Center for Addiction Research, Education, and Service (CARES)

Megan Meyer MSW, PhD, School of Social Work – Principle Investigator
Andrew Coop, PhD, School of Pharmacy – Co-Investigator
Fernando Wagner, PhD, School of Social Work – Co-Investigator
Seante Hatcher, MSW, School of Social Work – Co-Investigator
Lynn Marie Bullock, DNP, RN, NEA-BC, School of Nursing – Co-Investigator

A growing body of research on the potential of psychedelic-assisted therapies (PAT) to 
treat a variety of mental health conditions, including substance abuse and addiction, has 
coincided with rising mental health and substance abuse rates in recent years and the drug 
decriminalization movement, fueling what’s being described as the “psychedelic renaissance”
(Brain Futures, 2022). It is well-known, for instance, that substance use disorders (SUDs) and 
death rates due to substance use have risen in the last decade, especially during the pandemic, 
with over 106,600 deaths due to drug overdose in 2021 - the highest on record (Panchal et al., 
2023). Rates of psychedelic use are no exception to rising use rates, with an estimated 2% of the 
U.S. population using hallucinogens in 2018 (Substance Abuse and Mental Health Services 
Administration, 2019), an increase of 56% since 2015 (Yockey et al., 2020). Coinciding with 
escalation in drug abuse and overdose rates, however, is research evidence demonstrating the 
efficacy of PAT to treat addiction. A 2016 systematic review of 25 years of clinical trials 
summarized the anti-addictive effects of psychedelics, presenting evidence supporting the 
efficacy of LSD and psilocybin for treating alcohol, tobacco and heroin use disorders (dos Santos 
et al., 2016). A 2017 study of 44,000 illicit opioid users, from the National Survey on Drug Use 
and Health between 2008 and 2013, found psychedelic use was associated with a 40% reduced 
risk of opioid abuse and 27% reduced risk of dependence (Pisano et al., 2017). A 2019 survey of 
343 respondents with prior alcohol use disorder (AUD) and reporting cessation or reduction after 
the use of psychedelics in non-clinical settings found that 83% no longer met the AUD criteria 
following their psychedelic experience (Garcia-Romeu et al., 2019).

Paul Sacco, PhD, MSW, School of Social Work – Principal Investigator
Laura Ting, PhD, MA, School of Social Work – Principal Investigator

The purpose of this study is to foster a highly skilled and committed workforce, the proposed project aims to conduct pilot 
exploratory analysis with the goal of developing intervention components to prevent burnout and 
increase retention among early career behavioral health professionals. Using a sequential QUALqual design,
41 we will begin by gathering data from newly graduated social workers and nurses
(>6 months & <2 years) working in behavioral health settings and then conduct interviews with 
clinical supervisors and program directors in behavioral health settings. In the interviews with new 
clinicians, we will explore their personal strategies for preventing burnout, their future intentions 
with respect to leaving their jobs, and the support they are currently receiving at work. We will 
also ask them to reflect on and discuss various potential modalities for helping to offset burnout 
and promote retention including compensation, training, and clinical supervision. 
Using insights gathered from the new clinicians, we will then conduct interviews with provider 
leadership. During these interviews, we will share information about main themes from the new 
clinicians, with an emphasis on gathering leaderships’ feedback about the feasibility and scalability
of different potential interventions where they work. We will also explore their ideas for retaining 
staff and preventing burnout among early career behavioral health providers. Our specific aims 
are:
Specific Aim 1: Examine how early career nurses and social workers in behavioral health settings
remain engaged with their work and avoid occupational burnout and explore the acceptability of 
potential individual level approaches.
Specific Aim 2: Explore the feasibility and scalability of retention intervention components for 
implementation among new clinicians working in behavioral health settings.
Our aims are closely aligned with The Center for Addiction Research, Education, and Service 
(CARES) mission, Core 1: Workforce development and community-based training and technical 
assistance) of the CARES mission which states that faculty will “Conduct needs assessment by 
discipline to identify primary barriers to addiction-related workforce participation and retention 
among behavioral health professionals” (see https://www.umaryland.edu/cares/). The proposed 
research also reflects the goals of a NIDA Notice of Special Interest (NOT-DA-23-008). In this 
NOSI, it states, “There are numerous individual-, organizational-, and system-level challenges to 
recruiting, training, and retaining behavioral health professionals. Unfortunately, little research has 
been conducted to develop and evaluate strategies to addressing these challenges.”

