Targeted antitobacco ads may not be as effective as ads for all audiences

Published on: April 29, 2021
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UNIVERSITY PARK, Pa. — Antitobacco media campaigns that directly target vulnerable minority groups may be no more effective for the intended group than more broadly appealing ads, according to a Penn State study. However, antitobacco messages may evoke anger toward the industry regardless of the audience.

In the study, the researchers tested the efficacy of antitobacco advertising that targeted two vulnerable groups — Black individuals and sexual/gender minority individuals. The study’s results were published in the journal Nicotine and Tobacco Research.

“In many ways there are groups that have been disproportionately affected by tobacco, in no small part because the tobacco industry has intentionally tried to market to and sell their products to these communities,” said Chris Skurka, an assistant professor of media studies in the Donald P. Bellisario College of Communications. “The communities we talk about in this study are just two examples.”

For years, antitobacco campaigns focused on health consequences. Campaigns like The Truth highlight deceptive strategies used by tobacco companies, instead of just the health risks.

“For many years The Truth campaign has been using what we call ‘counter industry marketing’ to cultivate a new norm that smoking is not cool, and the tobacco industry is not your friend,” Skurka said. “We were interested in whether communities targeted by Big Tobacco would be receptive to anti-smoking Truth ads that target their ingroup.”

The researchers found little evidence that the targeted ads were influential for the intended group. When the ads were made specifically for their in-group, there was little effect on those groups’ beliefs and motivations toward tobacco.  However, antitobacco advertisements for a general audience elicited anger across all surveyed groups.

In the web-based experiment, 1,161 young American adults were asked to watch one of eight advertisements at random. Around one-third of the respondents identified as Black, one-third as a sexual/gender minority and one-third as neither.

Some saw an advertisement by The Truth campaign that did not target a specific group. Others saw a Truth ad targeting Black Americans. Another group watched a Truth ad targeting sexual or gender minority individuals. And the fourth group, the control group, watched an ad unrelated to smoking.

There was minimal evidence that the targeted ads were more effective than the ads that did not target a specific group. Anger was associated with greater support for tobacco control policies and negative attitudes toward the industry from the respondents. Skurka said the results demonstrate how important it is for antitobacco campaigns to remember the role of emotion when making decisions.

“We know that emotion drives behaviors,” he said. “It seems like anger is a really potent way to motivate antitobacco outcomes in people. Studies have looked at fear response to anti-smoking campaigns, I think we should also look at anger and disgust at the industry as well.”

Co-authors of this study were Christopher Wheldon, Temple University, and Nichols Eng, a doctoral student at the Bellisario College. Skurka is an affiliate faculty member of the Science Communication Program, a program in the Bellisario College that supports research in the science of science communication.

Parents more lenient about alcohol with teens who experience puberty early

Published on: April 28, 2021
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UNIVERSITY PARK, Pa. — Parents of teens who went through puberty early may be more lenient when it comes to letting them consume alcohol, according to a new Penn State study. But the researchers said that even if adolescents appear more mature, drinking alcohol is still not safe for them.

Rebecca Bucci, a doctoral candidate in criminology at Penn State, said the study — published today (April 28) in Child Development — aimed to discover why adolescents who go through puberty early are more likely than their peers to drink alcohol.

“A surprising proportion of parents in our study allowed their early-developing children to drink alcohol at the age of 14 — in fact, one in seven,” Bucci said. “It is important to remember that early puberty does not mean the child is more advanced in cognitive or brain development. They are not older in years or more socially mature. So allowing them freedoms common for young adults is risky.”

According to the researchers, previous studies have found that adolescents who go through puberty early compared to their peers are at a greater risk for problem behaviors, including being two to three times as likely to drink alcohol.

While prior studies often didn’t delve into why these heightened risks exist, the researchers said there are theories. For example, adolescents who develop earlier than their peers may have weaker relationships with their parents or have less parental supervision.

To this point, Bucci said there are conflicting theories about how to parent adolescents who are more physically mature than their peers.

“Parents want to do what is best for their children, and some may wonder whether a child who starts looking older should begin to have some adult freedoms,” said Jennifer Maggs, professor of human development and family studies and Edna P. Bennett Faculty Fellow in Prevention Research in Human Development and Family Studies. “Ultimately, we wanted to understand why adolescents who experience puberty at younger ages drink more than others, including factors involving the parents.”

The researchers used data from more than 11,000 adolescents in the Millennium Cohort Study — a nationally representative sample of children in the United Kingdom. Data was collected at various checkpoints throughout the children’s lives, including information on whether they’d ever drank alcohol, how often they drank and whether they had ever drank five or more drinks on one day.

They also gathered information about whether the parents permitted alcohol use, as well as the adolescents’ “perceived pubertal timing.”

“In our study, the measure of pubertal timing is based on adolescents’ reports of their own pubertal changes,” said Lorah Dorn, professor of nursing. “Adolescents were asked a series of questions about their physical development and we averaged these scores for each person and compared them to the scores of same-sex adolescents who were very close to them in age.”

The researchers then grouped participants into three perceived pubertal timing groups — early, on-time and late.

After analyzing the data, the researchers found that adolescents who experienced early puberty were more likely to drink at age 14 than their on-time peers.

Girls who went through puberty early were 29% more likely to have ever drank and 55% more likely to frequently drink. Among boys, the results were 22% and 61% more likely, respectively. Boys who developed early were also 78% more likely to have binge drank compared to boys who went through puberty on time.

Additionally, the researchers found that adolescents who experienced earlier puberty were more likely to be allowed to drink by their parents.

Specifically, while 15% of parents overall allowed their adolescents to drink alcohol at age 14, this was largely driven by parents of adolescents who went through puberty early — 20% of those parents allowed their children to drink. Teens who developed early were also more likely to have friends who drank and more likely to be allowed to hang out with peers without adult supervision.

According to the researchers, these factors partially explained why adolescents with early puberty had higher rates of drinking.

Bucci said the results suggest that parents can have a hand in helping their teens avoid early drinking.

“This further instills the idea that parents should consider not allowing their child to drink alcohol, even if they appear more physically mature,” said Jeremy Staff, professor of sociology, criminology, and demography. “Even if their child starts to look like a teenager or adult at a young age, parents should maintain the level of support and structure that matches their child’s actual age and developmental maturity level.”

The National Institute on Alcohol Abuse and Alcoholism and the Economic and Social Research Council UK helped support this research.

This article originally appeared in Penn State News.

E-cigarettes with cigarette-like nicotine delivery reduce exposure to lung carcinogen

Published on: April 12, 2021
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Doctor is comparing electronic vaporizer and conventional tobacco cigarette.

E-cigarettes that deliver a cigarette-like amount of nicotine are associated with reduced smoking and reduced exposure to a major cancer-causing chemical, or carcinogen, in tobacco, even with concurrent smoking, according to a new study led by researchers at Penn State College of Medicine and Virginia Commonwealth University (VCU). The study provides new and important information for smokers who may be trying to use e-cigarettes as a means to cut down on their smoking habit and lower their exposure to harmful toxicants.

“We found that e-cigarettes that delivered a similar amount of nicotine as traditional, combustible cigarettes helped reduce smoking and exposure to a harmful carcinogen,” said Jonathan Foulds, a researcher at Penn State Cancer Institute and professor of public health sciences and psychiatry and behavioral health. “This study shows that when smokers interested in reduction are provided with an e-cigarette that has cigarette-like nicotine delivery, they are more likely to achieve significant decreases in tobacco-related toxicants, such as lower exhaled carbon monoxide levels.”

The researchers conducted a randomized controlled trial of 520 participants who smoked more than nine cigarettes a day, were not currently using an e-cigarette device, and were interested in reducing smoking but not quitting.

Over 24 weeks, participants used an e-cigarette device filled with either 0, 8 or 36 milligrams per milliliter of liquid nicotine or a plastic tube (shaped like a cigarette) that delivered no nicotine or aerosol. The e-cigarette conditions were chosen to reflect a range of nicotine delivery: either none, low (8 mg/ml) or cigarette-like (36 mg/ml). The participants were also provided with smoking reduction instructions.

At weeks 0, 4, 12 and 24, the researchers sampled participants’ urine, testing for the tobacco-specific carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol, also known as NNAL. They found that participants using e-cigarettes filled with the cigarette-like level of liquid nicotine had significantly lower levels of NNAL at week 24 compared to baseline and compared to levels observed in the non-e-cigarette control condition.

According to Foulds, the findings represent an important addition to the scientific literature because they suggest that when e-cigarettes deliver nicotine effectively, smokers have greater success in reducing their smoking and tobacco-related toxicant exposure. Caroline Cobb, associate professor of psychology at VCU and lead author, said the study is important for two reasons.

“First, many e-cigarettes have poor nicotine delivery profiles, and our results suggest that those products may be less effective in helping smokers change their behavior and associated toxicant exposure,” Cobb said.

“Second, previous randomized controlled trials examining if e-cigarettes help smokers change their smoking behavior and toxicant exposure have used e-cigarettes with low or unknown nicotine delivery profiles,” Cobb said. “Our study highlights the importance of characterizing the e-cigarette nicotine delivery profile before conducting a randomized controlled trial. This work also has other important strengths over previous studies including the sample size, length of intervention, multiple toxicant exposure measures and control conditions.”

The question of whether an e-cigarette’s nicotine delivery profile is predictive of its ability to reduce harm and promote behavior change among smokers remains highly relevant to policymakers, public health advocates, health care providers and smoking populations. That knowledge will lead to better designed studies of the potential harms and benefits of e-cigarettes and ultimately inform tobacco regulatory policy, Cobb said.

Foulds said the study contributes to the ongoing question of what role e-cigarettes play in changing smoking behavior. Additionally, the study’s findings support limited safety concerns for the use of the specific e-cigarette and liquid combinations over the short term, even in the context of concurrent cigarette smoking. However, Cobb added, very little is known about the effects of e-cigarettes over the course of years, as opposed to the study’s 24-week period.

The study, “Effect of an Electronic Nicotine Delivery System with 0, 8, or 36 mg/ml Liquid Nicotine Versus a Cigarette Substitute on Tobacco-Related Toxicant Exposure: a Randomised Controlled Trial,” was published in Lancet – Respiratory Medicine.

Jessica Yingst and Susan Veldheer of Penn State College of Medicine; Alexa Lopez of University of Wisconsin-Milwaukee; Christopher Bullen of University of Auckland in New Zealand; Thomas Eissenberg, Le Kang and Miao-Shan Yen of Virginia Commonwealth University were also co-authors on this research.

This research was supported by the National Institutes of Health and the U.S. Food and Drug Administration. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or FDA.

Jonathan Foulds has done paid consulting for pharmaceutical companies involved in manufacturing smoking-cessation medications (e.g., Pfizer, GlaxoSmithKline, Johnson & Johnson); and has acted as a deposed and compensated expert witness on behalf of plaintiffs suing cigarette manufacturers. None of the study authors have accepted funding from tobacco or electronic cigarette manufacturers.

This article originally appeared in Penn State Health News.

Pandemic stress, boredom caused some PA residents to increase cigarette use

Published on: March 30, 2021
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HERSHEY, Pa. — Stress, increased free time and feelings of boredom may have contributed to an increase in the number of cigarettes smoked per day during the early months of the COVID-19 pandemic by nearly a third of surveyed Pennsylvania smokers. Penn State College of Medicine researchers said understanding risk factors and developing new strategies for smoking cessation and harm reduction may help public health officials address concerning trends in tobacco use that may have developed as a result of the pandemic.

Jessica Yingst, assistant professor of public health sciences and Penn State Cancer Institute researcher, said smokers who increased the number of cigarettes they smoked per day could be at greater risk of dependence and have a more difficult time quitting.

Researchers asked 291 smokers about their tobacco use patterns before and during the early months of the pandemic including how frequently they used tobacco products, reasons why their use patterns changed and whether they attempted to quit. Nearly a third of smokers reporting increased use due to stress, increased free time and boredom. One participant stated, “Working at home allows me to smoke at will rather than being in a smoke-free environment for 8 hours per day.” In contrast, 10% of participants decreased their tobacco use and attributed that to schedule changes, being around non-smokers such as children, and health reasons.

Nearly a quarter of participants reported attempting to quit smoking during the pandemic. A third of those who attempted to quit conveyed that they did so to reduce their risk of poor outcomes should they become infected with COVID-19. One participant stated, “I quit as soon as I came down with a fever and cough. Clearly, I am aware of how detrimental smoking is to my health; however, I did not consider how it could make me more vulnerable to COVID-19 and its effects. I was terrified and quit immediately.” Ultimately, seven people were successful in quitting all tobacco use.

The research team also asked the participants about their perceptions of health risks during the pandemic. More than two-thirds of participants believed their risk of contracting COVID-19 was the same as non-tobacco users. However, more than half of those surveyed thought they were at higher risk to suffer serious complications from COVID-19. The results were published in the International Journal of Environmental Research and Public Health.

“Knowing the reasons for increased tobacco use and the motivations of those who successfully quit smoking can help us identify how to better address cessation efforts during the pandemic,” Yingst said. “New methods like telemedicine and increasing public health messaging could encourage people to stop smoking in the absence of public support groups or other in-person interventions.”

This study was conducted by the Penn State Center for Research on Tobacco and Health. Tobacco users interested in participating in future research can call 844-207-6392 or visit the center’s website to learn more about current studies and find out if they are eligible to participate.

Nicolle Krebs, Candace Bordner, Andrea Hobkirk, Sophia Allen and Jonathan Foulds of Penn State College of Medicine also contributed to this research. Foulds has done paid consulting for pharmaceutical companies involved in producing smoking cessation medications, including GSK, Pfizer, Novartis, J&J and Cypress Bioscience. The other authors have no disclosures to report related to this publication.

This research was supported by the National Institutes of Health and the National Center for Advancing Translational Sciences through Penn State Clinical and Translational Science Institute (UL1 TR002014). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

This article originally appeared in Penn State News.

Family ties protect young adults from substance misuse

Published on: March 29, 2021
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Opioid use disorders now affect over 2.1 million people in the United States, and rates of drug overdose have skyrocketed over the past three decades. In a collaboration between the Penn State Population Research Institute and Syracuse University’s Lerner Center for Public Health Promotion, researchers presented their findings in a recently published research brief and a recent article in Drug and Alcohol Dependence.

Lead author Alexander Chapman, sociology and demography doctoral candidate at Penn State, says many people who misuse opioids begin during young adulthood. In this age group, one of the most important trends over the past several decades are changes in family formation. Given marriage rates have been declining over the last decade, there are now more adults without a partner or children, a group researchers refer to as “disconnected adults”.

“Because of changing family structures and the dismantling of many institutions that served as safety nets, increasingly young adults are self-medicating for psychological pain and distress,” said Chapman.

The researchers analyzed data on adults ages 18-34 from the 2002-2018 waves of the National Survey on Drug Use and Health to determine links between these changes in family structure and opioid use. They found that married young adults, and those with children, have lower rates of addiction and overdose.

“Some young adults are facing family conflicts and breakdowns, which increases in rates of substance misuse,” Chapman said. “Our findings suggest that new policy efforts, like expanded Child Tax Credits that enable people to achieve the families they wish to have, may have long-term benefits in preventing substance misuse.”

Additionally, the researchers recommend young adults establish social connections within their communities. “Meaningful employment, friendships, and participation in faith-based and other community organizations also provide support, purpose, and meaning,” said Chapman. “If we want to keep people from misusing drugs, we must provide opportunities for everyone to engage in activities that bring meaning and purpose.”

The work is being supported by Penn State’s Population Research Institute, the Social Science Research Institute, and the National Institute of Aging.

Additional authors of the brief include Ashton Verdery, Harry and Elissa Sichi Early Career Professor of Sociology, Demography, and Social Data Analytics at Penn State; and Shannon Monnat, Lerner Chair for Public Health Promotion, associate professor of sociology, and co-director of the Policy, Place, and Population Health Lab in the Maxwell School at Syracuse University.

This article originally appeared in Penn State News.

Penn State researchers combat problems of substance misuse

Published on: March 28, 2021
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UNIVERSITY PARK, Pa. — The misuse of alcohol, opioids, and other substances poses many serious, well-known risks to people’s health and communities. During the COVID-19 pandemic, economic stress, social isolation, and anxiety about the future may have deepened the public health emergency posed by substance misuse and addiction.

Across dozens of projects, researchers in Penn State’s College of Health and Human Development (HHD) are leveraging their own expertise and collaborating with their peers to address the genetic underpinnings of addiction, the effects of drug use on the brain, and three key areas of focus to address substance use: prevention, treatment and recovery.

Researchers are connecting with their colleagues across the University, many through Penn State’s Consortium to Combat Substance Abuse (CCSA). A recent initiative and priority for the University, the CCSA unites researchers from every college and campus to prevent and treat addiction.

“By uniting the expertise and experience from across the University under one umbrella, the CCSA is uniquely positioned to help build a world free from addiction,” said Stephanie Lanza, interim director of the CCSA, director of the Edna Bennett Pierce Prevention Research Center, C. Eugene Bennett Chair in Prevention Research, and professor of biobehavioral health. “And researchers in the College of Health and Human Development have an important role to play in building that world.”

The projects in this story demonstrate some of the challenges that researchers are addressing and some of the novel solutions they are employing to help protect society from substance misuse and addiction.

The view from the front lines

Erica Usher works in one of the many communities ravaged by the opioid epidemic, but she has hope for the future of her three preteen children who she is raising in Fayette County, Pennsylvania. Usher serves as the prevention supervisor for the Fayette County Drug and Alcohol Commission, where she has worked to prevent substance abuse for nearly two decades. She believes in the power of prevention to help stem the opioid crisis and the other substance misuse crises that we face. Read more about why Usher is optimistic.

We Are … uniting our strengths

Penn State unites against substance use and addiction through the CCSA, an interdisciplinary think tank administered through the Social Science Research Institute. The University developed the consortium to foster creative, interdisciplinary thinking that will solve real-world problems related to substance misuse. Learn more about the CCSA and the University’s initiative.

Prevention: Stopping a fire before it starts

The PROSPER program has strengthened family bonds and helped young people avoid addiction. PROSPER, a prevention program that targets sixth and seventh graders, has reduced substance use in communities across Pennsylvania and Iowa since 2001. Students that are part of this program learn social-emotional and decision-making skills that help them avoid substance abuse, improve family life, and decrease delinquency. Similar programs can help decrease youth substance misuse each year. Read more about how we can prevent substance misuse before it starts.

Prevention and treatment: Protecting new mothers when they are most vulnerable

One in 300 cesarean sections will lead to opioid abuse by new mothers. Each year in America, 4 million women will give birth, and of those, 1.2 million women will have a cesarean section. After a cesarean section, women commonly are given opioids for post-delivery pain management. Researchers are working to keep these women and their families safe during this vulnerable time. Learn more about supporting new mothers after a cesarean section. 

Treatment and recovery: Getting healthy and then working on it every day

Though many people see recovery as safe and stable — the same way that recovery from the flu is safe and stable — recovery from substance abuse often requires consistent hard work and active support to be maintained. Viewing recovery as a continuing care model could lead to a more supportive, healthier and more productive society. Read more about supporting people in treatment and recovery.   

This article originally appeared in Penn State News.

Life Unites Us introduces innovative tools to address opioid use disorder in Pa.

Published on: March 26, 2021
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MIDDLETOWN, Pa. — Continuing its Life Unites Us campaign to end the stigma around opioid use disorder, the Douglas W. Pollock Center for Addiction Outreach and Research at Penn State Harrisburg, in conjunction with the Pennsylvania Department of Drug and Alcohol Programs and national nonprofit organizations The Public Good Projects and Shatterproof, has partnered with researchers and staff from the Institute of State and Regional Affairs at Penn State Harrisburg to create a data dashboard that sheds light on opioid and substance use disorder stigma in Pennsylvania.

Weston Kensinger, Pollock Center director, said that challenging and changing established beliefs and reducing stigma is a key factor in removing barriers to treatment and opportunity, as stigma often hinders individuals from seeking and receiving needed treatment and support.

He added that stigma reduction campaigns generally work to address this by sharing stories; however, they often do not provide the needed information, resources or tools for their target audience to understand the many types of stigma that exist or address the specific types and levels of stigma held to influence behaviors. That is where the dashboard comes in.

“Through the use of our web portal and data dashboard, including our web-based trainings and maps, users can better understand the types of stigma that exist, uncover the levels of stigma held by specific target audiences and within user-defined demographics, and gain the resources needed to effectively confront stigma in their local communities,” said Kensinger.

The dashboard includes access to multiple data sets, results of the campaign’s reoccurring statewide stigma reduction survey, and resources such as webinars and ArcGIS maps that researchers, community organizations, medical professionals, lawmakers and the public can use to address stigma. Through various filters, organizations can take a deep look at opioid-related stigma and its effects based on age, race, gender, population density, location and other demographics. Further, the dashboard includes information on advocacy, locating resources and addressing structural barriers.

“This is the first evidence-based substance use disorder stigma reduction behavior change campaign in the nation,” Kensinger said. “It is much more than a typical campaign that only shares people’s stories and gives a few weblinks to general resources. The dashboard component of the campaign allows users to better understand stigma and make data-driven decisions to guide programming, policy and future research initiatives.” Kensinger said he hopes it will prove to be a model for other states.

The data dashboard was designed and developed with a variety of user groups in mind, such as the general public, government officials, single-county authority and community-based organization personnel, and health care professionals involved with substance use disorder prevention, treatment and recovery. The launch of the dashboard is a critical addition to the campaign, which has already reached many people. Between the campaign launch in late September 2020 and February 2021, more than 2.1 million content impressions have been made, and the campaign is now reaching an average of 12,500 individuals per day.

Övgü Kaynak, assistant professor of psychology, outlined the different ways the dashboard can be used.

“Members of the public who want to gain a better understanding of stigma related to substance use disorders can use the health indicators portion of the dashboard to delve into relevant data,” Kaynak said. “Users can explore data related to criminal justice, first responders, institutions, medical providers and social networks. Further, using the maps on the dashboards, they can locate recovery-oriented community-based organizations in their local communities and across the state.”

Erica Saylor, Pollock Center research associate, added that advocates, policymakers, and state and local government officials who want to get a better idea of how stigma is seen in their regions or by specific populations can use survey results within the dashboard.

“They can access findings from our representative statewide stigma survey to better understand how constituents feel, identify areas of need when developing programming or seeking grant funding, or to take a data-driven approach to advocacy and policy change,” said Saylor.

Christopher Whipple, assistant professor of psychology, explained how the dashboard fits into the overall stigma reduction campaign.

“The media outreach portion of the campaign focuses on raising awareness and support, providing stories of hope, and encouraging those with disorders to seek and receive treatment,” Whipple said. “The dashboard complements the media outreach by providing needed information and tools for persons across the commonwealth to better understand stigma so that they can make data-informed decisions and take an evidenced-based approach for driving change within their communities. By equipping and educating the public, policymakers and health care professionals with these targeted data and resources, they can better develop programs and policies that help to reduce stigma and ultimately save lives.”

The campaign will continue its social media efforts, provide additional resources and data, reach out to more community organizations, talk to politicians, and run ads and op-eds.

Kensinger said overcoming stigma is only one part of addressing substance use disorder. Ensuring equitable access to long-term treatment and recovery options, strengthening government programs, and reforming the criminal justice system also are important.

Overcoming and reducing stigma “is only one part of helping people recover; there is still so much more work to do,” he said.

This article originally appeared in Penn State News.

Addressing stigma and discrimination one story at a time

Published on: March 22, 2021
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UNIVERSITY PARK, Pa. — The Story Powered Initiative is a newly relaunched nationally focused initiative that addresses stigma and discrimination through sharing individual stories. Founded and led by Glenn Sterner, assistant professor of criminal justice at Penn State Abington and Consortium to Combat Substance Abuse (CCSA) affiliated faculty member, the initiative is an expansion of the Share Your Opioid Story initiative, which primarily addressed stigma surrounding opioid use and the opioid epidemic.

The Share Your Opioid Story began as a Pennsylvania-focused collaborative project with the Independence Blue Cross Foundation and the Pennsylvania Department of Drug and Alcohol Programs that zeroed in on opioid use disorder and the greater opioid epidemic in 2018. It eventually blossoming into a national movement featuring stories of all walks of life from all over the United States. Through the work of the Share Your Opioid Story project and addressing stigma associated with the opioid crisis, Sterner’s team realized that stigma continues to impact many members of our communities, not necessarily only those within the substance-use disorder community.

“More than ever before, individuals all over the country face discrimination and stigma daily regarding their race, ethnicity, gender, and sexual orientation,” said Sterner. “We also recognize that those who are justice-involved, have an intellectual or physical disability, experience a mental health diagnosis, and many others are often left behind. Through the Story Powered Initiative, we invite those who have experienced stigma at a personal, social, or systemic level to share their story and let their voice be heard.”

The Story Powered Initiative is one of many efforts of the Substance Use Stigma Reduction Collaborative, a working group within CCSA. Led by Sterner and Jennifer Murphy, program chair and associate professor of criminal justice at Penn State Berks, the collaborative seeks to enhance partnerships to engage in highly impactful research, create and implement evidence-based practices, and host community events that can reduce stigma. Additionally, the collaborative has also developed a collective of key faculty members and practitioners dedicated to research, outreach and teaching surrounding stigma.

When Sterner started this work in 2018 with the opioid crisis, he said that it was an uphill battle because the team needed to build trust within the substance use community. It took some time for people to feel comfortable sharing their stories because of possible personal or professional consequences from talking about themselves or a family member.

“Ultimately, I think that through story sharing, people are able to regain self-agency and feel empowered,” said Sterner. “It’s a way for people to talk about their experiences in a safe space and encourage others to not only do the same, but also foster a degree of empathy and solidarity from people who haven’t had those experiences. I think the more opportunities we have to help people feel included, the better off we all are.”

If you need assistance or know someone who is struggling, you can reach visit the Resources page of the Story Powered Initiative or connect with the team on FacebookTwitter, or Instagram. If you or someone you know is interested in sharing their story, you can submit your story here or reach out to the team directly for more information.

This article originally appeared in Penn State News.

Evidence-to-Impact Podcast: Exploring PacMAT (Pennsylvania Coordinated Medication-Assisted Treatment Program)

Published on: March 15, 2021
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The Evidence-to-Impact Podcast explored Pennsylvania Coordinated Medication-Assisted Treatment Program, or PacMAT, which builds evidence-based medication-assisted treatment (MAT) programs for Pennsylvanians suffering from opioid use disorder. We spoke with Laura Fassbender, executive advisor in the Office of the Secretary at the Pennsylvania Department of Health, and Max Crowley, Associate Professor of Human Development and Family Studies and the director of the Evidence-to-Impact Collaborative at Penn State University, about the challenges and successes behind developing the interdisciplinary architecture for PacMAT. Listen to the episode here or on any podcast app.

Facebook posts could identify substance use risk in homeless youth

Published on: February 1, 2021
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UNIVERSITY PARK, Pa. — What a person posts on Facebook could predict their risk for substance use, according to new research led by the Penn State College of Information Sciences and Technology.

In their work, researchers built novel detection systems, using machine learning and natural language processing techniques, that can identify certain kinds of substance use based on an individual’s Facebook posts. They focused their efforts on predicting substance use among homeless youth — a high-risk population with elevated rates of hard drug use.

“Because of their transience, young people experiencing homelessness are extremely hard to reach for research and intervention purposes,” said Anamika Barman-Adhikari, associate professor of social work at the University of Denver. “Social networking sites such as Facebook present an important and accessible data source for understanding the social context of these youths’ substance use behaviors.”

Barman-Adhikari explained that because artificial intelligence is much more sophisticated than the rudimentary modeling techniques that social science researchers often rely on, more accurate and predictive models to capture the complexity of this behavior can be developed.

“This could potentially be helpful to a nonprofit agency that is trying to triage homeless youth into substance users and nonsubstance users in order to direct their limited resources toward people who are likely to engage in substance use,” said Amulya Yadav, PNC Technologies Career Development Assistant Professor at the College of IST and principal investigator.

To build and train their models, the researchers collected more than 135,000 Facebook posts from homeless youth in the last year. In addition, these homeless youth participants were asked to complete a survey providing their demographic information and insight on how they became homeless and how often they feel that they lack companionship. The latter questions are “not directly about demographic characteristics or substance use, yet they can be utilized for substance use predictions,” the researchers wrote in their paper. Most importantly, participants were asked to note which, if any, drugs they used in the last 30 days.

The researchers used machine learning techniques to pre-process the social media posts — such as identifying hashtags, emojis, slang and misspelled words — to get the data into a form where it could be learned by machine learning models. Then, they used the model to analyze the posts.

They found that posts that contained words such as “love” or “sincerely” correlated with the authors not being substance users. On the other hand, if swear words were included in the posts, the authors were more likely to engage in substance use. They also used sentiment analysis tools to classify pieces of text as happy or sad.

“What we found, which is fairly intuitive to expect, is that people who posted more happy posts are less likely to engage in substance abuse, and people who post more angry or sad quotes are more likely to engage in substance abuse,” said Yadav.

While the model has not yet been deployed, Yadav envisions creating a Google Chrome plugin that could be installed in the computer rooms of homeless shelters or drop-in centers. Users could then agree to provide access to their Facebook data, and the information could be provided to case workers.

“Our tool could provide homeless shelters with information about whether an individual is likely or not to engage in substance abuse,” said Yadav. “Then, each individual’s case management plan can be modified to fit their needs based on this information.”

Also collaborating on the project were Zi-Yi Dou, a master’s student at Carnegie Mellon University (CMU); and Fei Fang, assistant professor at CMU. Their work will be presented at the virtual AAAI Conference on Artificial Intelligence this week, where another paper including Yadav, exploring the use of artificial intelligence algorithms in preventing the spread of HIV among homeless youth, is being presented.

This article originally appeared in Penn State News.

Eric Claus Hired As New CCSA Co-Funded Faculty Member

Published on: February 1, 2021
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The CCSA continues to expand its group of co-funded faculty with Eric Claus, Associate Professor of Biobehavioral Health. Claus’ research works to identify neural and cognitive mechanisms that support behavior change in substance use disorders through numerous techniques like functional MRI, MEG, EEG, and brain stimulation. Prior to starting at Penn State, Claus worked at the Mind Research Network. He earned his PhD in Psychology and Neuroscience from the University of Colorado.

Infants exposed to second-hand smoke may develop behavior problems later in life

Published on: January 28, 2021
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UNIVERSITY PARK, Pa. — When parents think of baby-proofing, they may think of baby gates and outlet covers, but there might be something less obvious to consider: whether previous occupants of their home were smokers. According to a National Institutes of Health-funded study by researchers at Penn State and the University of North Carolina at Chapel Hill (UNC), babies can be exposed to nicotine left behind in the home.

Infants and toddlers may be at higher risk of exposure than older children. “Babies spend a lot of time on the ground, and tend to put everything into their mouths, so they may ingest nicotine from surfaces such as furniture and floors where smoke has settled,” explained the study’s principal investigator, Lisa Gatzke-Kopp, professor of human development and family studies at Penn State. “We found that some babies had exposure levels as high as smokers.”

The study also linked second-hand smoke exposure with behavior problems and symptoms of hyperactivity in children. This association remained significant, even after controlling for family poverty level; parental education; parental history of depression, hostility or attention deficit hyperactivity disorder; caregiver IQ; complications during pregnancy; and other factors.

“The effects of children ingesting nicotine from surfaces means that children can be exposed even if adults don’t smoke in the child’s presence. If the child is in a home where smoking takes place, or is held or cared for by an adult who smokes, that residue that remains on floors, clothing, and hair, can still find its way to the child’s system” said Gatzke-Kopp.

The researchers measured smoke exposure by taking saliva samples from 1,096 children when they were 6, 15, 24 and 48 months old, as part of the Family Life Project (FLP), a larger study of the biological, social and environmental factors that impact the well-being of children.

Since 2003, the FLP has collected a vast amount of data from more than 1,000 families living in semi-rural counties in Pennsylvania and North Carolina, many of whom are living in poverty. These include data from physical and mental health assessments, academic assessments, genetic information, blood and saliva samples, interviews of parents and teachers about the children’s cognitive and emotional development, site visits to the children’s classrooms and homes, and more.

Gatzke-Kopp and her fellow FLP researchers have followed the study participants from infancy through middle school and are now measuring outcomes such as asthma and obesity.

“Our team has done a heroic job of keeping in contact with families. We’ve sent researchers all over the country and have gathered data remotely as well. For those who don’t have internet at home, we have mailed questionnaires,” said Gatzke-Kopp.

The FLP is part of a larger initiative funded by the National Institutes of Health, Early Childhood Health Outcomes (ECHO), which links studies of approximately 50,000 children in 34 cohorts all over the country. Both Penn State and UNC have FLP research teams, and both are investigating behaviors and exposures that may put children at risk for substance abuse or other negative outcomes — even before they are born.

“ECHO allows us to increase the sample size by harmonizing measures, providing more diversity than any one study can offer,” Gatzke-Kopp said. With this much data at our disposal, our colleagues can develop interventions, trainings for educators, and educational programs for parents and caregivers that will contribute to keeping them safer and healthier.”

“I would love to talk with other researchers who are interested in the smoking data,” said Gatzke-Kopp. “We are excited by the possibilities this study has for helping children.”

Researchers interested in collaborating with Gatzke-Kopp may contact her at lmk18@psu.edu.

This article originally appeared in Penn State News.

Despite advances, behavioral health legislation still lags behind

Published on: January 20, 2021
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UNIVERSITY PARK, Pa. — The COVID-19 pandemic, which has led to over $16 trillion in increased healthcare, criminal justice, child welfare, education, and labor market costs. has pushed the topic of mental and behavioral health to the forefront for many Americans. In a new study, Penn State researchers examined all federal behavioral health legislation over the last three decades and found that while federal mental and behavioral health policies have increased in number, opportunities for improving behavioral health policy remain.

The study found that from 1989 to 2019, 4,574 mental health bills have been introduced to Congress, and of those mental health bills, 484 directly referenced behavioral health. Of those behavioral health bills, almost half were introduced by the Senate and nearly 80% were sponsored or co-sponsored by Democrats. The greatest number of sponsors or co-sponsors for the bills hailed from California, New York, Illinois, and Texas.

Language matters in behavioral health legislation 

The study’s principal investigator, Max Crowley, associate professor of human development and family studies and director of the Evidence-to-Impact Collaborative (EIC), suggests that federal behavioral health legislation that directly includes cost-effectiveness, evidence-based terminology, or uses a prevention frame is more likely to be enacted into law than legislation that does not reference these topics.

“Historically, there was a dearth of mental and behavioral legislation, but that has started to shift in the last couple decades,” said Crowley.

Crowley notes that the terms of “behavioral health” and “mental health” are often used interchangeably, but the study specifically focused on legislation that directly referenced “behavioral health” or related terms. Behavioral health legislation was further reviewed for content related to specialty service settings (such as mental health clinics or psychiatric hospitals), evidence-based terminology, prevention framing, and consideration of cost-effectiveness.

The results of the study found that of all the behavioral health bills introduced, almost 70% included content related to prevention framing, and 76% had evidence-based terminology. However, only 58% included content related to community or specialty settings, and 58% included cost-effectiveness content.

“Overall, we found that mental health bills have a less than 10% chance of being enacted into law. Going forward, our country will need more structured legislation surrounding mental and behavioral health systems, particularly in specialty and community settings.  This need is further punctuated by the deleterious effects that the COVID-19 pandemic has had on mental and behavioral health, writ large,” said Crowley.

Connecting researchers to policymakers  

Evidence suggests that there is a need to educate policymakers about the opportunities surrounding behavioral health intervention. Penn State’s Research-to-Policy Collaboration (RPC), has spent the last several years engaging in outreach efforts to connect with policymakers on these issues. The RPC facilitates engagement between researchers and legislative staff, helping them to translate their research and experience into evidence-based policies through crafting legislative language and providing scientific evidence for congressional testimonies.

Taylor Scott, assistant research professor for the Edna Bennett Pierce Prevention Research Center, co-director of the RPC and another author on the NIH study, says that the RPC’s model is one way for researchers and policymakers to work together.

“The RPC works to build trusting relationships between the scientific community and policymakers,” Scott said. “Given the pandemic, it’s more important than ever for researchers and policymakers to interact to craft evidence-based and prevention-framed legislation that works.”

The study was funded by the National Institutes of Health and appears in Translational Behavioral Medicine. The other authors on the study are Lawrie Green, a doctoral candidate in human development and family studies at Penn State, and Elizabeth Long, a postdoctoral research scholar with the RPC.

This article originally appeared in Penn State News.

Emotional dependency on smoking-vaping combo differs from just smoking

Published on: January 5, 2021
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UNIVERSITY PARK, Pa. — Researchers have known that emotions play a critical, but complex role in shaping dependency on smoking and vaping. Now, a team of researchers report that emotions that trigger dependency for people who both smoke and vape may be different from people who just smoke, a finding that may one day help scientists create more personalized programs to help people quit tobacco smoking and vaping.

In a study, the researchers found that negative emotions among dual users — people who both smoke and vape — tend to be associated with tobacco dependence, while positive emotions among exclusive smokers — people who only smoke cigarettes — tended to be associated with that group’s tobacco dependence.

Positive emotions — or positive affect — can include feelings usually associated with good moods, such as enthusiasm, joy and high energy. Negative emotions — or negative affect — include emotions linked with bad moods, such as sadness, disgust and anxiety.

The findings ultimately may help shape programs to people quit smoking, hopefully permanently, said Runze Li, Eberly Family Chair in Statistics and professor of Public Health Sciences.

“The goal of my research is to understand how emotions are associated with, or can cause, smoking relapse,” said Li, who is also an associate of the Institute for Computational and Data Sciences.

The challenge of designing smoking cessation programs is not determining if emotions play a role, but in determining just which emotions spark smoking dependency, according to Li. That adds a lot of variables to study, he added.

“I find that, as I study this more and more, people become more and more interested in the subject, but it also becomes more and more challenging,” Li said. “The purpose of this study is that we know that there is some variable that is associated with smoking dependence, and we tried to find exactly which one.”

Another problem this study sought to address is that people may respond to emotional cues in the lab compared to real life. However, when participants record their feelings while engaged in real-life pursuits, those responses may not be as accurate as gathering the data in a controlled environment, such as a laboratory.

According to Li, the use of computers and mobile technology offers researchers the ability to monitor study participants outside of the laboratory while still gathering more accurate data in near real time.

In this study, the researchers relied on this type of data-gathering — often referred to as ecological momentary assessment, or EMA — that uses a mobile app to let the participants record their emotions and smoking status in the real-world and in real-time.

“Before we had smartphones, people used to just use paper and pencil to collect data, but now it’s easy, for example, in this case, we used an app to capture most of the major emotions,” said Li.

The researchers, who report their findings in the current issue of Drug and Alcohol Dependence, recruited 136 dual users and 101 exclusive smokers for the study. The participants completed both an assessment on cigarette dependency and the two-week EMA.

While EMA studies are powerful ways to gather data, one problem can be the amount of data that is collected and the computational power that is needed to analyze it, said Li. Supercomputers are often needed to manage this type of data. In this study, the team used Penn State’s Roar supercomputer for numerical analysis.

Li said the team also investigated links between other aspects of the emotional states and cigarette dependency. For example, they found different relationships between the groups when they compared how intense the moods were, how long emotional states persisted and how rapid the mood swings were with dependence. Among dual users, the researchers found that more intense bad moods, shorter bad-mood duration and higher positive-mood swings were associated with higher cigarette dependence. In exclusive smokers, the patterns of associations were, however, different. In this group, longer negative moods, less pronounced swings in positive moods and higher variability of negative moods were associated with higher dependence.

Li worked with Anne Buu, associate professor of health promotion and behavioral sciences and biostatistics and data science; Su-Wei Wong, postdoctoral research fellow, and Wei-Chung Su, assistant professor of public health, University of Texas; Zhanrui Cai, doctoral candidate, Penn State; Hsien-Chang Lin, associate professor of public health, Indiana University Bloomington; Douglas E. Jorenby, director of clinical services, University of Wisconsin Center for Tobacco Research and Intervention (UW-CRTI); and Megan E. Piper, associate professor of medicine, University of Wisconsin Department of Medicine and the associate director of research at UW-CTRI.

The researchers said that future research may compare how cigarettes and e-cigarettes may affect the regulations of emotions.

This article originally appeared in Penn State News.

Light smokers may not escape nicotine addiction, study reveals

Published on: December 29, 2020
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Even people who consider themselves to be casual cigarette smokers may be addicted, according to current diagnostic criteria. Researchers at Penn State College of Medicine and Duke University found that many light smokers — those who smoke one to four cigarettes per day or fewer — meet the criteria for nicotine addiction and should therefore be considered for treatment.

“In the past, some considered that only patients who smoke around 10 cigarettes per day or more were addicted, and I still hear that sometimes,” said Jonathan Foulds, professor of public health sciences and psychiatry and behavioral health, Penn State. “But this study demonstrates that many lighter smokers, even those who do not smoke every day, can be addicted to cigarettes. It also suggests that we need to be more precise when we ask about cigarette smoking frequency.”

According to Jason Oliver, assistant professor of psychiatry and behavioral sciences, Duke University, when assessing nicotine addiction — clinically referred to as “tobacco use disorder” — clinicians are encouraged to fully assess the 11 criteria listed in the 5th edition of the Diagnostic and Statistical Manual (DSM-5). As a shortcut, he said, clinicians more typically ask smokers how many cigarettes they smoke per day.

“Lighter smoking is correctly perceived as less harmful than heavy smoking, but it still carries significant health risks,” Oliver said. “Medical providers sometimes perceive lighter smokers as not addicted and, therefore, not in need of treatment, but this study suggests many of them may have significant difficulty quitting without assistance.”

The researchers examined an existing data set from the National Institutes of Health, including more than 6,700 smokers who had been fully assessed to find out if they met the DSM-5 criteria for tobacco use disorder. They found that 85% of the daily cigarette smokers were addicted to some extent — either mild, moderate or severe addiction.

“Surprisingly, almost two thirds of those smoking only one to four cigarettes per day were addicted, and around a quarter of those smoking less than weekly were addicted,” Foulds said.

The researchers found that the severity of cigarette addiction, as indicated by the number of criteria met, increased with the frequency of smoking, with 35% of those smoking one to four cigarettes per day and 74% of those smoking 21 cigarettes or more per day being moderately or severely addicted.

The findings appeared in the American Journal of Preventive Medicine.

“This was the first time that severity of cigarette addiction has been described across the full range of cigarette use frequency,” said Foulds, a Penn State Cancer Institute researcher.

Oliver added that the study highlights the high prevalence of tobacco use disorder even among those considered to be light smokers and provides a basis from which treatment can begin to target this population.

“Previous research has found that non-daily smokers are more likely than daily smokers to make a quit attempt,” Oliver said. “Clinicians should ask about all smoking behavior, including non-daily smoking, as such smokers may still require treatment to successfully quit smoking. Yet, it is unclear the extent to which existing interventions are effective for light smokers. Continued efforts to identify optimal cessation approaches for this population remain an important direction for future research.”

The National Institute on Drug Abuse supported this research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Jonathan Foulds has done paid consulting for pharmaceutical companies involved in manufacturing smoking-cessation medications (e.g., GlaxoSmithKline, Johnson & Johnson); and has acted as a deposed and compensated expert witness on behalf of plaintiffs suing cigarette manufacturers.

This article originally appeared on Penn State Health News.

Preventing risky drinking by college students the focus of new Penn State study

Published on: December 3, 2020
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UNIVERSITY PARK, Pa. — Is there a simple way for parents to reduce the chance of their college-age children having problems resulting from drinking alcohol? Professor of Biobehavioral Health Robert Turrisi was recently awarded a 5-year, $3.6 million grant from the National Institute on Alcohol Abuse and Alcoholism to determine whether brief interviews with randomly selected parents of incoming Penn State University Park students will result in less risky drinking and associated negative consequences.

Interviewers will talk with parents for 15-20 minutes via video conference about approaches to addressing alcohol use with their children and to let them know what numerous studies have shown is the most effective thing they can do to help their teens, which is not allowing them to consume alcohol, even in small amounts.

Underage alcohol consumption has consistently been linked to more frequent consequences across students’ college years, including blackouts, drinking more often and more heavily, and a greater likelihood of driving under the influence or riding with an impaired driver, according to Turrisi. These outcomes can negatively affect students’ grades, their physical and emotional well-being, and can put them at greater risk of assault or legal problems.

“The vast majority of parents in the pilot studies for this project felt that allowing their teen to drink small amounts of alcohol at home in a controlled environment or occasionally with close friends was protective and would ‘take away the mystery’ of alcohol consumption,” Turrisi said.

The interview process, dubbed “P-Chat,” is designed to be informative and non-judgmental.

“We ask parents if we can share what the recent studies from U.S., Europe and Australia have all found,” Turrisi explained. “We also mention that the scientific findings will seem a bit counterintuitive. We then share that letting their teens drink even small amounts has not been found to be protective. We pause for about 10 seconds, which seems like hours, and then share that the findings from all of the studies show that even small amounts of alcohol are associated with pretty terrible harm.”

“We then suggest that this new health information is similar to when parents learned they could help their children by using infant car seats and seat belts and not smoking in public places because they are relatively simple solutions that can have profound benefits,” Turrisi continued. “After this has settled in, we ask, ‘Would you be willing to consider changing and not letting their them have even small amounts of alcohol until they are older?’ Nearly all parents indicate that they are extremely likely to do so.”

“I often see a glow on parents’ faces when the learn there’s something simple that they can do to help their kids that’s based on science,” Turrisi said.

The study participants are divided into four groups. The first group will participate in the P-Chat interview; the second will participate in the interview and receive a 20-page handbook written by Turrisi, titled “Talking with College Students about Alcohol”; the third will receive the handbook only; and the fourth will be a control group with no intervention.

Also participating on this project are Research Professor Kimberly Mallett, co-developer of P-Chat; and Assistant Research Professor Racheal Reavy, both with the Edna Bennett Pierce Prevention Research Center at Penn State; and Cyndy Hill, director of the Penn State Parents Program.

This article originally appeared in Penn State News.

Engineering professor named as new Consortium to Combat Substance Abuse director

Published on: November 19, 2020
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Paul Griffin, professor of industrial and manufacturing engineering and recently returning Penn State faculty member, will become the next interim director of the Consortium to Combat Substance Abuse (CCSA) beginning in summer 2021. Griffin, an expert in health systems engineering, is already a co-funded faculty member of CCSA within the Social Science Research Institute (SSRI)

CCSA is Penn State’s network of researchers, educators and practitioners who work together to develop and implement effective programs, policies and practices aimed at preventing and treating addiction and its spillover effects on children, families and communities.  

