Questions
Can you tell us about your work?
I’m really privileged to co-lead the research initiative on infectious disease and substance use along with my colleagues, Elana Rosenthal and Rachel Silk. Our work is essentially focused on people with substance use disorders and the infectious complications that result from addictions. So, our work is entirely human subjects. We work with real people who have addictions and other high-risk conditions associated with substance use, and we work in community-based settings, so we partner with organizations that are doing direct service delivery to these disproportionately affected communities. And we embed clinical care as well as research so this can happen in a culturally competent way that we can bring science to people who need it the most.
How wide is the scope of substance abuse?
Substance use disorder is really an umbrella term that is nonspecific to what substance the people are using. So, people can become addicted to substances like opioids, which of course is the major epidemic in our country, but also stimulants such as cocaine or methamphetamines. They can even become addicted to benzodiazepines. There’s also a family of addictions that are behavioral, like addictions to gambling or other problem behaviors. So, the world of substance use and addictions is quite wide.
You do human studies research. Who are these people and how do you work with them?
People who use drugs are first and foremost people. They come from every walk of life. You’ve probably passed them in your grocery store, in your church community. So, people who use drugs are people. How we find them is often by meeting people where they are, and this is a phrase that’s often heard and used in the harm reduction community. Because we want to make care advantageous and easy and a no-brainer for people who use. So, we go and meet people where they intersect in their community. They may be going to find other people who use drugs so that they can have communion and have a space where they feel non-stigmatized. They may be going to access unused drug use equipment, so we have syringe service programs. They may be going to find treatment, so we have medication-based treatment for substance use disorders.
Can you tell us about the GLP-1 (semaglutide) study that you’re working on?
Unfortunately, we are now in what’s called the fourth wave of the drug overdose death crisis. And so, we’ve gone through horrible deaths related to opioid pills, then to heroin and subsequently to fentanyl and synthetic opioid overdose. And now we’re in a phase where stimulants are really becoming a challenging part of the overdose death crisis. Simulants refers to both methamphetamines as well as cocaine. Now here in our region, especially in Baltimore City, we have a long-standing opioid use disorder epidemic, but we also have a very entrenched cocaine use disorder epidemic. Unfortunately, despite the decades of knowledge about this, we have no FDA-approved treatments for cocaine use disorder or any stimulant use disorder.
When patients come to us saying they want treatment, they want to improve, we really are grasping at straws and utilizing off-label medications, for which the evidence base is weak to moderate. So, what our group is hoping to do is to explore a novel therapeutic mechanism utilizing GLP-1 agonists. Now everyone’s heard of Ozempic or Wegovy or these new classes of medications that have been blockbuster and just game-changing in terms of diabetes management, obesity, and weight loss.
However, what’s been discovered in some of these early trials is that there may be a central nervous system effect or somehow an effect on craving, and this anti-craving effect may extend beyond food toward other substances of consumption. So, there’s a lot of research going around right now in the alcohol use disorder field using GLP-1 agonists, and we hope here at the University of Maryland Institute of Human Virology to be the first in the nation to study GLP-1 agonists, semaglutide, for the treatment of cocaine use disorder in subjects with cocaine use.