Max Spaderna, MD, School of Social Medicine – Principal Investigator
Sarah Kattakuzhy, MD, MPH, School of Medicine – Co-Investigator
Habib Omari, PhD, School of Medicine – Co-Investigator
Elana Rosenthal, MD, School of Social Medicine – Co-Investigator

This study will look at barriers and facilitators associated with linkage to, delayed 
linkage to, and retention in psychiatric care. To answer these questions, we will use data from 
the Long-term Outcomes of Opioid-using Persons (LOOP) study, a two-year, prospective, 
natural-history cohort of 200 individuals designed to characterize opioid use. The LOOP study is 
fully enrolled and anticipated to complete data collection in August 2023. Participants were 
eligible for LOOP if they were older than 18 years old and met criteria for OUD within the past 
three years. Every six months, LOOP participants complete surveys regarding their 
demographics, substance use outcomes, psychiatric symptoms, and quality of life outcomes. 
Patients identified as needing a referral to a psychiatrist can be linked either to a psychiatrist in 
the community or a psychiatrist associated with LOOP that can treat patients through
telemedicine visits.
AIM 1: Identify factors associated with linkage to psychiatric care in patients with OUD referred 
for psychiatric treatment.
• Hypothesis 1a: Successful linkage will be associated with lower OUD scores, more 
severe psychiatric illness as rated by screening tools, and telemedicine mode of 
psychiatric services (vs. in person)
o Endpoint: Linkage to care, defined as attendance of at least one visit with the 
LOOP psychiatrist
• Hypothesis 1b: Time to linkage to care, defined as number of days from referral to first
intake appointment, will be associated with OUD scores and mode of psychiatric services 
o Endpoint: Time to linkage to psychiatric care with the LOOP psychiatrist
Aim 1 Approach: Utilizing existing data from LOOP, we will identify patients referred to the 
LOOP psychiatrist at any time point and assess for linkage and time to linkage to psychiatric 
care. Frequencies of demographics, substance use outcomes, severity of psychiatric illness, 
model of care visit (in person vs. telemedicine) and quality of life metrics will be compared 
based on linkage (Aim 1a) and time to linkage (Aim 1b) to care. Multivariable logistic regression 
models will be used to compute adjusted odds ratios and 95% confidence intervals for 
associations between multiple factors and linkage to psychiatric care. Poisson regression models 
will be used to compute incidence rates of delayed linkage in care. Multivariable Cox 
proportional-hazards models will be used to determine factors associated with delayed linkage to 
care. Patients will accumulate person-time from when they are referred to psychiatric care to 
when they attend their first visit with the LOOP psychiatrist.
AIM 2: Identify factors associated with retention in psychiatric care for patients with OUD. 
• Hypothesis 2: Retention in psychiatric care with the LOOP psychiatrist for patients with 
OUD will be associated with lower OUD scores and telemedicine mode of psychiatric 
services (vs. telemedicine)
o Endpoint: Retention in care, defined as remaining in psychiatric care with the 
LOOP psychiatrist for 6 months after linkage
Aim 2 Approach: Utilizing LOOP data, we will compare patients with OUD based on their 
retention in psychiatric care by frequencies of demographics, substance use, severity of 
psychiatric illness as rated by screening tools, model of care visit (in person vs. telemedicine), 
and quality of life metrics. Multivariable log-binomial regression models will be used to compute 
adjusted risk ratios and 95% confidence intervals for associations between multiple factors and 
retention in psychiatric care.
AIM 3: Understand barriers and facilitators to linkage to and retention in psychiatric care for 
patients with OUD. 