Griffin is eager to lead CCSA by helping to identify where engineering and technology researchers can help fill in the gaps for social scientists. “I have big shoes to fill, but I am thrilled for the opportunity to lead the expansion of CCSA’s reach throughout the broader research community,” said Griffin. 

Stephanie Lanza, professor of biobehavioral health and director of the Edna Bennett Pierce Prevention Research Center, serves as CCSA’s current interim director. Lanza plans to stay closely involved with the work of CCSA and will remain a member of CCSA’s executive committee. 

CCSA remains laser focused on novel, interdisciplinary solutions to the systemic problems of substance use,” Lanza said. “I think Paul Griffin will provide important leadership to the consortium’s efforts moving forward. I am excited to see how his focus on health systems analytics will bring new research perspectives to Penn State’s efforts as well as bring in the expertise of others to widen our network’s reach.” 

Prior to returning to Penn State, Griffin served as the St. Vincent Health Chair and director of the Regenstrief Center for Healthcare Engineering at Purdue University and as the Virginia C. and Joseph C. Mello Chair in the H. Milton Stewart School of Industrial and Systems Engineering at Georgia Tech. From 2009 to 2014, he was the Peter and Angela Dal Pezzo Chair and the head of the Harold and Inge Marcus Department of Industrial and Manufacturing Engineering at Penn State.

This article originally appeared in Penn State News.

Certain CBD oils no better than pure CBD at inhibiting certain cancer cell lines

Published on: November 17, 2020
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A person's left hand holds an amber bottle, their right hand holds a dropper with liquid in it. In the background is a plant.

Cannabidiol (CBD) oils are equally or less effective at inhibiting the growth of certain cancer cells compared to pure CBD, according to Penn State College of Medicine researchers. The results of their recent study indicate that future research into the clinical applications of cannabinoids should include an analysis of whether the pure cannabinoid compound or intact plant material is more effective at achieving the therapeutic effect. IMAGE: GETTY IMAGES | MYSTERYSHOT

HERSHEY, Pa. — Cannabidiol (CBD) oils are equally or less effective at inhibiting the growth of certain cancer cells compared to pure CBD, according to Penn State College of Medicine researchers. The results of their recent study indicate that future research into the clinical applications of cannabinoids should include an analysis of whether the pure cannabinoid compound or intact plant material is more effective at achieving the therapeutic effect.

The researchers evaluated whether CBD oils were better than pure CBD at inhibiting the growth of different cancer cell lines. They studied brain, skin and colorectal cancers — using two cell lines for each cancer type — and found that pure CBD was able to reduce cell viability in three of the six cell lines tested and that the effect was cell line specific and not specific to select cancers. None of the CBD oils tested were able to reduce viability to a greater extent than pure CBD.

Prior research found that CBD or tetrahydrocannabinol (THC) can reduce cancer cell viability in some cancer cell models. Proponents of medical marijuana argue that there is an additive effect between the various compounds in the plant material that increases its therapeutic efficacy compared to individual, pure cannabinoid compounds. Kent Vrana, professor and chair of the Department of Pharmacology, said the study did not support this concept, known as the “entourage” effect.

“Based on our results, we recommend that specific investigations on the entourage effect be carried out when determining the therapeutic uses of medical marijuana and other cannabinoid products,” Vrana said.

Wesley Raup-Konsavage, co-author of the study published in the journal Medical Cannabis and Cannabinoids, said the study was carefully designed so that the amounts of CBD oil used for testing had an equivalent amount of CBD as the pure CBD in the experiments. The researchers obtained three types of CBD oil with certificates of analysis and had their composition verified by a third party laboratory. Equal concentrations of CBD were used to treat the six cell lines.

After evaluating the viability of the treated cell lines, researchers determined that the CBD had an effect on one of each of the colorectal cancer, melanoma and glioblastoma cell lines tested. The viability of the other cell lines tested was not significantly reduced.

Because a previous study evaluating the use of THC for treating breast cancer cells suggested that there is an entourage effect in that context, Vrana cautioned that careful testing of cannabinoids should be done for each proposed therapeutic context.

“Pure CBD had the ability to reduce certain cancer cell types’ viability in this study,” Vrana said. “It would be reckless for a consumer to assume that a CBD oil product off the shelf could have the same effects for them, which is why careful studies around the entourage effect are needed for each intended therapeutic application.”

Vrana said that even if there were cases where the entourage effect were proven for therapeutic uses, cannabinoid products are unregulated and consumers would not be able to know in many cases whether an off-the-shelf or off-the-street product had the right components to result in the desired therapeutic outcome.

“The variability in composition and activities of botanical extracts highlights difficulties in assessing their therapeutic potential compared to pure chemical compounds,” Vrana said. Raup-Konsavage and Vrana plan to continue investigating the “entourage” effect of cannabinoids in other therapeutic applications.

Nurgul Carkaci-Salli of Penn State College of Medicine and Kelly Greenland and Robert Gearhart of Keystone State Testing LLC also contributed to this research.

The research was supported by PA Options for Wellness, a Pennsylvania-approved medical marijuana clinical registrant. Penn State College of Medicine is a Pennsylvania-approved Academic Clinical Research Center. The funder had no involvement in study design, data collection, analysis and interpretation or the writing of the report.

This article originally appeared in Penn State News.

Student-athlete substance use during COVID-19: Suppressed, silent, or poised to surge?

Published on: November 2, 2020
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In a new post for SSRI’s COVID-19 Insights from the Experts blog, Associate Professor of Criminal Justice at Penn State Great Allegheny and CCSA faculty affiliate, Katherine McLean, discusses the impact of COVID-19 on student-athletes and substance use.


The impact of the COVID-19 pandemic on substance use has been complex and varied, if not entirely unexpected. Despite restrictions in access to both licit and illicit drugs, there is evidence of both increased use, and increased harm, associated with the use of certain drugs. Some experts fear an uptick in alcohol consumption among individuals seeking to cope with stress related to isolation, unemployment and general uncertainty, with recent surveys showing increases in both drinking and relapse among individuals diagnosed with alcohol use disorder . The pandemic may also demonstrate the long-term limitations of supply reduction strategies toward the amelioration of illicit drug use (as well as adjacent health and social problems); multiple states, including Pennsylvania, reported surges in opioid overdose in the months following government “lockdowns.” As noted within a previous post , the (re)emerging overdose crisis may follow from drug market disruptions that cause individuals to drastically reduce their opioid consumption, only to resume use at their pre-pandemic levels. For similar reasons, persons in recovery – suddenly cut-off from in-person counseling groups, support networks, or medication-assisted treatment – are particularly exposed to overdose in the wake of relapse, due to reduced tolerance. Indeed, such lessons have already been gleaned in the wake of other “natural” disasters such as Hurricane Maria .

How do protective factors influence substance use in college?

Even as the pandemic has revealed and exacerbated the vulnerability of certain populations to drug-related harms, other groups of substance users may be shielded by new protective factors that accompany dramatic changes in social context. College is a well-known risk environment for problematic alcohol use patterns, including underage drinking, binge drinking, and heavy drinking; yet preliminary data collected by researchers at the Edna Bennett Pierce Prevention Research Center indicates that first-year undergraduates on Penn State’s main campus are drinking less, and less frequently, than their peers in previous cohorts. While returning students, enjoying access to established friend networks, may continue to consume alcohol at higher levels (albeit within smaller groups), new students lacking social capital may see fewer opportunities to imbibe, as the university’s COVID-19 mitigation policies limit recreational activities. They may also face less pressure, and perceive fewer reasons, to overconsume alcohol on the occasions they do drink, with tailgating and other largescale social gatherings indefinitely on hold. A summer 2020 survey of 145 fraternities and sororities found that merely 8.7% of respondents thought it “somewhat or very likely” they would “host parties as usual” this fall.

Why are student-athletes particularly at risk for (certain) substance use?

Shifts in college drinking subcultures may particularly impact student-athletes; ample research suggests that college students who participate in sports exhibit higher levels of alcohol consumption (including binge consumption) than their non-athlete peers. While apparently counterintuitive, such findings may reflect the competitive instincts of individuals drawn to athletics, the unique stresses faced by student-athletes, or group-level normative influences that encourage more frequent drinking. Given the suspension of nearly all fall sports at Penn State this semester, it might be expected that student-athletes especially are drinking less, deprived of not only occasions to socialize, celebrate, and commiserate, but crucial information on their teammates’ alcohol use patterns. It is less clear how changes in the collegiate campus and sports environment might shape the use of other recreational substances, including substances whose use is non-normative or less social. As a member of a research team that is poised to study patterns of opioid use and misuse among Penn State student-athletes, the impact of the pandemic on this subset of drug consumption is of particular interest.

How are student-athletes uniquely at risk for opioid misuse and how may COVID-19 influence that trajectory?

Both anecdotal evidence and scholarly research suggests that student-athletes may be uniquely at risk for opioid, and specifically prescription opioid, misuse, perhaps as a consequence of heightened exposure due to injury. While there is no comprehensive data source reporting injuries among college student-athletes, a 2018 study by the NCAA found that 11% of surveyed student-athletes had used narcotic pain medication with a prescription in the past year, while 3% had consumed drugs that were not prescribed to them. Other research focusing on prescription opioid misuse among a broader swath of college sports participants has yielded much higher estimates of non-medical prescription opioid use (NUPO) among certain sub-populations. Compared with 8% of all college students surveyed, 11.5% of male athletes – and 17.9% of injured male athletes – reported NUPO in the past year. In addition to illuminating one possible pathway into prescription opioid misuse by student-athletes (injury and the medication of associated pain), this study demonstrates the unique risks faced by male athletes, who were nearly twice as likely as their injured female counterparts to engage in NUPO. Both findings might inform predictions around opioid misuse by college athletes in the context of COVID-19.

What about the ongoing postponement of sports and other recreational activities?

With many, if not most, school and recreational sports leagues cancelled since March 2020, it is logical to assume that injury rates among established college athletes have declined, forestalling the injury-to-opioid trajectory for some. This string of events may have especially cut the risk for first-year college students who saw their final high school seasons precipitously shut down; the NCAA has shown that student-athletes are nearly twice as likely to begin prescription opioid use in high school, rather than college. Among athletes suffering chronic or repetitive injuries, another route of exposure to prescription opioids – for acute post-surgery pain – may have fallen off with the postponement of elective surgeries within hospital systems across the country, as COVID-19 infections surged in not only early spring, but mid-summer; conversely, such delays may have forced injured athletes into a sustained reliance upon prescription opioids to manage untreated and progressive pain. (Overall, it remains to be seen how such health system-level disruptions may have impacedt the overall availability of prescription opioids, opportunities for their diversion, and the initiation of misuse across the U.S. population.) An inability or unwillingness to attend in-person physical therapy sessions during the pandemic may additionally encourage overuse.

“Reopening” – of schools, sports, gyms, and social institutions at large – may pose its own hazards for the health and substance use of student-athletes. Extended periods of reduced or restricted training are known to heighten athletes’ risks of catastrophic injury, particularly within contact sports; in fact, some orthopedists have already observed a spike in traumatic injuries alongside the limited resumption of fall sports. Doubly conditioned by the “sport ethic” that demands a willingness to push past bodily limits , and norms of masculinity that encourage physical risk taking , males athletes might be expected to suffer injuries, and self-medicate with opioids, at even higher-than-usual levels. New injury may not be a necessary condition for the resumption of prescription opioid use; after spit tobacco, narcotic pain medication is the second most common drug cited by NCAA athletes that is used “specifically to prepare for practice.”

Alongside lower activity levels, the prolonged off-season may also have seen more recreational substance use among student-athletes facing few formal and informal controls. While alcohol, spit tobacco and e-cigarettes enjoy continuous popularity among college athletes, the use of illicit drugs (such as marijuana, cocaine, ecstasy, and even heroin) peaks outside the period of competition . The unique temporality of student-athletes’ drug use may reflect seasonal fluctuations in their social bond to sports. Facing an excess of time, and a temporary detachment from team norms that sanction certain substance use, athletes may enjoy more occasions to experiment, and perceive fewer associated risks, whether physical or social. Here, the use performance enhancing drugs during the pandemic may provide an instructive parallel. Though no official data has been released, the extended lapse in athlete surveillance following from travel bans and social distancing mandates has triggered much concern around a possible surge in doping among elite athletes. As the U.S. Anti-Doping Agency (USADA) pared down out-of-competition testing to “mission critical” levels in the spring of 2020, CEO Travis Tygart speculated that some athletes [were] “going to try to exploit every opportunity they can.”

What are some possible avenues for prevention and harm reduction for the student-athlete population?

As the nation at large continues to face uncertainty regarding the pandemic’s trajectory and a full return to “normal life,” it is difficult to prognosticate the volume and types of different substance use among college athletes across sports and competition levels; indeed, the weight of this uncertainty and accompanying anxiety may represent yet another risk factor for substance use among young adults whose future – athletic, academic, and professional – hangs in the balance.

Still, existing knowledge suggests possible avenues of prevention and harm reduction during the shutdown, and the early stages of sports resumption. Athletic directors and team coaches whose campuses remain on a sports hiatus may still attempt to maintain connections with their student-athletes, remind them of their long-term goals as athletes, and foster a sense of shared commitments and mutual care. Norms-based interventions, which have proven effective in lowering levels of alcohol consumption among college students at large , may be particularly successful at establishing social standards around substance use among student-athletes specifically, particularly when paired with communications that serve to reinforce team identity . These interventions may also be enacted remotely, mobilizing high-influence student-athletes (such as team captains) to convey both health-oriented information and social disapproval for excessive alcohol and other substance misuse. As the spring sports season approaches, trainers and coaches may also seek to proactively avert prescription opioid misuse by being attentive toward the heightened risk of injury after a period of dormancy.

Ultimately, the pandemic may represent an opportunity to better understand, and address, student-athletes’ pathways into and motivations for sport-related substance use.

New study will examine women with opioid-use disorder in criminal justice system

Published on: October 27, 2020
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Abenaa Jones, PhD

Abenaa Jones, assistant professor of human development and family studies and Consortium to Combat Substance Abuse co-funded faculty member. IMAGE: PENN STATE

UNIVERSITY PARK, Pa. — A new five-year, $842,000 grant from the National Institute on Drug Abuse (NIDA) will allow Penn State researchers to examine opioid-use disorder among criminal justice-involved (CJI) women.

Abenaa Jones, assistant professor of human development and family studies and Consortium to Combat Substance Abuse (CCSA) co-funded faculty member, is the principal investigator on the project. Jones’ will be mentored by a team of senior investigators, including Carl Latkin, professor of health, behavior, and society at the Johns Hopkins Bloomberg School of Public Health; and Derek Kreager, director of Penn State’s Criminal Justice Research Center (CJRC) and Social Science Research Institute co-funded faculty member.

The project aims to link CJI women in medication-assisted treatment (MAT) programs and other services while also developing an intervention. Women are among the fastest-growing population of incarcerated individuals, and the arrest rate for drug possession or use for women tripled between 1980 and 2009, according to a report from the Vera Institute of Justice. However, much of the current criminal justice behavioral and drug interventions are male-focused, which shows a significant gap in effective strategies to reduce opioid-use disorder among CJI women.

“There is a shortage of effective interventions that link CJI women to needed drug use treatment such as MAT programs,” notes Jones. “Consequently, continued substance use, recidivism in the criminal justice system, and other adverse outcomes are prevalent among these women. This research is critical because of not only improving the health and social outcomes for these women, but to also reduce the societal costs of incarceration and substance use dependence.”

The study collaborates with CJI woman, MAT providers, and criminal justice professionals to identify the barriers to opioid-use cessation, HIV-related risk behaviors, and exposure to violence among CJI women. Then investigators will develop a gender-specific and trauma-informed intervention that links and retains CJI women with opioid-use disorder to MAT programs, necessary social services, and provide opioid overdose response training.

Jones hopes the study will develop more evidence-based interventions to reduce substance use and its co-occurring health and social consequences among marginalized and vulnerable communities.

“Drug-dependent and criminal justice-involved women have unique needs compared to the equivalent population of men,” Jones says. “When these women are released into their communities without the tools and services to maneuver substance use, overlapping criminal justice obligations such as parole, poverty-related issues, and the adverse effects of unaddressed trauma, optimal health and social outcomes reduce and we contribute further to the rising societal costs of incarceration and drug dependence. It’s critical that we continue to develop interventions that help a high-risk and under-resourced population.” 

This article originally appeared in Penn State News.

Survey shows depression and anxiety among Pennsylvania youth

Published on: October 13, 2020
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Teen seated on bed, cradling their kneesUNIVERSITY PARK, Pa. — Data from the most recent Pennsylvania Youth Survey (PAYS) show an alarming percentage of Pennsylvania’s youth suffer from mental health symptoms such as depression and anxiety. According to the 2019 PAYS, in which 239,340 students from 419 Pennsylvania school districts participated, 38% of all students indicated that they felt depressed or sad most days in the past 12 months.

“The mental health statistics for 10th and 12th graders are particularly concerning,” said Geoff Kolchin, program analyst for the Pennsylvania Commission on Crime and Delinquency (PCCD). Approximately 1 in 5 had considered suicide in the past year, according to the survey.

The PAYS is an anonymous survey of 6th, 8th, 10th and 12th grade students conducted every two years. The students report on what they think, know and believe about a wide range of risk factors such as substance use, bullying, and mental health issues — as well as protective factors such as family involvement and engagement in youth activities. Statewide and county-level survey results are available on the PCCD website, and participating school districts receive a report tailored to their local community.

Evidence-based Implementation Support (EPIS) specialists from Penn State, in partnership with state and local agencies, are dedicated to providing PAYS training and technical assistance to schools, agencies and community groups to support the well-being of Pennsylvania youth.

‘Yes, these are local problems.’

Cathy Keegan, Milton Area School District superintendent, is one of many community leaders using PAYS data to address the risks that students face.

“There is true power in using the data. We chose to look more deeply at the risk factors for depression and suicide,” Keegan explained. “We focused on the amount and nature of bullying; percentage of bullying by type; threats of acts of violent behavior on school property; access and usage of alcohol, cigarettes, and prescription drugs; and lastly, food insecurity. Because we remained focused, we are celebrating significant progress in all of these areas.”

Keegan said that knowing the PAYS survey results led to systemic change, including the training of all instructional staff in the Question, Persuade, Refer suicide prevention program; the implementation of the Positive Action social and emotional learning curriculum; and the use of the Positive Behavior Intervention and Support framework, all of which have been shown by research to be effective.

Keegan credited EPIS Systems Change Specialist Meghan Blevins with building local support for creating new systems and programs to help students with serious issues such as depression and food insecurity.

“Meghan expertly and professionally tackled tough community member questions, using the data to demonstrate that yes, these are local problems,” Keegan said.

‘We need to hear what’s going on.’

“PAYS is the way to find out what’s going on within your community and in your schools,” Kolchin said.

Kolchin expressed concerns about the use of marijuana, alcohol and vaping devices, as well as students feeling disengaged from school — especially given the stresses that youth are facing during the current pandemic.

“It’s important to keep in mind that this data is directly from our kids,” said Kolchin. “We need to hear what’s going on. It’s not just about what our kids are doing, but understanding the causes and how we can be effective with limited resources.”

PAYS is funded by PCCD, the Pennsylvania Department of Education and the Pennsylvania Department of Drug and Alcohol Programs. Rose Baker, assistant research professor at Penn State’s Edna Bennett Pierce Prevention Research Center, supervised the 2019 PAYS survey design, administration and analyses.

This article originally appeared in Penn State News.

Campaign seeks to change attitudes toward opioid addiction

Published on: October 7, 2020
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WYOMISSING, Pa. — Did you know that people who experience stigma toward their drug use are less likely to seek out help? And did you know that opioids are medications prescribed by doctors to treat persistent or severe pain? These are just two of the messages that are part of a Penn State Berks awareness and educational campaign on opioid addiction. The campaign is intended to change attitudes among faculty members and students and to train students to administer naloxone, a drug that counters the effects of opioid overdose.

“Addiction is a brain disease, but it still carries a lot of stigma,” said Jennifer Murphy, associate professor of criminal justice, who is leading the campaign along with Brenda Russell, professor of applied psychology. “Many people do not understand how addiction works; they see it as a moral flaw. We hope to educate students at Penn State Berks about the reality of addiction and how naloxone can save lives.”

Penn State Berks was one of 13 institutions of higher education included in the nearly $1 million that was awarded by the PA Department of Drug and Alcohol Programs on behalf of the federal Substance Abuse and Mental Health Services Administration to prevent and reduce opioid use among college students and to train them in the administration of naloxone. At a January press conference about the grant, Gov. Tom Wolf said, “Educating college students on the risk of opioid use, and training institutions of higher learning on how to administer naloxone are two ways we can save lives and lessen the impact of this crisis.”

The Berks team received their funding in January 2020 but had to postpone the campaign due to the onset of the COVID-19 pandemic. The campaign, which will now run through the end of October, includes posters on campus, messages on the college’s electronic bulletin boards and social media posts. In addition, Murphy and Russell used part of the funds to evaluate the attitudes of faculty and staff members before the awareness campaign began, and they will evaluate attitudes again when the campaign ends. The goal, they said, is to see if the campaign will change negative attitudes.

In prior work, Murphy and Russell had already put several programs into place on campus to address the prevention of opioid use among college students and to provide naloxone training on campus. For example, in December 2019, they invited representatives from the Caron Treatment Centers — an internationally recognized not-for-profit dedicated to addiction and behavioral healthcare treatment, research, prevention and medical education, located in Wernersville, Pennsylvania — to educate the campus community about addiction.

During their visit, Douglas Tieman, president and chief executive officer of Caron Treatment Centers, spoke at a faculty seminar and gave a demonstration on the use of naloxone, with assistance from a representative of the Council on Chemical Abuse. Students also received similar training in the spring semester. Murphy and Russell conducted pre- and post-test evaluations of the participants’ addiction knowledge and attitudes and found that the participants showed reduced stigma after receiving training. In addition, faculty members and students who attended the seminars received a naloxone kit.

During the last year, Murphy and Russell also have been working to assess police officers’ knowledge about addiction and attitudes toward people who use opioids. Their study has three specific goals — to assess addiction knowledge among police officers and the level of stigma police officers hold toward people who use drugs, to identify the individual-level characteristics of police officers that contribute to their levels of addiction knowledge and stigma, and to use the survey results to identify the need for an educational/intervention tool that could be developed and tested to increase addiction knowledge and reduce stigma levels among police officers.

In addition, Murphy published a book, titled “Illness or Deviance? Drug Courts, Drug Treatment, and the Ambiguity of Addiction,” in which she investigates various perspectives on drug addiction. The book examines a drug court, a diversion program where people who are arrested and in need of drug treatment can avoid incarceration, and affiliated drug treatment programs, to see how addiction was labeled and managed in each setting.

Russell’s other research focuses on female offenders and intimate partner violence, and she has published books on this topic: “Intimate Partner Violence and the LGBT+ Community” (Springer, 2020); “The Battered Woman Syndrome as a Legal Defense: History, Effectiveness, and Implications” (2010); and “Perceptions of Female Offenders” (2013).

This article originally appeared in Penn State News.

PROSPER launches website to support communities in preventing youth substance use

Published on: October 2, 2020
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4 middle school students standing in front of schoolA new website, located at prosper.psu.edu, recently launched to aid in recruiting Pennsylvania communities and families to participate in PROSPER, or PROmoting School-community-university Partnerships to Enhance Resilience, a program proven to reduce substance use in middle school students.

“The new PROSPER website provides a platform for us to broadly disseminate information about effective prevention programming and practices across Pennsylvania. This is especially timely given the COVID-19 pandemic, which has made schools, families, and communities especially dependent on online resources,” said Janet Welsh, PROSPER director and research professor at the Edna Bennett Pierce Prevention Research Center.

The website highlights the project’s 18 current locations throughout Pennsylvania to provide prospective families with program and contact information and an overview of how communities and families can benefit from the program. Community leaders interested in starting a local PROSPER site can get started by filling out this form.

PROSPER, designed by scientists at Penn State and Iowa State University in 2001, supports the delivery of evidence-based programs for middle-school students and their families. The program decreases substance use throughout entire communities by working with students in schools and within families after school hours. The in-school component provides students with a healthy self-image to plan goals, problem solve, and resist substance use and other risky behaviors. The after-school component guides parents in supporting their children while setting effective limits, ultimately improving family life.

“When youth prosper, we all do,” Welsh said.

PROSPER is funded by the Substance Abuse and Mental Health Services Administration, the United States Department of Agriculture, and the National Institute on Drug Abuse.

This article originally appeared on the Edna Bennett Pierce Prevention Research Center’s website.

Pollock Center leads new stigma reduction campaign for Opioid Use Disorder

Published on: September 9, 2020
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Pollock Center Logo with textMIDDLETOWN, Pa. — Researchers at Penn State Harrisburg are teaming with the Pennsylvania Department of Drug and Alcohol Programs and state and national non-profit organizations to lead a statewide campaign to reduce the stigma associated with Opioid Use Disorder. The Douglas W. Pollock Center for Addiction Outreach and Research at Penn State Harrisburg is spearheading the effort which aims to change misinformed attitudes surrounding the disorder and alleviate their negative consequences.

“Pennsylvania’s Opioid Use Disorder stigma reduction campaign is an 18-month, $1.95 million, evidenced-based project that aims to become a model for other states to follow,” said Weston Kensinger, Pollock Center director and principal investigator on the project. “The campaign uses social media to leverage university researchers, public health non-profits, and state and local resources to provide real-time outcomes in combating stigma.”

Penn State has made addressing substance abuse a strategic priority throughout the University and established the Penn State Consortium to Combat Substance Abuse with the goal of tackling the problem at multiple levels. A consortium partner, the Douglas W. Pollock Center for Addiction Outreach and Research was established in 2019 with a mission to assist special populations and community organizations. The current campaign brings expertise from researchers across Penn State including the Pollock Center, Penn State Harrisburg’s School of Behavioral Sciences and Education, the college’s Institute for State and Regional Affairs, as well as faculty from across the University.

As Kensinger explains, the stigma campaign will help raise awareness of the discrimination often experienced by those suffering from, or in recovery from, substance abuse disorder and the negative impact this can have.

“There are multiple forms of stigma, including ‘public stigma,’ when the general population supports discriminatory stereotypes against a group of people; ‘self-stigma,’ when that group internalizes the stereotypical messages they receive; and ‘structural stigma’ where the policies, rules and practices of social institutions arbitrarily restrict the rights and opportunities of people with an Opioid Use Disorder,” said Kensinger.

“This can be extremely harmful to those struggling with the disorder, and can, for example, prevent them from seeking the treatment they need,” he said.

The project’s first phase, which took place from April through June 2020, involved completing exploratory research to help guide the project, composing a literature review, interviewing community-based organizations, administering a statewide survey, and creating data displays to compile information. To further develop, implement, and deliver the campaign, the Pollock Center worked with two non-profit public health organizations: The Public Good Projects (PGP), and Shatterproof.

The campaign, now in Phase II, has begun to “develop tailored messaging for social media platforms and will be providing community-based organizations with resources through webinars and e-newsletters,” according to Kensinger. This method of campaign engagement provides a powerful way to deliver information to the community during this time of a global pandemic, Kensinger said, because social media is easily accessible to many audiences and a primary means for institutions to reach people.

The Pollock Center has reached out to over 370 stakeholders and community-based organizations across the state to gain their input and to give them the opportunity to become involved with the campaign by contributing content, ideas and support. Through their outreach and influence, an increasing number of social media channels will provide real-time outcomes in combating stigma. Additionally, monthly webinars on various topics relevant to community-based organizations will be provided.

“We want to make sure community-based organizations are getting the information and resources they need to succeed, so we are providing webinars on pertinent topics including advocacy, locating resources, addressing structural barriers, and the overall landscape of stigma in treatment and recovery,” said Övgü Kaynak, assistant professor of psychology at Penn State Harrisburg and a co-investigator on the project.

The stigma reduction campaign emphasizes that language matters when it comes to addiction.

“Language is one of the simplest and yet most effective ways of combating stigma,” Kensinger said, encouraging people to refer to those struggling with drug use as a “person with substance use disorder” rather than a “substance abuser” or “addict.” The campaign also teaches to avoid terms such as “clean” or “dirty,” or any other adjective that depicts someone with a disorder negatively.

In addition, the Pollock Center will evaluate the stigma reduction campaign and its effects on public attitudes across the commonwealth. This evaluation will help determine whether campaign activities helped to change attitudes around opioid use disorder and treatment.

“If we find that this campaign was effective in reducing stigma throughout the state, this evidence will help other states start the process of changing public attitudes around substance use disorder,” said Christopher Whipple, assistant professor of psychology at Penn State Harrisburg and a co-investigator on the project.

Pandemic adds to challenges

According to Kensinger, the timing of the campaign has become critical, as those with substance abuse disorder “face a horrific storm under the pandemic,” experiencing “increased social isolation and decreased social connectedness,” and a “decrease in access to peer-to-peer services.” He added that the stay-at-home orders caused many individuals to feel reluctant to seek treatment, and some existing treatment may be altogether postponed due to fears of contracting the virus. The pandemic also made community outreach more difficult.

In addition to spreading awareness and providing resources, the stigma campaign makes data more accessible to the public. The Pollock Center is working with the Pennsylvania State Data Center and Center for Survey Research to create a web portal which includes online training/webinars, digital mapping, digital dashboards for data display, and results of the statewide stigma survey. By compiling the wealth of knowledge from experts and organizations across the Penn State community, the center is creating a one-stop hub for anyone to quickly become informed about stigma and addiction.

A recent press release from Pennsylvania Gov. Tom Wolf’s office addressed Pennsylvania’s efforts to end addiction stigma. The state has become the first to partner with Shatterproof’s national strategy of eliminating the stereotypes surrounding substance use disorder. The campaign’s public launch is slated for Sept. 14.

This article originally appeared in Penn State News.

Evidence-to-Impact Podcast Explores the Stigma of the Opioid Crisis with CCSA Affiliate Member, Glenn Sterner

Published on: August 31, 2020
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This month’s episode of the Social Science Research Institute‘s Evidence-to-Impact Podcast featured CCSA Faculty Affiliate, Glenn Sterner, PhD, Assistant Professor of Criminal Justice at Penn State Abington, and Stephen Forzato, Deputy Chief for Statewide Drug Initiatives at the Pennsylvania Office of Attorney General about reducing the stigma of the opioid crisis and greater issues of substance use. Listen to the episode here.

Words used to describe alcohol intoxication may give clues to drinking habits

Published on: August 19, 2020
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UNIVERSITY PARK, Pa. — People have always used different words to describe the inebriating effects of alcohol, from “blotto” in the 1920s to “honkers” in the 1950s. Now, new Penn State research suggests the language young adults use to describe the effects they feel from drinking may give insight into their drinking habits.

A team of researchers led by Ashley Linden-Carmichael, assistant research professor in the Edna Bennett Pierce Prevention Research Center, examined the language young adults use to describe different levels of inebriation. The team was able to not only discover the language young people are using, but also discovered four distinct “classes” of drinkers: happy drinkers, relaxed drinkers, buzzed drinkers and multi-experience drinkers.

Linden-Carmichael said the results — recently published in the journal Experimental and Clinical Psychopharmacology — can not only give insight into the drinking habits of young adults, but could also help researchers and clinicians fine-tune their language during interventions and research studies.

“We’re finding that young adults have a wide range of vocabulary they use around drinking, and we should make sure we’re using words that they are using instead of more clinical terms like ‘intoxicated,’” Linden-Carmichael said. “Even the word ‘drunk’ may not be seen as the highest level of drinking. As researchers or clinicians, we need to incorporate contemporary language into our work.”

According to the researchers, the young adult age range from 18 to 25 is a high-risk period for dangerous alcohol use, with about 37% of young adults reporting binge drinking — typically defined as five or more drinks in two hours for men or four or more for women — at least once in the past month and 10% reporting binge drinking on five or more days in the past month.

Linden-Carmichael said that understanding the drinking habits of young adults is critical to intervention efforts, and that some recent research suggests that how drunk someone feels may be a better predictor of risky behavior than an objective measure of how drunk they actually are, like blood alcohol content (BAC).

“If a young adult is particularly risk-prone and is considering driving home after a night of drinking, are they going to do the math of how many drinks they’ve had over a certain number of hours or are they going to ask themselves how they feel?” Linden-Carmichael said. “How drunk someone feels is subjective, but understanding how to measure that could be helpful in preventing risky behavior.”

For the study, the researchers recruited 323 young adults who reported having at least two heavy episodes of drinking in the previous month. The participants filled out a 10-minute survey during which they provided words they typically used to describe how they feel while drinking. They also answered questions about their typical drinking habits.

“We wanted to get a good representation of language used across the whole United States,” Linden-Carmichael said. “We used Amazon’s Mechanical Turk as a crowd-sourcing platform to reach young adults from across the country and to have them generate words to describe light, moderate and heavy drinking episodes.”

After analyzing the data, the researchers found that most of the participants could be sorted into four categories, each with their own vocabulary and habits.

The largest group was “happy drinkers,” who made up 31% of participants and who mostly reported feeling happy when drinking. The next group, at 24%, were “relaxed drinkers,” who reported feeling happy, relaxed, and buzzed. “Buzzed drinkers” made up 18% of participants and reported feeling buzzed and dizzy. Relaxed drinkers tended to report heavier alcohol use and buzzed drinkers tended to report drinking less often.

“Finally we had the group that we called the ‘multi-experience drinker class,’ which made up 27% of our participants,” Linden-Carmichael said. “They reported feeling buzzed, tipsy, drunk, and were also the only group to report ‘wasted’ as a common word to describe how they feel while drinking. So this group might be the one most likely to drink for the purpose of getting drunk.”

Linden-Carmichael added that studying these language differences may help give insight into people’s motivations for drinking, and that those motivations may give further clues about how much someone is drinking and how often.

“When interventionists are working with young adults who are struggling to reduce their drinking, they might benefit from using the same language that their participants are using,” Linden-Carmichael said. “For example, the word ‘intoxicated’ isn’t commonly used and may be associated with winding up in the hospital because of alcohol poisoning. So they could benefit from being sensitive to differences in the way people use different words.”

Hannah K. Allen, assistant professor at the University of Mississippi, and Stephanie T. Lanza, director of the Edna Bennett Pierce Prevention Research Center, also participated in this work.

The National Institute on Drug Abuse from the National Institute on Alcohol Abuse and Alcoholism helped support this research.

This article originally appeared in Penn State News.

An AI Algorithm to Help Identify Homeless Youth At Risk of Substance Abuse

Published on: August 12, 2020
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A male drug addict with a syringe is using drugs sitting on the floor. International Day Against Drug Abuse. Addiction concept.

UNIVERSITY PARK, Pa. —  While many programs and initiatives have been implemented to address the prevalence of substance abuse among homeless youth in the United States, they don’t always include data-driven insights about environmental and psychological factors that could contribute to an individual’s likelihood of developing a substance use disorder.

Now, an artificial intelligence (AI) algorithm developed by researchers at the College of Information Sciences and Technology at Penn State could help predict susceptibility to substance use disorder among young homeless individuals, and suggest personalized rehabilitation programs for highly susceptible homeless youth.

“Proactive prevention of substance use disorder among homeless youth is much more desirable than reactive mitigation strategies such as medical treatments for the disorder and other related interventions,” said Amulya Yadav, assistant professor of information sciences and technology and principal investigator on the project. “Unfortunately, most previous attempts at proactive prevention have been ad-hoc in their implementation.”

“To assist policymakers in devising effective programs and policies in a principled manner, it would be beneficial to develop AI and machine learning solutions which can automatically uncover a comprehensive set of factors associated with substance use disorder among homeless youth,” added Maryam Tabar, a doctoral student in informatics and lead author on the project paper that will be presented at the Knowledge Discovery in Databases (KDD) conference in late August.

In that project, the research team built the model using a dataset collected from approximately 1,400 homeless youth, ages 18 to 26, in six U.S. states. The dataset was collected by the Research, Education and Advocacy Co-Lab for Youth Stability and Thriving (REALYST), which includes Anamika Barman-Adhikari, assistant professor of social work at the University of Denver and co-author of the paper.

The researchers then identified environmental, psychological and behavioral factors associated with substance use disorder among them — such as criminal history, victimization experiences and mental health characteristics. They found that adverse childhood experiences and physical street victimization were more strongly associated with substance use disorder than other types of victimization (such as sexual victimization) among homeless youth. Additionally, PTSD and depression were found to be more strongly associated with substance use disorder than other mental health disorders among this population, according to the researchers.

Next, the researchers divided their dataset into six smaller datasets to analyze geographical differences. The team trained a separate model to predict substance abuse disorder among homeless youth in each of the six states — which have varying environmental conditions, drug legalization policies and gang associations. The team observed several location-specific variations in the association level of some factors, according to Tabar.

“By looking at what the model has learned, we can effectively find out factors which may play a correlational role with people suffering from substance abuse disorder,” said Yadav. “And once we know these factors, we are much more accurately able to predict whether somebody suffers from substance use.”

He added, “So if a policy planner or interventionist were to develop programs that aim to reduce the prevalence of substance abuse disorder, this could provide useful guidelines.”

Other authors on the KDD paper include Dongwon Lee, associate professor, and Stephanie Winkler, doctoral student, both in the Penn State College of Information Sciences and Technology; and Heesoo Park of Sungkyunkwan University.

Yadav and Barman-Adhikari are collaborating on a similar project through which they have developed a software agent that designs personalized rehabilitation programs for homeless youth suffering from opioid addiction. Their simulation results show that the software agent — called CORTA (Comprehensive Opioid Response Tool Driven by Artificial Intelligence) — outperforms baselines by approximately 110% in minimizing the number of homeless youth suffering from opioid addiction.

“We wanted to understand what the causative issues are behind people developing opiate addiction,” said Yadav. “And then we wanted to assign these homeless youth to the appropriate rehabilitation program.”

Yadav explained that data collected by more than 1,400 homeless youth in the U.S. was used to build AI models to predict the likelihood of opioid addiction among this population. After examining issues that could be the underlying cause of opioid addiction — such as foster care history or exposure to street violence — CORTA solves novel optimization formulations to assign personalized rehabilitation programs.

“For example, if a person developed an opioid addiction because they were isolated or didn’t have a social circle, then perhaps as part of their rehabilitation program they should talk to a counselor,” explained Yadav. “On the other hand, if someone developed an addiction because they were depressed because they couldn’t find a job or pay their bills, then a career counselor should be a part of the rehabilitation plan.”

Yadav added, “If you just treat the condition medically, once they go back into the real world, since the causative issue still remains, they’re likely to relapse.”

Yadav and Barman-Adhikari will present their paper on CORTA, “Optimal and Non-Discriminative Rehabilitation Program Design for Opioid Addiction Among Homeless Youth,” at the International Joint Conference on Artificial Intelligence-Pacific Rim International Conference on Artificial Intelligence (IJCAI-PRICAI), which was to be held in July 2020 but is being rescheduled due to the novel coronavirus pandemic.

Other collaborators on the CORTA project include Penn State doctoral students Roopali Singh (statistics), Nikolas Siapoutis (statistics) and Yu Liang (informatics).

This article originally appeared in Penn State News.

Parental Substance Abuse Impacting Families During COVID-19

Published on: August 6, 2020
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In a new blog post for the Social Science Research Institute’s COVID-19 “Insights from the Experts” blog, CCSA co-fund, Rina Eiden, discusses the impact of increased substance use among parents during COVID-19. Eiden states her post that, “Alcoholic beverage sales increased dramatically by about 55%in March 2020 compared to March 2019. Similarly, sales of combustible cigarettes have increased across several countries during the pandemic, with survey respondents indicating tobacco use as their primary stress reduction strategy.” Read the blog post here.


Market research regarding substance use during the COVID-19 pandemic is alarming. For instance, alcoholic beverage sales increased dramatically by about 55%in March 2020 compared to March 2019. Similarly, sales of combustible cigarettes have increased across several countries during the pandemic, with survey respondents indicating tobacco use as their primary stress reduction strategy. Similar concerns have been raised about other substances . According to the American Medical Association, by July 2020, more than 35 states reported an increase in opioid-related deaths , particularly those linked to fentanyl products. The Overdose Detection Mapping Application Program (ODMAP) indicated an increase of 42% in opioid overdoses nationally by May 2020 compared to the previous year, with a 17.6% increase in overdoses between March and May 2020. The Pennsylvania Department of Health data indicate similar increases in opioid related EMS calls with an increase of 15.3% in April, 22% in May, and a 14% in June 2020 compared to corresponding monthly rates a year earlier.

In this post, I will discuss the complex issue of substance use during the COVID-19 pandemic with a specific emphasis on the likely negative impacts on the family unit. I also offer recommendations to help support individuals and families.

Substance use increases risk for infection

Almost all substances of abuse increase pandemic related health risks . For instance, heavy drinking weakens the immune system and reduces the ability to cope with infection – raising concerns about specific pandemic related personal and societal costs associated with alcohol. This relationship is dose dependent – greater alcohol consumption increases susceptibility to viral infections. Similarly, use of combustible cigarettes increases risk for adverse outcomes related to COVID . Individuals with opioid use disorder who often experience a multitude of mental and physical health risks are more likely to experience negative COVID related outcomes and face greater barriers to health care. Moreover, parents’ substance abuse and associated risks may also weaken compliance with pandemic prevention practices, further compromising the health and adjustment of parents and their children. For instance, there is ample evidence that alcohol use is associated with different forms of risky sexual behaviors that increase risk for HIV infection and interference with prevention practices (i.e., condom use). Results indicate double the risk among binge drinkers and 87% increased risk for HIV-incident-infection if alcohol was used at the time of sex. Clearly, hazardous drinking promotes impulsive decision making and may also impact decisions to comply with pandemic safety measures. Thus, parents with substance abuse problems are at higher risk for pandemic related negative health outcomes that may have cascading effects on family processes and on the wellbeing of children.

COVID-19, Substance Abuse, and the Family

The primary non-pharmaceutical intervention to reduce transmission risk for infectious disease epidemics like COVID-19 is social distancing. However, while being critical for reducing transmission risk, social distancing also leads to greater social isolation that may be particularly debilitating during pregnancy and postpartum, when there is greater need for social support. Social isolation increases perceptions of even everyday stressors as being more intense and decreases restorative and repair physiological functioning. Pandemic stress and anxiety and the stress of social isolation undermine mental health, increase relationship conflict, and exacerbate alcohol and other substance abuse. Indeed, stress is an established risk factor for the onset and maintenance of hazardous drinking, smoking, and other substance use, and social isolation and loneliness predict increasing problematic substance use and difficulty reducing use. Those with partners may be at even greater risk – married people reported being more emotionally affected during the SARS epidemic as well as experiencing greater family stress, including fear about cross-infection and worry about family members’ well-being. Cohabitation or being married did not protect against mental health problems during the SARS quarantine . Such emotional stress may be even greater among individuals preparing to start a family.

Maternal Substance Use in Pregnancy

The prenatal period is a time of enhanced vulnerability during which a range of influences can have a long-term impact on children’s physical and mental health, and risk behaviors. Maternal substance use in pregnancy reflects a condition of high fetal stress due to lack of nutrients to the fetus. Pregnancy substance use may also lead to changes in brain and biological development, contribute to birth defects such as Fetal Alcohol Spectrum Disorder , contribute to withdrawal symptoms after delivery such as Neonatal Opioid Withdrawal Syndrome , and have other, more subtle negative effects on development. For example, use of combustible cigarettes in pregnancy increases risk for conduct disorder in children – that includes persistent behavioral and emotional problems such as such as difficulty following rules, respecting rights of others, and following societal rules of social conduct. Cocaine use in pregnancy increases risk for regulating reactivity or arousal during emotionally arousing or frustrating situations.

Many women with substance use problems are spontaneously able to reduce or quit using substances once they realize they are pregnant. Persistent substance use after pregnancy recognition is often associated with increased risk for other adversities including poverty, maternal stress, lack of family support, and maternal mental health issues. These may contribute to a cascade of developmental processes that increase risk for poor health outcomes and risk behaviors across the lifespan. There is accumulating evidence that maternal stress and comorbid risks during pregnancy also have long lasting effects on developmental outcomes. Children of substance using mothers may experience placement in out of home care and may have frequent changes in caregiving situations – a known marker for lifelong adverse outcomes.

Fathers.

Substance using mothers often have substance using partners, thereby increasing risk for poor outcomes in children . For instance, hazardous father drinking has significant negative implications for family functioning, including long-term costs to children. Growing up in a household with a parent who misuses alcohol is a significant risk factor for later alcohol problems. Indeed, children of fathers with alcohol problems (COAs) are four to 10 times more likely to have clinically significant levels of alcohol problems themselves , to have earlier onset of drinking, and to progress from alcohol use to abuse additional substances. Thus, COAs are a large and critical component of the underage drinking population. These results cannot be attributed to genetic link alone , as noted in studies using genetically informative designs . Results from longitudinal studies spanning infancy to adolescence indicate that fathers with alcohol problems and their partners (who were mostly light drinking/abstaining mothers) displayed lower warmth and sensitivity toward their infants during parent-infant play interactions. Parental warmth and sensitivity in infancy was a critical step in the pathway to adolescent substance use. Indeed, low parental warmth and sensitivity in infancy set the stage for a cascade of parenting and child risks, leading to underage drinking and substance use by late adolescence. COAs are also more likely to engage in behaviors that increase health risks and have poor health outcomes.

Substance Abuse and Parent Adjustment (Depression, Stress, Anxiety).

Substance abuse is linked to an inter-related complex set of problems in individual adjustment such as depression. Some substances of abuse have acute effects on increases in anger and hostility that are likely exacerbated by pandemic anxiety, stress, and social isolation. Additionally, many parents are facing disruptions in work, loss of jobs, and extreme anxiety due to uncertainties in job and living conditions. Some are essential workers and facing significant risks for infection. Others are working at home for the first time and having to handle dual responsibilities of child-care and work at the same time. Some are living in intergenerational households and having to care for their parents or elderly relatives while coping with pandemic related issues. Many have few supports and are isolated. The combination of stress and anxiety from these multiple ongoing issues and using substances as a primary coping strategy may significantly impact parenting quality and increase family conflict and aggression. These co-occurring risks may also have increase family morbidity and mortality due to COVID-19.

