of higher education can register as OOPPs and distribute naloxone widely.

At organizations such as NDRI, now a registered Opioid Overdose Prevention Program, this policy shift enables researchers to distribute the opioid-overdose antidote directly to those at risk for overdose, as well as their peers and family members. This policy change represents an opportunity for researchers to both fulfill a critical ethical obligation to study participants and better understand how this medication may help to reduce health risks and save lives. As a registered OOPP, NDRI (and its outreach workers, field coordinators, and ethnographers) can now provide naloxone to participants in the course of their day-to-day interactions and to others who might be – or might encounter – individuals at risk.

At NDRI, we have several NIH-funded research projects that have been working collaboratively with the New York City and State Departments of Health and other organizations to help expand the reach of overdose prevention and response training and widely distribute naloxone – ideally to promote universal access, especially in communities at risk. We are aiming to help reach a broad demographic cross-section of at-risk populations, including those managing chronic pain, military veterans, the homeless, young and old prescription opioid users, and those accessing medically-assisted treatment (MAT).

In one of our studies, Opioid Misuse and Overdose Risk Factors among Veterans, we are working with military veterans who manage various forms of physical, psychological and social pain with opioids. Following our registration as an OOPP we are now teaching veterans via a training video developed by the Department of Health and Mental Hygiene in New York City, about how to recognize, prevent, and respond to an overdose, and we are giving veterans naloxone provided by the New York State and New York City Departments of Health. In addition to providing this life saving medication, we are assessing veterans’ knowledge of naloxone’s applications and methods of administration and how to assist veterans themselves to become peer health outreach workers and overdose prevention experts. Thanks to the newly implemented public health statutes and those who advocated for them, several participants in our study have already been able to save others’ lives by administering naloxone and this after only several months of distributing the life-saving medication.

For more information, contact Alex Bennett


Grant Funded: Bath Salts & the Illicit Drug Market: Use, Violence & Health Consequences

September 15, 2014

Photo courtesy of the Drug Enforcement Administration

The proposed investigation of the illicit bath salts market will clarify the subculture developing around use and sales, including changes in product, pricing and packaging, and levels of market- and use-related violence. The study will also document users' perceptions of health and safety risks; for example, it will identify subculture etiquettes y which regular users may modulate consumption so as to avoid serious consequences. The knowledge emerging from this study will enable the development of more accurate drug education, prevention, treatment and health related programs for bath salts users.

Principal Investigators: Ellen Benoit and Eloise Dunlap
Abstract


Grant Funded: Increasing HIV Testing in Urban Emergency Departments via Mobile Technology

July 1, 2014

Photo courtesy of EPSRC IRC Infectious Diseases

When hospital emergency departments (EDs) offer routine HIV testing to reach substance users and other high-risk patients, those who could benefit most frequently decline. Thus, an important health priority remains not only offering HIV testing to more patients, but developing strategies to increase test rates by working with patients who are reluctant to learn their HIV status. The proposed research will develop and evaluate the acceptability, feasibility, and preliminary efficacy of a mobile computer-based video intervention designed to increase HIV test rates among vulnerable patients in EDs and other high volume clinical settings nationwide.

Principal Investigator: Ian Aronson
Abstract


Grant Funded: Challenges to Opioid Treatment Programs after Hurricane Sandy: Impact, Preparedness Planning, and Recovery Efforts

May 1, 2014

Photo courtesy of jerseyshorevolunteers.com

There are more than 300,000 opioid-addicted patients who are receiving methadone maintenance therapy from opioid treatment programs (OTPs) in the United States. Large numbers of these attend OTPs located in areas impacted by Hurricane Sandy. Disruption of methadone dispensing and other services can have severe consequences to patients (and treatment seekers) such as relapse, dropping out of treatment and resumption or increase in HIV/HCV injection risk behaviors. The goal of this study is to develop recommendations for OTPs in their recovery efforts from Hurricane Sandy and their planning for future emergencies by obtaining data from OTPs (directors, staff, de-identified records, and patients), out of treatment persons who subsequently sought addiction treatment, and New Jersey and New York SOTA Directors about Sandy preparedness and response.

Principal Investigator: Andrew Rosenblum
Abstract