Nalini Negi, Ph.D., MSW, Associate Professor, University of Maryland School of Social Work, Principal Investigator
Wendy Camelo Castillo, MD MSc Ph.D., Assistant Professor, University of Maryland School of Pharmacy, Co-Principal Investigator
Fernando Wagner, Sc.D., MPH, Professor, University of Maryland School of Social Work, Co-Principal Investigator

Project Description: Latinos who are mostly foreign-born and monolingual are among the fastest-growing groups in Baltimore. With CARES funding, we will gather important Phase I pilot data for a NIH R01 proposal to implement a larger research program to build an integrated system of care for under-insured or uninsurable substance-using Latino im/migrants (LM). Using Community Based Participatory Research (CBPR) principles, six focus groups with LM and six with behavioral health specialists (BHS) will be conducted to elucidate barriers and facilitators to SUD services in Baltimore. Next, a Community Advisory Board (CAB) consisting of LM and BHS will co-initiate the building of a “system of care” approach for substance-using underinsured, and uninsurable Latino immigrants in Baltimore. This application represents an important step toward decreasing health disparities among an extremely vulnerable and underserved population, Latino immigrants. 

Brook W. Kearley, Ph.D. Research Assistant Professor, University of Maryland School of Social Work, Principal Investigator 
Annabelle M. Belcher, Ph.D., Assistant Professor, University of Maryland School of Medicine, Co-Investigator 
Alexandra Wimberly, Ph.D. Assistant Professor, University of Maryland School of Social Work, Co-Investigator

Project Description: This qualitative study will assess potential barriers to staff acceptability of medication for opioid use disorder (MOUD) programs in detention centers.  Study aims include A1a. Assess staff acceptance of soon-to-be-implemented MOUD programs at four geographically diverse Maryland jails; A1b: Assess for types of stigmas held by these staff, including (1) perceptions of MOUD efficacy, (2) attitudes towards MOUD, and (3) stigma against people who use opioids (PWUO); A2. Assess any differences in perceptions and attitudes towards MOUD and PWUO between various levels of staff in these detention center settings (leadership, line officer, health/medical, discharge coordination staff) across the sites; and A3. Assess the feasibility of a staff-tailored training intervention designed to address barriers to MOUD acceptability. 

Bethany DiPaula, Pharm.D., BCPP, FASHP, Professor, University of Maryland School of Pharmacy, Principal Investigator 
Catherine Cooke, PharmD, MS, BCPS, PAHM, Research Associate Professor, University of Maryland School of Pharmacy, Principal Investigator

Project Description: Inadequate access to medications for opioid use disorder (OUD) contributes to undertreatment and has been exacerbated by the COVID pandemic. Variable pharmacy access to buprenorphine has been raised as a local and national issue, yet data on the extent of this problem, contributing factors, and solutions are limited and conflicting. This project will assess the availability of buprenorphine/naloxone in Maryland community pharmacies and real-world obstacles that pharmacists face when stocking and dispensing this medication for the treatment of OUD. Based on the findings, the researchers will propose targeted strategies to address the obstacles. The goal is to improve treatment access and care for individuals with OUD.

Max Spaderna, MD, Assistant Professor, University of Maryland School of Medicine, Principal Investigator 
Charles Callahan, DO, Adjunct Professor, University of Maryland School of Medicine, Co-Principal Investigator 
Aaron D. Greenblatt, MD, Assistant Professor, University of Maryland School Medicine, Co-Principal Investigator 
Samuel B. Little, Ph.D., Clinical Associate Professor, University of Maryland School of Social Work, Co-Principal Investigator 

Project Description: Providing permanent housing benefits homeless individuals with opioid use disorder, but this is often difficult to provide, The Social Work Assistance and Stipends for Housing (SASH) study will give six months of housing stipends that can be used for a broad range of temporary housing options to homeless individuals receiving methadone for opioid use disorder treatment. These stipends will be accompanied by 12 months of Social Work assistance aimed at finding permanent housing for the participants. The purpose of SASH is to determine whether these interventions will improve outcomes for housing, quality of life, opioid use disorder, and methadone treatment.

Michelle Tuten, Ph.D., MSW, Associate Professor, School of Social Work, Principal Investigator
Aaron Greenblat, MD, Assistant Professor, Scool of Medicine, Co-Principal Investigator 
Eric Weintraub, MD, Associate Professor, School of Medicine, Co-Principal Investigator

The proposed study represents phase I of a multi-phase research plan to develop a smoking cessation intervention tailored to the specific needs of a population enrolled in OUD treatment. Phase I consists of a survey study of the demographic characteristics and smoking behaviors of patients enrolled in OUD treatment at baseline, and an initial efficacy trial for N=20 participants randomly assigned to receive smoking cessation medications combined with contingency management (CM) for daily medication ingestion (Enhanced smoking cessation [ESC: n=10]) or usual care (UC: n=10). These data will help us determine the population’s level of interest in smoking cessation intervention and provide initial data on whether enhanced care shows promise as a smoking reduction intervention. 