Family and Community Processes

During the pandemic, increase in substance use is also associated with change in the context of use – with many parents using more substances in the home context. This increase in substance use at home given the context of the pandemic is particularly troublesome because of associations with greater risk for family conflict and negative health outcomes for children (e.g., through second-hand smoke exposure or other drug exposure). For instance, there are robust associations between fathers’ heavy drinking and father to mother intimate partner conflict, and between parental engagement in illicit substance use and greater child exposure to family and community violence . Fathers’ moderate to heavy drinking was prospectively predictive of increased partner conflict among community samples. Results of meta-analyses indicate that the risk for conflict among moderate to heavy drinkers is twice that of light drinking or abstaining fathers, and even higher for binge drinking (drink more than 5 drinks on one occasion) fathers. This is likely exacerbated as a consequence of social isolation, loss of social support, and pandemic stress and anxiety, given prior literature on increased risk for aggression and conflict when couples experience low social support. Increasing rates of physical and emotional partner violence have been reported during the COVID-19 pandemic . A large body of literature and theory supports the significant predictive role of the couple conflict and relationship quality for parenting quality and major child outcomes, including behavior problems at home or at school.

Maternal substance use in pregnancy is also often a marker of larger risk for continued substance use in the postnatal period, often single parenthood, greater exposure to community violence, and instability in quality of caregiving. Children of substance using mothers may be more biologically vulnerable and need greater support and engagement with health care, that may be more difficult in the context of continued maternal substance use. Children who are placed in out of home care may be often being cared for by older adults who are more vulnerable to pandemic related health risks. Children placed in foster care often experience more than one foster care situation and in the context of the pandemic and limits on availability of substance use treatment, their parents may experience greater difficulty meeting requirements for reunification.

Recommendations

Online parenting classes designed to provide parenting support and treatment for parents with substance abuse problems may be well suited to addressing the complex and difficult issues surrounding parental substance abuse. For some, anxiety related to health during the pandemic may be a powerful motivator for change. Thus, providing access to treatment may be especially beneficial in the context of the pandemic for those who are motivated to change substance abuse behaviors due to health concerns. Interventions for substance using mothers and fathers during the transition to parenthood may be particular effective – providing an incentive for behavior change during a major life transition.

In conclusion, parental substance abuse is a significant risk factor for adaptive functioning for both parents and children. This may be exacerbated with the stress and anxiety associated with a pandemic – but may also provide an opportunity for change. There is an increased need for safe and accessible substance abuse treatment services during this time.

A list of resources for parents and families can be found here, including national and state food security resources; substance abuse support services for tobacco, alcohol, and other substances of abuse; mental health services for anxiety and depression; and national, state, and local domestic violence support services.

Cannabinoids May Affect Activity of Other Pharmaceuticals

Published on: August 3, 2020
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Cannabinoid-containing products may alter the effects of some prescription drugs, according to Penn State College of Medicine researchers. They published information that could help medical professionals make safe prescribing choices for their patients who use prescription, over-the-counter or illicit cannabinoid products.

Kent Vrana, professor and chair of pharmacology at the College of Medicine, and Paul Kocis, a pharmacist at Penn State Health Milton S. Hershey Medical Center, compiled a list of 57 medications that may not function as intended when used with medical cannabinoids, CBD oil (hemp oil) and medical or recreational marijuana. The list was published in the journal Medical Cannabis and Cannabinoids.

The medications on the list have a narrow therapeutic index, meaning they are prescribed at specific doses – enough to be effective, but not enough to cause harm. Vrana says it’s important for medical professionals to consider the list when prescribing medical cannabinoids and how it may affect other medications a patient is taking.

To develop the list, the researchers looked at the prescribing information for four prescription cannabinoid medications. This information included a list of enzymes in the body that process the active ingredients in those medications, which can include delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). They compared this information against prescribing information from common medications using information available from regulatory agencies like the U.S. Food and Drug Administration to identify where there may be overlap, called a drug-drug interaction.

The list contains a variety of drugs from heart medications to antibiotics and antifungals. As one example, researchers identified warfarin, a common anticoagulant that prevents harmful blood clots from forming, as having a potential drug-drug interaction with cannabinoid products. Often prescribed for patients with atrial fibrillation or following cardiac valve replacement, the drug has a narrow therapeutic index, and Vrana cautions that medical professionals consider this potential drug-drug interaction both when prescribing warfarin to patients on prescription cannabinoids or prescribing cannabinoids to a patient taking warfarin.

The researchers say that medical professionals should also consider patient use of CBD oil products and medical and recreational marijuana when using or prescribing drugs on the identified list. Most of those products lack government regulation and there is little to no prescribing or drug-drug interaction information for those products.

“Unregulated products often contain the same active ingredients as medical cannabinoids, though they may be present in different concentrations,” Vrana said. “The drug-drug interaction information from medical cannabinoids may be useful as medical professionals consider the potential impact of over-the-counter or illicit cannabinoid products.”

Vrana advises that patients be honest with their health care providers about their use of cannabinoid products – from over-the-counter products to recreational marijuana. He says that doing so can help ensure the safe and effective use of prescribed medications.

In addition to the identified list of 57 prescription medications with a narrow therapeutic index that is potentially impacted by concomitant cannabinoid use, a comprehensive list of 139 medications that could have a potential drug-drug interaction with a cannabinoid is available. Vrana and Kocis plan to routinely update this drug-drug interaction list as newer medications are approved and real-world evidence accumulates.

Kent Vrana receives a sponsored research agreement from PA Options for Wellness, a medical cannabis provider and clinical registrant in Pennsylvania, and this research was supported in part by the agreement. The College of Medicine and PA Options for Wellness have a 10-year research agreement designed to help physicians and patients make better informed clinical decisions related to cannabinoids.

This article originally appeared in Penn State Health News.

The CCSA Expands With Four New Co-Funded Faculty Hires

Published on: June 12, 2020
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The CCSA is expanding! We are pleased to announce four new co-funded faculty hires who will be joining us in our work to address the systemic problems of substance misuse.

Paul Griffin, PhD: Professor of Industrial and Manufacturing Engineering in the College of Engineering at Penn State University Park

Griffin’s work focuses on health analytics, health system engineering, and the modeling of public health intervention.

Louisa Holmes, PhD: Assistant Professor of Geography in the College of Earth and Mineral Sciences at Penn State University Park.

Holmes’ work focuses on health disparities and the socio-spatial determinants of health; tobacco control and substance use; and quantitative and geospatial research methods, particularly representative survey research and area-level observational studies

Abenaa Jones, PhD: Assistant Professor of Human Development and Family Studies in the College of Health and Human Development at Penn State University Park

Jones’ work focuses on drug addiction and co-occurring factors associated with drug addiction (i.e., HIV/AIDS) as well as evaluating structural (i.e., judicial interventions, policies), and behavioral interventions aimed to reduce substance use and associated health and social consequences.

Kelly Rulison, PhD: Associate Professor of Human Development and Family Studies in the College of Health and Human Development at Penn State University Park

Rulison’s work focuses on the dynamic social processes and contexts that shape the development of health-risk behaviors during adolescence like rates of drug use and delinquency rapidly increase during adolescence.

‘PROSPER’ Program Continues to Respond to Families’ Educational Needs

Published on: May 5, 2020
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The COVID-19 pandemic has caused major disruptions for Pennsylvanians, including the closing of schools and the interruption of other educational programs. Penn State’s PROmoting School-community-university Partnerships to Enhance Resilience (PROSPER) project is continuing to connect and engage Pennsylvania families and keep schools informed.

Through the PROSPER program, Penn State researchers and extension educators partner to build resilient families and provide research-based prevention programs across Pennsylvania. According to Janet Welsh, PROPSER field director and associate research professor of health and human development and senior research associate with the Edna Bennett Pierce Prevention Research Center, school closures caused an abrupt interruption of several of PROSPER’s evidence-based prevention programs.

“The Strengthening Families Program: for Parents and Youth 10-14 (SFP 10-14) is a seven-week drug and alcohol prevention program offered to parents and caregivers and their 10 to 14-year old youth. It is conducted outside of school and includes a family meal followed by a two-hour session,” Welsh explained. “LifeSkills Training is a 15-lesson drug, alcohol, tobacco, and violence prevention program taught during school in sixth through eighth grades by trained teachers and instructors.”

Penn State Extension educators along with Welsh and Geneen Burris, Penn State’s Evidence-based Prevention and Intervention Support program specialist, brainstormed ideas on how they could continue to connect and engage families who were participating in the programs and keep schools informed.

“We developed a plan to create articles about some of the topics covered in SFP 10-14 and post them to the Penn State Extension website. This not only provides families with valuable information about communicating and problem-solving, but may also entice families to register for future programs,” said Christy Tomascik, Penn State Extension educator.

In addition, PROSPER team leaders continue to communicate electronically with families, reminding them of the ideas and strategies they learned while attending the program.

Online options for the PROSPER programs are also being explored. “LifeSkills Training will hopefully be offered to students as part of their remote learning,” said Karen Thomas, Penn State Extension educator. “SFP 10-14 may be more challenging considering the high level of personal interactions. However, specific session messages with summaries, tips, and activities are being sent home to currently participating families.”

“The uncertainty of what lays ahead makes planning for future prevention programs difficult, but PROSPER Extension educators are supporting districts and families with resources and stand ready to assist when needed,” said Thomas.

The PROSPER program is a collaboration between researchers and Penn State Extension educators, representatives from school districts, community agencies and organizations, as well as past parents and youth participants. Since starting research in 2001 with a sample of more than 11,000 children, PROSPER has seen significant improvements in family life and youth development, as well as reductions in teenage delinquency and substance abuse.

This article originally appeared in Penn State News and SSRI News.

Collegiate Recovery Community Continues Providing Support Virtually

Published on: May 4, 2020
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UNIVERSITY PARK, Pa. — The Penn State Collegiate Recovery Community (CRC) is a program of Student Affairs that supports students in recovery from alcohol and other substance use disorders. On April 18 the program held its Spring Celebration of Recovery on Zoom. The celebration is an event held each semester in which current Penn State students, alumni, family and friends gather to acknowledge their various recovery milestones.

The event was led by a speech from Patrick K., an alumnus of the Penn State CRC, after which students were invited to take a chip and say a few words. At the end, attendees celebrated graduating members.

While the event had to be moved online from its typical location in the Pasquerilla Spiritual Center, more than 70 people attended, including the current members as well as alumni representing every era of the CRC.

“I’m proud of our community for weathering this period of social distancing,” said Jason Whitney, Penn State CRC program coordinator. “They are a highly supportive community, and they have made the best of the situation from the beginning. This celebration was a huge success, and the capstone of a very strong year for our students in recovery.”

Since Penn State’s move to remote learning, the CRC has been successful in converting to a remote format and continuing to provide support and online space for students in recovery. The CRC holds virtual peer support seminars every day from Monday through Friday.

This article originally appeared in Penn State News.

Health Systems Engineering Expert Returns to Industrial Engineering

Published on: April 29, 2020
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UNIVERSITY PARK, Pa. — Paul Griffin, an expert in health systems engineering, will return to the Penn State Harold and Inge Marcus Department of Industrial and Manufacturing Engineering (IME) as a professor on Aug. 15. He is also a co-hire of the Consortium to Combat Substance Abuse (CCSA) within the Social Science Research Institute (SSRI).

Griffin served as the Peter and Angela Dal Pezzo Chair and head of the department from 2009 to 2014. He departed the University to join Georgia Tech as the Virginia C. and Joseph C. Mello Chair in the H. Milton Stewart School of Industrial and Systems Engineering. Griffin served in this role until 2017, at which time he moved to Purdue University to serve as the St. Vincent Health Chair and director of the Regenstrief Center for Healthcare Engineering (RCHE).

“I am excited to return to Penn State because I miss working with the IME faculty and students, plus I love the State College area,” Griffin said. “I am also eager to join CCSA as they are helping to identify where engineering and technology researchers can help fill the gaps for social scientists. In order to solve complex societal problems, you need to be connected with a broader research community.”

The return of Griffin to the IME faculty highlights the department’s push for interdisciplinary collaboration. Via his dual appointment with SSRI, he will focus his research on health systems engineering and care delivery, health analytics, cost effectiveness modeling in public health and health supply chain coordination. In particular, Griffin is interested in mitigating the negative consequences of opioids and related substances.

Ling Rothrock, interim department head and professor, said that he is honored to welcome Griffin back to IME.

“He has had a transformational impact in Purdue University’s Regenstrief Center for Health Care Engineering,” Rothrock said. “His research focusing on the disparities of health care access in rural and low-income populations sheds light on policy-level mitigation strategies and makes him a great fit for IME and CCSA.”

His current work with RCHE aims to help mitigate substance abuse using a community-wide systems approach. In particular, the RCHE group focuses on improving patient care for opioid addiction treatment and referral management, integrating heath information technology and supporting analytics, public health evaluation, modeling syringe services programs and developing point of care technologies. Their work is funded by several agencies including the Centers for Medicaid and Medicare Services and the Substance Abuse and Mental Health Services Administration.

Griffin’s work has implications for patient care and public health policy. Griffin explained that health care systems are complex and have many moving parts.

“There are a variety of entities that make up these systems like triage, emergency departments and intensive care units,” Griffin said. “I want to know how these work together and what happens when you make a change. It’s not just the providers that play a role in patient care, so how can these systems be improved?”

Stephanie Lanza, professor of biobehavioral health and director of the Edna Bennett Pierce Prevention Research Center, serves as CCSA’s interim director. Lanza explained that Griffin is a critical new hire for CCSA.

“CCSA is focused on novel, interdisciplinary solutions to the systemic problems of substance use,” Lanza said. “His focus on health systems analytics will bring new research perspectives to Penn State’s efforts, and he will provide important leadership to the consortium’s efforts moving forward.”

Griffin is a fellow of the American Institute for Medical and Biological Engineering (AIMBE) and serves as co-chair of the bi-annual INFORMS Healthcare Conference. He received his doctorate in industrial engineering from Texas A&M University.

This article originally appeared in Penn State Engineering News.

Penn State Stands Out As ‘Exception’ For Team Research Collaboration

Published on: March 27, 2020
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The Millennium Science Complex, on the Penn State University Park campus, houses the Huck Institutes of the Life Sciences in one wing and the Materials Research Institute in the other. Image: Penn State

University Park, Pa. — The faculty at Penn State may view their extensive interdisciplinary research collaborations as normal, but it turns out that Penn State’s successful culture of innovation through interdisciplinary collaborations is anything but normal. It is an exception.

In December 2019, a research team led by Steve Brint of the University of California, Riverside published an article in The Journal of Higher Education that evaluated the effectiveness of interdisciplinary research and cluster hiring at 20 universities; the study revealed that despite recruiting top experts in the field, more often than not, the waves of success were just not happening after the hires were made. The study noted that “There are exceptions to this rule. One university in our sample stood out.” That exception was Penn State. UC Riverside asked for permission to write about Penn State as that exception.

Penn State Senior Vice President for Research Lora Weiss said there are several strategies that Penn State has developed to enable successful collaborations. She identified four key points:

1. College deans and institute directors at Penn State nurture continuous and genuine partnerships. Weiss described how “co-funded hires are a genuine partnership between college deans and the institute directors. The hires are not only jointly funded, but the partnerships are founded on working closely to create a shared and joint vision.” The relationship extends to managed expectations for research performance, tenure success, external funding awards, time commitments, and grad student supervision and training. Tenure homes are in the departments, but a continual dialog occurs among the deans and institute directors, Weiss said.

2. Institute directors are top scholars in their respective fields. As noted in the UC Riverside paper, institute directors at Penn State are top scientists and scholars in their fields, with established reputations. This is exceptionally attractive to new co-hires, to sponsors and to junior faculty. Weiss explained that “these leaders recognize the importance of ensuring sufficient opportunities for junior faculty that are aligned with the promotion and tenure process, while simultaneously fostering research directions focused on meaningful breakthroughs.”

3. Penn State provides professional staffing of shared resources and core facilities. The University maintains a highly effective and efficient approach to sharing resources, equipment, and facilities. “Penn State has dedicated staff who maintain and operate the resources, as opposed to a single investigator or single research group,” Weiss said. This enables investigators and graduate students to have more time to focus on research and to foster additional collaborations. The technical staff’s expertise gained on one research project can be shared or adapted to a project in a different discipline. The institute lab directors have also been intentional in creating a strategic approach to sharing resources, equipment, and facilities so that staffing and operating the labs at the university-level allows them to develop broad expertise and to handle the day-to-day management.

4. Penn State provides seed grant funding that is directed from the institutes. “These grants support high-risk and high-payoff collaborations, bold forays into new research directions, and the creation of new partnerships,” Weiss said. Grants are monitored with various metrics for impact, including meaningful breakthroughs, new proposal submissions, joint papers and new sponsored research. Early on, large seed grants were a major enabler for interdisciplinary success. Penn State has kept these seed grants in the forefront of its interdisciplinary programs.

A research ecosystem designed for collaborations

Penn State, like its many R1 university peers, touts itself as a very interdisciplinary research institution; former Vice President for Research Neil Sharkey, who retired in 2019, often described Penn State’s seven interdisciplinary research institutes as “the envy of our peers.” If Brint’s survey is an accurate reflection, then Penn State really is unique in its ability to get interdisciplinary teams to coalesce. In the latest National Science Foundation’s annual Higher Education Research and Development (HERD) Survey, Penn State is ranked in the top ten in 18 areas of research expenditures, in categories ranging from engineering to astronomy to social sciences. No other university in the survey has as many top-ten fields.

The University’s practices have supported several successful cluster hires in recent years — practices that may have avoided a common situation where members of a group hire eventually get absorbed into a department, missing out on the magic of truly interdisciplinary work. Penn State’s strategy aims to have researchers come into an organization that both expects and strategically supports collaboration. In fact, University administration has moved away from calling them “cluster hires,” and has made an unofficial effort among administration to instead refer to them as “strategic hires,” underlining an enterprise-wide effort to be intentional with supporting a research mission of teams of exceptionally talented investigators.

Among the successful consortia that were formed at Penn State using strategic hiring is the 2-Dimensional Crystal Consortium (2DCC), a multi-million dollar, NSF-funded program that advances the synthesis of 2-D materials. Directed by Joan Redwing, professor of materials science and engineering and electrical engineering, and formed within the Materials Research Institute, 2DCC is now a national user facility. The consortium resulted from a small, internal investment and a leadership decision to cluster faculty and resources to expand the discovery and excitement around graphene. It brought together approximately 20 faculty from three colleges and seven departments.

Nurturing the program has paid off: “In addition to the NSF program, we now have a number of companies involved and funding research in this area as part of the ATOMIC Industry-University Cooperative Research Center directed by Professor Mauricio Terrones,” Redwing said. She noted that “the small institutional investment enabled clustered collegiality and dialogue well before the NSF announcement for funding. The resulting science and high-quality proposals submitted since then has been astounding.”

Another exemplar of interdisciplinary research collaborations for Penn State is the Child Maltreatment Solutions Network, launched in 2012 by the Social Science Research Institute. The consortium, led by Jennie G. Noll, professor of human development and family studies and director of the network, now includes faculty from seven departments across five colleges.

In 2016, the network received funding from the Eunice Kennedy Shriver National Institute for Child Health and Human Development to launch a first-of-a-kind, five-year study aimed at illuminating the bio-psych-social mechanisms that underlie the long-term negative health consequences of child maltreatment.  In 2017, the network was awarded the first-ever Capstone Center Grant from the NIH for child maltreatment prevention research.

Noll reflected on coming to Penn State and overseeing a cluster hire team; leadership and vision were among the top ingredients she listed for making sure the cluster hire progressed and had impact. She reiterated that the institute directors clearly have a vision for where the field needs to go, which is a function of having deep knowledge of the field — Noll came to Penn State from the Cincinnati Children’s Hospital. She acknowledged the benefits of having the Penn State interdisciplinary institute directors afforded the decision-making power with regard to hiring and staffing; this strategy of granting those tasks to active scholars in the field ensures that the gaps in the field are being addressed.

“At the end of the day, you want the sum to be greater than the individual parts,” Noll said. The strategic vision continues to help drive the new team to “work together on something bigger than their own siloed research; these directors must have an idea of what the field needs,” she said.

Noll also pointed out the human element in a happy team: “I think we like each other, as a group. We work well together and genuinely help each other.” Fostering a positive team environment can be helped by making sure faculty are not heading toward burnout, providing adequate support resources, and making sure deans and departments understand the benefits of giving members space and time to chase the big, time-consuming opportunities.

Carrot or stick

Of course, administrative and institutional hurdles can nurture or suffocate a new cluster hire.

Both Noll and Weiss noted that hiring the group is only the first step. A successful interdisciplinary collaboration is a huge undertaking, and it is a mistake for a university to make a large investment at the front end to form it, and then not expect it to need continued support.

Administratively, one lesson Noll said she has learned is the importance of protected time to work on the collaboration. She negotiated with deans and administration after the formation of the program to implement the necessary tradeoffs. She said that the University has to maintain a commitment to running the program and providing “the resources to be able to think big.”

A grand administrative challenge

The University’s success in designing a research enterprise that can support interdisciplinary teams was no accident. Former Senior Vice President for Research Eva Pell, who served from 1999-2009, is largely credited with laying down the initial building blocks that incentivized faculty, deans and administration to start working in a less siloed fashion. Strategic programs in the institutes were conscientiously designed in a manner that supported and enhanced the colleges’ research efforts.

The very design of the Millennium Science Complex, which opened in 2012, houses the Huck Institutes of the Life Sciences in one wing and the Materials Research Institute in the other. The state-of-the-art building is meant to foster easy physical access to labs, and maybe more importantly, to colleagues working with the institutes. The two wings of the building meet at a center point so that it forms a large triangle, and there is a large common social space, home to weekly talks from scientists in any discipline, which are always well-attended (the free coffee helps, too).

It really does change the field

Nurturing productive interdisciplinary collaborations may be more art than science, and much of it still seems to come down to human factors — that includes the monumental task of getting a large team of leaders to not only believe it can work, but to also agree to work together to grow these kinds of teams. Weiss describes this as “sweat equity,” where everyone involved has to continually work hard to make the collaborations a success. Certainly, Penn State has had a few initiatives fizzle out over the years.

Weiss recognized that to make a difference, we must take risks. She said she likes to quote Adam Savage of the “Mythbusters” in saying “failure is always an option,” but she also noted that when leadership has a strong vision of what the field needs, and when it comes together with creativity and exceptional talent, as Noll said, “it really does change the field.”

This article originally appeared in Penn State News.

Prenatal Substance Exposure Impacts Adolescent Attitudes Toward Gun Violence, Study Finds

Published on: March 25, 2020
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UNIVERSITY PARK, Pa. — The wave of mass shootings across the United States in the last two decades has reignited the discussion of gun violence and the role it plays on childhood development. New research has found that prenatal substance exposure may contribute to positive attitudes toward guns and violence among adolescents.

This association may occur through an indirect pathway from substance exposure to higher child aggression in kindergarten to greater engagement with bullying perpetration and victimization in early adolescence, according to researchers from Penn State, the University at Buffalo (State University of New York), Buffalo State (State University of New York), and the Rochester Institute of Technology.

“We found that maternal substance abuse in pregnancy was associated with higher risk for children to behave aggressively in kindergarten,” said Rina Eiden, professor of psychology at Penn State and Consortium to Combat Substance Abuse (CCSA) co-funded faculty member. “Maternal substance use in this sample was associated with greater socioeconomic adversity and greater placement in non-biological parent care like foster or kinship care. These children were also living in neighborhoods with higher rates of crime and were exposed to more community violence.”

Eiden, whose research focuses on risk and resilience processes among children of substance abusing parents and early childhood interventions for mitigating risks, said that over half of the families in the project were recruited because of maternal substance use in pregnancy, particularly cocaine, and many were in unstable home environments.

“These families also experienced significant exposure to community violence in addition to difficult home lives,” Eiden said. “Our results indicate that a pattern of child aggression that was sustained over time and contexts was associated with aggressive attitudes supporting gun violence.”

According to Eiden, the current project stemmed from a research program that began in 2000 on the effects of prenatal cocaine exposure on children’s development. As in other studies of prenatal cocaine and other substance exposure, researchers found that substance exposed children had lower birth weights and had more trouble regulating or modulating their arousal under stress in infancy.

It was not until the National Institute of Health called for studies on gun violence five years ago that Eiden and her team realize that the sample might be suitable for examining how parental substance abuse, socioeconomic adversity, and neighborhood contexts might be associated with greater risk for violence and victimization including risk for gun violence.

The researchers recruited 216 families from two urban hospitals that predominantly served a low-income population for the study. The mothers were screened after delivery to identify participants with high rates of prenatal substance use. The families consisted of 116 infants exposed to cocaine and other substances, and 100 not exposed to cocaine but possibly exposed to other substances like alcohol, cigarettes or marijuana. The infants were assessed beginning at one month with follow-up assessments every six months until and including kindergarten age, in second grade, and throughout early adolescence.

The assessments included whether children were exposed to violence in the home (e.g., shootings, beatings); incidents of early childhood aggression noted by teacher ratings and classroom observations at the kindergarten age; incidents of bullying perpetration and victimization; and any positive attitudes towards guns and violence.

“My team was interested in looking at the pathways to violence, victimization and adolescent substance use,” Eiden said. “The goal was to examine two pathways to violence/victimization: reactive and proactive. Reactive aggression happens in response to provocation while proactive aggression is planned to achieve a specific goal. Our findings suggest that bullying perpetration or being victims of bullying was not associated with greater comfort with guns or power, but rather was associated with using violence as a retaliatory coping mechanism.”

Eiden said one way to help prevent these outcomes may be early intervention to help reduce aggressive behavior.

“We know from other research that children naturally decrease aggressive behaviors between three and four years of age,” Eiden said. “If this decrease does not happen, there is greater continuity in aggressive behavior. Thus, helping parents with strategies to reduce child aggression by positive parenting and helping children cope with environmental stressors may be good prevention strategies.”

Additionally, Eiden said that treating substance use as a public health issue and not a criminal one may help not only parents with substance use problems but also children and families. Providing parents with treatment for substance abuse and helping them with strategies that promote children’s self-regulation and lower risk for aggressive behavior in the infant/toddler period may have long lasting effects on developmental outcomes into adolescence. Self-regulation is the ability to manage emotions and behavior in accordance with the demands of the situation like resisting highly emotionally reactions to upsetting stimuli and calming oneself down.

In the next few years, Eiden said she hopes to release more findings from this sample as the families complete the adolescent wave of data collection.

“I believe we will find that as these children enter late adolescence, there will be an even stronger connections among the parental substance use problems, socioeconomic adversity, exposure to community violence, continuity of aggression from childhood to late adolescence, and weapon carrying including the potential for gun violence,” Eiden said.

This article also appeared in Penn State News.

Hotels Benefit from Marijuana Legalization, Study Finds

Published on: March 10, 2020
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A Penn State researcher found that recreational-marijuana legalization positively affected hotel revenues in Denver, totaling approximately $130 million in new hotel revenues.
IMAGE: Alex Person, Unsplash

UNIVERSITY PARK, Pa. — Legalization of recreational marijuana may lead to increased hotel revenues, according to a Penn State researcher, who found that after legalizing marijuana, the City of Denver, Colorado, saw roughly $130 million in new hotel revenues.

“The production, sale and consumption of recreational marijuana have been legalized in at least 10 states, and many others are considering legalization,” said John O’Neill, professor of hospitality management. “My findings could be useful to government officials and business owners in states that are considering legalization.”

O’Neill focused his study on Denver, Colorado, since the state was one of the first to legalize recreational marijuana at the beginning of 2014. No other area provides a longer period of time to study, he said, adding that Denver is a large and diverse area, providing both a substantial and possibly generalizable sample from which to draw results.

O’Neill used hotel data from STR, formerly known as Smith Travel Research, as well as the geocoordinates and opening dates of recreational marijuana dispensaries in the Denver area, to conduct his study. He used these data to examine marijuana’s effects on hotel performance in the ensuing years. His findings appeared in the latest issue of the Journal of Real Estate Literature.

“I found that recreational marijuana legalization positively affected hotel revenues in Denver, totaling approximately $130 million in new hotel revenues,” said O’Neill.

The positive effects lasted only about a year, primarily as a result of increases in prices. After a year, revenue rates returned to normal.

“We found that Denver hotels were able to charge and receive higher prices for hotel rooms following recreational marijuana legalization, and also found increased visitation to the Denver area with growth in occupied hotel rooms of 9% in 2014, higher than any other year we studied, resulting in positive economic impact,” said O’Neill.

O’Neill also found that the positive effects were more pronounced in tourist-oriented, lower-priced hotels than in higher-priced hotels catering to commercial travelers. Additionally, the positive effects were unrelated to the distance between hotels and recreational marijuana dispensaries.

“I found that although hotels generally located in the neighborhoods and areas of the city where dispensaries are located experienced the most positive effects, there was no evidence that distance to marijuana stores was a significant factor affecting hotel performance,” said O’Neill. “It could be that guests visit dispensaries only once or twice during any trip, and that proximity to other support amenities, such as restaurants, lounges and conventional retail establishments, as well as hotel attributes, such as brand and price, are more important considerations in their hotel selection.”

O’Neill notes that the time period he examined in his study corresponds to a period of general economic growth in the United States.

“Although I studied Denver during a period of economic growth, its growth after legalizing recreational marijuana was above and beyond what would have been otherwise expected without legal recreational marijuana,” he said. “In addition, its growth was greater than comparable cities, such as Albuquerque, Austin and Salt Lake City. Also, its growth was greater than national averages. I believe the difference in hotel revenues was due to the legalization of recreational marijuana in Denver.”

This story originally appeared in Penn State News.

Research On E-Cigarette Flavors – Penn State Cancer Institute

Published on: March 5, 2020
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A new study by researchers at Penn State College of Medicine finds that adults enjoy sweet e-cigarette flavors just as much as teens, suggesting that a federal policy on e-cigarette products may have consequences for adults – and not just the youth targeted by the measure. Jonathan Foulds, professor of public health sciences at the College of Medicine, talks about the findings. Learn more: https://bit.ly/2wqzKsu

Device Helps Deliver Electronic Cigarette Vapors For Research

Published on: March 5, 2020
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IMAGE: © iStock/mauro grigollo

HERSHEY, Pa. — The increased use of electronic cigarettes and vaping products has increased the need to better understand how and if addiction to these products is different than in traditional cigarettes. One way to objectively measure addictive potential is through changes in the brain, but researchers say a limited number of methods currently exist to deliver the vapor (called aerosol) during magnetic resonance imaging, commonly called MRI.

Assistant Professor of Psychiatry and Public Health Sciences Andrea Hobkirk’s prototype device is designed to do just that — delivering up to four different aerosols during MRI scanning and mimicking the everyday use of a vaping device.

According to the researchers, the ability to deliver four different aerosols is important to compare flavorants often added to the vaping liquid. Penn State Clinical and Translational Science Institute’s Bridges to Translation Pilot Grant Program funded the research to develop the prototype, and Hobkirk and team recently reported their results in the journal Substance Abuse: Research and Treatment.

Safely and effectively delivering e-cigarette aerosol during MRI is important to determine what changes in the brain contribute to addiction of e-cigarettes, Hobkirk said, especially as it relates to the use of flavor, which law bans in traditional cigarettes. The pilot grant helped develop the MRI-compatible equipment, calibrated the amount of nicotine in the vapor and evaluated the device.

“With this new technology, we can determine if flavor characteristics change the addictive potential of nicotine-delivery products such as e-cigarettes,” Hobkirk said. “This research will translate to tobacco policy and treatment by helping us understand how flavored tobacco products contribute to nicotine dependence for new tobacco users and influence smokers’ ability to switch from traditional cigarettes to harm-reduction products.”

The research team reported that the device delivers nicotine effectively for human absorption and at the expected reduction in concentration due to the sticky nature of nicotine. They list several potential adjustments that can preserve the amount of nicotine that reaches the participant, including using Teflon tubing or shortening the tubing length. The team also can deliver consistent airflow at 10-second intermittent aerosol delivery using the device, with further research needed to allow additional variability. Importantly, MRI scan image quality is not affected by the use of the equipment.

The team is seeking additional funding to use the device to study brain responses to e-cigarette cues, including e-cigarette images and flavored aerosols, among regular users.

“Understanding how the brain responds to e-cigarette cues can provide information on how e-cigarette addiction develops in the brain, and how we might be able to treat it,” Hobkirk said. “Studying brain responses to cues can also help us to predict which e-cigarette products will be the most likely to result in addiction for new users.”

Hobkirk also is a former Early-Stage Investigator Training Program (KL2) scholar, which also supported her research in this area. She left the program when she was successful in securing a career development award from the National Institute on Drug Abuse. She ultimately wants to develop a translational research program related to smoking cessation and tobacco policy.

National Center for Advancing Translational Sciences, Penn State Highmark Gift Fund, National Institute on Drug Abuse and Pennsylvania Department of Health Tobacco CURE Fund supported this research.

Other researchers on this paper are Zachary Bitzer, Reema Goel, Craig Livelsberger, Neil Trushin and Jessica Yingst, Department of Public Health Sciences; Prasanna Karunanayaka, Sebastian Rupprecht, Christopher Sica and Jianli Wang, Department of Radiology; Brianna Hoglen and Kenneth Houser, Department of Psychiatry; Jonathan Foulds, Departments of Psychology and Public Health Sciences; John P. Richie Jr., Departments of Public Health Sciences and Pharmacology; Lauren Spreen, Department of Molecular Biology; and Qing X. Yang, Departments of Radiology and Neurosurgery – all from Penn State College of Medicine — and Ryan Elias, Department of Food Science, Penn State College of Agricultural Sciences.

This article originally appeared in Penn State News. 

Wolf Administration Provides Naloxone to Pennsylvania Airports; Encourages Availability of Life-Saving Medication in Public Venues

Published on: February 27, 2020
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Harrisburg, PA – At an event at Harrisburg International Airport (HIA) the Wolf Administration today announced that it will be providing free naloxone to Pennsylvania airports as part of an ongoing effort to expand access to the life-saving medication and decrease opioid overdoses across the commonwealth.

The naloxone will be stored with airport AED machines and first aid kits with the suggestion that all airport personnel are trained to both carry and administer the medication. Many airports already have their own public safety teams with police, fire and EMS, so this distribution will be available to those teams if needed as well.

“A key component to decreasing the number of overdose deaths in Pennsylvania is widely distributing naloxone in communities and public venues,” said DDAP Secretary Smith. “When dealing with an epidemic like the opioid crisis, life-saving medication should be a part of every first aid kit and readily available. We encourage everyone – business owners, members of the general public, loved ones affected by substance use disorder, and individuals suffering from the disease – to equip themselves to respond in an emergency.”

The other airports involved in the program are Philadelphia International Airport, Pittsburgh International Airport, Williamsport Regional Airport, Wilkes-Barre Scranton International Airport, University Park Airport and Lancaster Airport.

“Naloxone is a life-saving medication that can reverse the effects of an opioid overdose,” Secretary of Health Dr. Rachel Levine said. “Since 2018, we have provided free naloxone kits to more than 14,000 Pennsylvanians- that means 14,000 lives can be potentially saved. We know that Pennsylvanians are dedicated to helping to save lives of not only their loved ones, but also anyone who has overdosed.”

The Wolf Administration has increased federal funding for the distribution of naloxone to $5.4 million and expanded access to naloxone through a number of initiatives. Naloxone is carried at most pharmacies across the state year-round. Dr. Levine issued a standing order prescription to any Pennsylvanian to get naloxone at a pharmacy for anyone who may need it. Naloxone is available to many with public and private insurance at pharmacies either for free or at a low cost.

In addition, naloxone has also been made available through the Pennsylvania Commission on Crime and Delinquency’s Centralized Coordinating Entities, free public naloxone giveaways at Pennsylvania Health Centers, partnerships with Pennsylvania colleges and universities, and distribution to narcotic treatment providers throughout the commonwealth.

The Opioid Command Center, established in January 2018 when Gov. Wolf signed the first opioid disaster declaration, meets every week to discuss the opioid crisis. The command center is staffed by personnel from 16 state agencies and the Office of the Attorney General, spearheaded by the departments of Health and Drug and Alcohol Programs.

Data show that in 2018, more than 4,400 people died from a drug overdose. This represents a nearly 18 percent decrease in drug overdose deaths from 2017.

Efforts working with state agencies, local, regional and federal officials during the past four years have resulted in significant action to address the opioid crisis. Recent efforts include:

  • More than 7,000 kits of naloxone were distributed to Pennsylvanians in September 2019 and another 7,000 kits were distributed in December 2018.
  • The Prescription Drug Monitoring Program has reduced opioid prescriptions by 30 percent and has virtually eliminated doctor shopping.
  • The Opioid Data Dashboard and Data Dashboard 2.0 is providing public-facing data regarding prevention, rescue and treatment.
  • The waiver of birth certificate fees for those with opioid use disorder has helped nearly 4,000 people, enabling easier entry into recovery programs.
  • A standing order signed by Dr. Rachel Levine in 2018 allowed EMS to leave behind nearly 2,325 doses of naloxone.
  • More than 6,000 health care professionals have been visited and provided training on how to prescribe opioids cautiously and judiciously.
  • 813 drug take-back boxes help Pennsylvanians properly dispose of unwanted drugs, including 482,000 pounds of unwanted drugs in 2018.
  • The Get Help Now Hotline received more than 32,200 calls, with nearly half of all callers connected directly to a treatment provider.
  • The state prison system has expanded their Medication-Assisted Treatment (MAT) program, which is viewed as a model program for other states.
  • More than 100 licensed physicians or prescribers have been disciplined for wrongful practice over the past two years.
  • Several agencies have worked together to collaborate on the seizure and destruction of illicit opioids across Pennsylvania.
  • The coordination with seven major commercial providers has expanded access to naloxone and mental health care, while also working to make it more affordable.
  • Naloxone has been made available to first responders through the Commission on Crime and Delinquency, with more than 25,000 doses made available and more than 4,500 saves through that program. In addition, EMS have administered more than 32,400 doses of naloxone.

For more information on Pennsylvania’s response to the opioid crisis visit www.pa.gov/opioids.

Research Suggests Adults, Not Just Teens, Like Electronic Cigarette Flavors

Published on: February 27, 2020
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IMAGE: GETTY IMAGES: MOUSSA81

UNIVERSITY PARK, Pa. — On Feb. 6, the U.S. Food and Drug Administration (FDA) began to enforce a previously issued policy on unauthorized, flavored, cartridge-based e-cigarette products with the goal of addressing the current epidemic of youth use of e-cigarettes. A new study by researchers at Penn State finds that adults enjoy sweet e-cigarette flavors just as much as teens, suggesting that the policy may have consequences for adults too.

The researchers studied changes in flavor preference in a group of long-term, adult e-cigarette users and found that, over time, preference for the traditional tobacco, menthol and mint flavors decreased, while preference for chocolate, candy and other sweet flavors increased.

“Our data show that flavors aren’t just popular with the youth, but with adults as well,” said Ping Du, first author of the study published in the Annals of the American Thoracic Society and associate professor of medicine and public health sciences at Penn State College of Medicine. “Many of the participants in our study indicated that they used e-cigarettes as a means to quit smoking or avoid relapse, and these flavors may be part of the reason why they end up using e-cigarettes in the long-term.”

The researchers analyzed responses from 383 adult participants between the ages of 22 and 75 who completed an online e-cigarette survey between 2012 and 2014 and a follow-up survey between 2017 and 2019. In both surveys, participants were asked to name their preferred liquid flavor.

Preference for fruit flavors remained stable while preference for tobacco, menthol or mint decreased over time from 40 percent at baseline to 22 percent at follow up. Preference for chocolate or candy and other sweet flavors was most noticeable in younger adults 18 to 45 years old and increased from 16 percent at baseline to 29 percent at follow up.

In the follow up survey, the participants were asked to describe their anticipated reactions in regards to potential FDA regulations. About 50 percent indicated they would find a way to buy their preferred flavor or add flavoring agents themselves if their preferred, non-tobacco flavors were banned.

Jonathan Foulds, professor of public health sciences at the College of Medicine, indicated that most of the participants in this study used tank-based electronic cigarettes and these e-cigarette users can continue to purchase flavored e-liquids in bottles from vape shops. Consumers may also still be able to access flavors through disposable vapes. However, it is unclear if many of those products will remain available after May 12 — the deadline for manufacturers to submit premarket applications to the FDA in order to remain on the market.

According to Foulds and Du, members of the Penn State Cancer Institute, restrictions on all non-tobacco e-cigarette flavors could help prevent non-users — especially adolescents or youth — from initiating e-cigarette use. Yet, a variety of resources are available to teens and adults who want to obtain flavors that range from online videos demonstrating how to add flavors or make your own liquids, to social media networks and websites that make it easier for people to obtain unregulated products off the streets or from foreign countries.

“Unauthorized flavor additions or buying products off the streets is dangerous for personal health since we don’t know what the chemicals are in those products,” Du said.

About 10 percent of respondents indicated that if their preferred flavor was banned, they’d consider going back to smoking. Du said that the results of the study may help clinicians and researchers address the concern that many long-term users state an intention to seek illicit flavor sources if their flavor was banned, which may cause unforeseen health problems.

“We don’t know what the long-term effects of this new policy will be, but the evidence we’ve collected says that adult, long term e-cigarette users with a preference for sweeter flavors may face health risks trying to obtain or make their preferred flavors,” said Du.

Rebecca Bascom, Tongyao Fan, Ankita Sinharoy, Jessica Yingst and Pritish Mondal of Penn State College of Medicine also contributed to this research.

This work was supported by the National Institutes of Health and the Center for Tobacco Products of the U.S. Food and Drug Administration. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the FDA.

This article originally appeared in Penn State News.

Scholars Collaborate On Addiction Treatment Research

Published on: February 25, 2020
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Andrea Hobkirk, Ph.D., is studying the problem of relapse after addiction treatment. She recently was a scholar in Penn State Clinical and Translational Science Institute’s Early-Stage Investigator Program (KL2). She left the program when she was successful in securing a career development award from the National Institute on Drug Abuse. It is through the Early-Stage Investigator Program that she met a collaborator, fellow scholar Steven Hicks, M.D., Ph.D. Hobkirk recently received a Young Investigator Grant from the Brain and Behavior Research Foundation for the collaborative project.

“Penn State Clinical and Translational Science Institute’s KL2 program was critical in helping me obtain this award by affording me the time and resources to develop the project,” Hobkirk said. “The program also introduced me to my collaborator, Dr. Hicks, whose expertise is essential for completing the project aims.”

The research could lead to an inexpensive and non-invasive method to measure brain responses to addiction treatment. By understanding these changes, the effectiveness of an addiction treatment program can be determined for each patient.

“In sustained recovery, patients have more self-control over compulsive substance use and more enjoyment from activities that don’t involve substance use,” Hobkirk said. “These improvements are driven by changes in brain function. New research shows that changes in the genetic material in saliva may reliably show these brain changes.”

To test this idea, Hobkirk will study those who are addicted to nicotine. Smokers will receive study cigarettes with very low nicotine levels or with usual nicotine levels for six weeks while they provide saliva samples and complete functional magnetic resonance imaging (MRI) to measure brain function. The study explores potential links between genetic information in the saliva and brain changes related to improvements in self-control and reward response. Hobkirk is collaborating with Hicks because he is using a similar method involving genetic material in saliva to screen for autism.

“The results will bring us closer to identifying biomarkers that can provide early signs that addiction treatment is or is not working for an individual. This will help us to change or extend interventions for those who are not responding to treatment to prevent the risk of relapse,” Hobkirk said.

The collaboration shows the strength of the Early-Stage Investigator Program.

“Our KL2 program brings together junior faculty from a variety of scientific disciplines in a cross-campus research training program,” Diane Thiboutot, M.D., program co-director, said. “The face-to-face interactions of our scholars within the program allows them to generate ideas for interdisciplinary, team-based research.  We are excited to add the recent success of Drs.Hobkirk and Hicks in receiving the Brain and Behavior Research Award to our growing list of successful collaborative research grants among our KL2 scholars at Penn State.”

Added Hicks, “Participation in Penn State Clinical and Translational Science Institute’s Early-Stage Investigator Training Program allowed us to identify opportunities for synergy in our research programs and led to Dr. Hobkirk’s innovative and successful application to the Brain and Behavior Research Foundation.”

Hobkirk is an assistant professor of psychiatry and public health sciences. Hicks is an assistant professor of pediatrics. Grant K23 DA045081 supports this project. Grant KL2TR002015 supports Hicks. Lorah Dorn, Ph.D., is the co-director of the Early-Stage Investigator Training Program.

This article originally appeared in the CTSI’s newsletter.

PROSPER featured in White House “Rural Community Action Guide: Building Stronger, Healthy Drug-Free Rural Communities”

Published on: February 11, 2020
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Jennifer Deichert, PROSPER prevention coordinator in Fayette County, with ONDCP Director Jim Caroll and ONDCP Senior Adviser for Rural Affairs Anne Hazlett

PROSPER is featured on page 43 of this new tool released by the Office of National Drug Control Policy (ONDCP), to assist rural community leaders in building an effective local response to the crisis of addiction.The Rural Community Action Guide includes background information, recommended action steps, and promising practices for a range of issues related to drug addiction in rural America.

Fayette County PROSPER team members Jennifer Deichert, PROSPER prevention coordinator; and Jim Custer, Fayette County sheriff, attended the launch event as invited guests.

Parents and Communities Can Help Prevent Teen Vaping, Experts Say

Published on: February 11, 2020
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Penn State prevention coordinator Melissa Tomascik encouraged parents to have open and honest conversations about their expectations and the consequences for engaging in risky behaviors, during the Jan. 30 episode of “Conversations LIVE” on WPSU.IMAGE: BLACK ROCK DIGITAL/SHUTTERSTOCK.COM

UNIVERSITY PARK, Pa. –  As vaping becomes more prevalent in high schools and middle schools, parents and communities can take steps to help prevent teens from vaping or engaging in other risky behaviors, according to experts at Penn State.

Melissa Tomascik, prevention coordinator for the PROSPER (PROmoting School-community-university Partnerships to Enhance Resilience) program, and Jonathan Foulds, professor of public health sciences and psychiatry at the Penn State College of Medicine, responded to concerns about the rise in vaping by teens on the Jan. 30 episode of “Conversations LIVE” on WPSU.

“Vaping is a huge concern with parents,” Tomascik told viewers. “Vaping has only been around since 2015, so we don’t know what kind of gateway drug it could be.”

More than one-quarter of 12th graders nationally have vaped nicotine in the past month, according to the National Institute on Drug Abuse.