Specific Aims: 
AIM 1. To assess the demographic and smoking behaviors of N=50 patients enrolled in OUD treatment at baseline.  
AIM 2a. To compare participants randomly assigned to receive ESC or UC on demographic and smoking behaviors at baseline and 1, 3, and 6 months post-treatment (AIM 1).
AIM 2b. to assess the initial efficacy of ESC (n=10) relative to UC (n=10) on a proportion of the population who fill a prescription for smoking cessation medications, self-reported smoking quantity and frequency, self-reported NRT use, carbon monoxide levels, and substance use at 1, 3, and 6 months post-treatment enrollment.  
AIM 3. To assess the level of medication adherence (medication ingestion/scheduled observation sessions) for ESC participants.  

Annabelle M. Belcher, Ph.D., Assistant Professor, School of Medicine, Principal Investigator 
Todd Gould, MD, Professor, School of Medicine, Co-Principal Investigator
Eric Weintraub, MD, Associate Professor, School of Medicine, Co-Principal Investigator
Sarah Kattakuzhy, MD, Assistant professor, School of Medicine, Co-Principal Investigator

Methadone is a first-line, evidence-based treatment for opioid use disorder (OUD). Unfortunately, retention and adherence in methadone treatment is a major challenge. OUD patients frequently present with co-morbid depression (OUDCD), a risk factor for poor OUD treatment outcomes, overdose, and suicide. The last two decades have seen an exciting and transformational development in the treatment of depression – ketamine. As a safe, rapid-acting anti-depressant deliverable within the context of methadone maintenance treatment, ketamine could feasibly change the landscape of treatment for OUD patients with comorbid depression. This proposal seeks to evaluate implementation outcomes (feasibility and patient acceptance) as well as preliminary efficacy of ketamine on methadone treatment outcomes for OUD patients with comorbid depression and depressive symptoms presenting for methadone treatment.

Specific Aims:
SA1: Assess the feasibility and acceptance of a two-week regimen of sub- anesthetic antidepressant doses of ketamine as an adjunct to methadone in a racially diverse, low-income sample (n=6) of patients seeking treatment for opioid use disorder. 
SA2: Measure the impact of this ketamine dosing protocol on 1- and 3- month methadone maintenance treatment retention and depression.

Marik Moen, Ph.D., MPH, MSN, RN, Assistant Professor, School of Nursing, Principal Investigator
Max Spaderna, MD, Assistant Professor, School Of Medicine, Co-Principal Investigator 
Sarah Kattakuzhy, MD, Assistant Professor, School of Medicine, Co-Principal Investigator 
Aaron Greenblatt, MD, Assistant Professor, School of Medicine, Co-Principal Investigator

Substance use disorders (SUD) are among the greatest public health challenges facing the United States, resulting in millions of lives and billions of dollars lost. Improving research on SUD is necessary to address the public health crisis of substance misuse and disorders. Further, we recognize that successful employment and treatment for persons with SUD can prevent death and illness, but social determinants of health (e.g., housing, income, transportation, education) are barriers to treatment. As programs and employers seek to address these health-related social needs (HRSN), they are missing the stakeholder (patient, staff, and employer) perspective on how assessing unmet needs is viewed, what social needs are most relevant, and what to do about them. If we fail to grasp the stakeholder preferences and values, we miss opportunities to address critical problems, appropriately allocate resources, or adapt care/interventions for improved outcomes. To address the need for improved SUD research and lack of patient-centered approaches to addressing health-related social needs, the PURPLE and PEARL projects are collaborating to implement the following projects.

Improving Patient and Provider Engagement in Addiction Research Through A Longitudinal Research Collaborative - PEARL 
PEARL’s main objective to improve substance use research and incorporate the lived experience of individuals with substance use in the research process through the creation of a collaborative research council comprised of patients, staff, and investigators who will evaluate and develop addiction research. PEARL will consist of two interventions, the Research Advisory Council (RAC) and the Research Advisory Forum (RAF). The RAC will be comprised of investigators, staff, and patients of the ATP, and will meet quarterly to discuss and provide feedback on current protocols and various aspects of research including recruitment and compensation of study participants, study operations, study risks and benefits, promotion of justice and cultural relevance, and new ideas for substance use research projects. The semi-annual RAF open meeting will be led by patient RAC members as a forum to solicit feedback on several topics including making research projects more valid and meaningful to patients, addressing gaps in care that may inform the development of new investigations, and allowing Principal Investigators (PIs) to disseminate their research findings directly to the affected population.

Promoting Understanding in social needs Research Projects by Listening and Engagement - PURPLE 
PURPLE’s main objective is to help establish the PEARL RAC and then engage RAC members in guiding a qualitative research study. The PURPLE study seeks to gain firsthand expertise about the preferred methods of assessing, documenting, and addressing HRSN from persons with substance use disorders, from direct-service staff, and employers of persons with SUD. PURPLE will engage the PATIENTS program from the School of Pharmacy to facilitate implementation of the 10-Step Patient Engagement Framework and work with faculty from the Schools of Nursing, Social Work, and Medicine and ATP partners to implement the study. All interventions will be held at the University of Maryland Addiction Treatment Program (ATP), a certified substance use treatment program that collocates medical care, wellness programs, and research.

Bethany A. DiPaula, PharmD, BCPP, School of Pharmacy, Principal Investigator

Catherine E. Cooke, MS, PharmD, BCPS, PAHM, School of Pharmacy, Co-Principal Investigator

Project Goal

Expand access to medications for managing opioid use disorder (OUD) by establishing strategies for the financing of a physician-pharmacist collaborative model

Problem and Significance

Opioid use disorder (OUD) is a national emergency that requires additional resources to address. Evidence-based medications have been shown to decrease morbidity and mortality and increase treatment retention but are underused. The shortage of healthcare providers trained and available to manage patients with OUD medications contributes to undertreatment.

Employing new strategies and engaging all qualified healthcare professionals are key elements to increasing access to treatment for patients with OUD.  The physician-pharmacist collaborative model is an innovative solution to addressing workforce needs for patients with OUD. Utilizing pharmacists with extensive education and skills in medication management can reduce the resource gap in available care for patients with OUD. Close collaboration between prescribers and pharmacists can optimize medication selection, improve patient safety, and expand access to care. However, pharmacists do not have a traditional payment model to provide these services, which limits their ability to collaborate in non-acute care settings.

 Approach

Semi-structured interviews will be used to elicit third-party payer perspectives on expanding access to OUD medications through financing of physician-pharmacist collaborative model. A white paper will be produced describing the identified barriers and proposed solutions. A survey of the third-party payers will assess the impact of the White Paper.

Bradford Schwartz, MD, School of Medicine, Principal Investigator

Zach Dezman, MD, MS, School of Medicine, Co-Investigator

Christopher J. Welsh, MD, School of Medicine, Co-Investigator

Emergency Department-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) is emerging as an effective bridge to substance abuse treatment. The implementation of SBIRT via peer recovery coaches (PRC) is a relatively new phenomenon in the emergency department. PRC’s are typically non-professional community health educators, many of who are in long-term recovery themselves, who receive training in motivational interviewing. PRCs have successfully piloted ED-based SBIRT programs in many of the large-volume ED sites in the University of Maryland Medical System (UMMS) network, boasting improved linkage to care, 30-day retention rates, and higher patient satisfaction. Smaller ED’s with lower patient volumes and tighter budgets often do not have access to SBIRT. We evaluated the impact of a telemedicine model, utilizing Peer Recovery Coaches to deliver SBIRT, in two freestanding emergency departments. We hypothesized that the intervention of telemedicine to deliver SBIRT would be non-inferior to in-person communication in regard to patient referrals to outpatient substance abuse treatment as well as 30-day retention rates in treatment. Interestingly, this study occurred during the COVID pandemic. 