“In PROSPER, we start to talk with kids in 5th and 6th grade,” said Tomascik. “We teach them skills to cope with stress. And we want them to be prepared to say ‘no’ if they experience peer pressure.”

Tomascik offered these recommendations for parents and guardians:

  • Start open and honest conversations about your expectations and the consequences for engaging in risky behaviors.
  • Discuss the statistics and health concerns. There may be a perception that “everyone is doing it”; however, if 25% of their peers are vaping, this means that 75% are not.
  • Bonding is very important. Keep connected and interested in your kids’ lives — academic, social, and spiritual — and in their health.
  • Get to know their friends and social networks. When they go out, ask questions: Find out where they’re going, who they’ll be with, and when and how they are getting there and returning home.
  • Be alert for any changes or signs that could signal emotional or behavioral problems, conduct or academic problems, or issues with sports or friends. Express concern, stay calm and seek support if needed. The earlier a problem is addressed, the better.

“We focus on prevention, no matter what substance is out there. We know decreasing risk factors, increasing protective factors, and supporting our youth will give them a healthier future,” said Tomascik.

She also advised communities to support evidence-based programs for youth and families, like PROSPER. Penn State’s EPISCenter supports a range of evidence-based programs for schools and service providers across Pennsylvania.

This article originally appeared in Penn State News. 

Congressional Briefing: ​The Real Dangers of Equating Opioid Dependence with Addiction

Published on: January 21, 2020
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The National Prevention Science Coalition to Improve Lives (NPSC) and the Congressional Addiction, Treatment and Recovery Caucus (ATR)  co-hosted a briefing with internationally recognized experts to discuss the dual challenges of addiction and dependence in developing policy responses to the opioid epidemic.  Although many people conflate addiction and dependence, they are not the same, and the distinction has important implications for the millions of people who rely on opioid medications for pain management.

This briefing brought together lawmakers, regulators, physicians and other scientists, and the public into this critical conversation. Speakers addressed the science of addiction and dependence, how the distinction between them affects clinical practice and policy, and specific strategies suggested by the medical and prevention sciences for ensuring that patients’ differential needs are met. The latter includes: (1) a public health campaign to educate the public, lawmakers, industry leaders and community organizations about the distinction between dependence and addiction and its policy implications; (2) destigmatizing appropriate medical use of opioids to ensure patients receive needed treatments; (3) routinely implementing assessments to distinguish patients with addiction from those with dependence to appropriately guide remedies; and (4) scaling up evidence-based individual, family, school and community-level preventive interventions and policies to reduce exposure to the detrimental conditions that lead to addiction (Prevention and Intervention).  Although prescribing and monitoring are largely a physician-based undertaking, state and federal governments play a role in providing regulatory oversight and legislative guidance that support the evidence-based initiatives needed.

This article was originally posed on the NPSC website.

Marijuana Policies: A Call to Shift From a Criminal Justice Approach to a Public Health Approach

Published on: January 9, 2020
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Despite the billions of dollars, marijuana prohibition has cost society; this strategy has failed to protect communities. Instead, it has caused great harm, particularly for marginalized populations. These adverse outcomes are rooted in policies enacted to tackle this public health problem that has little to do with public health.

Marijuana possession continues to be treated as a criminal matter, even though, historically, there are no examples of criminal law solving a public health matter. In effect, this punitive approach has supported mass incarceration for relatively minor offenses, placing an excessive burden on taxpayers, destroying communities, and perpetuating racial biases.

Ineffective and excessive criminal justice responses 

The decades-long War on Drugs has resulted in harsh sentencing laws and has contributed to one of the highest rates of mass incarceration in the world.

In 2006 alone, there were 829,625 marijuana arrests. During the 1990s through 2005, marijuana arrest rates nearly doubled from 20 percent to 40 percent, but past-month use among high school seniors during this same time increased. Average potency and availability have also increased, despite this sweeping response from the criminal justice system. Criminalization is ineffective.

This overreaction from the criminal justice system is in part due to marijuana currently being classified as a Schedule I drug, the same classification given to heroin. Drugs in this classification are claimed to have the potential for abuse, no currently accepted medical uses, and lack of accepted safety for medical use. Marijuana, however, does not meet these criteria; thus, keeping it as a Schedule I drug unjustifiably maintains its prohibition.

Racial disparities in enforcement

Non-white individuals are disproportionately targeted by law enforcement, with blacks 3.73 times more likely than Whites to be arrested for marijuana possession nationally, despite similar rates of use.

This disparity is even more extreme in individual states, such as Iowa, where blacks are 8.34 times more likely to be arrested than Whites for marijuana. These figures are consistent with many other sources of evidence that suggest systemic racism drives enforcement patterns.

Preventing adolescent use

While decriminalization of marijuana is projected to have many economic and social benefits, legislation must balance decriminalization with the need to prevent teenage use. Teenage marijuana use can alter the course of brain development and increase risk for dependence and possibly addiction. Heavy use in adolescence has been associated with several developmental delays. Importantly, when teenagers believe using a drug is not harmful, they are more likely to use it.

With the loosening of laws surrounding marijuana use, we might anticipate an increasing number of youths more likely to partake. Accordingly, age limits on access to, possession of, and use of marijuana should be concurrently enforced. Also of the utmost importance is for the public to be informed of the hazards of use during adolescence so that appropriate precautions can be taken at the household and community levels.

Policy recommendations

A substantial body of research justifies reallocating resources from criminal justice to public health policies. A public health approach focuses on the implementation and enforcement of regulations to manage health risks through policy changes, such as taxation, regulation of advertising, and age limits. Several policy recommendations are offered here for consideration:

  1. Support a detailed, comprehensive, scientific evaluation of the impacts from current laws surrounding both medical marijuana and adult-use to guide future legislation.
  2. Re-categorize marijuana from Schedule I to Schedule III or IV to be more consistent with its known pharmacological properties and effects.
  3. Update the regulatory structure by applying uniform standards to the types of products that can be sold or marketed to the public.
  4. Invest prevention resources in delaying the age of initiation of marijuana use past the period when the brain is still developing (around age 25) to reduce the impact on neurodevelopment.
  5. Support screening, early detection, and intervention. Focus both on at-risk youth who have not yet initiated to avert pathways to use in adolescence and youth who have already begun using marijuana to avoid negative consequences.

It is time to move away from a criminal approach to marijuana policy and towards a public health approach to more appropriately and effectively allocate precious resources, avoid racial bias, and prevent adolescent misuse.

This op-ed originally appeared in The Hill and was written by Diana Fishbein and Elizabeth Long. Elizabeth Long, Ph.D. is a postdoctoral scholar at the Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, and a member of the National Prevention Science Coalition to Improve Lives (NPSC). Diana Fishbein, Ph.D., is a professor and program director at The Pennsylvania State University and co-director of the National Prevention Science Coalition to Improve Lives (NPSC).

Wolf Administration Awards Nearly $1 Million in Grants to Higher Education Institutions for Opioid Prevention

Published on: January 9, 2020
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Governor Tom Wolf announced today that the Department of Drug and Alcohol Programs (DDAP) is awarding nearly $1 million in federal Substance Abuse and Mental Health Services Administration (SAMHSA) grants to prevent and reduce the use of opioids by college students and to create naloxone training opportunities for post-secondary institutions.

The grants are part of the $55.9 million SAMSHA grant secured by the Wolf Administration to bolster the state’s response to the prescription opioid and heroin epidemic.

“We consistently attack the state’s opioid crisis from all angles, and this grant will enable additional focus on an integral part of our work – prevention,” Gov. Wolf said. “Educating college students on the risk of opioid use and training institutions of higher learning on how to administer naloxone are two ways we can save lives and lessen the impact of this crisis.”

“We have learned from the opioid crisis that substance use disorder does not discriminate and one of our hardest hit demographics are traditionally college-aged Pennsylvanians age 18-30,” said DDAP Secretary Jen Smith. “The commonwealth’s unprecedented amount of federal funding has allowed us to take a comprehensive look at our prevention programs for secondary and post-secondary institutions and identify gaps in our system. This is the first of many steps the administration will be taking in strengthening prevention and awareness for adolescents in Pennsylvania.”

The funding will be directed to 13 higher education institutions through grant agreements up to $100,000. Awardees will expand existing preventive programs and partner with key local stakeholders to develop and implement new projects. Projects may include raising campus awareness, reducing stigma, increasing access to overdose reversal trainings, and grief support.

Awardees County(ies) Supporting
Delaware County Community College Delaware, Chester
Duquesne University Allegheny
Immaculata University Chester
Indiana University of Pennsylvania Research Institute Indiana
Lackawanna College Bradford, Northumberland, Lackawanna, Luzerne, Susquehanna, Wayne
Lehigh Carbon Community College Carbon, Lehigh, Schuylkill
Montgomery County Community College Montgomery
Muhlenberg College Lehigh
Penn State Berks Berks
Robert Morris University Allegheny
Shippensburg University Cumberland, Franklin
Temple University Philadelphia
West Chester University Chester

During Governor Tom Wolf’s second term, DDAP will place a heavy focus on reducing stigma associated with substance use disorder, intensifying primary prevention efforts, strengthening treatment systems, and empowering sustained recovery. The aim of these efforts will be to positively influence the knowledge and behavior around the topic of addiction.

For more information about the work the Wolf Administration is doing to combat the opioid crisis, visit pa.gov/opioids.

This article originally appeared on the Governor’s Office website.

Everyone Plays A Role: New Research and Strategies Shared At Addiction Symposium

Published on: December 18, 2019
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Anirban Paul answers a question while he participates in a panel about animal models and translational research during the 5th annual Penn State Addiction Symposium on Tuesday, Dec. 10, 2019.

Dr. Yngvild Olsen’s message at the Fifth Annual Addiction Symposium was clear: Addiction is a chronic illness, and it’s critical that the health care community and public recognize that.

More than 200 people filled the seats in Junker Auditorium at Penn State College of Medicine for Olsen’s address at the Penn State Addiction Center for Translation’s addiction symposium Dec. 10 to hear new strategies for treating substance use disorder.

Surgeons, social workers, lab scientists, public health analysts, primary care providers, nurses, students and trainees gathered together to discuss the latest innovations in addiction research, education and treatment. A variety of Penn State’s campuses were represented, including University Park, Harrisburg, Abington, Schuylkill and the College of Medicine in Hershey. Members of the community at large also attended.

A FAMILY AFFAIR

The symposium kicked off with a dinner at the Hotel Hershey on Dec. 9. Dr. Sarah Kawasaki, assistant professor of psychiatry and behavioral health and director of addiction services at Pennsylvania Psychiatric Institute in Harrisburg, discussed strategies Penn State Health is using to fight the opioid crisis. After finishing her update, she introduced her brother, Dr. Joshua Sharfstein, vice dean for public health policy practice and community engagement and professor of the practice in health policy and management at John Hopkins Bloomberg School of Public Health, who gave the first keynote address of the symposium.

Sharfstein joked as he began that writing a book is a risky activity for a married couple. Nevertheless, he and Olsen, his wife, set out to provide a comprehensive overview of the opioid crisis in their new book – “The Opioid Epidemic: What Everyone Needs to Know.” They donated their speaking fee so that everyone who attended the symposium could receive a copy of their book.

EVERYONE PLAYS A ROLE

Sharfstein concluded his remarks at the dinner by stating that everyone plays a role in reducing low-value care in the opioid epidemic.

Researchers, educators and clinicians assembled the next morning to provide updates on their projects. They discussed animal models, attitudes and policies about the opioid epidemic, e-cigarettes and opioids in healthcare and initiatives to improve outcomes for substance use disorder. Yuval Silberman, assistant professor of neural and behavioral sciences, was the featured Penn State faculty speaker and spoke about the effects of adolescent alcohol exposure on neurocircuit function in the adult brain.

Just before lunch, Edward Rendell, former governor of Pennsylvania, teleconferenced in to answer questions about his work with Safe House Philadelphia – which aims to be the first safe injection site in the country.

MOVING INTO THE FUTURE

A message repeated multiple times by multiple speakers during the symposium was that stigma is a huge hurdle in overcoming addiction. In their remarks, Sharfstein and Olsen emphasized that language matters when talking about addiction – especially with patients.

As she brought the event to a close, Patricia “Sue” Grigson, chair of the Department of Neural and Behavioral Sciences and director of the Penn State Addiction Center for Translation, expressed optimism at how much progress had been made since last year’s symposium, but challenged those in attendance to continue making forward progress.

“We’ve only just begun tackling the problem of addiction,” Grigson said. “Today we heard from investigators with exciting studies underway and from educators and clinicians working to improve treatment for patients with substance use disorders. I look forward to seeing the results of these promising initiatives.”

PHOTO GALLERY

View all the photos from the Addiction Symposium on Flickr. 

This article originally appeared in Penn State Health News.

Researchers Receive Nearly $5 Million to Curb Opioid Cravings

Published on: December 10, 2019
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Professional headshots of Patricia Opioid overdoses take the lives of tens of thousands of Americans annually. Two researchers from Penn State College of Medicine have received nearly $5 million from the National Institutes of Health (NIH) to study whether an already-approved drug can be used to reduce cravings and prevent relapse in those struggling with opioid addiction.

The two-year project, led by Patricia “Sue” Grigson, professor and chair in the Department of Neural and Behavioral Sciences, and Scott Bunce, associate professor in the Department of Psychiatry, is part of the NIH’s Helping to End Addiction Long-term Initiative, which aims to improve treatments for chronic pain, curb the rates of opioid use disorder and overdose an achieve long-term recovery from opioid addiction.

The investigators, members of Penn State Addiction Center for Translation, said the project is designed to address a key factor in relapse, and a common request made by people who are struggling with opioid use disorder – for something to reduce or eliminate their cravings.

“I interviewed patients and health care providers from a variety of settings who work with patients addicted to opioids,” Bunce said. “The patients asked me to give them something that could help reduce their craving and the providers confirmed that it was a common wish among patients struggling with opioids or other substance use disorders.”

With this project, the researchers hope to take a drug that already has been approved by the United States Food and Drug Administration to treat obesity and Type 2 diabetes and use it to reduce cravings in patients addicted to opioids. The drug is called a glucagon-like peptide-1 (GLP-1) receptor agonist, and it helps promote a feeling of satiety, or satisfaction. Previous work using animal models has demonstrated the drug may be effective in reducing self-administration of certain drugs.

According to Grigson, this project represents a fundamental shift in the way people think about addiction. Addiction has traditionally been thought of as a hijacking of the “reward pathway,” but Grigson said this project will investigate the role of the “need pathway” in addiction.

“Experts in the field have understood for a while that drug-seeking behaviors may be related to someone liking or wanting the drug,” Grigson said. “We are realizing that people may also need the drug. It may explain why some people engage in desperate behaviors to obtain drugs – behaviors we would normally associate with scarcity of a resource.”

Grigson said trials using GLP-1 receptor agonists to reduce cravings for alcohol and nicotine are already underway, but that Penn State College of Medicine will conduct the first trial that uses GLP-1 agonists to treat opioid addiction.

Researchers will give the drug to patients over the course of several weeks, while gradually increasing the dose. Throughout the course of the study, they will measure whether the drug is reducing cravings using a variety of tools. According to the researchers, self-report questionnaires are one method, but they are subjective and can be manipulated. The timing of the assessment may not align with when patients are experiencing cravings.

To address these challenges, Bunce and Grigson will use a technology called functional near infrared spectroscopy to measure how the brain responds to drug cues. This technology will allow the researchers to compare a patient’s brain activity against their verbal response and determine whether the medication is helping take the edge off of cravings.

“We will examine neural activity in the prefrontal cortex, which is involved in both the direction of attention and the regulation of many behaviors,” Bunce said. “The prefrontal cortex of individuals at greater risk for relapse may be more responsive to opiate cues, while at the same time being less responsive to stimuli that are typically experienced as positive. These individuals will also show less activity in the areas of the cortex responsible for regulating behavior.”

Grigson and Bunce are also partnering with Hobart “Bo” Cleveland and Timothy Brick of Penn State Social Science Research Institute to measure how patients are doing in real time. One tool they will use involves a telephone app that will ‘ping’ patients periodically and ask them to indicate their levels of craving, stress and mood. Another tool that will be used is a wearable device that will track patients’ sleep, cardiovascular function, breathing and location. The researchers will also use data from animal studies to supplement the patient data.

Ultimately, the results will help Grigson and Bunce determine whether the drug is safe and effective for treating opioid use disorder. The results could be used to support the development of a clinical trial.

“Opioid use disorder is nuanced and requires a range of techniques to help people quit using and remain drug free,” Bunce said. “If the GLP1 agonists prove effective, it will be one more tool for physicians to use in helping their patients to stop abusing opioids.”

This article originally appeared in Penn State Health News.

Commonwealth Update: Gov. Wolf Signs 8th Opioid Disaster Declaration Renewal, Vows Continued Concerted Efforts

Published on: December 6, 2019
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Governor Tom Wolf signed the eighth renewal of Pennsylvania’s Opioid Disaster Declaration. In January 2018, he took the unprecedented step of signing the first disaster declaration so the state could focus resources and break down government siloes to address the burgeoning heroin and opioid epidemic.

“Renewing the disaster declaration and its provisions is a reminder that the collaborative efforts put forth by a large and diverse group of state agencies, third-party organizations and stakeholders is having a positive effect on the opioid crisis in Pennsylvania,” Gov. Wolf said. “We will continue to work tirelessly until we can claim victory over this crisis.”

Through continuous and expanding efforts, Pennsylvania’s response to the crisis has been heralded as a model for the nation by the Pennsylvania Medical Association. The commonwealth was awarded the second highest amount of federal Department of Health and Human Services state opioid response funding to continue with programs already under way that focus on housing, education, and expanded medication-assisted treatment programs, among others. Since 2017, Pennsylvania has been allocated $141 million in federal funding.

Through the collaborative efforts of the Opioid Command Center and its partners, Pennsylvania has:

    • Distributed nearly 6,800 doses of naloxone free to members of the public through naloxone distribution days;
    • Assisted thousands of individuals affected by the closures of doctor’s offices through the Prescription Drug Monitoring Program’s Patient Advocacy Program;
    • Continued conversations with numerous stakeholders and partners about the growing trend of stimulant use;
    • Added new data to the opioid data dashboard highlighting how the opioid crisis has increased the spread of infectious diseases and hospitalization for serious medical conditions, such as endocarditis, cellulitis and abscesses;
    • Awarded $3.4 million in federal grants to support services of pregnant and postpartum women with opioid use disorder;
    • Hosted MAT summits across the state to encourage and provide support to those treating individuals with the disease of addiction;
    • Partnered with the Independence Blue Cross Foundation to bring the “Someone You Know” public health awareness campaign to Pennsylvania. The display shares the stories of the 20 campaign ambassadors who share their personal experiences with opioid use disorder;
    • Hosted the first Opioid Summit, bringing together professionals, community members, families and others impacted by the opioid crisis in Pennsylvania;
    • Answered nearly 30,000 calls to the Get Help Now hotline to help get someone into treatment or for general assistance; and
    • Awarded $2.1 million in general grants to assist community recovery projects for individuals with substance use disorder.

In addition, Pennsylvania’s rate of opioid prescriptions is now below the federal average and from 2017 to 2018 – the most recent data available – overdoses deaths declined by 18 percent.

Find more information on the state’s response to the opioid crisis.

Read the full disaster declaration renewal.

Sessions for Medication-Assisted Treatment at the Penn State College of Medicine

Published on: November 22, 2019
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The Penn State College of Medicine is offering a no-cost educational opportunity for community providers through Penn State Project ECHO. The ECHO model is used to provide front-line clinicians with the knowledge and support they need to manage patients with complex conditions in the patient’s own communities.

The Penn State College of Medicine will be launching our third Medication-Assisted Treatment for Opioid Use Disorder ECHO on January 8, 8-9AM, with sessions taking place every other week — 1.0 hour sessions for twelve sessions. These sessions will be done on video conferencing through zoom, which can be accessed through your phone, at your desk. Together, specialists and primary care providers collaborate to discuss de-identified patient cases and develop recommendations for patient care. Over time, providers become micro specialists – engaged in a wider community of learners and empowered to address complex conditions. As a result, patients get the high-quality care they need, when they need it, and close to home.

If you are ready to enroll in this ECHO, please take a few moments to fill out our survey so that we can make these sessions most valuable to you. This survey will take no more than 15 minutes to complete and will serve as your official registration: https://is.gd/echomatoud3

These sessions will also provide some brief lectures on opioids covering topics of interest to the ECHO group such as Medication Assisted Treatment 101, caring for pregnant patients, caring for adolescents, how to manage comorbid mental illnesses and more. In addition, the main thrust of the sessions will come from participants who will present de-identified cases to each other and our team in order to gain confidence and competence in buprenorphine prescribing.  These sessions are CME eligible. 

Spots will be filled on a first come, first serve basis. We plan to register 25 physicians.

SAMHSA Awards Penn State Project ECHO $1.5 Million to Address Underage Drinking

Published on: November 21, 2019
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Several people sit around a conference table, on which there are papers, pens and computers. A sign on the wall bears the Project Echo and Penn State College of Medicine logos.

Project ECHO at Penn State College of Medicine will use a grant from the U.S. Substance Abuse and Mental Health Services Administration to address underage drinking and opioid use in ten rural counties in central Pennsylvania.

Project ECHO at Penn State College of Medicine will use a $1.5 million federal grant to address underage drinking and opioid use in ten rural counties in central Pennsylvania. The five-year grant was awarded by the U.S. Substance Abuse and Mental Health Services Administration.

“Alcohol and other substance use in children has a significant public health impact, given youth have greater susceptibility to risk-related injuries,” said Jennifer Kraschnewski, director of Project ECHO at Penn State College of Medicine and a Penn State Health primary care clinician-investigator who studies community health interventions. “In fact, three out of four deaths in adolescents are due to unintentional injury, homicide and suicide, and alcohol is involved in more than one third of those deaths.”

The administration has estimated that fewer than 10% of adolescents in need of substance abuse treatment receive it. Additionally, a barrier to addressing underage drinking is the lack of appropriate screening, intervention and referral for alcohol use among youth.

Penn State Project ECHO is taking steps to equip school nurses and pediatricians with strategies to address underage drinking through the training and delivery of substance use screening, brief intervention and referral to treatment – steps collectively referred to as the SBIRT technique. Guidelines recommend primary care providers incorporate these techniques into routine care. Screening is not only important to identify children currently engaged in alcohol use, but also provides positive reinforcement for youth not currently using, which is known to delay initiation of alcohol use.

“Project ECHO at Penn State leverages a multi-disciplinary team of experts to enhance capacity for treatment in our local communities,” Kraschnewski said. “Our hope is to support and educate school nurses and pediatricians throughout the Commonwealth to provide the care and referral to treatment that Pennsylvania children need.”

“The public health impact of adolescent substance use and its preventable morbidity and mortality demonstrates the need for increased capacity across the healthcare landscape,” said Dr. Sheryl Ryan, chief of the Division of Adolescent Medicine at Penn State College of Medicine, and chair of the American Academy of Pediatrics Committee on Substance Use and Prevention. “The academy supports the use of the SBIRT technique as a guide to enhance that capacity with regards to substance use screening and intervention.”

About Project ECHO

Project ECHO (Extension for Community Healthcare Outcomes) at Penn State uses a telehealth model to connect specialists with community providers across PA and beyond. Together, they discuss de-identified patient cases and develop recommendations for care. Over time, community health providers become experts, and fewer patients have to travel for specialized services.

Project ECHO fosters a guided, virtual learning community aimed at practice improvement: providers receive mentoring and feedback, strengthen their skill set related to more complex diseases, and retain responsibility for their patients. As a result, patients get the high-quality care they need, when they need it and close to home.

This article originally appeared on Penn State Health News.

Popular electronic cigarette may deliver nicotine more effectively than others, researchers say

Published on: November 18, 2019
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A hand holds an electronic cigaretteWhen it comes to nicotine delivery, not all electronic cigarettes are created equally, according to Penn State researchers. New research from Penn State College of Medicine shows that JUUL, a popular pod-based electronic cigarette, can deliver more nicotine at a faster rate than most other types of electronic cigarettes that have been studied.

Jessica Yingst, first author and researcher at the College of Medicine, said that previous studies of other electronic cigarettes with high liquid nicotine concentrations revealed that many delivered very little nicotine to the user. The researchers profiled the nicotine delivery capabilities of JUUL, which is known to have a high concentration of nicotine in its pods.

“The JUUL users we studied obtained blood nicotine concentrations almost three times as high as most of the e-cigarette users we previously studied,” Yingst said. “JUUL’s nicotine delivery is very similar to that of cigarettes.”

The researchers published their findings Nov. 15, 2019, in JAMA Open Network. Six regular JUUL users were asked to puff on their device every 20 seconds for ten minutes for a total of 30 puffs. Blood was collected at intervals during and after vaping. The researchers used liquid chromatography and mass spectrometry to analyze the amount of nicotine in the blood at each time point.

Researchers also asked the participants to rate their withdrawal symptoms and other subjective effects like craving and anxiety both before and after vaping. The participants also completed the Penn State Electronic Cigarette Dependence Index — a questionnaire designed to measure addiction to electronic cigarettes. JUUL users who completed the survey self-reported higher nicotine dependence compared with more than 3,000 experienced long-term users of other electronic cigarettes.

Jonathan Foulds, PhD, a co-author of the study and a professor of public health sciences, said that the results obtained from this study with JUUL are different from prior findings that e-cigarettes were less addictive than regular cigarettes.

“In previous studies, we found that e-cigarette users were less addicted than smokers,” Foulds said. “However, the high nicotine delivery of the product and the scores on this study suggest that JUUL is probably as addictive as cigarettes.”

According to the researchers, the high addiction potential of these e-cigarettes is an important reason why non-smokers should not try them – but they may provide a way for smokers to switch to a less harmful form of nicotine consumption.

“In previous work, we determined that JUUL delivered lower levels of some harmful chemicals than cigarettes and even some other e-cigarettes,” said John Richie, PhD, co-author of the study and professor of public health sciences at the College of Medicine.

Foulds cautioned that products like JUUL pose a dilemma for public health experts.

“This type of product is likely addictive and is attractive to teenagers,” Foulds said. “But those same qualities that make it addictive may enable it to help adult smokers switch to a much less harmful form of nicotine consumption.”

Shari Hrabovsky, Andrea Hobkirk and Neil Trushin, all of Penn State College of Medicine, also contributed to this research.

This research was supported by Penn State Social Science Research Institute, Penn State Cancer Institute and Penn State Clinical and Translational Science Institute. It made use of a new observational study suite, which has specially designed airflow to create an ideal testing environment for studying electronic cigarette or tobacco use. The suite is a resource of the Clinical and Translational Science Institute’s Clinical Research Center at Penn State College of Medicine.

The authors were supported by grants from the National Institutes of Health and the Centers for Tobacco Products of the United States Food and Drug Administration.

The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1 TR002014. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

This article originally appeared in Penn State Health News.

SAMHSA Update: Launch of FindTreatment.Gov

Published on: November 4, 2019
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On October 30, 2019, the Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) announced the launch of FindTreatment.gov, a newly designed website that will help connect Americans looking for substance abuse treatment with approximately 13,000 locations across the United States. HHS Secretary Alex Azar and SAMHSA Assistant Secretary Elinore McCance-Katz issued the following statements:

“Better access to treatment, prevention, and recovery services is one of the five pillars of HHS’s strategy to end the opioid crisis,” said HHS Secretary Alex Azar. “Under President Trump, we have unequivocally and strongly supported medication-assisted treatment in particular because we see addiction as a medical issue, not a moral failing. Addiction demands treatment, not judgment. We know that finding access to the right provider, at the right time, can be essential to helping someone start on the road to recovery. Now, thanks to FindTreatment.gov, more Americans will have easier ways to the find the treatment that they or loved ones might need.”

“An easily-accessible system to locate treatment will be a critical tool for individuals to get the care they need” said Elinore F. McCance-Katz, Assistant Secretary for Mental Health and Substance Use. “Increasing treatment access is an integral part of the approach to address substance use disorders across the country.”

Further background from HHS:

  • Over 19.3 million American adults had substance use disorder (SUD) in 2018, and connecting them with appropriate treatment is a critical step to combating the opioid crisis in America
  • In 2019, estimates suggest 1.27 million Americans are receiving medication-assisted treatment, a 38 percent increase from an estimated 921,000 Americans in 2016
  • FindTreatment.Gov is designed to provide the most relevant information for each individual’s recovery needs by creating a modern, user-friendly experience that is visually clear, simple, and welcoming to those in crisis
  • Visitors can access information on location, treatment options, payment and insurance information, and over 13,000 state-licensed facilities, based on data compiled by SAMHSA
  • Examples of treatment include:
    • Residential treatment – Live-in care, lasting for a month up to one year
    • Outpatient treatment – Treatment at a program site while the patient continues to live on their own
    • Detoxification – Supervised withdrawal from substance use
    • Interim care – When immediate admission to other care isn’t available
    • Content and design were developed over the last year by incorporating 300 pieces of feedback, plus 60 long-form informational interviews, from recovery professionals, help line operators, local advocates, parents seeking help, and Americans in active recovery

Applications Are Open for the Community Fellows Program!

Published on: October 31, 2019
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Interested in becoming a 2020-2021 Community Fellow?

Fellowships will provide funding for full-time Penn State University faculty members for up to two course releases (or the equivalent time for non-teaching faculty) across one or two academic years (up to $7,500 per course release for a total of $15,000).  Fellows are also eligible to apply for Community Collaboration funds (up to $5,000 for community activities, described below).  Faculty teams of two can divide the course release funds between them. Commonwealth campus faculty are strongly encouraged to apply.

Applications should first be submitted for approval to the faculty member’s department/program head. Once the Head’s approval is obtained, the application should be forwarded to the candidate’s Chancellor/Dean. The Community Fellows Call will be yearly, and for each call, Chancellors/Deans may submit two Community Fellows proposals.

 

  • December 2, 2019: Chancellors/Deans forward up to two Community Fellowship proposals, along with their and the Department Head’s statements of support to ssri-seed-grant@psu.edu;
  • The CCSA’s Executive Committee will review proposals;
  • December 20, 2019: Faculty members will be notified of funding for the 2020-2021 academic year. Fellows should work directly with their Department Heads to schedule course releases.

You can find out about the application process here.

Penn State, PA team up to promote treatments for substance abuse disorders

Published on: October 29, 2019
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Handshake Stock Image

 

UNIVERSITY PARK, Pa. — The opioid epidemic and larger problems of substance misuse continue to deeply impact communities across the Commonwealth of Pennsylvania and the nation. In 2017, more than 70,000 drug overdose deaths occurred in the United States, with Pennsylvania ranking third with the highest rates of death due to drug overdose. A new partnership between leadership at Penn State’s Evidence-to-Impact Collaborative and the commonwealth will support the needs of individuals living with substance use disorders through a combination of medication with counseling and behavioral therapies.

The goal of the partnership is to help train practitioners to prescribe Medication-Assisted Treatment (MAT) successfully and efficiently within their communities. MAT combines behavioral therapy and medications to treat substance use disorders and is regarded as the gold standard for treatment, particularly for opioid treatment programs. However, practitioners must first undergo training to receive a waiver from the federal government in order to prescribe MAT in office-based settings. The new partnership is part of an ongoing collaboration between the Commonwealth and Penn State in support of the Pennsylvania Coordinated Medication-Assisted Treatment (PAC-MAT) program.

“Penn State and the commonwealth share the mutual goal of combating the opioid epidemic in our communities. We hope the training provided through this partnership will arm practitioners with the training they need to successfully administer such treatments to people more quickly and more efficiently,” stated Susan McHale, director of Penn State’s Social Science Research Institute.

Penn State’s partnership with the Pennsylvania Department of Health, Pennsylvania Department of Drug and Alcohol Programs, and the American Society of Addiction Medicine includes the facilitation of eight regional MAT summits throughout Fall 2019 in locations across the commonwealth.

The purpose of the summits is to promote awareness of MAT options, provide strategies for success using MAT, and increase the number of practitioners using the waiver to prescribe MAT, specifically the drug buprenorphine, in an office-based setting. Buprenorphine is the first medication to treat opioid dependency that is permitted to be prescribed or dispensed in physician offices, significantly increasing treatment access. These efforts seek to build workforce capacity by giving providers the ability to prescribe MAT and combat addiction throughout the commonwealth.

“Substance use disorder does not discriminate based on income, race, gender, age, or where you live.  Every Pennsylvanian knows and loves someone that is battling addiction,” said Secretary of Health Rachel Levine.

For more information about the eight regional MAT summits, visit the DDAP website.

This article also appeared in Penn State News.

College of Medicine researchers receive NIH funding for addiction research

Published on: October 25, 2019
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A head-and-shoulders professional photo of Sue Grigson

Patricia “Sue” Grigson, PhD

The National Institutes of Health have awarded more than $2 million to Patricia “Sue” Grigson, professor and chair in the Department of Neural and Behavioral Sciences, and Scott Bunce, associate professor of psychiatry and behavioral health and clinical psychologist, as part of the Helping to End Addiction Long-term Initiative.

The initiative aims to improve treatments for chronic pain, curb the rates of opioid use disorder and overdose and achieve long-term recovery from opioid addiction.

Addiction research is a key priority at Penn State College of Medicine.

The college’s Addiction Center for Translation, directed by Grigson, was created to address substance-use disorders, particularly given the current rise in drug overdose deaths.

A head-and-shoulders professional photo of Scott Bunce

Scott Bunce, PhD, MA

A team of Penn State researchers, clinicians and community partners have come together to conduct and disseminate cutting-edge research and share evidence-based methods in substance use prevention and treatment with the community.

Meanwhile, Penn State Project ECHO hosts knowledge-sharing networks, led by expert specialist teams mentoring multiple community providers, to help guide treatment on a number of conditions, including opioid use disorder.

Read more about the NIH addiction initiative here.

This article originally appeared in Penn State Health News.

Run-DMC founder Darryl McDaniels to speak on mental health, addiction, recovery

Published on: October 25, 2019
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UNIVERSITY PARK, Pa. — The Penn State Smeal College of Business Office of Diversity Enhancement Programs has partnered with several units across the University to provide a unique opportunity to hear real talk about mental health.

Darryl “DMC” McDaniels of Run-DMC fame will speak at 5 p.m. Tuesday, Oct. 29, in 101 Thomas Building at University Park about mental health, addiction and recovery.

McDaniels is a rapper, author and founding member of legendary hip-hop trio Run-DMC, the second rap group to be inducted into the Rock and Roll Hall of Fame, in 2009. He has spoken publicly and written about addiction and recovery, and how he came to embrace the value of therapy.

His memoir “Ten Ways Not to Commit Suicide” details McDaniels’ battle with depression and sobriety, including his stark admission about overcoming suicidal thoughts.

“As we approach the end of the semester, job offers, relationships, final exams and holiday stresses can combine to create potentially fragile situations for some in the University community,” said Jamie Campbell, Smeal’s assistant dean for Diversity Enhancement Programs.

“McDaniels’ straight talk about his own challenges might prompt some in attendance to evaluate their own situation and consider accessing one of several avenues for help the University offers.”

A representative from Penn State’s Counseling and Psychological Services will serve as moderator of McDaniels’ discussion.

His talk is free and open to the public.

It also is sponsored by the College of Arts and Architecture, the Donald P. Bellisario College of Communications, the Penn State Office of the Vice Provost for Educational Equity, and Penn State Student Disability Resources.

Collaborative Community Service Conference offers opiate addiction resources

Published on: October 23, 2019
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Dr. Glenn Sterner stands on stage as he delivers a speech. There is a slide behind him reviewing drug overdose deaths in the U.S. from 1999-2017

In his keynote address, Dr. Glenn Sterner, assistant professor of Criminal Justice at Penn State Abington, provided an overview of the opioid crisis from the early 2000s until today. “This is a disease. This is not a moral failing,” he said. IMAGE: Samantha L. Bower

SCHUYLKILL HAVEN, Pa. — Penn State Schuylkill and Lehigh Valley Hospital – Schuylkill collaborated to present “Opioids: The Crisis Next Door,” a free conference held on campus Sept. 19 that detailed the facts and signs of addiction, as well as the resources available to help community members affected by the epidemic. The conference’s 200 attendees heard from a variety of addiction and behavioral health experts throughout the day-long event.

Understanding the Opioid Crisis

In his keynote address, Glenn Sterner, assistant professor of criminal justice at Penn State Abington, provided an overview of the opioid crisis from the early 2000s until today. He explained the difference between opiates, which are naturally derived, and opioids, which are synthetic or chemically altered; spoke about where these drugs come from; and explored the ways in which addictions develop. Perhaps most importantly, however, Sterner spoke about the stigma of addiction, and how the stigma surrounding opioid abuse acts as a barrier to treatment.

“This is a disease. This is not a moral failing,” he said. “[Opioid abuse] disrupts our families, disrupts our communities.”

Sterner explained that, to combat the problem, community engagement, support and understanding are essential.

Sterner concluded his address by sharing helpful resources, including one he developed himself. The Share Your Opioid Story initiative offers addicts and their loved ones the opportunity to tell the real stories behind the opioid crisis. By sharing these true stories, the initiative intends to inspire hope in others, dispel myths and decrease stigma.

“When we address this in a comprehensive way – when we work across all of our capacities in our communities – we can do this,” he said.

Following Current Drug Trends

Schuylkill County District Attorney Michael O’Pake spoke next, offering the crowd a legal perspective on controlling the opioid crisis. O’Pake spoke about the crime in Schuylkill County, noting that almost every crime has an element of drug abuse to it. Some people, he explained, steal for drug money; others neglect their children while high. Soberingly, he admitted that he cannot stop the flow of drugs into the county, but explained that “my goal is to lessen the impact of drugs in Schuylkill County.”

Schuylkill County District Attorney Mike O'Pake delivers a presentation, standing in front of a slide that examines drug overdose deaths by county between 2016-18

Schuylkill County District Attorney Michael O’Pake offered the crowd a legal perspective on controlling the opioid crisis. He admitted that he cannot stop the flow of drugs into the county, but explained that, “My goal is to lessen the impact of drugs in Schuylkill County.” IMAGE: SAMANTHA L. BOWER

O’Pake talked about the success of Schuylkill’s Drug Treatment Court, a 14-month program that has graduated three classes. This program assists people in recovery by providing them with housing, supporting their employment, and fostering their relationships to maintain the road to recovery.

“The only way to beat this problem is through education, treatment and enforcement,” O’Pake said. “Together, those three things will lessen the impact of drugs in Schuylkill County.”

Seeking Counseling and Identifying Resources

Bill Rowan, program director of the Center for Counseling Services at Lehigh Valley Hospital – Schuylkill, spoke about counseling and resources pertinent to the disease of addiction. He mirrored the sentiments of speakers before him while also touching on the personal responsibility inherent to treating any disease, saying, “You are not responsible for a disease; you are responsible for recovery from that disease.”

Rowan challenged attendees to see the crisis from a different perspective, saying, “We have to change the conversation about what it means to have a substance-abuse disorder diagnosis.”

Like a diabetic should eat healthful food and take insulin, Rowan encouraged opioid users to take the reins of their recovery.

Bill Rowan delivers his presentation in front of a projected image of Penn State Schuylkill and Lehigh Valley Hospital - Schuylkill logos

Bill Rowan, program director of the Center for Counseling Services at Lehigh Valley Hospital – Schuylkill, spoke about counseling and resources pertinent to the disease of addiction. IMAGE: SAMANTHA L. BOWER

Addiction Prevention and How to Recognize the Hidden Signs of Drug Abuse

Diane Rowland, prevention services coordinator at the Schuylkill County Drug and Alcohol Program, shared information about addiction prevention and informed attendees how to recognize the signs of drug abuse. Her methods include “knowing your person” – his or her appearance, attitude, typical behaviors and activities.

When someone strays from normal patterns and habits, Rowland recommended looking at “The 4 Ms,” which she describes as “Mood, Mess, Money and Missing (possessions, presence).” Addiction changes individuals’ moods, and usually leaves their lives a mess, she explained. Addiction also affects the individual’s and his or her loved ones’ money, and loved ones also often find things missing — whether it be the addicted person’s presence or their own possessions.

Rowland concluded that knowing the signs of drug abuse helps prevent catastrophe, emphasizing, “The sooner a drug problem is recognized, the easier it is to get help.

Diane Rowland holds a microphone while standing in front of a projector slide reading "Six Signs to Know about Substance Abuse, Addiction, and Prevention

Diane Rowland, prevention services coordinator at the Schuylkill County Drug and Alcohol Program, shared information about addiction prevention and informed attendees how to recognize the signs of drug abuse. Rowland concluded that knowing the signs of drug abuse helps prevent catastrophe, emphasizing, “The sooner a drug problem is recognized, the easier it is to get help.” IMAGE: SAMANTHA L. BOWER

Integrated Team Approaches to Recovery and Wellness

Dr. Gillian Beauchamp, emergency medical physician and toxicologist at the Lehigh Valley Health Network, delivered the final expert presentation of the day. As an emergency medical physician, Beauchamp is no stranger to cases of overdose, and she spoke about how her team works in concert to help show addicts the road to recovery and wellness.

Dr. Gillian Beauchamp stands on stage in front of a projector slide identifying various areas of the brain triggered by addiction.

Dr. Gillian Beauchamp, emergency medical physician and toxicologist at the Lehigh Valley Health Network, delivered the final expert presentation of the day. Dr. Beauchamp works with an emergency room team and EMS professionals to treat overdose victims. “The idea,” says Beauchamp, “is that hope happens at a place like a hospital. It happens in an emergency department.” IMAGE: SAMANTHA L. BOWER

For Beauchamp, the conversation leading to recovery begins at the scene of the overdose, continues in the ambulance ride to the hospital, and progresses through the remainder of the individual’s hospital stay.

“The idea,” said Beauchamp, “is that hope happens at a place like a hospital. It happens in an emergency department.”

Much of Beauchamp’s presentation focused on the positive energy necessary for an individual to choose recovery, especially noting the importance of compassion from health care professionals.

“One huge message that is really important today is hope,” she said, citing examples from the other presenters. “Hope really needs to be a big part of how we talk with people in recovery, and their families.”

The Human Cost of Addiction

Perhaps the most powerful portion of the day, the conference closed with testimonials from people who have experienced the crisis firsthand. Some lost children, others gained custody of their grandchildren. All made a point to shed the jacket of anonymity to dispel the stigma surrounding the disease.

Carmen McGlothlin, founder of Facebook support group Grandparents Raising Grandchildren, shared a poignant message about her own experience. McGlothlin’s grandchildren are essentially orphaned, their mother dead from an overdose and their father – McGlothlin’s son – incarcerated.

“This is a multigenerational epidemic,” she said, underscoring that it “not only affects the addicts themselves, but the families who love them.”

This is the human cost of addiction – the people, places and things addicts lose while struggling to manage their substance use disorder.

‘Many Hands Make Light Work’

Penn State Schuylkill and Lehigh Valley Hospital – Schuylkill are uniquely positioned to bring expert speakers and professional help to Schuylkill County residents, as evidenced by this opioid conference. Through collaboration, these institutions provided a valuable community service.

The conference’s most important takeaway was that everyone can play a role in mitigating this crisis. In the old Pennsylvania Dutch axiom, shared by Penn State Schuylkill Chancellor Patrick M. Jones when welcoming everyone to the conference, “Many hands make light work. Only together can we address this epidemic.”

View Glenn Sterner’s presentation: “Understanding the Opioid Crisis,” by Dr. Glenn Sterner

Dr. Glenn Sterner, assistant professor of criminal justice at Penn State Abington, delivered the keynote speech at Penn State Schuylkill and Lehigh Valley Hospital – Schuylkill’s “Opioids: The Crisis Next Door” conference, hosted at the Schuylkill campus on September 21, 2019. Sterner’s talk, titled “Understanding the Opioid Crisis,” provided an overview of the epidemic  from the early 2000s until today. He explained the difference between opiates, which are naturally derived, and opioids, which are synthetic or chemically altered; spoke about where these drugs come from; and explored the ways in which addictions develop.

New NIJ-funded project to track post-prison trajectories of ex-inmates living with addiction

Published on: October 23, 2019
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Kimberly Davidson

Kimberly Davidson, a doctoral student of criminology and principal investigator of the project.

 

UNIVERSITY PARK, Pa. – Despite widespread national attention, the opioid epidemic and larger problems of substance use and misuse continue to deeply affect communities across Pennsylvania and throughout the nation. The impact of the opioid crisis and other substance abuse problems hits even harder for people grappling the criminal justice system, who are twelve times more likely to have substance use disorders (SUDs) than those among the general population.

Beginning in January 2020, a new two-year $91,000 grant from the National Institute of Justice (NIJ) will fund a Penn State-led project called “The Experiences of Men with Substance Use Disorders Exiting Prison at the Height of the Opioid Crisis.” The project aims to understand the post-prison trajectories of men with SUDs while evaluating the trends and common challenges of reentry. The funding will support the project’s principle investigator and an undergraduate research assistant in the coding and analysis of in-depth qualitative interviews with inmates, and with the cleaning and analysis of statewide quantitative data.

According to Kimberly Davidson, a doctoral student of criminology and principal investigator of the project, tracking the post-prison paths of men with SUDs will better highlight the changes needed within and outside the prison system to support inmates with SUDs. The project will also leverage partnerships with Pennsylvania’s Department of Corrections (PADOC) and Commission on Sentencing (PCS) to analyze the post-release outcomes of three statewide inmate reentry cohorts. These quantitative analyses will illustrate how reentry has been impacted by the shifting landscape of the opioid crisis, in addition to contextualizing the experiences of the 88 men in the interview sample within aggregate statewide trends.

Much of Davidson’s work focuses on the need for high quality substance abuse programming like a Therapeutic Community (TC), which many correctional institutions have already incorporated. TCs are a group-based drug and alcohol treatment program that have demonstrated evidence of effectiveness in lowering rates of relapse and recidivism.

She explained that, “There are some issues that make it more difficult for inmates with SUDs to truly engage with the recovery process while in prison. For example, the Pennsylvania Department of Corrections has 4-month long prison-based TC programs, but the TC model used in other inpatient settings calls for 12 to 18 months of treatment. Prison norms, like masculinity and invulnerability, also counter the structure and culture of TC programs, which are group-oriented and rely on peer influence and feedback to help in the recovery process.”

Davidson began interviewing inmates with histories of SUDs prior to their release from a Pennsylvania state prison in December 2016. The pre-release interviews focused on a respondent’s childhood experiences, personal history with substance use and criminal behavior, prior treatment experiences, and plans for reentry. Davidson noted that many respondents expressed hopefulness for their futures following their reentry.