Sarah Kattakuzhy, M.D., School of Medicine, Principal Investigator

Maryland is among the top five states in the incidence of opioid-related deaths, with a rate of 32.2 deaths/100,000 persons, more than twice the national average. Despite the significant burden of disease attributable to opioid use disorder (OUD), and a wealth of data linking accessible treatment services to improved outcomes, implementation of evidence-based therapy remains poor. Barriers to the treatment of OUD exist at the patient, provider, and health system levels. However, stigma– both explicit and implicit- is the common driver of these barriers, reinforcing the gap between treatment need and uptake. Bias and poor education within the medical community serve to exacerbate this gap, limiting the number of patients who seek OUD care, and perpetuating the broken systems that reinforce addiction. To address the opioid epidemic, the healthcare workforce must not only expand but address stigma and bias through comprehensive, culturally-competent, interdisciplinary education in OUD.

The project Accelerating Interdisciplinary Resident Education in Opioid Use Disorder and Harm Reduction (AIROH) is an OUD education intervention to improve the knowledge and skills of residents on the front lines of the opioid epidemic and augment the physician workforce able to provide comprehensive, culturally-competent, and evidence-based care to patients with OUD. This initiative consists of two parallel interventions:

• OUD Primer: a didactic curriculum completed by every first-year (PGY-1) IM and FM resident at UMB, which includes longitudinal didactic education and buprenorphine waiver training.
• OUD Elective: an optional two-week elective that would provide an expanded didactic curriculum along with immersive clinical experience for second and third-year (PGY-2/3) IM and FM residents.

The project is led by a multidisciplinary team spanning the Departments of Medicine, Family & Community Medicine, and Psychiatry, including Drs. Sarah Kattakuzhy, Aaron Greenblatt, Dani Baek, Britt Gayle, and Elana Rosenthal.

To evaluate the success of the OUD Primer and OUD Elective interventions, all residents participating in the AIROH initiative will complete a survey entitled “Knowledge of and Attitude towards OUD” (KAO) before and after the OUD Primer or OUD Elective. The survey includes knowledge questions pertaining to diagnosis and management of OUD, as well as attitude questions, self-reflective assessments of bias and confidence in caring for individuals with OUD.

In 2020, the AIROH Program was initiated, conducting fall training sessions for PGY-1 FM and IM residents, including buprenorphine waiver training completion. Preliminary outcome data from the KAO was accepted for presentation at the American Society of Addiction Medicine 2021 conference. In 2021, we will complete didactic training, and hold the OUD Elective for PGY-2 and 3 residents. Beginning in July 2021, AIROH is poised to transition as a funded permanent training program, managed by the Maryland Addiction Consult Service, with expansion into the advanced practice provider and healthcare student populations- exemplifying the power of the CARES grant program.  

Jodi Jacobson Frey, PhD, MSW, LCSW-C, CEAP, School of Social Work, Co-Principal Investigator

Marianne Cloeren, MD, MPH, FACOEM, FACP, School of Medicine, Co-Principal Investigator

Although clinical outcomes are improved in patients with opioid use disorders who hold employment, many of these individuals do not work. This study seeks to provide valuable data for the multiphase interprofessional project, “Operation PROSPER – Peer Reintegration and Other Services Promoting Employment in Recovery”, which will identify and help to systematically overcome the barriers to employment faced by individuals receiving Medication Assisted Treatment (MAT) for Opioid Use Disorder (OUD) in University of Maryland clinics. More specifically, this study will concentrate on defining the gap in critical soft skills among adults receiving MAT; therefore, a focus will be on identifying areas needing improvement and support to prepare adults for interviews, to obtain jobs, and to sustain employment. This study has four aims, the first being to provide data on strengths and gaps in vocational soft skills using the ERS and perceived work disability using the World Health Organization Disability Assessment Schedule 2.0 among working-age patients receiving MAT and meeting inclusion criteria. The second aim is to assess, through focus groups with counselors and clinic administrators, and interviews with a sample of patients, the feasibility and potential benefit of using the ERS and customized ERS Action Planning tool as a prevocational service to support treatment offered at MAT programs for patients with OUD seeking employment.The third aim is to use asset mapping techniques to describe and summarize currently existing resources and partnerships throughout Baltimore City (and State of Maryland as appropriate) to meet the needs identified in the ERS Action Planning tool. Finally, the fourth aim is to compare results from the asset map to data collected from counselors, participants, and a sample of employers and workforce development program staff to identify gaps in resources and services identified as needs by the ERS Action Planning tool. The results of this study will produce much-needed information on strengths and gaps for obtaining and sustaining employment, with specific attention to soft skills and the needs of patients with OUD who are in recovery with MAT.