“There’s evidence that children and work are anchored to sobriety. Many of the men I interviewed said they wanted to focus on staying sober for their children and providing for their families,” Davidson noted.

When it came time to complete the follow-up interviews, Davidson focused on the men’s experiences since their release from prison. The expected challenges of reentry permeated the post-release interviews like housing, employment, family reunification, parenting, transportation, health, stigma, and re-acclimating to life outside of prison. However, in addition to those issues, the challenges of sobriety compounded the trials of reentry. Many of the men often had family or friends who actively used drugs or alcohol, while some men had environmental or behavioral “triggers” present that caused them to use. For many, there was difficulty simply coping with the many challenges of reentry without turning to substances.

“During the post-release interviews, I found that many men with SUDs struggle substantially during the months post-release, with many of them relapsing, violating their parole, and being reincarcerated. The men who do manage to stay sober often end up living a life of self-imposed isolation to ensure they do not relapse. This also relates to the issue of the harsh surveillance of parole itself, of being under supervision, which criminalizes normal pathways of recovery.” About one-third of the “post-release” interviews took place in a state prison, as a substantial portion of the men interviewed were incarcerated for violations of parole during the data collection timeframe.

Building upon multiple prison-related research projects like the Prison Inmate Network Study (PINS) started by Derek Kreager, professor of sociology and criminology and Director of the Criminal Justice Research Center at Penn State, Davidson says she wanted to work with the prison population after completing a practicum placement in a county jail while doing her undergraduate degree in music therapy. For her, Kreager’s work in correctional institutions, and especially his research involving prison-based TCs, motivated her to pursue a graduate career at Penn State and engage in research to help the thousands of inmates struggling with SUDs. Ultimately, Davidson hopes the project will inform policy changes surrounding reentry, parole, prison-based and community drug and alcohol treatment, and community corrections.

“I feel privileged and honored to tell the stories and the truths of these men. They spoke so openly with me about the worst experiences and moments of their lives, but they also shared their hopes and dreams of staying sober, finding a good job and rebuilding their future with me. I hope that this project and any other research afterwards will shed light on when and how reentry planning collapses, the impact of continuity of care through aftercare, the circumstances surrounding relapses and recidivism, and what protective factors strengthen pathways of desistence and recovery.”

2019 Bennett Lecture discusses how mindfulness can help treat people living with addiction

Published on: October 22, 2019
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Stephanie Lanza, director of the Edna Bennett Prevention Research Center and interim director of the Consortium to Combat Substance Abuse, presented a plaque to Katie Witkiewitz, professor of psychology at The University of New Mexico, in appreciation of her presentation at the 2019 Bennett Lecture in Prevention Science, on Oct. 15.

Mindfulness was the topic at hand for this year’s Bennett Lecture in Prevention Science, held on Oct. 15 in 110 Henderson Building. The Bennett Lecture is an annual fall event hosted by the Edna Bennett Pierce Prevention Research Center. This year’s speaker, Katie Witkiewitz, professor of psychology at The University of New Mexico, gave a presentation to students, faculty, staff and community members titled “Mindfulness-Based Interventions for Addiction: Making a Better Band-Aid®.”

Building upon years of research beginning in the 1970s began by Alan Marlatt, who pioneered research in relapse prevention and harm reduction, Witkiewitz helped conduct the first study of using a Vipassana meditation course as a method for relapse prevention for individuals suffering from alcohol addiction and currently incarcerated in the early 2000’s. Vipassana meditation courses involves individuals meditating for several days of silence from morning until evening. The results of the study showed that after release, women who took the Vipassana meditation course were less depressed, less hostile, did not engage in as much substance use, and had lower rates of recidivism. However, after that first study, she shared that it was an uphill battle to obtain funding for a clinical trial of meditation as a treatment for addiction. After that, she and her colleagues decided to use the term “mindfulness-based relapse prevention” (MBRP) instead to reach a wider audience. She helped develop MBRP sessions with both formal and informal practices for clinicians to use with their patients.

“Relapse is the most common outcome following treatment for addiction. When I started my career as a young clinical psychology graduate student, I had a patient who I worked with to create a treatment plan for her alcohol dependence,” Witkiewitz said. “We worked with her for weeks to provide her coping skills and identifying her triggers. She wasn’t drinking, she was doing great. Then she had a hard week where she was meeting up with a friend who might encourage her to drink. And then she got fired from her job – that we didn’t see coming – and she relapsed. I remember being just devastated, and I know that this treatment was never going to be effective because I knew life was going to get in the way for other people.”

To date, Witkiewitz has conducted three randomized trials with community treatment agencies with hard-to-reach populations. She said that almost half to three-quarters of the respondents in the trials were engaging in mindfulness practices up to twelve months post-release from a community treatment facility. She noted that compared to gold standard relapse prevention treatment, MBRP does work to prevent relapse of alcohol or drug use.

“I think a lot of recovery work focuses on treatment that attempts to provide skills for increasing coping or directly targeting relapse. But it does not teach people coping skills or self-awareness to handle life situations that cause them to relapse in the first place. This is where mindfulness can come in and help give people the strength to deal with life,” she said.

Practicing mindfulness, according to Witkiewitz, involves observing ourselves and letting our minds wander in a non-judgmental space. She said the core of mindfulness for addiction is that whatever triggers people to use substances is not going to go away, so to instead hold onto that trigger in our awareness and in the present moment in a non-judgmental space.

“I think it’s important to stay with discomfort and really ‘be with’ daily joys and comforts. When you’re really being present in the moment, you bring awareness to yourself and respond in ways that serve us rather than react in detrimental ways,” she reiterated to the audience.

Witkiewitz conducted a second talk, “Alcohol Harm Reduction is Health Promotion: A 15-year Journey Examining Patterns and Predictors of Alcohol Treatment Outcomes,” at the Pasquerilla Spiritual Center on Oct. 16, as part of the Child Study Center speaker series. She discussed how abstinence from alcohol is often viewed as the most desirable and ideal outcome for individuals with alcohol use disorder; however, most individuals with alcohol use disorder do not want to abstain from drinking and do not seek treatment. She explained that reductions in drinking are a viable alternative to abstinence as a harm reduction strategy and are a significant public health priority.

Witkiewitz is a licensed clinical psychologist and has worked extensively on the development of a theoretical model of biopsychosocial influences on substance use relapse. She has been conducting research examining patterns and predictors of alcohol use since 1998 and has recently been working to improve research and methodological practices in the study of alcohol treatment outcomes. To date, she has written 5 books and over 190 peer-reviewed publications and book chapters, and she has given over 75 presentations and invited talks. Her research has been supported by grants from the National Institute on Mental Health, the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, and the National Center for Complementary and Integrative Health, totaling more than $22 million in research funding since 2004.

A recording of the talk is also available on YouTube.

This article originally appeared on Penn State News.

Professor to moderate congressional briefing on opioid dependence, addiction

Published on: October 17, 2019
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Diana Fishbein, professor of human development and family studies and director of the Program of Translational Research on Adversity Neurodevelopment in the Prevention Research Center at Penn State, is co-organizing and moderating the congressional briefing, “The Real Dangers of Equating Opioid Dependence with Addiction,” at 1:30 p.m. on Nov. 19 at the U.S. Capitol Visitor’s Center in Washington, D.C.

The National Prevention Science Coalition to Improve Lives (NPSC), of which Fishbein is founder and co-director, and the Congressional Addiction, Treatment and Recovery Caucus (ATR), are co-sponsoring the briefing with internationally recognized experts to discuss the dual challenges of addiction and dependence in developing policy responses to the opioid epidemic.

The briefing will address the significant policy implications of the difference between addiction and dependence and what that means for ensuring that patients’ differential needs are met.

“Although many people equate addiction and dependence, they are not the same, and the distinction has important implications for the millions of people who legitimately rely on opioid medications for pain management,” said Fishbein, who will be hosting her 20th congressional briefing.

Patients who are prescribed opioids to manage their chronic pain needs include veterans, ex-athletes, accident victims, and those with disabilities or suffering from diseases such as cancer.

“We need to get rid of stigma surrounding opioids, as some people need them to effectively manage their pain,” Fishbein said. “Proper screening, appropriate prescribing, and careful monitoring can prevent the escalation from dependence to addiction.”

The briefing will bring lawmakers, regulators, physicians, scientists and the public into this critical conversation. Although prescribing and monitoring are largely a physician-based undertaking, state and federal governments play a role in providing regulatory oversight and legislative guidance that support the evidence-based initiatives.

“It is imperative that we ensure pain patients who could benefit from opioid analgesics do not suffer unintended consequences of policies aimed at restricting access to these medications when their use is appropriate,” Fishbein said. “Our goal is to educate policy makers and communicate what is a field consensus regarding what the research is showing, so that policy decisions can be based on sound science.”

The briefing is being co-organized by John Roman, senior fellow at the National Opinion Research Center, University of Chicago. Presenters include Nora Volkow, director, National Institute on Drug Abuse; Susan Glod, associate professor of medicine, Penn State College of Medicine; Dr. Joshua D. Lee, director of addiction medicine fellowship and associate professor of population health and medicine and general internal medicine and clinical innovation, New York University School of Medicine; and Phillip W. Graham, director, Center on Social Determinants, Risk Behaviors, and Prevention Science, RTI International.

The NPSC is a nonprofit organization of scientists, educators, practitioners and clinicians, policy makers, foundation representatives and national affiliates whose members work to apply validated scientific findings to wide-scale effective implementation of practices and policies to improve the lives of children, adolescents, their families and communities.

This story originally appeared on Penn State News.

Tabletop exercise addresses comprehensive response to opioid crisis

Published on: October 16, 2019
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Participants in the tabletop exercise on opioid responseThe Penn State Center for Security Research and Education, in collaboration with Penn State HarrisburgPenn State Homeland Security Programs, and the Pennsylvania Emergency Management Agency (PEMA), held a tabletop exercise that addressed first-responder and whole-community response and resilience to the ongoing opioid crisis.

The exercise, which took place Sept. 24 at PEMA headquarters in Harrisburg, also was supported by the Governor’s Office for Homeland Security and the Pennsylvania Department of Health’s Bureau of Public Health PreparednessDickinson Law in Carlisle and Immaculata University were academic contributors.

More than 50 experts participated in the one-day program that involved local agencies in a discussion about effectuating comprehensive response to overdose incidents. Participant experts represented a wide array of backgrounds, including state and local law enforcement agencies; emergency medical technicians; public health and health care professionals; and scholars from the fields of law, security studies, public policy and public health, among other relevant areas. The participants addressed specific challenges, including resource sharing among responders; capacity-building for long-term recovery; effective integration of nontraditional partners such as spontaneous volunteers and donors; and public education and outreach to improve prevention.

The exercise was based on a scenario, written by a Penn State expert group that included doctoral students under the guidance of the Pennsylvania Department of Health’s Bureau of Public Health Preparedness, that envisioned realistic response challenges stemming from a sudden increase in opioid overdoses in the lower Susquehanna Valley over the course of a weekend. By addressing the resources used and challenges faced in collaborative actions, the exercise aimed to strengthen the whole-community approach to emergency response.

The program also included briefings from state and local agencies; a scenario discussion moderated by Andrew Pickett, director of the Bureau of Public Health Preparedness at the Pennsylvania Department of Health; and a hot wash featuring an expert panel on the applied research response to the challenges identified in the exercise. The hot wash aimed to inform Penn State’s research agenda and discussed various aspects of research, including need and opportunities for interdisciplinary work; coordination across the commonwealth; predicting hotspots of overdose incidents; measuring responder and societal resilience in the opioid crisis; and developing professional training for emergency responders across the whole community.

Students and staff from the Penn State Harrisburg School of Public Affairs and the Penn State School of International Affairs in University Park assisted in the proceedings of the event.

This story originally appeared in Penn State News.

AI could offer warnings about serious side effects of drug-drug interactions

Published on: October 16, 2019
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Drug interaction alertsThe more medications a patient takes, the greater the likelihood that interactions between those drugs could trigger negative side effects, including long-term organ damage and even death. Now, researchers at Penn State have developed a machine learning system that may be able to warn doctors and patients about possible negative side effects that might occur when drugs are mixed.

In a study, researchers designed an algorithm that analyzes data on drug-drug interactions listed in reports — compiled by the Food and Drug Administration and other organizations — for use in a possible alert system that would let patients know when a drug combination could prompt dangerous side effects.

“Let’s say I’m taking a popular over-the-counter pain reliever and then I’m put on blood pressure medicine, and these medications have an interaction with each other that, in turn, affects my liver,” said Soundar Kumara, the Allen E. Pearce and Allen M. Pearce Professor of Industrial Engineering, Penn State. “Essentially, what we have done, in this study, is to collect all of the data on all the diseases related to the liver and see what drugs interact with each other to affect the liver.”

Drug-drug interaction problems are significant because patients are frequently prescribed multiple drugs and they take over-the-counter medicine on their own, added Kumara, who also is an affiliate of the Institute for CyberScience, which provides supercomputing resources for Penn State researchers.

“This study is of very high importance,” said Kumara. “Most patients are not on one single drug. They’re on multiple drugs. A study like this is of immense use to these people.”

To create the alert system, the researchers relied on an autoencoder model, which is a type of artificial neural network that is loosely designed on how the human brain processes information. Traditionally, computers require labeled data, which means people need to describe the data for the system, to produce results. For drug-drug interactions, it might require programmers to label data from thousands of drugs and millions of different combinations of possible interactions. The autoencoder model, however, is suited for semi-supervised algorithms, which means it can use both data that is labeled by people, and unlabeled data.

The high number of possible adverse drug-drug interactions, which can range from minor to severe, may inadvertently cause doctors and patients to ignore alerts, which the researchers call “alert fatigue.” In order to avoid alert fatigue, the researchers identified only interactions that would be considered high priority, such as life-threatening, disability, hospitalization and required intervention.

Kumara said that analyzing how drugs interact is the first step. Further development and refinement of the technology could lead to more precise — and even more personalized — drug interaction alerts.

“The reactions are not independent of these chemicals interacting with each other — that’s the second level,” said Kumara. “The third level of this is the chemical-to-chemical interactions with the genomic data of the individual patient.”

The researchers, who released their findings in a recent issue of Biomedical and Health Informatics, used self-reported data from the FDA Adverse Event Reporting System and information on potentially severe drug-drug interactions from the Office of the National Coordinator for Health Information Technology. They also used information from online databases at DrugBank and Drugs.com. Duplicate reports and reports about non-serious interactions were removed.

The list included about 2,891 drugs, or approximately 110,495 drug combinations. The researchers found a total of 1,740,770 reports on serious health outcomes from drug-drug interactions.

Kumara worked with Ning Liu, former doctoral student in industrial engineering and operations research and currently a data scientist at Microsoft; Cheng-Bang Chen, former doctoral student in industrial engineering and operations research and currently researcher and assistant coordinator at the Center for Health Organization Transformation; and Dolzodmaa Davaasuren, former master’s degree student in industrial engineering and currently a doctoral student in IST.

This story originally appeared in Penn State News.

Abstracts can be submitted for fifth annual Penn State Addiction Symposium

Published on: September 30, 2019
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Drugs, alcohol, cigarettes

The Penn State Addiction Center for Translation is accepting abstracts for consideration as poster and oral presentations at the center's fifth annual Penn State Addiction Symposium. Send a 250-word abstract, complete with title, author(s), affiliations and the presenter's email address, to PSACT@pennstatehealth.psu.edu. The symposium program will feature the abstracts. Presentations will be selected according to merit and relevance. The deadline is Oct. 14.

The fifth annual Penn State Addiction Symposium will be held from 9 a.m. to 4 p.m. on Tuesday, Dec. 10, in Junker Auditorium at Penn State Health Milton S. Hershey Medical Center. Keynote speakers will be Dr. Yngvild Olsen and Dr. Joshua Sharfstein, authors of “The Opioid Epidemic-What Everyone Needs to Know.” They will present “Applying Science to Clinical Care — What it Really Means to Treat Addiction as a Chronic Illness” at noon. Lunch is provided to those who register. 

This year’s featured Penn State faculty speaker will be Yuval Silberman, assistant professor of neural and behavioral sciences, who will present “Stress Neurocircuitry and Addiction Across the Lifespan.” 

Faculty members and clinician/scientists will share their current addiction-related research using brief five- to 10-minute data blitz-style presentations. These presentations will show the breadth of preclinical and clinical addiction research going on at Penn State campuses.

The symposium is sponsored by the Penn State Addiction Center for Translation and Penn State Clinical and Translational Science Institute.

For more information and to register, click here.

Schuylkill nursing professor researches impact of opioid addiction on families

Published on: September 25, 2019
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Two yound people holding hands

Marianne Adam, associate teaching professor in the College of Nursing at Penn State Schuylkill, has been an asset to the Penn State nursing community, educating future nurses while researching substantial health issues ranging from palliative care, diabetes, and her current focus — the opioid epidemic.

The nation’s opioid epidemic has become an ever-present public health concern that plagues our communities. In 2017, Pennsylvania was ranked 3rd in the nation for deaths due to drug overdose, having an estimated economic impact of $1 trillion.

The magnitude of this issue has spurred many to take action, including Penn State. In early 2019, the University hosted its first summit on the opioid epidemic, attracting almost 200 researchers, practitioners and educators from across the Penn State community, including Adam.

Adam developed an interest in the opioid epidemic when her local newspapers began reporting on overdoses in nearby schools and the impact on youth in the community. With college-age children of her own and concern for her community, she said she felt personally invested and obligated to help be a part of the solution.

“In 2016 the initial Community Based Research Network conference was held, and the focus of the initiative was to support nursing faculty that were interested in research,” said Adam. “We were charged with identifying stakeholders and potential research partners in their communities while simultaneously the opioid crisis was hitting the county I live in. It was in my community, impacting local school districts.”

Through funding from the Penn State Social Sciences Research Institute (SSRI), Adam was able to launch her newest research project, “Families Forging a Path to Treatment for Opioid Addiction.” The project’s main focus is to better understand the perspectives of the affected individual’s family. The research aims to provide pivotal information about family members’ efforts to support their loved one, the resources they accessed, barriers to care, and challenges to consider when developing programs and policies.

“The person in active addiction has to be ready for treatment; there’s a critical window from when the individual says they are ready and when treatment can actually be arranged,” said Adams. “The goal is to develop a novel intervention strategy that family members can access while they’re looking for treatment and help make the transition more seamless.”

Methodology for the project builds on qualitative  data from a prior study, which investigated the lived experience of family members with an opioid-addicted loved one. The current research project will utilize surveys to examine family member status, treatment and recovery strategies, care of minors, and information and media sources accessed. Survey questions ask participants to share recommendations to healthcare providers and advice for other families impacted by this disorder.

Adam said she aims to better understand individual and family experiences while developing strategies to support the family, which in turn, can help the affected individual. Her personal interest and commitment to the epidemic drives her to help make a tangible change in affected communities, transforming treatment roadblocks for willing individuals with a substance use disorder and their families.

Those interested in participating in this research project may access the consent form and survey at https://tinyurl.com/y54jsywc.

If you or someone you know is suffering from an opioid addiction and need help or support, please contact the Substance Abuse Helpline 1-800-662-HELP (4357).

Training program available to recovering addicts

Published on: September 19, 2019
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Hands in fist bump

If you have a history of addiction recovery and want to help others, Penn State Shenango will host a Beaver campus Continuing Education course on “Certified Recovery Specialist Training” from 8:30 a.m. to 3:30 p.m., Saturdays, beginning Oct. 5 and ending Dec. 14, in Sharon Hall room 108 in downtown Sharon, Pennsylvania.

In 2017, Pennsylvania had the third highest overdose death rate in the country. Gov. Tom Wolf has since declared it a public health disaster, clearing the way for easier access to care and resources.

And of all the resources available to recovering addicts, a simple peer-to-peer program may be one of the most effective. Research has shown that peer recovery support services not only help addicts remain engaged in the recovery process, but also reduce the likelihood of relapse.

Certified Recovery Specialist Training is a 54-hour program that meets education requirements specified by the Pennsylvania Certification Board. To apply for CRS certification, individuals must meet additional board requirements, including: a history of addiction with recovery, a high school diploma or GED, successful completion of a CRS exam, and the signing of an ethical code of conduct.

The cost is $995 and includes all necessary materials. Online registration is now open at https://beaver.psu.edu/recovery-specialist.

The Pennsylvania Certification Board requires candidates to complete the CRS exam application. The cost of the exam is $125, payable directly to the board with the application and requisite documents.

Financial assistance may be available for qualified individuals.

For more information about the CRS program, or any program offered through Penn State Beaver Continuing Education, contact Jill Valentine at jak249@psu.edu or 724-773-3765.

Resources to combat opioid epidemic available through new WPSU project

Published on: September 18, 2019
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Glenn Sterner in blue suit jacket

Trisha Stouch lost her daughter Pamela to a drug overdose almost 10 years ago, but Stouch remembers like yesterday the moment she realized her daughter’s need for opioids had taken over her life.

A stay-at-home mom, frequent chaperone on school trips and softball coach, Stouch was an involved parent. But Pamela met a boy who changed everything: She started smoking marijuana, drinking and abusing pills. When Stouch found out Pamela was snorting OxyContin, she confronted her daughter.

“She came at me physically. She ripped my necklace off, my glasses,” Stouch said. “This was not my daughter.”

Stouch’s daughter’s struggle with opioid abuse is part of a new cross-platform media and outreach project produced by WPSU Penn State that features a collection of videos, a podcast and a new website.

The project, “Overcoming an Epidemic: Opioids in Pennsylvania,” aims to help raise awareness of evidence-based practices, programs and policies to prevent and treat opioid abuse, and to identify barriers that prevent the adoption and spread of effective practices and policies.

A 30-minute television show will air at 8:30 p.m. on Sept. 19 on WPSU-TV and explore some of the issues facing Pennsylvania as it battles its opioid crisis and how evidence-based solutions can help turn the tide in the fight against opioid misuse.

Cheraine Stanford, WPSU’s director of content strategy, said the project’s goal is to help save lives by creating media that will educate and motivate through various forms, including through video, a seven-episode podcast, a website and community events.

“Substance abuse, including the opioid crisis, is one of the most challenging issues facing Pennsylvania,” Stanford said. “As central Pennsylvania's public media station, we felt it was important to not just look at the problems being caused by the epidemic but what was being done to try to solve them.”

The project website consists of strategies used to fight the opioid epidemic presented through videos and a podcast produced by WPSU. Strategies featured in the project include reducing stigma, prevention options, legal system programs, care resource networks, family support, rural care and education, and recovery.

Reducing stigma is the focus of Glenn Sterner, assistant professor of criminal justice at Penn State Abington, whose project “Share Your Opioid Story” features 150 accounts of people’s struggles.

Stouch’s daughter Pamela is just one of the stories collected by Sterner, and he said stories like Pamela’s get repeated over and over. Pamela was isolated and too embarrassed to reach out for help. She ended up a statistic, part of the 130 people a day who die on average nationwide due to the opioid epidemic.

But that shouldn’t be the end of her story, Sterner said.

“The only way that we're going to move beyond those statistics to help you really understand the breadth, the depth, and frankly, the major issues associated with substance use disorder is by helping to share those stories,” Sterner said. “The more that we can talk about this issue, the more that we can openly support you in that recovery process, the more likely that you're going to get better.”

The cross-platform project has been made possible with support from the Penn State Office of the Provost. WPSU is an Outreach service of Penn State.

Visit the WPSU website for more information.

Penn State helps tackle opioid epidemic through consortium, public media project

Published on: September 18, 2019
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Open bottle of pills

The strategies being employed by Penn State to help combat the opioid epidemic were discussed today, Sept. 12, during an update to the Board of Trustees Committee on Outreach, Development and Community Relations at the Penn Stater Hotel and Conference Center.  

Presentations were given about the Penn State Consortium to Combat Substance Abuse (CCSA) — located within the Social Science Research Institute at Penn State — and Overcoming an Epidemic: Opioids in Pennsylvania— a cross-platform media and outreach project produced by WPSU Penn State.

In 2017, more than 72,000 Americans died from drug overdoses — more than twice than from motor vehicle accidents or gun violence, and Pennsylvania had the third highest overdose rate in the country.

The CCSA, launched in 2018, leverages the vast scope of researcher-practitioner experience to support, inform and improve programs that address prevention, addiction, and treatment and recovery, while supporting affected families and communities.  

The CCSA hopes to tackle the opioid crisis and all substance misuse, create a continuum of care and conduct outreach to influence the public, students and policy makers, according to Stephanie Lanza, CCSA interim director and director of the Edna Bennett Pierce Prevention Research Center. 

The CCSA will be hiring 12 faculty members to bolster scientific leadership for research, teaching and outreach and is preparing for its second annual conference that will focus on comprehensive, state-wide solutions to address substance misuse. Since its inception, the CCSA has awarded seed grants for 13 projects to help fuel innovative solutions, and established several faculty-community partnerships at Penn State Brandywine, Greater Allegheny and University Park campuses, to solve problems at local levels. 

In addition, Penn State Harrisburg recently established the Douglas W. Pollock Center for Addiction Outreach and Research. The center will play a key part in the consortium, helping further connect the campus to the community and veteran populations while drawing on the expertise of researchers, educators and practitioners from across the University.

According to Lanza, the consortium also continues to pursue external funding to address the future challenges of substance misuse as Penn State faculty are connecting and forming partnerships with one another.

“We anticipate these and other activities to sharpen our focus, lead to novel solutions and escalate our capacity to impact Pennsylvania and beyond,” she said.

From WPSU, which is an Outreach service of Penn State, Overcoming an Epidemic: Opioids in Pennsylvania hopes toraise awareness of evidence-based practices, programs and policies to prevent and treat opioid abuse, and to identify barriers that prevent the adoption and spread of effective practices and policies.

A 30-minute television show will air at 8:30 p.m. on Sept. 19 on WPSU-TV and explore some of the issues facing Pennsylvania as it battles its opioid crisis and how evidence-based solutions can help turn the tide in the fight against opioid misuse.

Cheraine Stanford, WPSU’s director of content strategy, said the project’s goal is to help save lives by creating media that will educate and motivate through various forms, including through television, radio, podcasts, the website and community events.

“Substance abuse, including the opioid crisis, is one of the most challenging issues facing Pennsylvania,” Stanford said. “As central Pennsylvania's public media station, we felt it was important to not just look at the problems being caused by the epidemic but what was being done to try to solve them.”

The project website consists of strategies used to fight the opioid epidemic presented through videos and podcasts produced by WPSU. Strategies featured in the project include reducing stigma, prevention options, legal system programs, care resource networks, family support, rural care and education and recovery. 

“These efforts to address the challenges of Pennsylvania’s opioid crisis speak to the heart of our mission: to identify critical issues and utilize the expertise of our faculty and our diverse University outreach units to engage communities in creating viable and sustainable solutions,” said Tracey Huston, vice president for Penn State Outreach.

Visit the CCSA website for more information about the consortium, and the WPSU website for more information about the cross-platform project.

Douglas W. Pollock Center for Addiction Outreach and Research dedicated

Published on: August 27, 2019
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Man at podium at center opening

Substance abuse has been among the most serious health care challenges facing communities across Pennsylvania and the nation. As a strategic priority, Penn State is committed to combating substance abuse and as a result has established the Consortium to Combat Substance Abuse. As part of the consortium, Penn State Harrisburg has established the Douglas W. Pollock Center for Addiction Outreach and Research. University officials recently joined with Pollock Foundation representatives and state and local officials to dedicate the center. 

“With the establishment and dedication of the Douglas W. Pollock Center for Addiction Outreach and Research, Penn State Harrisburg becomes an active partner in the University’s priority to address substance abuse,” said Chancellor John M. Mason Jr. “We are truly grateful for the $2.5 million leadership gift from the Douglas W. Pollock Foundation which has made this a reality. Penn State Harrisburg is ideally suited to house the center because of our established research expertise, academic infrastructure that combines programs and faculty in related disciplines, and existing partnerships within the region and throughout Penn State. This is an ambitious endeavor, but one that we are pleased to be undertaking.”

The center will initially address two areas of the substance abuse problem within the region, while serving as a catalyst to enhance communications and align numerous agencies and organizations in efforts to combat substance abuse:

  • Veterans: Providing targeted assistance to veterans of the U.S. military and their families who are facing addiction-related challenges.
  • Community organizations: Helping bolster community organizations in their efforts to more effectively combat substance abuse across the state of Pennsylvania, as well as nationally.

“One of Penn State’s key strategic priorities is enhancing health. As the University has pursued implementation of the tenets of its strategic plan, problems of substance use continue to escalate, posing ever-increasing threats to the health and well-being of citizens of the commonwealth and the nation,” said Madlyn L. Hanes, vice president for Commonwealth Campuses and executive chancellor at Penn State. “Last fall the University announced a significant investment in improving health, and the Consortium to Combat Substance Abuse is a key component of our strategic plan implementation. The Douglas W. Pollock Center for Addiction Outreach and Research at Penn State Harrisburg will be a vital part of the consortium.”

Douglas W. Pollock was born and raised in central Pennsylvania and was a 1973 Penn State graduate. A student-athlete in college, Pollock was an ardent Penn State supporter, as well as a supporter of the military and its veterans. Pollock battled mental health issues and addiction throughout his life, which ultimately caused his untimely death in 2016 at the age of 64.

Mike Bangs, attorney for the Douglas W. Pollock Foundation, said, “Doug was plagued by addiction and unfortunately he lost his battle. Unfortunately, Doug’s story is not unique at all. There are deaths every day from addiction. The question we asked was, how can we best use the resources of the foundation to try to attack this problem as a legacy to Doug? That's how the Douglas W. Pollock Center for Addiction Outreach and Research came to life. This center will be hands-on. It will assist any organization on the front lines of attacking this issue. This gift has laid the foundation for the center, but the problem can only be resolved with the collaboration of the public and private centers, businesses, governments, foundations and individuals. We all have to work together and join our resources to attack this addiction problem.”

The center will be headed by Weston Kensinger, assistant teaching professor of health education in Penn State Harrisburg’s School of Behavioral Sciences and Education, where the center will be housed.

“The establishment of the Douglas W. Pollock Center for Addiction Outreach and Research provides a unique opportunity to serve as an extension of the Penn State Consortium to Combat Substance Abuse by providing direct outreach and working hand-in-hand with veterans and community organizations, so that they can better utilize, coordinate, and take advantage of the many resources, tools, and programs already available through the great work being done throughout the region and state,” Kensinger said. “While we celebrate the dedication of the Pollock Center today, there is much work and many challenges ahead.

“By leveraging partnerships, resources, and funding from throughout the University, community, county, and state we can provide veterans and community organizations with the tools and resources they need now, while also making a lasting, positive influence for the future. I believe we owe it to individuals, families, and communities struggling with substance abuse and the disease of addiction to not only meet the immediate need of reducing deaths; but also to facilitate the opportunity to recover to safe, healthy, and productive lives.”

Pennsylvania State Representative Thomas Mehaffie (R-106) spoke about the legislative support for the center.

“Every one of us has been touched by this epidemic, and many people have met with me, trying to come up with a way to figure out how to beat this problem,” he said. “The Douglas W. Pollock Center for Addiction Outreach and Research will provide an important resource as the state confronts the substance-abuse crisis. We are losing 14 Pennsylvanians each day to overdose deaths. This is something that cannot continue. Addiction cuts across all age groups, economic sectors and racial demographics. It is a pressing public health issue.

“We are doing what we can in Harrisburg to confront the opioid epidemic, which includes supporting the attorney general in lawsuits against drug manufacturers. However, I recognize we cannot legislate our way out of this scourge on society. I appreciate the generosity of the Douglas W. Pollock Foundation in making this center possible. Thank you to Penn State for showing leadership on this issue.”

Dauphin County Commissioner George P. Hartwick added that the fight against substance abuse is a community issue.

“All of us must come together in a sense of community and figure out what we can do. There is no handbook; addiction is a disease. All of us have the obligation to stop pointing fingers and be a part of the solution. Government cannot do it alone,” Hartwick said. “We have a lot to learn, and the ability to identify new research, new ways to be innovative, new ways to solve problems is a challenge that lies with this center. I think this partnership will be something that we can be proud of, but make no mistake about it, in Dauphin County we are still not winning the war and we need your help. Last year alone we had 128 accidental drug deaths. We need to figure out a way to provide support to individuals dealing with addiction. Let this be the day that we all get engaged to fight the war on substance abuse.”

For more information about the Douglas W. Pollock Center for Addiction Outreach and Research, visit harrisburg.psu.edu/pollock-center.

Penn State has a longstanding and proud tradition of serving the men and women of our military through education benefits, resources, support and more. This year's Military Appreciation Week from Nov. 8 to 16 will honor America's “Greatest Generation” with a week-long series of campus events, including a football game, Veteran’s Day ceremony, speaker series and more. Visit militaryappreciation.psu.edu to learn more.

Penn State aims to boost people, organizations fighting addiction with new center in central Pa.

Published on: August 27, 2019
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Man at podium at center opening

By

Penn State Harrisburg officially dedicated a new outreach center intended to serve as a “concierge” for people seeking help for addiction, and for community organizations looking to grow their capacity to address addiction.

The Douglas W. Pollock Center for Addiction Outreach and Research is based at Penn State’s campus near Middletown. It was created with a $2.5 million grant from a foundation established on behalf of Pollock, a Cumberland County native and Penn State graduate who died in 2016 at 64. Pollock had battled substance abuse and mental illness.

The center will have a special focus on helping military veterans. But its services will be available to anyone, and it will also have a major focus on helping organizations, according to Weston Kensinger, the director.

The center won’t provide addiction treatment. Rather, it will assess needs of people seeking treatment and direct them to a local organization or program that meets their needs. If the person faces other obstacles, the center will try to find programs or resources to overcome them.

“It’s really kind of playing matchmaker,” says Weston Kensinger, the director of the center.

With organizations, the center will help them find things like expertise and grants to help them grow and further their mission. Another role will be to tap research and information within Penn State University and push it out to local organizations. That includes making sure they have access to the latest evidence-based approaches to treating addiction, and helping them build programs based on the best science and information.

Still another role will be to coordinate the efforts of entities and programs from the federal level to state government to local grassroots.

The ongoing opioid addiction crisis was a factor in creating the center. However, Mark Kiselica, director of the school of behavioral sciences and education at Penn State Harrisburg, noted it will address other types of substance abuse including alcohol, and addictions such as those involving gambling or sex.

For example, if a pastor concluded addiction to gambling was a problem in the congregation or community, and wanted to start an effort to help, the center could provide guidance.

The center will have a staff of two along with two graduate assistants. A goal is to recruit two graduate assistants per year, with one being a military veteran and the other being involved with a community organization. The center will provide financial assistance toward their educations. A goal is to expand the number of people with addiction-related knowledge working in the local community, Kensinger said.

The center is still in the process of gearing up and doesn’t yet have a contact number for people seeking help. However, Kensinger says anyone who wants to contact the center can reach him at wsk120@psu.edu.

Marijuana may boost risky effects of drinking alcohol

Published on: August 19, 2019
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Maijuana and alcohol

As the legalization of medical marijuana and marijuana use are both on the rise in the United States, people are not necessarily using alcohol less and may be unaware of the risks of combining alcohol and marijuana, according to researchers.

A new study from Penn State found that compared to people who only drank alcohol, those who used alcohol and marijuana simultaneously were more likely to drink heavier and more often. They were also more likely to experience alcohol-related problems — like impulsive actions they later regretted.

“The results suggest that individuals who simultaneously use alcohol and marijuana are at a disproportionately higher risk for heavy, frequent and problematic substance use,” said Ashley Linden-Carmichael, assistant research professor at the Edna Bennett Pierce Prevention Research Center at Penn State.

The researchers said the findings — recently published in the journal Substance Use and Misuse — also suggest that prevention and intervention programs should take into account not just alcohol, but also if people are using additional substances, as well.

“Right now, a lot of campus programs focus on whether students are drinking, and while sometimes they are asked about other substances, it’s not necessarily whether they’re using these substances simultaneously,” Linden-Carmichael said. “I think we do need to be asking about whether they’re drinking in combination with other drugs, and educating students about how that exacerbates their risk.”

According to the researchers, marijuana use is at an all-time high among young adults in the U.S., possibly leading to people using marijuana and alcohol simultaneously.

“The problem with simultaneous use is that it can affect people cognitively and perceptually, and also have an impact on motor impairment,” Linden-Carmichael said. “There is a burgeoning area of research that is examining why people are using marijuana and alcohol together and what those effects are.”

In the study, Linden-Carmichael said she and the other researchers were interested in learning more about how people use marijuana and alcohol together. They also wanted to explore whether personality traits — like the tendency to pursue new and exciting experiences, or “sensation seeking” — were associated with higher odds of using alcohol and marijuana at the same time.

The researchers recruited 1,017 participants from 49 states in the U.S. between the ages of 18 and 25 for the study. The participants provided information about how often they used alcohol, marijuana and the two substances simultaneously. They also filled out questionnaires that measured their experiences with alcohol-related problems, whether they had a sensation-seeking personality, and how they perceived the drinking habits of their friends.

Linden-Carmichael said that across the board, individuals who used alcohol and marijuana simultaneously were at a greater risk than individuals using alcohol alone.

“Even after controlling for the number of drinks a person typically consumed, people who used alcohol and marijuana at the same time were at a greater risk for problems like blacking out, getting in an argument, or other concerns,” Linden-Carmichael said. “Additionally, 70 percent of those who engaged in simultaneous use reported using at least weekly.”

The researchers found that among people who used alcohol and marijuana simultaneously, those who used more frequently were more likely to drink more alcohol, more often, and for longer periods of time. They were also associated with using more marijuana more often.

Additionally, they found that people who used alcohol and marijuana together were more likely to have higher levels of sensation-seeking characteristics and think their friends were drinking larger amounts of alcohol.

Amy L. Stamates and Cathy Lau-Barraco, both at Old Dominion University, also participated in this work.

The National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism helped support this research.

Researchers estimate societal costs of the opioid epidemic

Published on: August 5, 2019
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Opioid deaths

The devastating consequences of the opioid crisis are far-reaching in the United States, impacting public health as well as social and economic welfare. Penn State researchers recently collaborated to address the issue in a supplement of The American Journal of Managed Care, titled “Deaths, Dollars, and Diverted Resources: Examining the Heavy Price of the Opioid Epidemic.”

According to Dennis Scanlon, distinguished professor of health policy and administration and director of the Center for Health Care and Policy Research at Penn State, the articles and commentaries in the special issue focus on the costs to governments, notably state governments.

“State and local governments have long shouldered the burden of the opioid epidemic and its costs to individuals and families,” said Scanlon. “They are at ground zero for the epidemic, where services for those being harmed by opioids are significant and costly, spanning well beyond healthcare for treatment and prevention.”

Scanlon, along with Christopher Hollenbeak, professor of health policy and administration at Penn State, authored the introduction to the special issue, noting, “We take an opportunity to raise several important broader questions we believe have not received enough attention but are critically important for learning from the current opioid epidemic and preventing the potential burdens that could be associated with the next epidemic.”

Topics in this special issue are diverse and include the costs of the opioid crisis on employment and labor market productivity, burdens on the child welfare system and special education, the increased costs to the criminal justice system, and the economic burden on state Medicaid programs.

“The supplement fulfills our initial goal of exploring the effects of the opioid crisis on societal costs,” Scanlon explained. “Each article in this special issue presents complex cost analyses of the implications of opioid misuse, shedding new light on the opioid epidemic at the state level, and adds to a growing body of literature about the opioid epidemic.”

For example, researchers found that in the United States between 2000 and 2016, opioid misuse reduced state tax revenue by more than $11 billion, including approximately $10 billion in lost income tax revenue and almost $2 billion in lost sales tax revenue. In another paper, researchers found that between 2007 and 2016, total costs to Pennsylvania’s criminal justice system from the opioid crisis was over $526 million.

Meanwhile, total Medicaid costs associated with opioid-use disorder more than tripled between 1999 and 2013, reaching more than $3 billion. Additionally, total annual education costs for children born in Pennsylvania with neonatal abstinence syndrome associated with maternal use of prescription opioids was estimated at over $1 million. Finally, researchers also found increased costs of almost $3 billion to the child welfare system from 2011 to 2016.

“Due to these costs, every American will continue to experience loss from resources diverted to the epidemic that could have been made available for other uses had the epidemic been prevented,” said Scanlon. 

Another unique aspect of the issue is the strong Penn State presence, as all authors are either faculty, staff, or current or former graduate students. Additionally, one of the commentaries is co-authored by Pennsylvania Secretary of Health Rachel Levine, who provides further perspective into the opioid crisis at the state level.

Other lead Penn State authors include Max Crowley, assistant professor of human development and family studies; Doug Leslie, professor of public health sciences and psychiatry; Paul Morgan, professor of education; Joel Segel, assistant professor of health policy and administration, and Gary Zajac, associate research professor.

Research contributions in the supplement were supported by the Commonwealth of Pennsylvania under the project “Estimation of Societal Costs to States Due to the Opioid Epidemic,” and as part of larger work supported under a Strategic Planning Implementation award from the Penn State Office of the Provost, “Integrated Data Systems Solutions for Health Equity.”

Funding for the production of this supplement was provided by Penn State’s Social Science Research Institute and by the Penn State Clinical and Translational Science Institute through the National Center for Advancing Translational Sciences, National Institutes of Health.

Marijuana policies are changing, but they are not always based on scientific knowledge

Published on: July 8, 2019
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Marijuana

By Diana H. Fishbein, Elizabeth Long and Sharon Kingston, opinion contributor for The Hill

Misconceptions regarding marijuana distort perceptions about its hazards and benefits. While marijuana remains on schedule 1 of the federal Controlled Substances Act, a number of state-level laws are changing the policy landscape. However, these changes are not always informed by decades of scientific knowledge. 

Incorporating existing science into the policy narrative promises to provide critical opportunities to make course corrections and avoid policies that are neither too restrictive nor permissive. 

A critical issue in marijuana policymaking is whether marijuana is addictive. Extensive scientific research has determined that marijuana does, in fact, have dependence-producing properties, activating several neurochemical “reward” systems of the brain, including the opioid system). Importantly, using marijuana also significantly increases risk of using other substances and developing a substance use disorder (SUD)).

Teenagers are at heightened risk for experimenting with drugs, and the earlier they use, the greater the risk for eventual dependence. Marijuana’s regular use during adolescence leads to dependence at higher rates than alcohol and, once dependent, adolescents experience a wide range of adverse effects

The brain is rapidly maturing during adolescence making it vulnerable to environmental influences that can alter the course of brain development. Consequently, chronic and/or heavy marijuana use in adolescence has been associated with a number of developmental delays. For example, teens who use marijuana heavily often show deficits in a range of cognitive functions (e.g., memory, reasoning, attention, concentration, decision-making). 

Also, marijuana use can exert negative impacts on mental health, by triggering psychotic disorders like schizophrenia in susceptible individuals, and worsening other mental health problems (e.g., bipolar disorder, substance abuse, social anxiety). We also see an increased incidence of suicidal ideation, attempts and completion

Importantly, even regular use (not only chronic/heavy) may disrupt healthy neurodevelopment. And the earlier marijuana use begins, the worse the outcomes the worse the outcomes.

Heavy use of marijuana also affects the reproductive system, potentially stalling development of reproductive systems, leading to a lag in brain areas responsive to the male hormone, testosterone, as well as problems with sexual performance.

The real concerns for teenagers are not death from overdose but rather impediments to short and long term functioning and its potential for SUD. Yet, there is a broad lack of awareness of these consequences

Although legislation restricts possession of marijuana by minors, recent more permissive drug laws are leading to a greater number of teens who perceive marijuana use as harmless. Decreases in perceived harm is directly associated with increased drug-taking.

Formulating policies that are consistent with scientific evidence will greatly increase their effectiveness. Several policy recommendations are offered here for consideration: 

  1. Invest resources in delaying the age of initiation of marijuana use past the age when the brain is still under construction (~ age 25) to reduce impact on neurodevelopment. Thus, risk for SUD would decline and the cascading negative effects on health would be prevented.
  2. Importantly, fund and widely implement a high-quality public education campaign to inform youth, parents, adults who work with youth, and healthcare providers about the dangers of marijuana use during childhood and adolescence.
  3. Support screening, early detection and intervention. Focus both on at-risk youth who have not yet initiated to avert pathways to use and youth who have already begun using marijuana to avoid negative consequences including SUD.
  4. Update the regulatory structure to keep pace with commercialization applying uniform standards on the types of products that can be sold or marketed to the public. 
  5. Support initiatives to reduce stigma related to SUD treatment and increase knowledge regarding marijuana’s effects, thereby encouraging young users to seek treatment.
  6. Invest in research and increase access to marijuana by scientists studying the impact of marijuana on risk for addiction and effects on neurodevelopment in adolescence.

Marijuana has a history replete with ill-informed notions about its effects. Fortunately, recent decades have produced a substantial body of evidence on marijuana to guide our policy decisions guide our policy decisions.

 

Diana Fishbein, Ph.D., professor and program director, The Pennsylvania State University and co-director of the National Prevention Science Coalition (NPSC). Elizabeth Long, Ph.D, postdoctoral scholar, Edna Bennett Pierce Prevention Research Center, Pennsylvania State University and member of NPSC. Sharon Kingston, Ph.D., associate professor of psychology, Dickinson College and Secretary of the NPSC.

Penn State-led national coalition bringing prevention science to life

Published on: June 21, 2019
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Children running

Over the past four decades, prevention science has grown steadily, producing evidence-based practices and policies that prevent negative medical, social and emotional impacts before they occur. Increasingly, the Penn State-led National Prevention Science Coalition to Improve Lives(NPSC) is being recognized for its work translating science to policymakers, educators, practitioners and communities.

Diana Fishbein, professor of human development and family studies at Penn State and president and co-director of the NPSC, said that the goal of the coalition is to improve lives by preventing social ills and promoting well-being by translating scientific knowledge into effective and sustainable practices, systems and policies.

“I founded the coalition six years ago while at RTI International, an independent, nonprofit research institute dedicated to improving the human condition based out of North Carolina,” said Fishbein. “I received a National Institutes of Health grant to develop a national conference series gathering scientists and agency representatives to begin a conversation about translating science to policy. The NPSC was formed to formalize the association of conference participants on social issues such as mental health, poverty and juvenile justice.”

Fishbein also was a co-investigator on a grant from the Obama administration’s Promise Neighborhoods initiative to uplift impoverished neighborhoods.

“When the grant ended we wanted to continue to translate our research to impact communities,” Fishbein said.

Currently, the coalition is largely a volunteer 501c3 nonprofit organization but receives foundation funding for various projects. It includes more than 700 members and is comprised of an interdisciplinary group of scientists, educators, community stakeholders, policymakers, advocates and foundation representatives. Additionally, there is a contingent of 59 Penn State researchers and graduate students who are members.

Fishbein recently received the Presidential Award from the Society for Prevention Research (SPR) in part for her work with the NPSC. Fishbein also received the SPR Public Service Award in 2018 and the SPR Translational Science award in 2017.

Other NPSC board members from Penn State were recognized by the SPR this year as well. Max Crowley, assistant professor of human development and family studies and director of the Social Science Research Institute’s Evidence-to-Impact Collaborative, and Taylor Scott, assistant research professor in the Edna Bennett Pierce Prevention Research Center, were recipients of the SPR’s Public Service Award. Crowley also is one of the founders of the Research-to-Policy Collaboration, which stemmed from the NPSC.

In addition, NPSC board member Will Aldridge, advanced implementation specialist and director of The Impact Center at FPG Child Development Institute at the University of North Carolina, won the SPR Translational Science award.

On an ongoing basis, the NPSC contributes to congressional briefings on a variety of topics.

“Six experts participated in a gun violence prevention briefing after the Parkland school shooting last year, which also included a young survivor and a mother who had lost her daughter in the shooting. This fall, the coalition will be briefing Congress on the differences between substance addiction and substance dependence,” said Fishbein, explaining that there are many people who rely on pain medications to manage chronic pain and are suddenly unable to access the medications they need through legitimate channels. Another NPSC initiative is helping to make sure that the children of substance users are referred to evidence-based programs and services.

Additionally, NPSC writes policy statements for legislators and is developing a congressional prevention science caucus to inform the decision-making process. Members of the group act as legislative consultants to make certain accurate science is being utilized in policymaking.

The NPSC serves as an outreach vehicle to organizational affiliates and communicates science to end users via op-ed pieces, and, new this fall, a webinar series.

“We want to bring the science to life; if we don’t, then we are just publishing for other scientists and not for those who stand to benefit,” Fishbein said.

Criminal justice professor presents research on police views of addiction

Published on: June 20, 2019
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Jennifer Murphy

Police officers who are repeatedly called to the scene of opioid overdose incidents may be at risk for “empathy fatigue,” according to a Penn State researcher who said additional training may be helpful in preventing emotional burnout.

Jennifer Murphy, associate professor and program coordinator for criminal justice at Penn State Berks, recently presented the study — which examined attitudes of select local police officers in the Pennsylvania toward people who use drugs and the administration of Naloxone — at the monthly meeting of the Berks Opioid Coalition at Alvernia University on May 3.

“This research is important because police officers are often the first responders to an overdose call,” Murphy said. “Because of this role, they could potentially serve as a positive referral source for people who overdose to enter drug treatment. However, if some police hold stigmatizing attitudes, they may not be likely to encourage people to enter treatment or may have less empathy toward people with substance use disorders.”

Murphy conducted the study with Brenda Russell, professor of applied psychology at Penn State Berks. The researchers surveyed more than 600 police officers in six counties in Pennsylvania on their attitudes and beliefs about people who use drugs and the drug policies within their departments.

The researchers found that overall, the police officers in the study felt that they received adequate training on the administration of Naloxone and felt comfortable administering the overdose-reversing drug.

But about 50 percent of officers reported being unsure about whether drug addiction is a disease. More than 50 percent of the officers in the study also reported believing that morals and willpower were major factors that contribute to addiction. These results indicate that more education on addiction is needed.

The researchers said they are continuing to analyze the survey data and examine possible differences in attitudes between counties but results are not representative of the state of Pennsylvania as a whole.

For additional information on this study, contact Murphy at JXM1192@psu.edu.

Smoking may impair body's blood pressure autocorrect system

Published on: June 14, 2019
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Cigarette burning

Smokers may be at a higher risk for developing hypertension, and an overactive response to normal drops in blood pressure may help explain why, according to researchers.

“The human body has a buffering system that continuously monitors and maintains a healthy blood pressure,” said Dr. Lawrence Sinoway, director of Penn State Heart and Vascular Institute. “If blood pressure drops, a response called muscle sympathetic nerve activity (MSNA) is triggered to bring blood pressure back up to normal levels.”

An additional system — called the baroreflex — helps correct if blood pressure gets too high, added Sinoway, who is also director of the Penn State Clinical and Translational Science Institute.

According to Sinoway, the study found that after a burst of MSNA, the rise in blood pressure in a chronic smoker was about twice as great as in a non-smoker, pushing blood pressure to unhealthy levels. The researchers suspect that impairment of baroreflex may be why.

“When the sympathetic nervous system fires, like with MSNA, your blood pressure rises and then a series of things happen to buffer that increase, to try to attenuate it,” Sinoway said. “We think that in smokers, that buffering — the baroreflex — is impaired.”

Jian Cui, associate professor of medicine, said the results suggest that this impairment may be connected to hypertension.

“The greater rise in blood pressure in response to MSNA may contribute to a higher resting blood pressure level in smokers without hypertension,” Cui said. “It's possible that this higher response to MSNA could also contribute to the eventual development of hypertension.”

The researchers said that while previous research has found a link between chronic smokers and higher levels of MSNA bursts, less was known about what happened to blood pressure after these bursts. Additionally, Sinoway said other studies examined the effects of acute smoking — a single session of being exposed to cigarette smoke — on non-smokers, instead of habitual smokers.

For the study, the researchers recruited 60 participants — 18 smokers and 42 non-smokers. None of the participants had hypertension. The smokers reported smoking an average of 17 cigarettes a day over a period of about 13 years.

To measure MSNA, the researchers inserted an electrode into the peroneal nerve, which sits below the kneecap, of each participant. Additionally, they measured heart rate, diastolic and systolic blood pressure, and mean arterial pressure at the brachial artery in the upper arm.

After analyzing the data, the researchers found no difference in systolic blood pressure between smokers and non-smokers. However, diastolic blood pressure, mean arterial pressure and heart rate were significantly higher in smokers. Smokers also had higher levels of MSNA. In addition, resting heart rate was significantly higher in smokers.

Cui said the findings, recently published in the American Journal of Physiology–Regulatory, Integrative and Comparative Physiology, give further evidence of the harmfulness of smoking.

“Our study reveals another mechanism by which habitual smoking may contribute to the development of hypertension,” Cui said. “Further studies are needed to examine if quitting smoking can decrease this accentuated response.”

In the future, Sinoway said he and the other researchers will continue to investigate the link between smoking and high blood pressure.

“We're hoping to better understand just how much cigarette smoking contributes to the development of hypertension,” Sinoway said. “Then, we can try to understand if there are things we can do to intervene and prevent chronic smokers from developing this condition.”

Cheryl Blaha, Penn State College of Medicine; Virginia Gonzalez, Penn State College of Medicine; Rachel C. Drew, University of Massachusetts Boston; and Matthew D. Muller, University Hospitals Cleveland Medical Center, also participated in this work.

The American Heart Association, CURE Tobacco Settlement Bridge Funding, and the National Center for Advancing Translational Sciences, National Institutes of Health helped support this research.

Course on addiction and recovery offered Fall 2019

Published on: June 4, 2019
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Addiction recovery image

An opportunity to obtain a Certified Recovery Specialist (CRS) certification, a Certified Family Recovery Specialist (CFRS) certification, or a better understanding of addiction and recovery, is available for Penn State students this fall. Curriculum & Instruction 497 is a 4-credit course that satisfies general health and wellness credits and is applicable to a wide variety of professions.

Instructor Jason Whitney will teach in-depth knowledge of addiction and recovery to prepare students that qualify for the CRS or CRFS Examination. The course covers three domains including Recovery Management, Education and Advocacy, and Professional Ethics and Responsibility.

Students pursuing the class may be interested in additional opportunities within the Penn State Collegiate Recovery Community such as internships and work-studies. For more information, contact Jason Whitney, via 814-404-4494 or JXW411@psu.edu.

Actress Lauren Holly featured in Battling Opioids podcast

Published on: June 4, 2019
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Battling Opioids podcast

Actress Lauren Holly grew up in Bucks County, Pennsylvania, in the midst of the opioid epidemic and is now using her talent to shed light on the important issue. In season three of Designated Survivor, coming to Netflix June 7, Holly acts as a privileged, political figure who falls to opioid addiction.

The role took significant preparation, as Holly had to educate herself on substance misuse to play the part. Holly has translated this knowledge to her personal life, teaching her kids of ways to prevent addiction.

Join Battling Opioids as they talk more with Holly about her fight against the epidemic in a podcast bringing attention to issues regarding systematic policies and substance misuse.

For many, friends and family, not doctors, serve as a gateway to opioid misuse

Published on: June 4, 2019
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Pain meds

In a common narrative of the path to opioid misuse, people become addicted to painkillers after a doctor prescribed them pills to treat an injury and then, later, switch to harder drugs, such as heroin. However, nonmedical opioid users were more likely to say they began abusing opioids after friends and family members offered them the drugs, according to researchers.

In a series of in-depth interviews with 30 opioid users from southwestern Pennsylvania, about 56 percent of the interviewees said they began using the painkillers recreationally first, said Ashton Verdery, assistant professor of sociology, demography and social data analytics, and an affiliate of the Institute for CyberScience, Penn State.

According to Verdery, the national narrative often portrayed in the media is that heroin abuse occurred after people were prescribed opioid pills by their doctors and became addicted to them. This narrative holds that when the government cracked down on prescription opioids and drug manufacturers began making pills more difficult to abuse in the late 2000s, these people then transitioned to heroin because of its lower price and higher relative availability.

“There's a lot about that narrative that I think is an overly simplistic way of thinking about this,” said Verdery. “What emerged from our study — and really emerged because we decided to do these qualitative interviews in addition to a survey component — was a pretty different narrative than the national one. We found that most people initiated through a pattern of recreational use because of people around them. They got them from either siblings, friends or romantic partners.”

He added that some study participants did say that they later engaged in “doctor shopping” to locate new sources of prescription pills when acquiring pills from those initial sources became more difficult.

The researchers, who report their findings in a recent issue of the Journal of Addictive Studies, said that understanding this pathway may help improve interventions and treatment options.

“It's not just that people were prescribed painkillers from a doctor for a legitimate reason and, if we just crack down on the doctors who are prescribing in these borderline cases we can reduce the epidemic,” said Verdery. “Our results really don't speak to that framework. They speak more to the need of educating people how dangerous these pills are and warning them about getting the pills from friends and family, because that's the way a lot of people are getting addicted.”

The researchers first recruited 125 participants to complete a survey that sought information on their demographics, substance use, social networks and risk factors. A total of 30 survey participants accepted an invitation to then take part in semi-structured, in-depth interviews that lasted about an hour.

The researchers conducted interviews with nonmedical opioid users from southwestern Pennsylvania because the region has been hit particularly hard by the opioid epidemic and features both rural and urban users.

Verdery suggests that the researchers would find similar results in other areas hit by the epidemic, but future research may explore addiction pathways in other communities and consider how other substance use may play a role in opioid addiction.

“We think that understanding this mechanism as a potential pathway is worth further consideration,” said Verdery. “At the same time, friends and family are critical resources that people who use opioids can draw on for support and help in seeking treatment, which is all the more reason to pay attention to how drug use affects and is affected by social relationships.”

Verdery worked with Khary Rigg, assistant professor of mental health law and policy, University of South Florida and first author of the study; Katherine McLean, assistant professor of administration of justice, Penn State Greater Allegheny; Shannon M. Monnat, associate professor of sociology and Lerner Chair for Public Health Promotion, Syracuse University; and Glenn E. Sterner, assistant professor of criminal justice, Penn State Abington.

Penn State’s Population Research Institute, Social Science Research Institute and Justice Center for Research, as well as the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the USDA National Institute of Food and Agriculture supported this work.

Studying implications of policy and law for treatment of substance use disorders

Published on: June 3, 2019
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Prescription pills

People who suffer from substance use disorder need effective treatments, however, 90 percent of those who need treatment do not receive it. One Penn State professor and his team are looking into the legal and financial barriers to treatment and how the law can be used to break down or build pathways through those barriers.

Matthew Lawrence, assistant professor of law at Dickinson Law, assistant professor in the Department of Surgery in Penn State's College of Medicine, and affiliate of the Consortium to Combat Substance Abuse, said that there are effective treatments for substance use disorder (SUD), but accessibility issues contribute to growing drug overdose rates.  

“I am researching ways the law can make health insurance coverage more effective in promoting access to treatment for substance use disorder, as well as the pivotal role played by family members of many patients in helping them access and finance treatment and how the law can increase or mitigate the burden on such family members.” Lawrence said.  He recently published two papers explaining his findings.

In his commentary recently published in the Journal of Law, Medicine, and Ethics, Lawrence provided a legal analysis of regulatory pathways to promote care for those with SUD or other under-treated illnesses through “risk adjustment” programs that alter insurance reimbursement. His analysis is intended to guide scholars in considering the most promising avenues for research, SUD advocates in identifying regulatory levers to promote coverage, regulators in considering which reforms can be accomplished administratively, and lawmakers in assessing possible legislation regarding these or other risk adjustment programs.

In a law review article recently published in the Northeastern Law Review, Lawrence surveyed how the current health care regulatory patchwork often relies on family members as a regulatory tool to influence the decisions or behavior of their loved ones, usually without compensating those family members, recognizing their efforts, or mitigating the complications created by doing so. The work explores and develops a normative framework for evaluating the social, emotional, financial and psychological consequences of these laws that “deputize family,” and uses that framework to suggest changes to current policy regarding consent to authorize disclosure of private health information to loved ones.

Lawrence’s research was inspired by and developed with the support of Dickinson Law’s Addiction Legal Resource Team (ALRT), a faculty-student collaboration. The team was formed in the summer of 2018 with the support of Dickinson Law Dean Gary Gildin.

“The team does not provide legal advice, but they have worked in the students’ home states to collect, develop and disseminate resources to inform patients and families about the legal system relating to insurance coverage for addiction treatment and where to find help,” said Lawrence. “The team also helps Penn State researchers understand legal issues they encounter in their work, collaborating on the development of grant proposals and collecting or developing legal guides.”

In particular, Lawrence and ALRT have explored resources related to the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The MHPAEA is a federal law that ensures group health plans and health insurance issuers who provide mental health or substance use disorder benefits offer coverage that is comparable to medical/surgical benefits coverage.

“Many individuals affected by substance use disorder are unfamiliar with the law and the challenging appeals process when receiving an insurance coverage denial,” Lawrence explained. “Additionally, the law does not protect families involved with loved one’s substance abuse treatment and recovery and does not take into account families and what they do.” 

This summer, Lawrence is continuing his research into how the law can facilitate treatment and recovery for those affected by substance abuse disorder and said he is excited to continue to collaborate with the students on the ALRT.

“The collaboration has played a key role in defining the direction of my work and motivating my work. Law students are now, in many cases, authoring their own work, and I look forward to co-authoring with students as well. They have led me to places I did not expect my research to go, but I’m so happy that it did. These issues could not be more important and it is a great privilege to work with, teach and learn from students who realize that but are also realistic about the dedication, patience and focus it takes to develop real knowledge and effect real change,” he said.

Support for the research was provided by Dickinson Law, Northeastern University School of Law, and the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School.

Collaboration brings 'Opioids: The Crisis Next Door' conference to Schuylkill

Published on: May 23, 2019
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First responders with overdose victim

Penn State Schuylkill and Lehigh Valley Hospital – Schuylkill, part of the Lehigh Valley Health Network, are teaming up to present the 2019 Wellness Conference, titled “Opioids: The Crisis Next Door.” The conference will address the facts about the disease of addiction, the signs of opioid abuse, and the resources available to victims and their loved ones, and will be held from 8 a.m. to 2:30 p.m. on Saturday, Sept. 21, in Penn State Schuylkill’s John E. Morgan Auditorium.

Topical discussions will include current drug trends; counseling and resources; preventative tools; recognizing the hidden signs of drug abuse; team approaches to recovery and wellness; panel discussions; and testimonials.

Glenn Sterner is the event’s keynote speaker. Sterner, assistant professor of criminal justice at Penn State Abington and an expert on the opioid epidemic, sits on Pennsylvania’s Opioid Overdose Task Force and is the founder of the “Share Your Opioid Story” initiative. Sterner’s research focuses on the application of social network analysis in understanding illicit, illegal and covert networks.

Additional presenters include Schuylkill County District Attorney Michael A. O’Pake; Lehigh Valley Hospital Emergency Medicine Medical Toxicologist Dr. Gillian A. Beauchamp; Lehigh Valley Hospital – Schuylkill Counseling Center Director William Rowan; and Schuylkill County Drug & Alcohol Program Prevention Services Coordinator Diane Rowland.

Other physicians, first responders, law enforcement and community members with relevant experience will participate in the event, as well. Grassroots organizations, providers and resources also will be available along Penn State Schuylkill’s mall walk during and after the panels and presentations. Participants are encouraged to speak with these professionals, who may have relevant personal and professional advice. Relevant grassroots organizations are invited to attend and set up an informational table at the event.

In 2017 overdose deaths in Pennsylvania were double the national average, according to a study conducted by the National Center for Health Statistics. In Schuylkill County, overdose deaths far outpace surrounding counties within the Commonwealth; the Center for Disease Prevention and Control reports that 34.5 overdose deaths occur per 100,000 people in the county, contrasted with 18.5 overdose deaths occurring per 100,000 people throughout the Commonwealth.

Knowing the statistics and coupled with personal anecdotes, the 2019 Wellness Conference committee chose to target this ubiquitous and pervasive issue.

The conference is free and open to the public. For planning purposes, registration is required for all attendees and grassroots organizations. Breakfast and a light lunch will be included. Due to the adult nature of the content discussed, this conference is intended for community members aged 14 and older. Learn more and register at sl.psu.edu/opioidconference.

For questions, call 570-385-6102 or 570-621-4242, or email raw44@psu.edu.

Penn State participates in Social Science Advocacy Day in Washington, D.C.

Published on: May 22, 2019
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Penn Staters at COSSA Day

Penn State researchers recently attended the Consortium of Social Science Association’s (COSSA) 2019 Social Science Advocacy Day in Washington, D.C., taking part in a full schedule of events to bring awareness to social and behavioral sciences. 

During the advocacy day, COSSA members met with legislators and their staffs to discuss the significance of the social sciences and to advocate open communication between COSSA and members of congress.

Attendee Michael Donovan, director of policy and outreach at Penn State’s Administrative Data Accelerator, said, “The COSSA Social Science Advocacy Day was a great opportunity for the atypical interaction of members of the Penn State research community with members of the legislative branch to generate and facilitate an ongoing dialogue.”

Along with Donovan, Penn State sent eight other researchers to meet with staff from the offices of U.S. Senators Bob Casey and Pat Toomey, as well as Rep. Madeleine Dean. The group was able to meet with Rep. Glenn Thompson in person.

“I am encouraged by the zeal with which Penn State researchers seek to leverage their important work for impact to relevant government audiences, by minimizing the gap between government and academia and by maximizing the policy relevance of research activities,” Donovan stated. “These goals can be accomplished by fostering relationships between the sectors so that regular cross-pollination and consultation can occur, and by framing social science accessibly, so that all audiences can engage freely.”

Other Penn State researchers that attended COSSA’s 2019 Social Science Advocacy Day included:

  • Christian Connell, associate professor of human development and family studies, associate director of the Child Maltreatment Solutions Network
  • Max Crowley, assistant professor of human development and family studies, director of the Evidence-to-Impact Collaborative
  • Maithreyi Gopalan, assistant professor of education
  • Stephanie Lanza, professor of biobehavioral health, interim director of the Consortium to Combat Substance Abuse, and director of the Edna Bennett Pierce Prevention Research Center
  • Mary Shenk, assistant professor of anthropology and demography
  • Glenn Sterner, assistant professor of criminal justice at Penn State Abington
  • Ericka Weathers, assistant professor of education
  • Evan Bradley, assistant professor of psychology at Penn State Brandywine 

Penn State’s Social Science Research Institute was a sponsor of the advocacy day.

PROSPER conference convenes experts and youth to help prevent substance abuse

Published on: May 20, 2019
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PROSPER Project kids

“We are now addressing a generation that could become addicted if they take a pill a few times. Prevention is critical,” said Steve Forzato, deputy chief of statewide drug initiatives for the Pennsylvania Office of Attorney General, to the audience assembled May 14 at the Ruth Pike Auditorium for the 17th annual PROSPER statewide conference.

The PROSPER (PROmoting school-community-university Partnerships to Enhance Resilience) conference brought together representatives from Penn State and Pennsylvania state agencies and school districts, to share recent developments in addressing substance misuse among middle school youth.

“They are inhaling e-liquids into their lungs and bloodstream, and they may have no idea what is in them,” said Craig Zettle, vice president of Botvin LifeSkills Training.

“Vaping, cigarettes and e-cigarettes are harmful. We need to keep our foot on the gas pedal by addressing youth smoking overall, not just going in the direction of vaping.”

Photo gallery: PROSPER conference convenes experts and youth to help prevent substance misuse

The 2019 PROSPER conference brought together representatives from Penn State and Pennsylvania state agencies and school districts to share recent developments in addressing substance misuse among middle school youth.

He cited the importance of using the Pennsylvania Youth Survey to determine trends in substance misuse, noting that many states do not have access to such data.

“We’re stuck in a whack-a-mole board of problems, including bullying and abuse of various substances, and the game keeps getting faster.”

“There are so many common risk and protective factors, that you don’t need a separate program to prevent use of each different substance,” added Janet Welsh, associate research professor in the Edna Bennett Pierce Prevention Research Center.

Zettle recommended sharing statistics with youth to help them make informed decisions, especially given the misinformation that they might hear from advertising, peers and sometimes adults.

Changes in behavior come from skill development

PROSPER gives families tools to prepare their children to make smart decisions and how to be assertive when confronted with a new situation.

“I feel like my kids have learned so much about peer pressure resistance skills, looking at things from their parents’ point of view, communication skills, and what makes a good friend,” said Christy Tomascik, prevention coordinator for Luzerne and Northumberland counties.

“I learn something new each time I teach the program, for example, how to use 'I' statements, to conduct family team meetings, and about kids’ stresses.”

Tomascik’s children, three of whom attended the conference — Annabelle, Will and Lola Wojciechowski — all said that participating in the PROSPER program brought them closer together as a family and taught them the skills to resist peer pressure.

PROSPER across Pennsylvania

Through the PROSPER program, Penn State researchers and extension educators are partnering to build resilient families and provide research-based drug abuse prevention programs across Pennsylvania.

“We know that our programs build resilience and helps people along their path,” said Denise Continenza, Penn State Extension educator from Lehigh County.

Addressing the PROSPER team members in the room, she said, “You are the advocates and cheerleaders. Thank you for all you have done.”

“Building community engagement to address substance misuse is distinctive strength of Penn State, and you are an important part of that work,” said Stephanie Lanza, director of the Edna Bennett Pierce Prevention Research Center and interim director of the Consortium to Combat Substance Abuse.

“PROSPER can have sweeping impact because of all of the people we can touch.”

READ MORE about how the PROSPER program uses evidence-based programming to fight substance abuse and addiction at impact.psu.edu.

Opioid-exposed newborns may react to pain differently after birth

Published on: May 16, 2019
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Pills

Babies exposed to opioids while their mothers were pregnant with them may need special care even before they start to experience withdrawal symptoms, according to Penn State research.

Researchers from Penn State College of Medicine found that as soon as 24 and 48 hours after birth, babies who were exposed to opioids prenatally reacted more strongly to pain and scored higher on a skin conductance test, which measures the electrical differences in skin in response to pain or stress.

Dr. Christiana Oji-Mmuo, assistant professor of pediatrics, said the study suggests that babies who were exposed to opioids in the womb may need special care earlier than previously thought.

“These babies are responding to pain differently than babies who were not exposed, so maybe we should be paying attention to pain management earlier,” Oji-Mmuo said. “If we have to do a painful procedure like a heel lance, we may have to provide extra comforting measures, both during the procedure and after if they continue to be stressed.”

Oji-Mmuo said that as opioid use continues to be a problem in the U.S., so does the risk of babies being born with neonatal abstinence syndrome (NAS). She said an estimated 55 to 94 percent of babies born to mothers who used opioids during pregnancy will develop NAS.

According to the researchers, opioids block the release of norepinephrine, a chemical released in the body during times of stress. When the baby is born and is no longer exposed to opioids, the baby experiences a spike in norepinephrine and other chemicals and hormones in the body. This can result in such symptoms as irritability, eating poorly, sweating, fever and seizures, among others.

Oji-Mmuo said that while there are guidelines for screening babies at risk for developing NAS, there is a need for better, objective tools to help predict NAS and its severity earlier in newborns.

“To best take care of these babies, it’s important that we recognize babies who are going through withdrawal very early,” Oji-Mmuo said. “We wanted to see if two different tests — skin conductance measures and facial reactions to pain — would correlate and predict withdrawal in newborns, because we really need accurate ways to assess these babies.”

The researchers enrolled 37 newborns — 22 with prenatal opioid exposure and 15 healthy controls — for the study. To measure the babies’ reaction to pain, the newborns were video-recorded while undergoing a heel stick, a standard procedure that most newborn babies undergo to give blood for screening tests.

To measure skin conductance, a noninvasive device with three electrodes was applied to one foot. The device measured electrical conductance in the skin, which can change when norepinephrine boosts sweat production.

After the data was analyzed, the researchers found that the babies exposed prenatally to opioids had higher skin conductance and reacted more strongly to pain during and after the heel-stick procedures. Additionally, Oji-Mmuo said the babies who had been exposed to opioids continued to be stressed after the procedure was over and they were swaddled and tucked in.

Oji-Mmuo said the results — recently published in the Journal of Maternal-Fetal & Neonatal Medicine — suggest that babies who are born exposed to opioids handle pain worse than babies who were not exposed.

“Even after the painful procedure was over, they continued to have higher skin conductance,” Oji-Mmuo said. “Even when the procedure was done and they’d been swaddled, they continued to have these higher measures compared to the babies who hadn’t been exposed to opioids.”

Kim K. Doheny, associate professor of pediatrics and neural and behavioral sciences; Rebecca R. Speer; Fumiyuki C. Gardner, research technologist; Megan M. Marvin; and Alexia C. Hozella, research assistant, also participated in this research.

The Children’s Miracle Network (Drs. Oji-Mmuo and Doheny) and the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (Dr. Doheny) helped support this work.

$2.5M gift to create the Pollock Center for Addiction Outreach and Research

Published on: May 16, 2019
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Addiction in the military

Penn State Harrisburg has received a leadership gift of $2.5 million from the Douglas W. Pollock Foundation to establish the Douglas W. Pollock Center for Addiction Outreach and Research on its campus.

The center will address two areas of the substance abuse problem within the central Pennsylvania region, while serving as a catalyst to enhance communications and align numerous agencies and organizations in efforts to combat substance abuse. The early focus for the center will be providing targeted assistance to veterans of the U.S. military and their families who are facing addiction-related challenges, and helping to bolster nonprofit community organizations in their efforts to more effectively combat substance abuse across Pennsylvania, as well as nationally.

“Substance abuse is devastating lives, families and communities across the Commonwealth and the nation, and Penn State is committed to a leadership role in addressing this crisis,” said Penn State President Eric J. Barron. “The Douglas W. Pollock Foundation will make it possible for Penn State Harrisburg to help both individuals and organizations in the region, and to generate the research and models that will have an impact far beyond Pennsylvania.”

Douglas W. Pollock was born and raised in central Pennsylvania and was a 1973 Penn State graduate. A student-athlete in college, Pollock was an ardent Penn State supporter, as well as a supporter of the military and its veterans. Pollock battled mental health issues and addiction throughout his life, which ultimately caused his untimely death in 2016 at the age of 64.

“It is fitting and appropriate that our foundation provides this gift to Penn State Harrisburg to establish the Douglas W. Pollock Center for Addiction Outreach and Research,” said Pollock Foundation Attorney Michael Bangs. “The goal of the center is to collaborate throughout Penn State, with the private sector, foundations and government entities to coordinate efforts to address the issue of addiction.”

The gift will support professorships, graduate scholarships, and research and outreach efforts to pioneer and evaluate innovative avenues of prevention, treatment and recovery; it also will provide funding to facilitate the day-to-day operations of the center.

The center will be headed by Weston Kensinger, assistant teaching professor of health education in Penn State Harrisburg’s School of Behavioral Sciences and Education, where the center will be housed.

“Penn State Harrisburg is ideally suited to house the center, given its established research expertise; its academic infrastructure that combines programs and faculty in many health-related fields; and its many existing partnerships within the region and throughout Penn State,” said Penn State Harrisburg Chancellor John M. Mason Jr.

“The Center for Addiction Outreach and Research is an ambitious endeavor with tremendous potential to make a lasting difference throughout the region. We are truly grateful for the generosity of the Douglas W. Pollock Foundation in helping the center to become a reality, and providing a foundation upon which we can build,” Mason said.

Penn State has made addressing substance abuse a strategic priority throughout the University and has established the Penn State Consortium to Combat Substance Abuse with the goal of tackling the problem at multiple levels. As a consortium partner, the Pollock Center for Addiction Outreach and Research at Penn State Harrisburg will be a unique addition to the region’s substance abuse programming with its early emphasis on assisting special populations and community organizations.

Through previous gifts to Penn State Harrisburg, the Douglas W. Pollock Foundation has supported scholarships for students studying education, and athletics, including the establishment of the Courtney Pollock Memorial Field and Softball Complex on campus, named for Pollock’s daughter Courtney, also a Penn State alumna. She died in June 2013 from cancer.

For more information about the Douglas W. Pollock Center for Addiction Outreach and Research, visit harrisburg.psu.edu/pollock-center.

Organizations and individuals interested in collaborating with and/or supporting the center are encouraged to contact Kensinger at wsk120@psu.edu or Marissa Hoover, director of development at the Harrisburg campus, at mrg159@psu.edu.

This gift will advance “A Greater Penn State for 21st Century Excellence,” a focused campaign that seeks to elevate Penn State’s position as a leading public university in a world defined by rapid change and global connections. With the support of alumni and friends, “A Greater Penn State” seeks to fulfill the three key imperatives of a  21st century public university: keeping the doors to higher education open to hard-working students regardless of financial well-being; creating transformative experiences that go beyond the classroom; and impacting the world by fueling discovery, innovation and entrepreneurship. To learn more about “A Greater Penn State for 21st Century Excellence,” visit greaterpennstate.psu.edu.

Study: Friends, family are most common gateway to addiction, not doctors

Published on: May 15, 2019
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Girl with pills

By Rich Lord, Pittsburgh Post-Gazette

The often-told story of the prescription for an opioid that launches the patient down the road to ruin is not the typical tale of heroin addiction, according to a new report by researchers from Penn State and other universities.

More common, according to the study this week in the Journal of Addictive Diseases, is the “friends and family” introduction to opioids, in which the first pill comes not directly from a pharmacy, but from a trusted person. The finding could have implications for the way in which addiction prevention and treatment are accomplished, as a crackdown on prescribing continues even as overdoses remain historically high.

“I think our findings contrast with the popular media narrative that’s out there right now and the public perception,” said Khary Rigg, an assistant professor at the University of South Florida who worked with data derived by Penn State researchers in southwestern Pennsylvania. “When you talk to the average person on the street, they think it’s all about big pharma and that doctors are overprescribing. … Our findings show that the two top common sources for getting opioids are friends or family.”

Mr. Rigg worked with Katherine McLean, an assistant professor of administration of justice at Penn State Greater Allegheny in McKeesport, and other researchers at Penn State and at Syracuse University. Ms. McLean led an effort to survey 125 opioid users and conduct in-depth interviews with 30 of them, which has also yielded findings on the varied responses to the encroachment of fentanyl into the drug supply. The users were from Allegheny, Fayette, Greene and Washington counties.

The study — called Opioid Misuse Onset: Implications for Intervention — found that four in five users started with prescription opioids before progressing to full-blown addiction, usually to heroin and fentanyl.

Around one-third got their first taste of opioids from a prescription written for them, often following a tooth extraction or surgery. A small sliver bought their first pills from a dealer.

But for a big majority, said Ms. McLean, the first pill was “something that was on offer,” usually for free, from a friend or family member. It's tough, she said, to “refuse what seems like an innocuous drug from a person you trust.” A few stole their first pills from family or friends, or paid something, but for most it started with a gift.

That's consistent with findings by Raminta Daniulaityte of Wright State University who has been studying opioid users since 2002.

As the market became saturated with pain medication in the early years of this century, she said, many habits started with a simple act of sharing. “They maybe share with their peers if somebody has a headache or a bad day,” she said.

A shared pill or two can have especially long-term consequences when the recipient is young, said Stephen Lankenau, a professor and associate dean for research at Drexel University, who has done studies focused on users who started in their teens.

“What it does is, it kind of sensitizes a person to this substance. They may try it once or twice and then not try it again for a while,” he said. “When there are other opportunities later to try it again, or in larger amounts, you may be primed for use.”

There are increasingly prevalent efforts to get narcotics out of medicine cabinets, including twice-annual National Drug Take Back Days, permanent medicine drop-off boxes, and various pouches that turn opioids into harmless goo that can be tossed in the trash.

Prescribers should tell patients about these measures, said Mr. Rigg. “I’ve been prescribed opioids in the past for a variety of things,” he said. “And they don’t tell me anything [like], ‘Hey, don’t take more of this,’ or, ‘Hey, when you’re done with these pills, you should throw them away.’”

Schools have a role to play, too, said Ms. McLean. “We really have to start arming individuals with up-to-date, accurate information about the risks posed by different substances,” she said. “School-based curricula are still extraordinarily important, perhaps at that critical middle-school-to-high-school transition.”

A Pittsburgh Post-Gazette look at school district drug prevention efforts found last year that relatively few use proven, evidence-based curriculum.

The Penn State data showed another very common ingredient in addiction histories: Of the 30 interviewed, 23 first saw substance abuse affect a childhood peer or caregiver, and many cited that as “a turning point” in their attitude toward drugs, making it seem “benign, commonplace or even fun,” according to the study.

“Witnessing your parents or siblings or uncle using drugs has an effect of normalizing the behavior,” Mr. Rigg explained. “It has an effect of saying, [that drug use] is a legitimate way of having fun or coping with problems.”

The implications? If society can reduce childhood exposure to drug abuse, it can bend the curve of addiction, according to the study. Identifying young people who are vulnerable to addiction and addressing the needs of their families could help to break the cycle, researchers said.

With the epidemic as widespread as it is, there's a dark downside to the finding that people in addiction often had youthful models. “[I]f the children of current opioid misusers are at increased risk of misuse as they age into adolescence and young adulthood, we may see [opioid misuse] and mortality continue to rise in the coming decade,” the authors wrote.

While fatal overdoses in the nine-county southwestern Pennsylvania region are down from their peak of 1,413 in 2017, drugs still took more than 800 lives here last year. Researchers are seeing new drug trajectories taking root, including people who never used prescription opioids starting on heroin; cocaine users shifting — sometimes inadvertently — to heroin and fentanyl; and opioid users moving to methamphetamine.

“The epidemic has changed a lot over the years,” said Mr. Rigg. “It’s a living, breathing thing.”

Share Your Opioid Story: A Community Conversation at Schlow Library on May 30

Published on: May 14, 2019
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Share Your Opioid Story

The Share Your Opioid Story initiative is hosting a Community Conversation at the Schlow Centre Region Library in State College to tell the stories behind the statistics of the opioid crisis. This community event will take place at 5:30 p.m. on Thursday, May 30 in the Downsbrough Community Room. To register, visit the event’s website

“The goal is to educate others on the realities of this critical community issue, address stigma associated with substance use disorders, and reduce barriers for people with substance use disorder by raising awareness of the many ways this issue affects individuals, families and communities,” said Glen Sterner, assistant professor of criminal justice at Penn State Abington.

During this workshop event, Tricia Stouch will share her opioid story and local partners will discuss solutions to combat stigma in the community. The community is invited to come and share their stories or simply learn more about how people can work together to address the issues facing our communities.

First annual conference to address substance misuse held at Penn State

Published on: May 3, 2019
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Thomas McLellan

Pennsylvania is in the midst of a full-fledged, substance misuse epidemic, with one out of every four families encountering this issue. Penn State is combating the crisis by drawing upon the expertise of researchers, educators, practitioners and policymakers, who gathered recently for the Consortium to Combat Substance Abuse(CCSA) Conference, held April 29 on the University Park campus.

The conference, “Envisioning a Future Free from Addiction: Research, Programs, and Practice to Prevent Substance Abuse,” kicked off with a community engagement breakfast featuring presentations from Penn State Vice President for Research Neil Sharkey and Geoff Kolchin of the Pennsylvania Commission on Crime and Delinquency, among others.

Penn State President Eric J. Barron and Congressman Glenn Thompson (R-PA) welcomed conference attendees after being introduced by Stephanie Lanza, interim director of the CCSA and director of the Edna Bennett Pierce Prevention Research Center.

Barron emphasized Penn State’s pledge to combat substance abuse in Pennsylvania, noting that the University's commitment to enhancing health is part of it’s land-grant mission.

“With 24 campuses spread across the Commonwealth, Penn State has a campus within 30 miles of 96 percent of Pennsylvanians,” said Barron. “We have tremendous reach, and the potential to have an impact on this crisis is strong.”

Thompson said, “There's not a zip code in this country that hasn't been impacted by substance abuse,” and called the epidemic “the public health crisis of our lifetime.”

A session on preventing the next substance abuse epidemic from a national perspective began with a keynote address from Thomas McLellan, former deputy director in the Office of National Drug Control Policy during the Obama administration. McLellan summarized findings from the 2016 Surgeon General’s Report, noting how increasing prices and taxes on alcohol has reduced drinking by 30 percent. He also detailed the government’s success in reducing cigarette smoking.

“A steep decline in smoking rates over the last 50 years is the result of good science in partnership with the government and communities,” said McLellan. “Penn State can leverage its resources to do the same for substance misuse.”

Following a poster session and round-table networking discussions about breaking down barriers to address substance abuse, the afternoon sessions focused on substance abuse prevention and forming new partnerships to move forward. Glenn Sterner, assistant professor of criminal justice at Penn State Abington, presented key findings from his collaborative work with opioid users in four Pennsylvania counties.

“Nearly one-third of opioid users have overdosed in the past year, and two-thirds of those have overdosed more than once. We need to think about how these substances are coming into our communities,” he stated.

Janet Welsh, associate research professor at Penn State and principal investigator of the EPiSCenter, outlined the PROSPER project, designed to deliver evidenced-based interventions to youth in collaboration with cooperative extension in numerous Pennsylvania counties.

“Reaching the 15,000 youth within PROSPER with interventions to prevent prescription drug misuse would lead to over $6.75 million in short-term societal benefits and could lead to major public health impacts,” she said.

Penn State Health researcher Dr. Sarah Kawasaki discussed a coordinated hub-and-spoke approach to the treatment of substance use disorder in central Pennsylvania, led by Penn State Hershey.

“The number of opioid overdose deaths has now surpassed the number of HIV deaths in this country. The hub-and-spoke model, with the hub located in Harrisburg and spokes spanning seven counties, is providing a continuum of care for opioid treatment and includes community health clinics, drug free counseling facilities, regional ERs, inpatient units, rural clinics, pain management, and probation/parole services,” Kawasaki stated.

Pennsylvania Secretary of Health Dr. Rachel Levine wrapped up the afternoon sessions by explaining the history of opioid and heroin addiction in Pennsylvania and the Commonwealth’s three-pillared response to the crisis: prevention, rescue and treatment.

Levine has advocated for a number of initiatives in the state, including the Opioid Stewardship Program, which works with medical schools to provide education on pain management, and the Prescription Drug Monitoring Program, an online tool to help physicians identify patients who are struggling with opioid addiction. The program has contributed to the reduction in opioid prescriptions in the state by 25 percent. In addition, Levine has advocated for the PA Prescription Drug Take-Back Program, with 813 take-back boxes spread across the state, including locations near University Park.

In 2018, Levine signed a standing order for first responders and the general public to expand Naloxone access, and spearheaded last year’s Naloxone Day where over 6,000 free Naloxone kits were distributed.

“Naloxone is a unique drug, its only purpose is to reverse opioid overdose and save lives,” Levine explained. There will be another Naloxone Day occurring this summer.

“While we are in the sixth iteration of 90-day statewide disaster declaration to help combat the heroin and opioid overdose epidemic, last year for the first time in five years, [Pennsylvania] saw a significant decrease in overdose deaths. We have bent the curve,” Levine concluded.

The conference was hosted by the CCSA, part of Penn State’s Social Science Research Institute. In addition to the conference, the CCSA is supporting 12 new faculty hires to attract scientific leaders dedicated to combating substance abuse, a competitive seed grant program, and Community Fellows awards.

Sponsors of the conference include Penn State Outreach, Addiction Center for Translation, Center for Applied Studies in Health Economics, Center for Educational Disparities Research, Center for Geriatric Nursing Excellence, Child Maltreatment Solutions Network, Child Study Center, Clearinghouse for Military Family Readiness, College of Nursing, Clinical and Translational Science Institute, Evidence to Impact Collaboratory, Huck Institute, The Methodology Center, Population Research Institute, Rock Ethics Institute, Bennett Pierce Prevention Research Center, College of Agricultural Sciences, College of Communications, College of Education, College of Health and Human Development, College of Medicine, Office of Government Affairs, Penn State Law, and the Office of the Vice President for Commonwealth Campuses.

Report: Fentanyl scares some opioid users, but others seek it

Published on: April 30, 2019
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Fentanyl

Rich Lord
Pittsburgh Post-Gazette


Along the wide spectrum of opioid users, there are those who fear fentanyl and those who are its fans, according to a recently published study led by Penn State University researchers. Understanding the mindsets of both kinds of users may be a key to reducing the damage done by the super-potent narcotic.

While some of the 30 users surveyed tried to avoid fentanyl — which is often mixed with, or sold as, heroin — most resigned themselves to using it, and roughly one in five preferred it, according to the study led by Katherine McLean, an assistant professor of administration of justice at Penn State Greater Allegheny in McKeesport, and Ashton M. Verdery, assistant professor of sociology, demography, and social data analytics at the University Park campus.

Those 30 users and the larger number (125) who filled out surveys for the study were largely united in one sentiment: They wished they knew what they were snorting, smoking or injecting.

Many talked of “the unpredictability of the illicit opioid market and how that unpredictability made it impossible for people to know what they were using and avoid overdosing, avoid getting ripped off, avoid withdrawal, avoid nodding off in a place in which they didn’t want to,” said Ms. McLean on Thursday.

The synthetic narcotic fentanyl has long been used as a powerful painkiller in conventional medicine. Illicit versions of the drug had periodically turned up in the heroin markets for years, but only became a consistent part of the mix in southwestern Pennsylvania from 2014 on.

Data from Allegheny, Armstrong, Beaver, Butler, Fayette, Greene, Indiana, Lawrence and Westmoreland counties, gathered on overdosefreepa.org by the University of Pittsburgh School of Pharmacy, shows that from 2015 through 2018, fentanyl was involved in 2,464 fatal overdoses. That's 60 percent of the drug deaths in those counties — a bigger share than any other drug. (Heroin was implicated in 43 percent and cocaine in 32 percent. Most fatal overdoses involve more than one drug.)

During those four years, fentanyl's prevalence soared. Present in 29 percent of fatal overdoses in 2015, it was part of the mix in 72 percent in 2018.

That led Ms. McLean — who volunteers for the needle exchange organization Prevention Point Pittsburgh and worked in the harm reduction field in New York City — and Mr. Verdery to research fentanyl’s impact on the drug world. They focused on Allegheny County because it “had the highest rate of fentanyl-involved mortality among all [large] U.S. counties” in 2016, and trailed only New York and Chicago in the raw number of deaths from the drug, according to their report in the journal Substance Use & Misuse.

The researchers drew their subjects mostly from Allegheny County, with smaller numbers from Fayette, Greene and Washington counties.

Most of the subjects started using between the ages of 18 and 25, and had been on opioids for five years or more. A minority had personally overdosed to the point of needing medical attention, but a large majority had a family member or friend die from drugs. Many cited fentanyl as the culprit in a loved-one’s death.

You’d think that would deter people, and for a few it did. One study participant said that if he gets purported heroin that, upon inspection, looks more like fentanyl — which is subtly different in color and texture — he will “turn right around, take it right back.”

A similar number took the opposite tack. “Once you’ve used fentanyl you can’t do [heroin] anymore,” one participant said. “It doesn’t touch you.”

Some liked fentanyl’s quicker-than-heroin high, or the cost-effectiveness relative to much-more-expensive unadulterated heroin. Some thought that withdrawing from fentanyl was less severe than from heroin.

Most, though, accepted the risk inherent in a fentanyl-flooded heroin market, and Ms. McLean grew to understand that.

“I think the people that we talked to, they had a lot going on in their lives. They had a lot of risks, a lot of harms, that they were trying to ameliorate at various times in their lives,” she said. Caught in addiction in many cases, they feared going into withdrawal on the job, or while trying to care for children.

Many had countervailing fears of “nodding out” or overdosing in those circumstances. All faced the problem of rarely knowing whether they were buying “crappy” stuff that wouldn’t even stave off withdrawal, or super-potent fentanyl that would knock them out — perhaps permanently.

Stopping cold, though, was not an easy proposition. “Many of these people had been using for 5, 10 years, so they also have a routine,” said Mr. Verdery.

Some dealt with the routine-breaking uncertainty presented by fentanyl by developing a trusted dealer. Few used the fentanyl test strips, available from Prevention Point Pittsburgh, which can reliably detect even small amounts of the drug.

“They don’t tell you the concentration of the fentanyl in the [stamp] bag,” said Ms. McLean, but they are “certainly preferable to nothing.”

Cocaine users might consider the test strips, too, as there is persistent evidence of fentanyl infiltrating the supply of that drug. There’s also a rising tally of overdoses involving both cocaine and fentanyl.

“If you consider the population of people who use cocaine in this country, it’s much larger than the population of people who use heroin,” said Ms. McLean. And many cocaine users are “opioid-naive,” meaning a small amount of fentanyl mixed in could have outsized consequences, she noted.

Mr. Verdery said that in the coming months, the team will release a second paper on the origins of the addictions of the people studied. The perhaps surprising finding: Few started down the road to opioids with a prescription written to them. Most got a taste from pills prescribed to someone else, and then passed on by a friend or relative.