Zachary Dezman, MD, MS, School of Medicine, Principal Investigator

It has been reported that fentanyl positivity may paradoxically worsen withdrawal in patients undergoing buprenorphine induction in the emergency department (ED). In this study, we will determine the overall prevalence of fentanyl use, and then stratify these patients by complaint. It is hypothesized that patients who are positive for fentanyl and are undergoing buprenorphine induction in the ED will be more likely to suffer from episodes of worsening withdrawal, or require a prolonged induction (multiple small doses spaced over 6-8 hours), than those who are fentanyl-negative. This research will add to the current dearth of information related to the impact of fentanyl use.

Kristen Rawlett, PhD, FNP-BC, School of Nursing, Co-Principal Investigator

Alexandra Wimberly, PhD, MSW, MPH, School of Social Work, Co-Principal Investigator

This study addresses the following treatment gaps: 1.) the need for women- focused services for those with opioid use disorder (OUD); 2.) the need to understand factors that impact medication assisted treatment (MAT) adherence, and 3.) the need to understand whether mindfulness interventions are a feasible and acceptable intervention to address MAT adherence. Accordingly, the aims of this study are to first adapt an existing mindfulness intervention for use with MAT adherence. Through running focus groups with women receiving methadone, this study seeks to understand the strengths and challenges of women as it relates to MAT adherence; and incorporate this learning in the mindfulness curriculum. Second, we will pilot the adapted mindfulness intervention for MAT adherence with women who are receiving methadone and test its impact on MAT adherence and substance use. Finally, this study will assess predictors of MAT adherence by controlling for the effects of demographics, self-stigma and motivation on MAT adherence and conducting qualitative interviews to better understand determinants of MAT adherence.

Victoria Selby, PhD, CRNP, UMB School of Nursing, Co-Principal Investigator

Marc Fishman, Maryland Treatment Centers (MTC) Medical Director, Co-Principal Investigator

Kevin Wenzel, PhD, MTC Research Scientist, Clinical Psychologist, Investigator

The Youth Opioid Recovery Support (YORS) model is a promising, innovative, inter-professional, behavioral approach that attempts to address barriers to opioid treatment engagement in the vulnerable young adult population, especially difficulties with medication adherence. Components of YORS include assertive outreach, home-delivered medication administration, contingency management, and family engagement.  The purpose of this study is to evaluate a pilot enhancement of the YORS intervention in patients who have chosen either extended-release naltrexone or extended-release buprenorphine for treatment, use of standard reimbursement to cover clinical services, and transitioning back to clinic-based care after an intensive phase of home delivery. The first aim of this study is to evaluate feasibility and preliminary efficacy of the enhanced YORS intervention compared to recent historical data from a pilot RCT including both a YORS intervention group as a benchmark and a TAU group as a control, on the outcomes of doses of medication received, rates of opioid relapse, and total number of opioid positive urine tests. The second aim is to demonstrate the benefits of the enhanced YORS intervention in a pre-post evaluation using each participant as their own control, on the secondary outcomes of HIV risk behaviors, criminal behaviors, functional improvement, overdoses, and pattern of crisis services utilization. The third aim is to assess whether the intensive YORS intervention has the possibility of priming less intensive continuing care by measuring the rate of receipt of a clinic-based dose in the month following the last home-delivered dose. Thus, this study will glean key information that will be used to improve engagement and medication adherence for youth with OUD.

The reference list is not included in the 5-page limit for the proposal.

Yes, faculty salaries are supported by SSG funding and should be included in the budget. Faculty requesting salary support should ensure that any salary support is approved by their respective school deans or department heads, as appropriate. 

There are no specified limits on the amount of salary support that can be requested.

The SSG proposal should specify the team's plans to apply for external funding and how the SSG pilot funding will enhance the team's prospect of obtaining future funding.