The biggest takeaway from all of their work, Ms. McLean said, is that people in addiction are not zombies lurching after the next fix, so to address their problems one needs to understand their complex processes and problems. “They are careful consumers, certainly not people who are wandering blindly,” she said. But they are addicted to something that is “packaged by unknown persons in unknown quantities of unknown substances.”

Digging Deeper: Opioid Crisis

Published on: April 25, 2019
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The opioid crisis has affected every state in some way, but Pennsylvania has been one of the hardest hit. In 2017 alone, overdose death reached almost 5600 people.  Unlike previous drug epidemics, the opioid crisis has affected rural and urban areas alike and may parts of the state are unprepared to deal with these issues.

On this episode of Digging Deeper, Penn State President Eric Barron talks with Stephanie Lanza, director of The Edna Benett Pierce Prevention Research Center and Glenn Sterner, assistant professor of criminal justice, about the opioid crisis and what Penn State is doing to help.

Understanding opioid users' views on fentanyl could help reduce overdoses

Published on: April 23, 2019
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Fentanyl

Opioid users fear accidental overdoses from street drugs laced with fentanyl, but unpredictable drug quality means they often lack reliable strategies to avoid it, according to a team of researchers who suggest that fentanyl test strips may reduce overdose deaths.

“The opioid crisis is one of the biggest issues in the United States right now,” said Ashton Verdery, assistant professor of sociology, demography, and social data analytics at Penn State. “Attention to fentanyl as a unique and blended component of the opioid crisis is absolutely imperative. It is separate from issues of heroin consumption and prescription pill consumption. It's a unique threat.”

Illicit drug manufacturers often add fentanyl —a synthetic opioid — to heroin and counterfeit prescription pills because it is cheap to produce. In this unregulated market, fentanyl concentration can fluctuate between batches, with potentially dangerous consequences for users who are unaware of its presence. Because the fentanyl is vastly more potent than morphine or heroin, even small amounts can cause overdoses.

“I think that fentanyl-related deaths are a somewhat understudied topic in general,” said Verdery. “Getting a handle on what leads to overdoses from fentanyl and ways to prevent it, I think, are critical research initiatives.”

In a paper recently published in Substance Use & Misuse, the researchers reported attitudes around opioid use in southwest Pennsylvania.

“We were motivated (to do the research) by the sudden and dramatic involvement of fentanyl in overdose deaths, particularly in southwest Pennsylvania,” said Katherine McLean, assistant professor of administration of justice at Penn State Greater Allegheny and lead author of the study. “Data from Allegheny County — the residence of the majority of our respondents — show that fentanyl was implicated in nearly 70 percent of overdose deaths in 2017.”

Using surveys and unstructured interviews, the researchers found that many opioid users believed they had been exposed to fentanyl in the last year. Most participants were concerned about the danger of fentanyl and attempted to avoid it by purchasing from trusted suppliers, declining to use suspect heroin or eschewing heroin in favor of prescription opioids. However, the researchers point out that most of these strategies are limited by the user's knowledge of drug content or access to the same dealer.

A surprising finding of the study, according to McLean, was that some participants expressed a preference for fentanyl. Although these users sought out fentanyl, seeing it as a less-risky or more cost-effective drug, they also felt that a lack of information stymied their ability to administer safe drug doses.

The researchers suggest that pre-consumption fentanyl-testing strips could be an important tool for managing the current opioid crisis.

“The risks or danger of fentanyl are exacerbated by a social context in which people are often unaware of its presence, or concentration, in the drugs they consume,” said McLean. “Empowering individuals with the tools to at least identify fentanyl might lower the incidence of accidental overdose among people that both want, and want to avoid, fentanyl.”

Fentanyl has also contaminated the supply of other drugs such as cocaine.

“There is substantial evidence that fentanyl is infiltrating the broader drug supply,” said Verdery. “Cocaine overdose deaths have increased dramatically, and fentanyl might be a big part of that. The broader availability of fentanyl makes the use of drugs more risky and uncertain. If people at least know what they're getting, they have the ability to make more informed choices, and I think that this is a valid harm-reduction strategy.”

The researchers are planning a larger-scale study on patterns of fentanyl use with more participants and a broader geographical focus.

Other researchers working on the project were Shannon Monnat, associate professor of sociology at Syracuse University; Khary Rigg, assistant professor of mental health law and policy at the University of South Florida; and Glenn Sterner, assistant professor of criminal justice at Penn State Abington.

The Social Science Research Institute at Penn State, the Justice Center for Research at Penn State, the USDA Agriculture and Food Research Initiative Program and the Population Research Institute funded this research.

'Alexa, I’m in pain': Smart assistants could help combat opioid crisis

Published on: April 23, 2019
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Virtual assistant smart speaker

For patients suffering with chronic pain, relief could soon be found as close as their nearest smart assistant.

Researchers at Penn State are developing a way to deliver on-demand, guided mindfulness practices via Amazon Alexa to patients experiencing chronic pain. Through their method, a smart assistant will provide Mindfulness-Based Stress Reduction (MBSR) practices to individuals in their homes. MBSR is a non-addictive, long-term pain-management alternative to opioid pain medication.  

“In particular with opioid addiction, there has been quite a bit of progress in coming up with methods that are non-addictive, and mindfulness is one of them,” said Saeed Abdullah, assistant professor of information sciences and technology and the primary investigator on the project.

While MBSR techniques have proven effective for chronic pain management and improving a patient’s quality of life, long-term adherence to these interventions can be a challenge for many individuals who experience chronic pain. The proposed Alexa addition incorporates methods for patients to practice regularly at home, which could increase compliance treatment rates and impact outcomes for patients.

“Long-term engagement with MBSR practices is essential for effective pain management and subsequently reducing the risk of opioid dependence,” explained Abdullah.

By utilizing a smart assistant like Amazon Alexa, through which a patient can have a direct conversation with a virtual coach, Abdullah and his research team believe that user engagement will be sustained over a long period of time. The researchers hope that increased use of MBSR practices could reduce the use of opioid medication to address chronic pain.

Abdullah has partnered with Stephanie Lanza, professor in the Penn State Department of Biobehavioral Health, director of the Edna Bennett Pierce Prevention Research Center, and interim director of the Penn State Consortium to Combat Substance Abuse (CCSA); and Sebrina Doyle, assistant research professor in the College of Health and Human Development and the Edna Bennett Pierce Prevention Research Center. The two were seeking a new way to offer patients support in using MBSR methods, according to Doyle.

“There are many MBSR applications for smart phones, but the one challenge, especially for people who are in chronic pain, is even getting to their smartphone device or finding another mechanism if they want a guided practice,” she said. “With Alexa, you don’t have to get up from your seat to access the practices.”

One guided practice commonly used in MBSR is a body scan. Doyle explained that during a body scan, a patient systemically goes through the different parts of the body and takes note of what they are feeling in those areas.

“There are lots of things that happen in our bodies all the time, and the body scan helps us to get familiar with that,” she said. “It’s paying focused attention to individual areas of your body, a little at a time.”

The team plans to run two phases of their study first to assess the quality of the dynamic content delivery, then to measure participants’ continued engagement with Alexa as they access MBSR practices. In addition, users will track their pain-related cognitions and alcohol, tobacco, marijuana, opioid and other drug use through a daily diary survey.

Doyle, who also serves as the assistant director of outreach for CCSA, said that this project helps to advance the consortium’s mission. The CCSA is comprised of a number of researchers, educators and practitioners from Penn State campuses who are developing and implementing programs, policies and practices aimed at preventing and treating addiction in the state.

According to the CCSA, Pennsylvania has consistently been among the top 10 states in the country in overdose deaths, with 5,456 lives lost in 2017.

“From my perspective, this project is exactly what the CCSA is meant to do,” said Doyle. “We are from completely different departments and are learning from each other. We’re paving the way in serving as an example for other people and other potential collaborations.”

“I want to solve problems that matter,” said Abdullah. “I want to make a better world as well as try to help people who need help.”

“This particular project really falls into what I want to do and the sort of contributions that I want to make as an IST researcher,” he concluded. “It’s about solving difficult problems using technology, and solving problems that affect a lot of people.”

The project is funded by an opioid seed grant from CCSA.

Opioid epidemic may have cost U.S. governments $37.8 billion in tax revenue

Published on: April 15, 2019
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Opioids and the nation

The opioid epidemic may have cost U.S. state and federal governments up to $37.8 billion in lost tax revenue due to opioid-related employment loss, according to Penn State researchers.

Additionally, the researchers found that Pennsylvania was one of the states with the most lost revenue, with approximately $638.2 million lost to income and sales tax. The study looked at data between 2000 and 2016.

Joel Segel, assistant professor of Health Policy and Administration, said that the results — recently published in the journal Medical Care — could help governments that are hoping to make up for lost revenue.

“This is a cost that was maybe not thought about as explicitly before, and a cost that governments could potentially try to recoup,” Segel said. “Instead of focusing on the cost of treating people with opioid use disorder, you could think about it in terms of a potential benefit to getting people healthy, back on their feet, and back in the workforce.”

Previous research estimated that in 2016 there were nearly 2.1 million Americans with an opioid use disorder, and approximately 64,000 deaths were the result of an opioid overdose. According to the National Institute on Drug Abuse, there were 2,235 opioid-related overdose deaths­­­ in Pennsylvania alone.

Segel said that while previous studies have looked at the cost of the opioid epidemic in terms of substance abuse treatment and other medical costs, he and the other researchers were interested in exploring other costs that may not have been captured before.

“We wanted to take a systematic approach to how we could think about some of the tax revenue that is lost if someone is unable to work due to opioid use,” Segel said. “This could be an important consideration for either state or federal budgets.”

The researchers used data from the National Survey on Drug Use and Health, as well as information from a previous study that estimated declines in the labor force due to the opioid epidemic. They used the TAXSIM calculator from the National Bureau of Economic Research to estimate losses in tax revenue.

After analyzing the data, the researchers found that from 2000 to 2016, there was an estimated decline of 1.6 million participants in the labor force, with about 68,000 of those in Pennsylvania. There were about 180,000 overdose deaths, with approximately 6,100 occurring in Pennsylvania.

Additionally, the researchers estimated losses of $11.8 billion to state governments and $26 billion to the federal government in tax revenue due to reductions in the labor force. For state governments, this included lost sales tax and income tax revenue. Losses to the federal government were entirely due to lost income tax revenue.

Segel said the results help show the value of treating people with opioid use disorder, and should be considered when treatment programs are being considered and evaluated.

“The state of Pennsylvania has been developing some innovative programs, and our results are something to consider as these programs are being considered for implementation,” Segel said. “Not only are treatment programs beneficial to the individual and to society, but if you’re thinking about the total cost of these treatment programs, future earnings from tax revenue could help offset a piece of that.”

Penn State has made a multi-year investment in bringing together researchers from many fields to address the challenges of substance abuse in Pennsylvania and beyond.

Dennis P. Scanlon, distinguished professor of health policy and administration and director of the Center for Health Care Policy Research; Yunfeng Shi, assistant professor of health policy and administration; and John R. Moran, associate professor of health policy and administration, all with Penn State, also participated in this work.

This work was supported by the Commonwealth of Pennsylvania under the project “Estimation of Societal Costs to States Due to the Opioid Epidemic,” and part of larger work supported under a Strategic Planning Implementation award from the Penn State Office of the Provost, “Integrated Data Systems Solutions for Health Equity.”

Register Today for the CCSA Conference

Published on: April 10, 2019
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CCSA logo

There is still time to register for the Consortium to Combat Substance Abuse's first annual conference, Envisioning a Future Free from Addiction: Research, Programs, and Practice to Prevent Substance Abuse, to be held Monday, April 29, on Penn State’s University Park campus at the Hetzel Union Building (HUB) from 9:30 a.m. to 5 p.m. A Community Engagement Breakfast session will be held before the conference from 8 a.m. to 9:15 a.m.for those able to attend. An updated agenda, list of sponsors, link to register, and more can be found on the conference page.

Preventing Teen Substance Abuse

Published on: April 9, 2019
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Janet Welsh

While legislators and researchers work together to develop treatment options and solutions for the nationwide opioid crisis, community members, schools and caregivers have turned their focus to developing ways to protect future generations from substance abuse. To help build resilient families in Pennsylvania, Penn State researchers like Janet Welsh are taking prevention research out of the lab and into communities where it matters most.

As the coordinator for the PROSPER team in Pennsylvania, Welsh works with the Edna Bennett Pierce Prevention Research Center and Penn State Extension to develop and deliver science-based prevention programs to Pennsylvania middle schoolers. Since starting research in 2001 with a sample of more than 11,000 children, PROSPER (PROmoting School-community-university Partnerships to Enhance Resilience) has seen significant improvements in family life and youth development, as well as reductions in teenage delinquency and substance abuse.

To read more about Welsh's work and the impact of the PROSPER program, visit impact.psu.edu.

Consortium to Combat Substance Abuse announces Community Fellows

Published on: April 3, 2019
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CCSA logo

Penn State’s Consortium to Combat Substance Abuse recently announced the first three recipients of its Community Fellows Programawards.

The program provides release time for faculty members to develop community collaborations and build sustainable, evidence-based or evidence-informed programs, policies and practices that can effectively address substance use and related issues within a targeted community in Pennsylvania.

Another goal of this initiative is to build the faculty member’s translational research expertise by providing successful candidates with opportunities to participate in webinars and workshops aimed at developing community engagement, program development, implementation and evaluation competencies, as well as insights into partnering with government officials to promote evidence-based policy, and grant-writing.

The funded projects are:

— “Enhancing overdose awareness and prevention training within the Penn State Greater Allegheny and McKeesport communities” — Katherine McLean and Sandra Trappen, administration of justice, Penn State Greater Allegheny, will work with Prevention Point Pittsburgh to expand the population of individuals trained to prevent, and equipped to reverse, opioid overdose.

— “Understanding the needs of Pennsylvania's recovery community” — H. H. (Bo) Cleveland, human development and family studies, University Park, will partner with the Pennsylvania Recovery Organizations Alliance to work with patients in substance use recovery.

— “Youth participatory action research as best practice: Empowering, healing, and learning with youth affected by the opioid and overdose crisis” — Kristen Goessling, human development and family studies, Penn State Brandywine, will work with the Saving Our Lives Collective and the Penn State Center in Philadelphia to focus on Philadelphia youth who have been adversely affected by the opioid and overdose crisis and the emerging communities of care responding to the crisis.

The Consortium to Combat Substance Abuse (CCSA) is housed within the Social Science Research Institute (SSRI) and is led by Interim Director Stephanie Lanza, professor of biobehavioral health and director of the Edna Bennett Pierce Prevention Research Center.

The mission of the consortium is to leverage the University’s research, education and outreach capacities toward a world free from addiction as a step toward enabling individuals, families and communities to reach their full potential. To advance this mission, Penn State has provided funds for a range of new activities, including supporting the development of interdisciplinary and translational research, education and outreach to combat substance abuse and related public health problems.

More information on the Community Fellows Program can be found on CCSA’s and SSRI’s funding webpages.

Scientists discover hundreds more genes with potential link to addictions

Published on: April 3, 2019
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Smoking man

Many human diseases, such as tobacco and alcohol addictions, are heritable. Until now, little has been known about what genetic factors contribute to these addictions, and if they put people at risk of inheriting other medical conditions. A recent study, published in Nature Genetics, reveals that these addictions may result from a complex blend of genes and environmental influences, and are genetically correlated to other health issues and diseases.

More than 100 international scientists, including researchers from the Department of Public Health Sciences at Penn State College of Medicine, teamed up with the National Institutes of Health (NIH) and National Institute on Drug Abuse (NIDA) for a genome-wide association study (GWAS) to examine inherited traits linked to tobacco and alcohol addiction.

The data analysis included information from nearly 1.2 million people, along with data from biobanks, epidemiology studies and direct-to-consumer genetic testing companies, such as 23andMe.

Researchers analyzed an array of phenotypes, or characteristics, related to individuals’ smoking and drinking behaviors, including at what age they started, how many cigarettes they smoke, how often they consume alcohol and whether they have successfully quit smoking. Next, the findings were compared to data on participants’ overall wellness, history of disease and life events.

According to the results, phenotypes associated with smoking are genetically correlated with several diseases. Meanwhile, an increased genetic risk for drinking shows a lower risk for many diseases.

Previous genetic studies identified 10 genes that affect the risk of addiction to tobacco and alcohol. This research expands the list of addiction-related genes by 40 times, highlighting more than 400 locations in the genome and more than 500 variants within these locations that influence smoking or alcohol use. These variants affect several chemical functions related to:

  • glutamate transmission, which is linked to communication and tied to memories and learning;
  • dopamine, which helps regulate movement and is linked to learned behaviors and the brain’s “reward system”; and
  • acetylcholine, which helps activate muscles.

“This research shows the power that big data can have in modern-day, large-scale genetic studies,” said Dajiang Liu, associate professor of public health sciences at Penn State College of Medicine, whose group led the statistical genetics analysis in the study. “Now, thanks to innovative computational methods our group developed, we have a better idea of which genetic variants may influence people’s likelihood of developing smoking and drinking addictions. We hope our work paves the way for more in-depth biological analyses of substance use behaviors in humans.”

Liu says additional research involving animal models and humans is needed to better understand the specific roles the genetic variants play in alcohol and tobacco addiction. Ultimately, he says the work may help to improve alcohol and smoking cessation programs.

Joining Liu from Penn State were Yu Jiang, a biostatistics graduate student and lead analyst for the project; Fang Chen, a research scholar; and Daniel McGuire, a research assistant and doctoral candidate in biostatistics.

This research was funded by the National Institute on Drug Abuse.

Opioid initiative earns 2019 Community Engagement and Scholarship Award

Published on: April 2, 2019
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Glenn Sterner

The Share Your Opioid Story Initiative, led by Glenn Sterner, assistant professor of criminal justice at Penn State Abington, has received the 2019 Penn State Award for Community Engagement and Scholarship.

The award recognizes a project that best exemplifies Penn State as an “engaged institution,” which the Kellogg Commission defines as an institution that has redesigned teaching, research, and extension and service functions to become even more sympathetically and productively involved with its communities.

In response to the pervasiveness of stigma associated with those affected by the opioid epidemic, Sterner spearheaded an effort to call attention to the crisis by inviting people to share their stories about how addiction has affected them. Sterner saw the initiative as an opportunity to educate the public on the realities of the disease while dispelling myths.

“The use of storytelling can act as a bridge for the gap between science and personal experience, increasing the receptiveness for change in attitude towards those affected by opioid use disorder,” a nominator said. “By humanizing the opioid epidemic, we are able to address assumptions about the disease and those affected by it to increase greater public compassion and decrease public stigma. The primary goal of this initiative is to change negative perceptions and assumptions about the disease of opioid use disorder and those affected by this disease.”

The initiative has reached millions of individuals through public health campaigns and outreach efforts. More than 100 narratives borne through this initiatives are available at www.shareyouropioidstory.com. In these stories, delivered through text, videos and photos, the public has access to first-person accounts of the realities of the opioid epidemic and its effects on individuals, families and communities. The site has been viewed more than 14,000 times from more than 60 countries.

Following the release of the website, community conversations were held across Pennsylvania. These talks featured individuals from the website, who engaged in discussions with members of the public around the hope found in recovery, from addiction or the loss of a loved one.

In a survey following these talks, respondents reported “the opioid crisis affects all walks of life,” “it shows how others feel and that change is possible” and “the talk helped me to understand more about addiction and the need for education around how to destigmatize addiction.”

According to the National Institute on Drug Abuse, more than 49,000 died of opioid drug overdoses in the nation in 2017. In Pennsylvania, more than 4,600 overdoses occurred in 2016.

Sterner, with the support of Penn State’s Criminal Justice Research Center, developed key partnerships with organizations including the Independence Blue Cross Foundation, the Pennsylvania Department of Drug and Alcohol Programs, and Mental Health Partnerships to execute the initiative.

Become a Certified Recovery Specialist

Published on: March 25, 2019
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Drug addict

Do you have a history of addiction recovery and want to help others?

The Certified Recovery Specialist Program being offered through the Penn State Shenango and Beaver campuses is a 54-hour, peer support program designed to meet the current educational requirements for the CRS credentials set forth by the Pennsylvania Certification Board (PCB).

Participants will receive education in:

  • Recovery Management (18 Hours)
  • Education and Advocacy (12 Hours)
  • Professional Ethics and Responsibility (6 Hours)
  • Confidentiality (6 Hours)
  • Relevant to the Field of Addiction (12 Hours)

Please note that Penn State Beaver is the education provider and the training is one part of the larger process to become a successful CRS. Participants must meet all of the other requirements before being certified.

To apply for certification to become a CRS, individuals must meet the following Pennsylvania Certification Board (PCB) requirements:

  • A history of addictions recovery (must have a minimum of 18 months, in a continuous manner, of personal, lived recovery experience)
  • High school diploma or GED
  • Successful completion of the Certified Recovery Specialist 54-hour training program
  • Successful completion of the Pennsylvania Certification Board CRS exam *
  • Sign an ethical code of conduct

For more information on the program, including a schedule and costs, visit the program’s website.

Employment Reductions and Government Revenue Losses from Opioid Misuse

Published on: March 25, 2019
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Opioids

By Amanda Honeycutt

The economic burden of the U.S. opioid epidemic likely exceeds $78.5 billion per year when considering its impact on healthcare, substance abuse treatment, the criminal justice system, and productivity costs. Although medication assisted treatment for opioid abuse (covered previously at our blog) may help to reduce these costs [pdf], the epidemic is likely to continue to negatively impact U.S. families and economic outcomes in our society for many years to come.

In a forthcoming brief report in Medical Care, Dr. Joel Segel and colleagues at Pennsylvania State University view the economic burden of the opioid epidemic through a different lens. Rather than asking how much state governments are spending to address the opioid crisis, they analyzed the losses in state and federal tax revenues resulting from opioid misuse.  Their analysis focused on the time period from 2000 through 2016, and found that state governments had losses in income and sales tax revenues of almost $11.8 billion. Additionally, the U.S. federal government lost almost $26 billion in income tax revenue over the same time period.  The authors point out that quantifying these losses may help state governments as they move to seek damages from opioid manufacturers. Legal strategies are likely to be similar to those pursued by states for the master tobacco settlement [pdf].

Interestingly, a key assumption of their analysis is a decline of 1.55 percentage points in labor force participation among 25-54 year-old adults attributed to prescription opioid misuse. This assumption derives from a 2018 study by economist Dr. Alan Krueger [pdf], whose unexpected death last weekend has saddened all of us who had long admired his commitment to applying economics to address pressing societal problems.

In that study, Dr. Krueger had analyzed the decline in U.S. labor force participation from its peak in 1997.  He noted that people who were not in the labor force (i.e., people who were neither now employed nor looking for work) were more likely to have poor self-reported health and at least one disability than employed or unemployed people (see Tables 4 and 5).

He further identified that 25-54 year-old men who were not in the labor force were more likely to experience pain and had higher reported pain levels than men in the labor force (see Table 6). He then sought to understand whether prescription opioid use/misuse might be tied to recent declines in labor force participation. He found that up to 43 percent of the decline in male labor force participation between 1999 and 2015 could be accounted for by the rise in opioid prescriptions during this time.  Dr. Krueger notes in his conclusion:

“[A]ddressing the decades-long slide in labor force participation by prime age men should be a national priority. Prime age men express low levels of SWB [social well-being] and report finding relatively little meaning in their daily activities. Because nearly half this group reported being in poor health, it may be possible for expanded health insurance coverage and preventive care under the Affordable Care Act to positively affect the health of prime age men. The finding that nearly half of prime age, NLF [not in the labor force] men take pain medication on any given day and that 40 percent report that pain prevents them from accepting a job suggests that pain management interventions could potentially be helpful.” (p. 55)

The opioid crisis in America continues to have devastating impacts for individuals, the families of people suffering from opioid misuse, local, state, and federal governments, and health care and social services providers and payers. My hope is that research, such as the important work by Dr. Krueger during his lifetime and current research by Dr. Segel and his colleagues will continue to move us toward policy that will reduce the burden of opioid misuse and improve the lives of those affected.

Lastly, Dr. Krueger’s important work on this and so many other issues is a legacy worth pausing to remember.

Inaugural substance abuse conference to be held April 29 at University Park

Published on: March 15, 2019
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Substance abuse

Penn State’s Consortium to Combat Substance Abuse (CCSA) will host a conference to bring together researchers, practitioners, policymakers, foundation representatives, and the public to discuss significant and emerging problems in combating substance abuse.

“Envisioning a Future Free from Addiction: Research, Programs, and Practice to Prevent Substance Abuse” will be held from 9:30 a.m. to 5 p.m. April 29 in the HUB-Robeson Center at University Park. A Community Engagement Breakfast session with networking opportunities and a speaker panel will be held before the conference at 8 a.m. for those able to attend.

The conference also will include sessions on preventing the next substance abuse epidemic, substance abuse prevention and treatment in communities, as well as a poster session and roundtable networking discussions.

Stephanie Lanza, CCSA interim director, encourages all to register for this free event.

“The inaugural conference hosted by the CCSA is a one-of-a-kind opportunity to join a discussion focused on solutions,” Lanza said. “Anyone who shares our vision for a brighter world, who wants to work to solve the complex problems of substance abuse, is welcome.”

To register for the conference or to find out more information, click here.

The CCSA, housed in the Social Science Research Institute, draws on the expertise of researchers, educators and practitioners from across Penn State to develop and implement effective programs, policies and practices aimed at preventing and treating addiction and its spillover effects on children, families and communities.

A close watch: IST seed grant funds study to assess and predict substance co-use

Published on: March 14, 2019
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Person using smart watch

A technology-based intervention that could reduce the risk of young adults simultaneously using alcohol and marijuana may soon be as close as a user’s wrist, thanks to a new study launched by researchers at Penn State.

The team recently earned a seed grant from the College of Information Sciences and Technology to assess and predict alcohol and marijuana co-use in young adults through the use of Apple Watches. Simultaneous use of these substances could lead to greater negative health outcomes and consequences, such as substance-use disorder, poor academic performance and impaired driving, compared to using them individually, the researchers said.

“We are trying to understand not only the behavior, but also the contexts that are associated with it,” said Saeed Abdullah, assistant professor of information sciences and technology and principal investigator on the project. “Maybe location, mood or other things indicate that a behavior is about to happen. Being able to predict that behavior is fundamental to being able to provide effective interventions.”

“We’re trying to first learn more about under what conditions people are combining alcohol and marijuana, and then we’re hoping to use this information to help identify moments of greatest risk for helping people reduce problems associated with high-risk use,” added Ashley Linden-Carmichael, assistant research professor of biobehavioral health and co-principal investigator on the project.

In the study, young adults will answer daily survey questions delivered via an Apple Watch or smartphone to measure behavioral and contextual data, such as how much alcohol and marijuana they’ve used, how they’re feeling, and specific events that preceded the substance use. This data could be useful in identifying risk factors associated with simultaneous alcohol and marijuana use and developing preventative measures.

Linden-Carmichael explained that by using an Apple Watch, researchers will be able to gather data in real time from young adults in their day-to-day environments. The ability to collect data through a wearable device could offer substance-abuse researchers more precise data, compared to past study efforts which measured these indicators through manual daily diary entries. Because manual entries are typically made up to 24 hours after the individual uses alcohol or marijuana, they can often be less reliable or subject to user bias.

“The field is moving to understanding real-world behavior as it is happening,” said Linden-Carmichael. “Having the ability to assess and really have an impact while participants are going about their daily lives is exciting.”

While the goal of this study is to collect data that could help minimize high-risk substance use in young adults, their methods could open doors to help with mental health issues and other health concerns.

“If you think about substance abuse and this study and the specific contributions and understanding of this behavior, perhaps we can come up with good intervention techniques,” said Abdullah. “From the IST perspective, this gives us a good understanding of design elements that work for specific health behaviors.

“Think about how the mobile phone changed how we looked at therapy interventions and healthcare,” added Abdullah. “Perhaps we’ll see something similar through wearables. It will hopefully be a new paradigm with data collection, intervention and enabling self-care.”

Other collaborators on the project include Stephanie Lanza, professor of biobehavioral health and director of the Edna Bennett Pierce Prevention Research Center, and Sahiti Kunchay, doctoral student in the College of Information Sciences and Technology.

In addition to a seed grant from the College of IST, the study will benefit from Apple Watches funded by a seed grant from the Department of Biobehavioral Health. The researchers hope to gain additional external funding to further advance the project.

Opioid crisis shows partnering with industry can be bad for public health

Published on: March 6, 2019
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Opioids

By Director of the Bioethics Program and affiliate faculty in Law and International Affairs, Pennsylvania State University, for The Conversation

“Show me the bodies!” someone demanded at the end of my lecture a few years ago.

As a scholar of public health ethics, law and policy, I had just warned an audience of professors and university administrators about the perils of partnering with, or taking money from, corporations – a common practice in public health research and policymaking.

It’s not always possible to prove harm like that, I said. But there are other reasons for government, the academy and public health organizations to maintain arm’s length relationships with corporations. Among them, preserving integrity and public trust.

As I document extensively in my book on corporate influence in public health, partnerships distort research agendas, not merely of individual researchers but of entire fields of research. They also reinforce the framing of public health problems and their solutions in ways that are most favorable to the corporate partners.

These concerns are most acute when corporations are creating or exacerbating a public health problem. Think of a soda company sponsoring exercise initiatives to burnish its reputation and deflect attention from the role of its brands in the obesity epidemic. But close relationships with corporations can be problematic even when companies are working on medicines or other potential solutions to health problems.

I failed to convince that skeptical audience member. But recent research found the bodies, or, at the very least, pointed to one place where we might start digging: the opioid crisis. The new study concluded that drug companies’ marketing of opioids to physicians was “associated with increased opioid prescribing and, subsequently, with elevated mortality from overdoses.” Recent court filings also suggest that doctors who met with opioid drug reps were 10 times more likely to have prescribed opioids to patients who later died of an overdose.

Marketing to physicians is only one of the strategies employed by opioid manufacturers. Between 2012 and 2017, five opioid manufacturers gave nearly US$9 million to 14 patient advocacy groups and medical societies. Although this sum is a drop in the ocean for drug companies with billions of dollars in opioid revenues, these were substantial sums for the recipients. And the companies’ investments paid off.

Many of the groups issued guidelines minimizing the addiction risks of prescription opioids. They also lobbied extensively to defeat legislation restricting opioid prescribing. When the CDC issued its draft guidelines to limit opioid use in 2016, opposition was significantly higher among organizations that had received industry funding.

The most commonly touted solution to financial conflicts of interest is disclosure of the conflict. The Physician Payments Sunshine Act of 2010 requires drug companies to disclose gifts to physicians and teaching hospitals. Democratic senator Claire McCaskill has introduced a bill to extend these provisions to cover payments made to patient advocacy groups.

But disclosure, while necessary, is not sufficient for addressing corporate influence in science, medicine and public health. While researching my book, I found plenty of evidence that drug, food and soda companies – among others – weave powerful webs of influence when they support the work of public health agencies, universities, patient advocacy groups and health professional associations.

It’s reasonable to expect corporations to exercise influence to the full extent permitted by law. But I believe governments have a responsibility to insulate themselves from corporate influence. Only by doing so can they meet their obligations to protect and promote public health. And universities should do likewise in order to protect scientific integrity. By inviting companies to partner, government and the academy play into corporate strategies of influence, imperiling their own integrity as well as science and public health.

When the National Institutes of Health launched a partnership initiative to address the opioid crisis in 2017, it turned to drug companies for guidance. They included an opioid company that pleaded guilty in 2007 to misleading regulators, doctors and patients about addiction risks and potential for abuse – and then continued its aggressive marketing for another decade, according to recent court filings. These documents also indicate that, while running newspaper ads in 2017 claiming that it was a “partner” in the fight against the opioid crisis, the company was still working on plans to expand the opioid market.

The world needs better options for pain management. And the opioid industry may play a role developing some of these options. But partnering with industry is hazardous – even if, as its director has pledged, the NIH enters these arrangements “with the utmost transparency,” and does not take cash payments.

Money need not change hands for partnerships to create reciprocity and influence, burnish the reputation of drug companies, and defuse support for more effective regulation of the marketing and prescribing of drugs. Collaboration may also lead to the neglect of other potential solutions to the opioid crisis – and other potential pain remedies beyond drug therapies.

If the opioid crisis has taught people anything, it’s that the interests of pharmaceutical companies and public health inevitably diverge. While opioid manufacturers and distributors were making billions of dollars, they were sowing the seeds of a crisis that has contributed to the deaths of more than 218,000 Americans and counting. In addition, the total societal costs of the opioid epidemic exceed half-a-trillion dollars per year.

Given these catastrophic costs, policymakers cannot afford to repeat and compound the errors of the past. While tackling pain management and opioid addiction, they must not neglect a third public health challenge: their own “addiction” to partnerships with the private sector. But, before public health officials can wean themselves off these collaborations, they must first acknowledge that they have a problem.

Why Social Science? – Because It Requires Confronting the Assumptions We Have About Others

Published on: February 27, 2019
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Lee Hoffer

By Lee Hoffer, PhD, Associate Professor of Medical Anthropology, Case Western Reserve University

Social science comes in many varieties, is comprehensive in scope, and applied to an infinite number of real-world challenges, questions, and problems society faces. At its core, it concerns the human condition. While an economist, criminologist, psychologist, or sociologist may emphasize different things about being human, and often use different methods, their research is about people. But the people who we seek some understandings about, or from, have lives apart from our research. In other words, their lives overlap with what we study but are also more complex than that. Their day-to-day living involves connections with others, a history, setting, and sociopolitical / economic context, all of which can change over time. Social science is messy this way.

The social science I conduct concerns understanding the use and consequences of illegal drugs and substance use disorder (SUD). As a medical and cultural anthropologist, my research has given me an up-close perspective on these topics and how people’s lives are affected by them. The recent opioid epidemic has significantly increased the public awareness and concern about drug addiction. It has mobilized long and much-needed healthcare resources to address this challenge, moving drug policy marginally away from the war on drugs. Starting my career in the 1990s, recent actions are welcomed, but bittersweet. Drug addiction has always needed more public health attention and only realizing this now as more people are dying is frustrating.

In drug addiction research, social science is often overshadowed by biological science. Although SUD involves a mixture of social and biological processes, the national research agenda and its associated funding are often weighed toward the former. In some conferences on addiction, no, or only a small fraction of, research is dedicated to people or human interaction. Like other social scientists, what I do is in the minority and highly specialized. As a cultural anthropologist, the primary methodology I employ is ethnography. Ethnography involves addressing research questions by interviewing and observing participants as they go about their daily routines and activities. Acknowledging their active role in this “fieldwork,” anthropologists refer to the people we research as participants.

To do ethnography, one must develop rapport with participants, and being part friend and part researcher presents challenges. Ethnographers must be self-aware of how their biases (i.e., assumptions) may influence the findings they develop and report. We have personal encounters in our research that can be influential. Vigilance is mandatory because, as much as we might think we know our participants, they are ultimately the experts on their own lives. And there are always surprises. A recently departed friend and mentor, Mike Agar, called these surprises “rich points,” acknowledging an opportunity for the researcher to learn, amend, and realign their understandings.

Over the years, I have learned a great deal from my research participants. They have been generous with their time in explaining things. Many such lessons occurred first-hand, observing what illegal drug users were doing and gaining perspective from their point of view. People are sometimes skeptical about conducting ethnography with illegal drug users. On a recent conference call a drug treatment provider remarked, “yeah, drug addicts lie and tell you what you want to hear.” I am confident for drug treatment professionals this is true. But I do not seek to change behavior or attitudes. Although I do not support illegal drugs, I do not take a moral stand about what my participants do. I have no agenda; there is nothing I “want to hear.” I just watch, listen and try to make sense of my data.     

It seems impossible to avoid assumptions people make about illegal drug users, “drug addicts,” or people with SUD. Here the filter our society applies is dense and difficult to refashion. I often hear how these people are violent, impulsive, out-of-control, in denial, self-centered, and egoistic. Biomedical research tells us their brains, i.e., neurological pathways associated with pleasure, have been hijacked by drugs and that they have diminished executive function, i.e., decision-making capacity. Some suggest they have “addictive personalities” or are incapable of empathy.

Confronting the above in both public and scientific discourse, I find many of the assumptions about my participants false, insufficient or only relevant in a particular point in time or social context. Most of the people I work with just want someone to listen to them and understand the challenges they face. Although there are relevant behavioral patterns and themes in research conducted on illegal drug use and SUD, I have witnessed a continuum that, more often than not, is very difficult to simplify. Ethnography demonstrates how complicated people’s lives are relative to the questions we seek to answer. Returning to my answer to “why social science,” confronting what we (and others) believe about the people we research is something I keenly appreciate about social science.   

LEE HOFFER is an Associate Professor of Medical Anthropology at Case Western Reserve University (CWRU) in Cleveland, Ohio. His research focuses on understanding the social, political, economic and cultural dimensions of illegal drug use and addiction. Dr. Hoffer has conducted community-based studies of heroin, crack / cocaine, methamphetamine, club-drug, inhalant, and non-prescription opiate use, as well as trends in use. His current work combines ethnographic research, epidemiology, and agent-based modeling (ABM) to better understand local illegal drug markets and their connection to drug epidemics. His research has received support from NSF, NIH / NIDA, and private foundations.

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Sharkey shares impact of Penn State research across University and beyond

Published on: February 25, 2019
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Old Main Bell Tower Clock

Since the University’s founding when Penn State’s first president Evan Pugh set forth the college’s research vision in 1859, innovation and knowledge creation have been a foundational element of the land-grant mission, according to Neil Sharkey, vice president for research. 

Describing research as a “driver of progress,” Sharkey shared the impact Penn State research activities continue to have today throughout the University, across the Commonwealth and beyond in a presentation to the Board of Trustees at its Friday (Feb. 22) meeting. 

“Universities have become the country’s innovation centers and Penn State is no exception. Our research enterprise serves the Commonwealth, nation and the world through innovative approaches to creating new knowledge and solving the global challenges of our time,” said Sharkey. “Beyond our desire and ability to benefit humankind, our ranking and reputation as a leading research university helps to attract talented faculty, while also boosting student applications and providing experiences for students that enable career success.” 

As a top-25 research university, Penn State researchers are at the forefront of fields as varied as big data, combating the opioid crisis, personalized medicine, renewable energy, climate change, infectious disease, rural innovation, water and food security, and more.

With research expenditures hitting a record high of $927 million in the 2017-18 fiscal year, the scale and scope of Penn State’s research activities are crucial measurements of the University’s standing among Association of American Universities (AAU), Big Ten peers and other world-class institutions. Penn State is one of only two institutions in the U.S. accorded land grant, sea grant, sun grant and space grant status; and Penn State University Libraries ranks 10th among North American research libraries, among other distinctions. 

To advance the potential of the research enterprise, the Office of the Vice President for Research collaborates with the University Research Council, deans and chancellors, and a broad range of units across Penn State in such areas as research protections, sponsored programs, ethics, commercialization and more. 

“The breadth of expertise and experience at Penn State helps us to maximize our impact in many crucial ways, from our collaborative interdisciplinary institutes and centers, to our entrepreneurial ecosystem across the state, to our current philanthropic campaign,” said Sharkey. 

At the trustees meeting, Sharkey shared a variety of examples outlining the positive impact of research across efforts to: 

Drive student opportunities and success

Attending a university as large and research-oriented as Penn State provides countless opportunities for students to collaborate across campus or continents, and over the past five years, nearly 8,000 students completed undergraduate research for academic credit. A variety of funding support and training grants are available to students through Penn State interdisciplinary institute and awards, Erickson Discovery Grants, federal training grants and corporate gifts. In 2017-18, external grants and contracts provided $24.7 million in graduate student research support, while 156 Erickson Discovery Grants were awarded to students at 11 Penn State campuses. 

Serve society

Through researchers andinterdisciplinary institutes, such as the Penn State Cancer Institute and Institutes of Energy and the Environment, Penn State is driving discovery in areas such as national security, malaria eradication, child maltreatment research and the development of climate-risk management strategies. For example, the Applied Research Laboratory at Penn State is a Department of Defense designated University-Affiliated Research Center that has supported national security efforts for more than 70 years with basic and applied research. More recently, a new Penn State Consortium to Combat Substance Abuse within the Social Sciences Research Institute is bringing together experts across the University to combat the opioid epidemic. 

Promote economic development and progress

As students, faculty, staff and community members engage in entrepreneurial activities, Penn State’s 21 LaunchBoxes across the state have attracted nearly $5 million in external matched and leveraged funds since 2016. With one of the nation’s friendliest intellectual property policies for industry sponsored research, Penn State continues to attract research partners from the private sector. On average, 500 companies, including many from Pennsylvania, sponsor projects every year. 

Attract leading faculty and outstanding students

Penn State’s sustained research growth, high scholarly output and citation count among AAU public institutions, number of Penn State faculty members in the National Academies, and ranking among the top producers of Fulbright scholars all help to attract outstanding faculty and students. In 2018, nearly 2,000 unique investigators received new awards and competitive renewals; and 967 sponsors provided awards.

Impact the world through discovery, innovation and entrepreneurship

A primary objective of Penn State’s philanthropic campaign, “A Greater Penn State for 21st Century Excellence,” is to impact the world through discovery, innovation and entrepreneurship. With a focus on food, water and energy security; human health; and economic development and job creation, the “Impact the World” imperative is the campaign’s best performing and had reached 81 percent of its goal by the halfway mark in the campaign.

“Among our researchers, faculty and graduate and undergraduate students, we have enthusiastic thought leaders and knowledge creators whose hard work, ideas and projects are having a beneficial impact across the University and beyond,” Sharkey said. “There is so much potential in this space to continue to build upon our teaching and research enterprise to drive economic development, job creation and student career success, as we continue to address the most pressing issues of our time.”  

To take a look at the full presentation, visit https://www.psu.edu/ur/newsdocuments/Presidents_Research_Report_Feb2019.pdf.

Project ECHO prepares doctors to manage addiction care closer to home

Published on: February 21, 2019
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Project Echo

For patients suffering from opioid use disorder, and for the physicians in small towns across Pennsylvania who are their first level of care, Project ECHO offers hope. The effort aims to give primary care physicians the tools they need to treat the growing group of Pennsylvanians addicted to opioids — many of whom live in regions with no specialized addiction resources. It’s a win-win: patients get a doctor who can treat them close to home, and physicians get to expand their knowledge, their professional network and their relationship with their patients.

The concept comes from a physician at the University of New Mexico who wanted to shorten the wait list at his gastroenterology clinic. Now, more than 220 institutions around the world use Project ECHO for at least 90 disease topics. And Penn State Health researchers hope to influence them all.

“Research evaluating the project hasn’t kept pace with growth of the movement clinically,” said Dr. Jennifer Kraschnewski, director of Project ECHO at Penn State College of Medicine and a Penn State Health primary care clinician-investigator who studies community health interventions. “It is our goal to create an evidence base to support the model and its ability to mentor primary care providers outside of urban academic hubs. We also aim to learn how to best grow and use Project ECHO as an intervention.”

Penn State expert clinicians are halfway through their first cohort of the Opioid Use Disorder Project ECHO, funded by a grant from the Substance Abuse and Mental Health Services Administration.

“What most excites me is that Project ECHO gets to the heart of the challenges of treating some of a physician’s toughest patients,” said Dr. Sarah Kawasaki, director of the Opioid Use Disorder Project ECHO at the College of Medicine. She is also director of Addiction Services for Pennsylvania Psychiatric Institute. “We’re creating a community to support and educate physicians and improve the chances that they can provide the care their patients need, rather than sending them to a specialist for first-line treatment.”

The program series includes 12 sessions, each of which is attended by up to 20 clinicians plus Kawasaki and her Project ECHO team. The Penn State team is comprised of other addiction experts from the College of Medicine and partner organizations. It serves as the hub, with each participating clinic a spoke learner. At each session, they discuss a complex patient case that has been deidentified and sent in by a participating clinician. They then listen to a short lecture. The project rolls from one group to the next, growing a network of specially trained physicians. In time, it should exponentially build the state’s ability to bring best-practice care to all patients.

Two attendees from The Wright Center for Community Health, a state-designated Center of Excellence in addiction and recovery, were part of the first Project ECHO group in November. Like Kawasaki’s program, The Wright Center is one of the state’s eight hubs for the Pennsylvania Coordinated Medication-Assisted Treatment (PAC-MAT) program. Another two physicians in the first group are from spokes of The Wright Center’s PAC-MAT program.

“Providing care in the addiction and recovery space for less than three years, we have an insatiable desire to learn and develop courses to support our physician-led care teams,” said Dr. Linda Thomas-Hemak, chief executive officer of The Wright Center. “That is why we signed up for ECHO.” Thomas-Hemak is also board-certified in internal medicine, pediatrics and addiction medicine.

Read the full article on Penn State Medicine.

Student shares story of opioid addiction to support others

Published on: February 18, 2019
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Sterner and Bergner

Erin Bergner, a Penn State Abington junior, is motivated, to say the least: She carries extra courses so she can graduate early, works in a faculty research lab, and holds down another part-time job. And all the while she is managing her recovery from opioid addiction and telling her story on ShareYourOpioidStory.comto help reduce stigma and support others in the grip of addiction.

“My hope is to help just one individual. I want people to know they have support,” she said. “It’s traumatic emotionally, and I don’t want anyone to think that they have to go through it by themselves.”

Here is her story, which she shares in greater detail on ShareYourOpiodStory.com:

After suffering abuse at a young age, Bergner developed an eating disorder and began to self-harm. She didn’t talk about her distress because of the stigma associated with mental health issues where she grew up, and she turned to marijuana as an escape.

“By tenth grade, I was using heavier substances like opioid pills and benzodiazepines. I was eventually introduced to heroin. I began using heroin more and more as it was easier and cheaper to get than opioid pills,” the Schreyer Honors Scholar said. “My senior year, my parents found out and sent me to rehab.”

Bergner spent 50 days in rehab, but relapsed immediately upon release.

“I went back to using heroin and overdosed. I was revived after receiving three doses of Narcan. I began using again two days later,” she said. “I eventually went into a 9-to-5 outpatient rehab program. After failing a drug test, I became much more committed to my rehabilitation and, as a result, I have been sober.”

She is looking forward to becoming a therapist and working with those living with addictions.

“Being one step closer to helping people makes me really happy, and that’s a huge motivation for me. I’m very open about my struggles today because I didn’t feel alone after hearing others tell stories that were so similar to mine,” she said.

“We’re not just a statistic, we’re individuals with hopes, dreams, and struggles. Everyone’s recovery looks different. You have to block out the judgements of others and always remember that all you have is yourself at the end of the day. Recovery is something no one else can do for you. You have to own it.”

The Psychological & Social Sciences major coincidently works in the research lab of Glenn Sterner, assistant professor of criminal justice at Abington and an research expert on the illicit use of opioids.

“I work on the ShareYourOpioidStory.com website help to find potential candidates to share their experiences,” Bergner said. “It’s not a typical college job, but it is giving me experience and making a difference.”

She is also an eager student in the psychological and social sciences major and credits faculty, especially Michael J. Bernstein, associate professor of psychology, for fueling her love of her major.

“When you find someone as passionate as you are about your major, it’s contagious,” she said.

Bernstein, in turn, calls Bergner “an amazing student.”

“She takes her studies seriously and is avid thinker about human behavior and how to understand why people act the way they do so as to make positive change in the world,” he said. 

About ShareYourOpioidStory.com

ShareYourOpioidStory is an initiative to share stories, reduce stigma, and come together to reduce opioid use in America. The organization is hosting a Community Conversation at Penn State Abington at 5:30 p.m. on Feb. 20. Register here.

Overdose deaths could increase with ‘changing nature’ of opioid epidemic

Published on: February 6, 2019
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Opioids

The opioid epidemic in the United States could be responsible for 700,000 overdose deaths between 2016 and 2025, according to a new study published today in JAMA Network Open.

“Preventing people from misusing prescription opioids is important and could help prevent some overdose deaths in the long term, but our study shows that the effect would be limited in reducing the overdose deaths in the immediate future,” said Qiushi Chen, an assistant professor in the Harold and Inge Marcus Department of Industrial and Manufacturing Engineering at Penn State and the lead author on the paper. “The majority of overdose deaths are now from illicit opioids, such as heroin and fentanyl instead of prescription opioids, and this changing nature of the epidemic has reduced the potential impact of programs targeting prescription opioids.”

In an effort to understand the outcomes that programs to limit prescription opioid misuse actually produce, Chen worked with colleagues from Massachusetts General Hospital, Harvard Medical School, and Boston University Medical School.

“The opioid crisis has been a national public health emergency for more than a year, and it’s getting worse,” said Jagpreet Chhatwal, an assistant professor at Harvard Medical School and a decision scientist at Massachusetts General Hospital Institute for Technology Assessment (MGH-ITA). Chhatwal is the senior author on the paper. “We set out to understand how reduction in incidences of prescription opioid misuse, by interventions of restricting opioid prescriptions supply, would influence the outcomes of overdose deaths in the next decade.”

Chen and the team developed a mathematical model to simulate the opioid crisis from 2002 to 2025. Using data available from Centers for Disease Control (CDC) and the National Survey on Drug Use and Health (NSDUH), the researchers calibrated the model to match the trends of overdose deaths from specific types of opioid consumption – recreational prescription misuse to opioid use disorder with prescription and illicit opioids – observed from 2002 through 2015. They then used the model to project probable outcomes of the epidemic, based on the continuing trends, through 2025.

The researchers found that, if that status quo continues, the annual number of opioid overdose deaths will increase from 33,100 in 2015 to 81,700 in 2025 – a 147 percent increase. Eighty percent of those overdose deaths will result from the use of illicit opioids, such as heroin or fentanyl. In every scenario tested, the researchers found that interventions aimed at reducing prescription opioid misuse decreased overdose deaths by three to five percent.

Under an extreme modeling scenario, a hypothetical situation where literally no new incidences of prescription opioid misuse occurred after 2015, the researchers found that number of deaths in 2025 would still remain higher than in 2015.

“More and more people are using illicit opioids. In the past, people might start using pain pills non-medically, which could then lead to illicit opioid usage, but data suggests that even more people are now starting with recreational use of illicit opioids,” Chen said. “Prescription opioids are now not necessarily the gateway that people must use to get to illicit opioids.”

According to the NSDUH, 30 percent of people who developed opioid use disorder did not start with prescription pills, but rather began immediately with heroin or fentanyl. Chen and his team project that the trend will continue, and, by 2025, nearly half of people with opioid use disorder will have initiated their opioid use with illicit drugs. 

“This study demonstrates that initiatives focused on the prescription opioid supply are insufficient to bend the curve of opioid overdose deaths in the short and medium term,” said co-author Marc LaRochelle, an assistant professor in the Grayken Center for Addiction at the Boston Medical Center. “We need policy, public health and health care delivery efforts to amplify harm reduction efforts and access to evidence-based treatment.”

Other contributors on this paper include Davis Weaver, a medical student at Case Western University who was a research associate at the MGH-ITA; Anna Lietz, a research associate at the MGH-ITA; Peter Mueller, a postdoctoral fellow at MGH-ITA and Harvard Medical School; Sarah Wakeman, the medical director of the Substance Use Disorders Initiative at MGH and an assistant professor of medicine at Harvard University; Kenneth Freedberg, a professor of medicine at Harvard Medical School and MGH and the director of the Program in Epidemiology and Outcomes Research at the Harvard University Center for Aids Research; Tiana Raphel, a medical student at University of Texas Southwestern Medical School who was a research associate at the MGH-ITA; Amy Knudsen, an assistant professor of radiology at Harvard Medical School and a senior scientist at the MGH-ITA; and Pari Pandharipande, an associate professor of radiology at Harvard Medical School and the director of the MGH-ITA.

Sterner awarded $2.7M to help fight opioid crisis

Published on: February 4, 2019
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Opioids

A Penn State Abingtonfaculty member was instrumental in securing three grants totaling more than $2.7 million to combat the opioid epidemic in Pennsylvania and nationwide.

Glenn Sterner, assistant professor of criminal justice at Abington and an expert on the illicit use of opioids, said the grants enhance opportunities to fight opioid addiction through supply side data-based interventions and increased connection with prevention strategies.

“We are continuing to expand our efforts to address the opioid epidemic, and through these grants we will be working collaboratively with colleagues across campuses, universities, and disciplines, and with community partners, to take on this serious issue,” Sterner said. 

“We have an incredible group of people dedicated to making impact in our communities through these funded projects.”

Sterner is the principal investigator on the first grant, which was funded for $683,000 by the federal Department of Justice/Bureau of Justice Assistance. Sterner will partner with the Pennsylvania State Police to use data to identify and disrupt the opioid networks in several Pennsylvania counties including Adams, Cumberland, Dauphin, Franklin and Perry, and encompassing sections of three major interstates (I-83, I-81 and I-76), which are known drug-trafficking corridors.

It will synchronize innovative, technology-driven enforcement strategies, which leverage information received through community input. There are several components to the program, including targeted enforcement and public outreach. The state will collaborate with research partners at Penn State, who will evaluate the program’s effectiveness utilizing measurable performance metrics.  

The second grant, funded by the National Institute of Justice, provides $725,000 to a team coordinated by Iowa State University that includes Sterner and an additional $220,000 directly to Sterner. It focuses on building intelligence networks to combat the opioid crisis in rural communities across the nation.

“We are working across multiple locations in Iowa, Missouri and Pennsylvania, among others, to assist rural counties so they can address these issues,” Sterner said. “We are teaming with local police in our rural communities to increase the capacity for intelligence-based intervention to address drug distribution. This could be replicated in other places.”  

The third grant for almost $1.1 million is funded by the Substance Abuse and Mental Health Services Administration. The grant, for which Sterner is part of the team, connects supply interruption and prevention to address opioid misuse in Pennsylvania. 

“We are developing the infrastructure to coordinate supply-based interventions and prevention-based initiatives in communities for K-12 students and their families,” Sterner said. “It’s a way for us to tackle both supply and demand for illicit substances in our communities.”

Sterner sits on the Opioid Overdose Task Force for the state of Pennsylvania. He also is a founding member of the Penn State Consortium to Combat Substance Abuse advisory board and an affiliated faculty of Penn State’s Criminal Justice Research Center. Sterner is the founder of the Share Your Opioid Story initiative.

On Feb. 20, Sterner will host “Reducing Stigma: A Community Conversation” at Penn State Abington from 5:30 p.m. to 7:30 p.m. To register, visit http://bit.ly/2S5oRGH. For additional information, contact shareopioidstories@gmail.com.

New, evidence-based diagnostic tool developed for abusive head trauma

Published on: January 14, 2019
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Injured teddy bear

Abusive head trauma is the leading cause of traumatic death and disability in infants and young children in the United States. However, multiple studies have shown that disparities and bias can affect physicians’ decisions to evaluate, diagnose and report suspected abuse. In response, researchers have developed an evidence-based predictive tool physicians can use to help confirm, exclude and report suspected abuse.

According to Kent Hymel, professor of pediatrics and Child Maltreatment Solutions Network faculty co-hire, the overall aim of their research is to reduce cases of missed or misdiagnosed abusive head trauma.

“The consequences of missing a diagnosis for abusive head trauma (AHT) can be severe and can even result in the death of the child if they are mistakenly returned to an abusive situation,” said Hymel.

To that end, Hymel and his colleagues in the PediBIRN research network have developed an evidence-based predictive tool for AHT that incorporates the predictive contributions of patients’ (positive or negative) completed abuse evaluations.

As published in Child Abuse & Neglect, Hymel and his research team analyzed 500 cases of acutely head-injured children under 3 years of age who were hospitalized for intensive care at 18 different sites between 2010 and 2013. Their analysis led to the derivation of a seven-variable prediction tool which they call the PediBIRN-7. The tool’s seven predictor variables include respiratory compromise at the scene of injury or during transport; bruising on the child’s ears, neck or torso; skull and other skeletal fractures; bleeding in the head and eyes; and brain swelling.

When evaluating their data, researchers found clusters of variables that best inform abuse versus nonabuse.

“The study was designed to include two of the variables, skeletal and retinal scans, however another five variables were derived through the data,” Hymel explained. “Interestingly, four out of the five additional variables coincide with a previous study that resulted in a predictive screening tool for child abuse.”

If validated, application of the PediBIRN-7 as an AHT prediction tool could inform physicians’ pending decisions to confirm, exclude and/or report suspected AHT.

“The PediBIRN-7 is another tool physicians can use when evaluating suspected AHT, in addition to scans and other screenings,” said Hymel. “Application of the PediBIRN-7 as an AHT diagnostic tool will hopefully reduce missed cases and disparities in the diagnosis of AHT.”

Currently, PediBIRN researchers are working to validate these findings in another study before the diagnostic tool can be adopted for use by physicians.

“There is no gold standard for diagnosing child abuse, and no tests or screenings tell the whole picture. Hopefully this new tool will give a more definitive diagnosis and help minimize under- or over-diagnosis,” Hymel said.

Other researchers on the project include Ming Wang, Vernon Chinchilli and Mark Dias, Penn State College of Medicine; Wouter Karst, Netherlands Forensic Institute; Douglas Willson, Children’s Hospital of Richmond; Bruce Herman, University of Utah School of Medicine; Christopher Carroll, Connecticut Children’s Medical Center; Suzanne Haney, University of Nebraska Medical Center; and Reena Isaac, Baylor College of Medicine.

The work was supported by Dartmouth-Hitchcock Medical Center, The Gerber Foundation, Penn State Social Science Research Institute, Penn State Health Milton S. Hershey Medical Center, and the National Institutes of Health.

The Child Maltreatment Solutions Network advances Penn State’s academic mission of teaching, research, and engagement in the area of child maltreatment. It is part of the Social Science Research Institute at Penn State.

Penn State mounts broad attack on opioid addiction in Pennsylvania

Published on: January 11, 2019
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Addiction Symposium

A startling 13 to 16 people die each day in Pennsylvania due to opioid overdose, among the more than 70,000 Americans who succumbed to the epidemic in 2017, according to the Centers for Disease Control and Prevention. That gives Pennsylvania the dubious distinction of being ranked near the top of opioid-related death rates in the U.S.

“Alcoholism is still the most common substance use disorder, but it has been eclipsed by the opioid crisis because people are dying,” said Dr. Sarah Kawasaki, medical director of the Advancement and Recovery opioid addiction treatment program at Pennsylvania Psychiatric Institute. “It’s killing people in the prime of their lives. Children are without parents. The number of deaths is what makes this epidemic so important.”

That’s why the clinicians, researchers and administrators with Penn State Health and Penn State College of Medicine have united to fight the opioid crisis. Their weapons are evidence-based clinical treatment, research and education, and they are aiming at every phase of the problem ― from pre-addiction through treatment and recovery.

“We feel a sense of urgency. Opioid use disorder is a multifaceted issue that needs to be addressed at every single level,” said Sue Grigson, director of the Penn State Addiction Center for Translation based on the College of Medicine’s Hershey campus. “Fortunately, we have the right individuals and expertise to do that, and we’re using grants as vehicles to help us.”

The grants include a $1.5 million clinical grant, awarded by the Substance Abuse and Mental Health Services Administration in November to, in part, help fund Project ECHO–an effort to enable doctors in widespread Pennsylvania counties to connect with experts in opioid addiction. Via teleconferencing, they have access to education and assistance with difficult cases.

Grigson also expects to hear this month whether the center will receive two additional grants totaling more than $100 million, which would expand referral services, educational outreach, translational research, screening and prevention projects, and new treatment methods. Founded just over a year ago, the center has wasted no time building a broad plan of attack.

Learn more about these efforts – and Penn State College of Medicine’s Addiction Symposium – in this Penn State Medicine article.

Students create eye-catching ad campaigns warning of opioid dangers

Published on: January 7, 2019
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Pain killer snake

Students who take Arpan Yagnik’s advertising classes often get more than they bargained for — starting with at least four weeks of creative aerobics. The end result? Increased creativity, confidence and highly coveted job skills.

“After students complete the classes, they have an arsenal of creative ideas. They know they are going to stand apart from others, “ said Yagnik, assistant professor of advertising and communication at Penn State Behrend and co-author of “Creative Aerobics: Fueling Imagination in the 21st Century.”

Last semester, he joined forces with Penn State’s Consortium to Combat Substance Abuse (CCSA) and asked his advertising classes to create multiple campaigns for the awareness, education or prevention of opioid abuse.

“I hoped to call attention to the opioid epidemic not only to our students, but to their families and communities,” he said.

The pill is the predator

“In class, we did exercises where we brainstormed similarities between two completely different things,” said Wesley von Tacky, a 2018 Penn State graduate. “A good friend of mine died from an opioid overdose, and I wanted to show the true pain of addiction. He owned a pet snake and scorpion, and in the ad I created, I made the point that opioids can be hidden, dangerous killers, like snakes. The pill is the predator.”

The students translated complex issues into advertising campaigns designed to change the hearts and minds of the public. “As a visual communicator, my goal is to create a conversation through an image,” said von Tacky.

“A successful ad creates an ‘a-ha’ moment,” added Yagnik. “To make an impact, you need to create simplified messages that are unique and memorable. That’s where our students can help Penn State researchers. They can get the message across — to the downtrodden and to people with varied educational and literacy levels.”

Students gain skills highly sought-after by employers

The classes feature work with real-world clients, and graduates have secured jobs in the corporate and non-profit sectors.

“When we work with clients, they love the ideas that our students generate,” said Yagnik. “When these students go on job interviews, they have confidence and a story to tell about how they successfully worked with clients. When they encounter challenges on the job, they think ‘bring it on’ because they have learned to adapt, collaborate in new ways, and to think creatively.”

“Dr. Yagnik wants you to think on a different level than anyone else. In advertising, you have to generate new ideas constantly,” said von Tacky. “He’s imaginative and has a strong desire for his students to be successful. He shows that he cares.”

“My goal is to take them to where I am and the rest of the journey is theirs,” said Yagnik.

Penn State faculty, staff or students who would like to partner with the Consortium to Combat Substance abuse may contact Sebrina Doyle, assistant research professor at the Edna Bennett Pierce Prevention Research Center, for more information.

Important NIDA Funding Opportunity: Opioid-Induced Respiratory Depression

Published on: December 10, 2018
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Researchers with microscopes

The Lung Association wanted to make you aware of an important funding opportunity from the National Institute on Drug Abuse (NIDA). According to the NIH, more than 2 million Americans have opioid use disorder. Millions more misuse opioids, taking medications longer or in higher doses than prescribed. NIDA has a new funding program that supports research to provide new strategies for the prevention and treatment of opioid misuse and addiction in order to help people with opioid use disorder achieve and maintain a meaningful and sustained recovery.

NIDA is specifically interested in funding grants to further our understanding of the very important issue of Opioid-Induced Respiratory Depression. The specific RFA can be found at: RFA-DA-19-002. Since this is a vital issue related to respiratory health and disease, the Lung Association wanted to make you aware of this rapid turnaround funding mechanism. The goal of this funding mechanism is to support the discovery and development of medications to prevent and treat opioid use disorders (OUD) and overdose.

This opportunity is unique in that NIDA is not bound by the three standard NIH submission dates per year. The institute is a conducting rolling submission and review process. Applications received by January 1, 2019 will be reviewed by February 22, 2019. Those received by April 1, 2019 will be reviewed by May 22, 2019. There are a number of additional dates through January 2020.

We hope you will consider and share this new opportunity.

Stop Overdoses in PA Week/Get Help Now – free Naloxone December 13

Published on: December 10, 2018
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Opiods

As you are likely aware, the commonwealth, and the entire country is in the midst of a major public health crisis, the opioid epidemic.

Under the leadership of Governor Wolf, the efforts in Pennsylvania to address this epidemic have been widespread, and have brought about change on the local, regional and state levels. These efforts have taken place across numerous agencies, and also through the Opioid Command Center, established through the Governor’s disaster declaration.

On December 10-14th, the state is holding “Stop Overdoses in Pa.: Get Help Now” week. This week is aimed at helping to reduce the stigma around this crisis, to get people the lifesaving medication naloxone, and make sure people know help is available.

We need your help in this effort. Please share far and wide within your organization and community that the Wolf Administration will provide Naloxone for free to all Pennsylvanians at nearly 80 locations across the state, primarily at state health centers and county/municipal health departments, on Thursday, December 13 from 11 a.m. to 7 p.m., as part of the administration’s ongoing effort to reduce the number of opioid overdoses and get residents into treatment. Information on all the locations is included in the official press release here.

In addition to being able to get naloxone for free on Dec. 13th, Naloxone is available at pharmacies statewide every day without a prescription thanks to a standing order prescription signed by the Secretary of Health, Dr. Rachel Levine. It is covered by most insurances at little to no copay.

The opioid epidemic touches everyone, regardless of age, race, socioeconomic class. It does not discriminate.

However, we are optimistic that the work being done is saving lives. We know that through each of us working to highlight our efforts to address this epidemic, we can further address the epidemic in Pennsylvania.

As valued partners in Pennsylvania’s fight against the opioid epidemic we hope that you will help us spread the word about this community resource. We encourage you to share this information on “Stop Overdoses in Pa.: Get Help Now” week to your organization, community, colleagues, friends, and family. The Pennsylvania Department of Health depends on your help in this collaborative effort.

We thank you for your support in this, and hope you have a wonderful holiday season.

Seed funding available to combat substance abuse

Published on: December 7, 2018
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CCSA RFA

Penn State’s Consortium to Combat Substance Abuse (CCSA) is seeking to support interdisciplinary teams of Penn State researchers whose work is aimed at combating opioid and other substance abuse.

CCSA Interim Director Stephanie Lanza, professor of biobehavioral health and director of the Edna Bennett Pierce Prevention Research Center, says that Pennsylvania and the nation needs more research into this troubling epidemic. “This call for proposals will seek research teams to conduct innovative, interdisciplinary and translational research to illuminate risk factors for substance use, abuse and addiction.”

Priority will be given to projects that make a convincing case for how the research can advance solutions to the systemic problems of substance abuse. Applications are particularly encouraged that map onto the University’s distinctive strengths in substance abuse research: pathways to addiction, criminal justice, and spillover effects to children, families, and communities. Proposals may focus on any substance of abuse, including alcohol, nicotine, cannabis, prescription drug misuse, and other illicit drug use.

Both Level 1 and Level 2 letters of intent are due Jan. 15. For more information on the opportunity, visit the CCSA’s Funding Opportunities page.

The CCSA is housed in Penn State’s Social Science Research Institute, one of seven cross-University research institutes within the Office of the Vice President for Research.

‘Ask the Experts’ addresses the opioid epidemic on cesarean sections

Published on: November 30, 2018
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Danielle Downs

The latest episode in the “Ask the Experts” series features Danielle Symons Downs, professor of kinesiology and obstetrics and gynecology, and associate director of the Social Science Research Institute at Penn State, discussing her research on the links between cesarean section deliveries and opioid prescribing after birth.

Downs also speaks about several initiatives aimed at combating the opioid epidemic and bringing awareness to maternal death rates in the United States, including the Penn State Consortium to Combat Substance Abuse and the March of Dimes’ #BlanketChange movement.

Watch the interview.

In the “Ask the Experts” video series, produced by the Center for Health Care and Policy Research (CHCPR) at Penn State, leaders in the industry share their perspectives on key topics affecting health care delivery and policy. The series is designed to reveal where and how important policy and practice topics intersect, and highlight ways in which research can advance that integration.

View past episodes of “Ask the Experts.”

Downs’ primary research theme is to design theoretically-driven, optimized, behavioral interventions to promote energy balance (e.g., increase physical activity, manage weight) in order to improve health outcomes for women and their offspring during the preconceptional, prenatal and postpartum/postnatal periods. Her research also involves translating her intervention findings to clinical settings. More about Downs’ exercise psychology laboratory can be found here.   

Dennis Scanlon, distinguished professor of health policy and administration and director ofCHCPR in the College of Health and Human Development at Penn State, interviews the guests on the “Ask the Experts” series. Scanlon’s research focuses on understanding the role of measurement, incentives, quality improvement and individual and organizational behavior change for improving important health care outcomes, including clinical quality, patient experience and economic efficiency. 

The mission of CHCPR is to create and disseminate new scientific knowledge that will help private and public decision-makers to develop cost effective services and programs that improve people’s health. CHCPR helps researchers interested in all aspects of health services and health care improvement find funding, develop quality research designs, collect and analyze data, and disseminate findings to the right audiences.

Addiction medicine expert to give two presentations

Published on: November 27, 2018
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Judson Brewer

Judson Brewer, M.D., Ph.D., an international expert in addiction medicine, will give two presentations at Penn State College of Medicine on Dec. 18.

Brewer will present “The Craving Mind: From Cigarettes to Cupcakes to Smartphones, the Mechanisms Underlying How Mindfulness Helps Change Unhealthy Habits” from 7:30 to 8:30 a.m. in Lecture Room D at the Department of Medicine Grand Rounds. He will also present “The Craving Mind: Why We Get Hooked, and How Mindfulness Helps Us Break Free From Addictive Habits” from noon to 1 p.m. in C3860 at the Penn State Addiction Center for Translation Topics in Addiction Seminar.

Brewer’s presentations are relevant to those of any background interested in addiction and its widespread influences on research, medicine, prevention, treatment, education, policy and community.

He is director of research and innovation, Mindfulness Center at Brown University School of Medicine.  Learn more about Brewer here. A TED Talk by Brewer can be viewed here.

The five types of problem drinking are more common at different ages

Published on: November 26, 2018
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Drinking study

Alcohol abuse is more complicated than simply drinking too much. There may be five separate types of problem drinkers, according to Penn State researchers, and each one may be more common at different stages of life.

In a study, Penn State researchers discovered five distinct classes or “profiles” among people with alcohol use disorder, with each profile defined by a specific set of symptoms. While each profile existed in people of all ages, certain profiles were more common at different stages of life.

For example, young adults were more likely to fit the profile characterized by drinking too much and experiencing hangovers and other withdrawal symptoms. Meanwhile, older adults in their late 50s to 60s were more likely to struggle with cutting back on their alcohol use.

Ashley Linden-Carmichael, assistant research professor of biobehavioral health and faculty affiliate of the Edna Bennett Pierce Prevention Research Center, said the findings suggest that diagnosing and treating alcohol use disorder is not one size fits all, and that care should be taken to treat a person’s specific symptoms.

“We need to think beyond whether someone has an alcohol use disorder, yes or no, and take a look specifically at what they’re struggling with and whether they’re in a particularly risky class,” Linden-Carmichael said. “Additionally, while young adults are most at risk for an alcohol use disorder, it’s clear that it’s also an issue for people in middle age or in older adulthood, too. But it might look different and they may be struggling with different aspects of drinking.”

Alcohol use disorder can include a variety of symptoms, ranging from drinking more or longer than intended, to more severe symptoms like experiencing withdrawal symptoms when not drinking alcohol. A person is considered to have an alcohol use disorder if they experience two or more of the designated symptoms.

To explore how alcohol use disorder varies among people at different ages, the researchers used data from a nationally representative group of 5,402 participants in the National Epidemiologic Survey on Alcohol and Related Conditions. The sample was restricted to participants who were between the ages of 18 and 64 and who met the criteria for an alcohol use disorder in the previous year.

To analyze the data, Linden-Carmichael used a new method developed at Penn State’s Methodology Center that allowed the researchers to discover hidden “profiles,” or groups of people who share similar symptoms of alcohol use disorder.

The researchers found five distinct profiles within the study participants.

  • Alcohol-induced injury: In addition to drinking too much, people in this profile reported getting into risky situations during or after drinking that may have resulted in injury.
  • Difficulty cutting back: People in this group struggled with wanting to cut back on their problematic drinking but being unable to.
  • Highly problematic, low perceived life interference: While people in this group reported experiencing many symptoms, they said their drinking did not interfere with their family, friends, work or hobbies.
  • Adverse effects only: People who fit this profile reported experiencing hangovers or withdrawal symptoms in addition to drinking too much.
  • Highly problematic: People in this group reported experiencing every symptom of alcohol use disorder.

In addition to identifying the five groups, Linden-Carmichael said they were able to use the method to see how prevalent each profile was at different ages.

Linden-Carmichael said the result — recently published in the journal Alcohol and Alcoholism — suggest that health care providers should consider looking at personalizing treatment and intervention efforts.

“Therapists could consider, for example, that when someone is a young adult, they should be looking for that person experiencing withdrawal symptoms,” Linden-Carmichael said. “Conversely, if someone is older, they could look for struggles with cutting back their drinking, or alcohol-related injuries.”

In the future, Linden-Carmichael said she would like to use the same method to look at the different classes of alcohol use disorder over time.

“I’m interested in seeing, for example, if someone has a certain profile at a younger age, what happens to them later?” Linden-Carmichael said. “If a person is in the adverse-effects-only class at 21, what does their drinking look like at age 60? Do they escalate or slow down? If we could have a similarly large study but follow them across age, that would be the most intuitive and most beneficial for practice.”

Stephanie T. Lanza, director of the Prevention Research Center and professor of biobehavioral health, and John J. Dziak, research associate in the Penn State Methodology Center, also worked on this research.

The National Institute on Drug Abuse at the National Institutes of Health helped support this work.

A Systems Approach to Opioid Mitigation

Published on: November 21, 2018
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Paul Griffin

Opioid and related substance abuse is devastating many communities across the country and has proven a particularly difficult problem to address. In this presentation, Griffin will discuss research being done at the Regenstrief Center for Healthcare Engineering at Purdue University to help mitigate substance abuse using a community-wide systems approach. In particular, he will discuss improving patient care regarding opioid addiction treatment and referral management, integration of heath IT and supporting analytics, public health evaluation, modeling syringe services programs and Pre-exposure prophylaxis, and the development of point of care technologies. The talk will take place Thursday, December 6, from 4:50 – 5:50 p.m. in 102 Leonhard Building. Refreshments will be served at 4:35 p.m. This work is funded by the Centers for Medicaid and Medicare Service.

About the Speaker

Paul Griffin is the director of the Regenstrief Center for Healthcare Engineering and the St. Vincent Health Chair at Purdue University. He also serves on the industrial engineering and biomedical engineering faculties there. His research interests area are in health systems engineering, cost and comparative effectiveness modeling, and health analytics. Prior to Purdue, Griffin was the Virginia C. and Joseph C. Mello Chair in the School of Industrial abd Systems Engineering (ISyE) at Georgia Tech. He also served as department head for Harold and Inge Marcus Department of Industrial and Manufacturing Engineering at Penn State from 2009 to 2014. Griffin began his academic career as an assistant professor in ISyE at Georgia Tech after completing his Ph.D. in Industrial Engineering at Texas A&M University.

Public comment request on White House report to stem the opioid crisis

Published on: November 9, 2018
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NIH logo

The White House National Science and Technology Council (NSTC) is seeking public comment on the Draft Report of the Fast Track Action Committee (FTAC) on Health Science and Technology Response to the Opioid Crisis. Comments are requested by December 5, 2018 and may be submitted to OpioidsRoadmap@OSTP.eop.gov (link sends e-mail).

The NSTC chartered the Opioid FTAC to support the President’s response to the opioid crisis by identifying (1) research and development (R&D) critical to addressing key gaps in knowledge and tools, and (2) opportunities to improve coordination of Federal R&D essential to combating the opioid crisis.

The report, “Health Research and Development to Stem the Opioid Crisis: A National Roadmap,” describes and provides recommendations in seven research areas:

  1. Biology and Chemistry of Pain and Opioid Addiction
  2. Non-Biological Contributors to Opioid Addiction
  3. Pain Management
  4. Prevention of Opioid Addiction
  5. Treatment of Opioid Addiction and Withdrawal
  6. Overdose Prevention and Recovery
  7. Community Consequences of Opioid Addiction

The report is available here: https://www.nih.gov/draft-ftac.

HEALing Communities Study: Developing and Testing an Integrated Approach to Address the Opioid Crisis

Published on: November 6, 2018
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Opioids

We are pleased to announce the launch of the NIDA 19-017 – HEALing Communities Study: Developing and Testing an Integrated Approach to Address the Opioid Crisis (Data Coordinating Center) (UM1- Clinical Trials Not Allowed) competition. Click on the link below to view more information.

  • Internal Submission Deadline: Friday, November 9, 2018
  • Funding Organization’s Deadline: Tuesday, December 11, 2018
  • Award Cycle: 2018
  • Discipline/Subject Area: Drug Abuse and Addiction Research Programs
  • URL: https://grants.nih.gov/grants/guide/rfa-files/RFA-DA-19-017.html
  • Funding Available: NIDA intends to commit up to $6.5M each year in FY 2019–2022 to fund one Data Coordinating Center, subject to availability of funds.
  • Letter of Intent: Sunday, November 11, 2018 (Although a letter of intent is not required, is not binding, and does not enter into the review of a subsequent application, the information that it contains allows IC staff to estimate the potential review workload and plan the review.)
  • Description:

The National Institute on Drug Abuse (NIDA), in partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA) is soliciting cooperative agreement applications with the intention of ultimately funding up to three research sites to participate in the ‘HEALing Communities Study’: Developing and Testing an Integrated Approach to Address the Opioid Crisis. The HEALing Communities Study will test the immediate impact of implementing an integrated set of evidence-based interventions across healthcare, behavioral health, justice, and other community-based settings to prevent and treat opioid misuse and Opioid Use Disorders (OUD) within highly affected communities. Highly affected communities of interest are counties or cities within states that are burdened with higher than average rates of overdose mortality and opioid-related morbidity, and other complications. Combined, all the communities participating in a single research site application must demonstrate having experienced at least 150 opioid related overdose fatalities (15% of these fatalities must be in rural communities) and a rate of 25 opioid related overdose fatalities per 100,000 persons or higher in the past year, based on the most recent complete year of data available. Communities within states ranking within the top third for age-adjusted drug overdose death rates in 2016, (per the Centers for Disease Control and Prevention) are of special interest. The integrated set of evidence-based prevention and treatment interventions should be designed to achieve the following goals: reduce overdose fatalities (by 40% in a 3-year period), and events; decrease the incidence of OUD; and increase the number of individuals receiving medication to treat OUD, retained in treatment beyond 6 months, and receiving recovery support services, and the distribution of naloxone compared to baseline. The Data Coordinating Center (DCC) will execute an array of scientific and support activities for the HEALing Communities Cooperative within three broad areas: coordination and communication, data, and health economics research.

For more information, please click on above URL to view solicitation.

Materials Required for the Penn State Downselect:

Please upload one PDF file (File name: Last name_NIDA 19-017.pdf) containing the following items in order no later than 4:00 p.m. on the internal submission deadline.

Cover Letter (1 page, pdf):

    • Descriptive title of proposed activity
    • Name(s), address(es), and telephone number(s) of the PD(s)/PI(s)
    • Names of other key personnel
    • Participating institution(s)
    • Number and title of this funding opportunity

Project Summary (no more than 1-page)

    • Identify the project scope that addresses the key aspects and elements, principal investigators, collaborators, and partner organizations.

Formatting Guidelines:

    • Font/size: Times New Roman (12 pt.)
    • Document margins: 1.0” (top, bottom, left and right)
    • Standard paper size (8 ½” x 11)

Questions concerning the limited submissions process may be submitted to limitedsubs@psu.edu.

View competition

Great Valley students develop app to combat veteran opioid abuse

Published on: October 31, 2018
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Code 4 PA participants

Penn State Great Valley students and alumni recently used their data analysis and coding skills in a state-wide challenge to fight the opioid epidemic, where they received recognition from SAP, a multinational leader in enterprise application software.

After working together at Penn State’s DataFest this spring, the Analytical Assassins team, along with a few new members, participated in Code4PA’s monthlong Codeathon challenge. Held across the state in Philadelphia, Harrisburg and Pittsburgh, the event focuses on the use of open data sets to generate ideas that will enhance public engagement or increase transparency of state data for greater innovation. This year, teams were tasked to address the opioid epidemic through prevention, saving lives, and ensuring access to treatment.

For the competition, the Analytical Assassins developed Ve-Care, a mobile application to help veterans transition back to their daily lives after service, ultimately preventing substance and opioid abuse among the population. They decided to focus on veterans for personal reasons: Jackie Markle, Penn State Great Valley data analytics alumna and team captain, is married to a veteran.

“Veteran topics are very near and dear to me,” said Markle. “My husband had a hard time transitioning to civilian life. While he is gainfully employed now, our personal experience helped drive the desire to serve others in similar circumstances.”

Opioid abuse is especially prevalent among veterans: a 2011 report shows veterans are twice as likely to die from overdose compared to the general population, and a 2014 study of 2,500 post-deployment soldiers found that 15 percent regularly used opioids.

While building the app, the team examined two years of veterans’ admissions and discharge data from Substance Abuse and Mental Health Services Administration (SAMHSA) and determined four profiles that are considered high risk for opiate abuse. This helped them realize the need for a personalized experience. Not only does Ve-Care provide a centralized hub for educational, medical, employment-related resources, but it also delivers push notifications specific to individual needs. Upon downloading the app, veterans complete a survey, which determines their specific needs and their risk for opioid abuse.

“The resources are out there; they are just so hard to find,” said Markle. “Our idea is to provide them with a one stop shop according to their risk category. For example, if one of the risk categories is unemployment, we can guide them to Google’s Military Occupational Specialty (MOS) tool to apply their skill sets to civilian jobs. We can also push resume writing resources, job search sites, and so on, until they update their profile as employed.”

“Risky” candidates are identified using an association algorithm that determines the most common profile of veterans who are susceptible to abuse.

“Many veterans experience psychological distress which is further complicated by substance abuse and related disorders,” said Karpagalakshmi Rajagopalan, a data analytics student and member of the Analytical Assassins. “While opioid abuse is widespread, the transition to civilian life can make veterans especially susceptible. By delivering the resources based on individual need, we can prevent them from getting into the abuse.”

After hearing about the event from a Penn State Great Valley staff member, Rajagopalan brought the Analytical Assassins together for another competition.

“When I found out the event was focused on addressing one of the biggest and real problems in Pennsylvania, the opioid epidemic, I knew I wanted to participate,” she said. “This is a very interesting problem to solve using data.”

“We never really parted ways,” added Markle. “We had so much fun working together at DataFest. I think participating in this event — especially to tackle a real-world issue — was a no brainer.”

The Code4PA Codathon kicked off in mid-September, where the team of eight met in person to learn about the challenge and brainstorm their solution. Over the next month, the Analytical Assassins worked virtually, collaborating on Slack or Skype to discuss the project, deadlines, and tasks. While each member had his or her own area of expertise, the group relied heavily on their strengths in data mining, algorithms, and Amazon Web Services. On Oct. 20, Markle presented Ve-Care to a panel of judges, and later the team received the SAP’s Veterans Challenge Use Case Award.

The recognition from SAP was exciting, but Markle and Rajagopalan feel especially fulfilled that their project will help veterans while tackling the devastating effects of the opioid epidemic.

“I was happy that the jury panel thought our idea could be extremely useful,” said Rajagopalan.

Markle agreed, hearing the practicality from others made the experience especially rewarding.

“We even heard from veterans competing against us in the challenge that the app would be helpful. Hearing it firsthand made all the late nights worth it!”

While Ve-Care is still in the development phase, the team hopes to partner with the Department of Military and Veterans Affairs in each county to link the programs together.

New State Program to Help Individuals Battling Opioid Use Disorder Find and Maintain Housing in Pennsylvania

Published on: October 19, 2018
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Gov. Tom Wolf

Governor Tom Wolf today announced a new state program that aims to direct $15 million for an opioid housing initiative that will fund a minimum of eight pilot projects in eligible urban and rural communities throughout the commonwealth. The proposed pilot programs must help individuals to become and remain engaged in evidence-based treatment interventions, provide individuals with the necessary support services to maintain housing stability, and provide pre-tenancy and tenancy education services.

“Through these grants, we are supporting programs that help those working toward recovery find and maintain a place to live and we are offering one of the most basic necessities for a healthy life,” Gov. Wolf said. “For those in or hoping to achieve recovery, a home can be an important factor in finding and continuing treatment and other services.”

A Request for Applications (RFA) for support services navigation and housing services for individuals with opioid use disorder (OUD) is now available on the commonwealth’s eMarketplace.

Developed by the departments of Drug and Alcohol Programs (DDAP) and Human Services (DHS), in partnership with the Pennsylvania Housing and Finance Agency and the Department of Community and Economic Development, the RFA’s goal is “to support innovative practices that will increase access to treatment and supports for individuals with OUD and help prevent overdose-related deaths.”

Housing instability, combined with unmet basic needs, makes the road to recovery and independence extremely challenging. According to national data, about one in five people experiencing homelessness has a chronic substance use disorder. This aligns with information gathered from Pennsylvania’s 45 state-sponsored OUD Centers of Excellence, a majority of which identify housing as a major barrier for their clients.

“We know that each individual seeking treatment is just that – an individual,” said DDAP Secretary Jennifer Smith. “They each have different situations and circumstances hindering their recovery. To truly combat this crisis, we must build capacity to support individuals by providing necessary, supportive wrap-around services like stable housing and case management.”

“The conditions in which a person lives, including access to safe, stable housing, plays a role in a person’s health. When a person experiences homelessness in addition to a substance use disorder, the lack of a secure home is often a barrier to staying engaged with treatment and recovery, if they are able to access treatment at all,” said DHS Secretary Teresa Miller. “Supporting programs that assist with housing access and stability will help more people stay engaged in treatment and reach recovery.”

The RFA is the first project launched as part of the $55.9 million SAMHSA grant secured to bolster the state’s response to the prescription opioid and heroin epidemic. Additional initiatives included in the grant are focused on expanding services to pregnant women and veterans affected by OUD, developing the treatment and recovery workforce, and strengthening criminal justice and law enforcement initiatives with a focus on reentrant supports.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has distinguished four major dimensions that support a life in recovery: health, home, purpose, and community. This project aims to support two components of the dimensions – home and purpose. By giving an individual a stable, safe place to focus on their recovery, paired with the independence and self-worth that housing provides, an individual’s overall health and wellbeing is greatly improved.

The counties that are eligible locations for pilot programs under the RFA were identified via a formula that equally considered the rate of individuals diagnosed with a substance use disorder (SUD) and rate of overdose-related deaths in a county.

For more information on the RFA, visit the PA eMarketplace.

Find more information on the state’s efforts to battle the opioid crisis here.

SSRI Spotlight: Michael Donovan

Published on: October 18, 2018
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Michael Donovan

As the Director of Policy & Outreach at Penn State’s Administrative Data Accelerator, Michael Donovan leads policy operations and facilitates collaborative projects between government partners and researchers to support the utilization of scholarly research in evidence-based policymaking.

At the Data Accelerator, Donovan contributes to the foundational goal of promoting the use of social science research in government policymaking, particularly through the use of administrative data from various sources and levels of government.  Donovan works to improve the translation and dissemination of social science research to outside audiences, including various policy communities (state, federal and local), other academics and the general public.

In particular, Donovan supports initiatives like the PA Integrated Data System (IDS), seeking to utilize data from the PA Commonwealth to gain insights through data linkages and analysis.  Another notable example includes his efforts on a collaborative, cross-domain project prepared for the PA Office of Attorney General regarding the estimation of societal costs to states as a result of the opioid epidemic.

Donovan collaborates with SSRI and the Consortium to Combat Substance Abuse (CCSA) to support interdisciplinary and translational research collaborations aiming to address the opioid crisis and the larger problems of substance abuse. This work is done in close consultation with policymakers to be both responsive to their needs and to maximize translation from academic research into real-world policy solutions.

Donovan utilizes his background in policy, government, and academia in this work. Prior to joining Penn State, Donovan served in the federal government for nearly a decade at the White House during both Obama Administrations.  During this time, he served in a commissioned officer role as Special Assistant to the President in the Office of Scheduling and Advance, where he coordinated the planning and execution of the administration’s strategic agenda.  He began his political career on the campaign trail in early 2007.

To prepare him for his work in both the political and academic realms, Donovan earned his bachelor’s degree in Political Science here at Penn State. During his tenure at the White House, he continued his education at Georgetown University’s Walsh School of Foreign Service with a master’s degree in National Security Policy Studies.

Donovan returned to his alma mater in order to both grow intellectually and professionally, as well as to contribute to work seeking to impact and improve lives.

Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort Study

Published on: October 18, 2018
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Annals of Internal Medicine Logo

The United States is in the midst of a crisis of opioid-related harms (1). Some efforts to address this crisis focus on expanding access to effective treatment of opioid use disorders (OUDs) (2). Prior nonfatal opioid overdose is a known risk factor for subsequent nonfatal and fatal overdoses (3–7), and engaging persons in treatment who survive an overdose may be effective in limiting subsequent fatalities. However, data on the association between treatment of OUD and mortality after a nonfatal overdose are limited to a single retrospective cohort study that analyzed enrollment in methadone maintenance treatment (MMT) at a single time point and found no association (3).
The 3 medications for OUD (MOUD) approved by the U.S. Food and Drug Administration are methadone, buprenorphine, and naltrexone. Randomized controlled trials of these medications have shown consistent benefits across many outcomes, including increased treatment retention and suppression of illicit opioid use (8–10). A recent systematic review and meta-analysis of 19 observational cohort studies identified substantial reductions in all-cause and overdose mortality for methadone and buprenorphine (11). However, the mortality benefit in this analysis was limited to time actively retained in treatment, and the 4-week period after discontinuation was associated with an especially high risk for death. The few studies that examined mortality among patients receiving naltrexone show an unclear effect (12–15).
Massachusetts has been particularly affected by the opioid crisis: Opioid overdose deaths more than tripled between 2010 and 2016 (16). Through Chapter 55 of the Acts of 2015, the state legislature permitted individual-level linkage of data from 16 Massachusetts government agencies to gain a deeper understanding of the circumstances that influence fatal and nonfatal opioid overdoses (17). For this analysis, we identified a cohort of persons in the Chapter 55 data set who survived an opioid overdose and described any episodes of treatment with MOUD before and after that overdose. Specifically, we sought to determine whether treatment with MOUD, including receipt of MMT, buprenorphine, or naltrexone, was associated with reduced risk for all-cause and opioid-related mortality.

To read the full paper, click here.

Consortium to Combat Substance Abuse announces fellows program

Published on: October 4, 2018
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Crushed pill

Penn State’s Consortium to Combat Substance Abuse (CCSA) and Social Science Research Institute (SSRI) are announcing a call for proposals for the Community Fellows Program to support faculty members seeking to develop university-community collaborations that address substance abuse and its spillover effects to families and communities.

The program provides release time for faculty members to develop community collaborations and build sustainable, evidence-based or evidence-informed programs, policies and practices that can effectively address substance misuse/abuse issues within a targeted community.

Another goal of this initiative is to build the faculty member’s applied/translational research expertise by allowing successful candidates to participate in webinars and workshops aimed at developing community engagement, program development, implementation and evaluation, partnering with government officials to promote evidence-based policy, and grant-writing.

CCSA is housed within SSRI and is led by Interim Director Stephanie Lanza, professor of biobehavioral health and director of the Edna Bennett Pierce Prevention Research Center.

The mission of CCSA is to leverage the University’s research, education and outreach capacities toward a world free from addiction as a step toward enabling individuals, families, and communities can reach their full potential. To advance this mission, Penn State has provided funds for a range of new activities, including supporting the development of interdisciplinary and translational research, education and outreach to combat substance about and related public health problems.

The request for proposals for the Community Fellows Program and instructions on how to apply can be found on CCSA’s and SSRI’s funding webpages.

Penn State launches new consortium to combat the opioid crisis

Published on: October 3, 2018
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Stephanie Lanza

Pennsylvania is one of the states most impacted by the growing opioid epidemic, with one of the highest overdose death rates in the country — but a new initiative bringing together experts from across Penn State aims to combat this crisis through data-driven, evidence-based innovation.

The Penn State Consortium to Combat Substance Abuse (CCSA) will draw on the expertise of researchers, educators and practitioners from across Penn State. The group plans to develop and implement effective programs, policies and practices aimed at preventing and treating addiction and its spillover effects on children, families and communities.

The CCSA will be housed in Penn State’s Social Science Research Institute, one of seven cross-University research institutes within the Office of the Vice President for Research. One of the consortium’s signature efforts will be the strategic hiring of 12 new tenure-track faculty members over the next four years, who will bring additional expertise in this critical field to the University and lead the charge to research and develop data-driven solutions to this public-health crisis.

“Across the University, individuals have been working in their labs, communities and elsewhere to identify this epidemic’s causes, pursue solutions and address systemic substance-abuse issues,” said Penn State Executive Vice President and Provost Nick Jones. “As Pennsylvania’s only land-grant institution, Penn State has a vital responsibility to lead the way in fighting this battle. By forging connections across our colleges and campuses and working with community leaders, we can tackle this epidemic head-on and work toward a world free from the disease of opioid addiction.”

The CCSA will provide seed-grant funding for new interdisciplinary teams aimed at combating opioid and other substance abuse and sponsor an annual conference to bring together substance abuse prevention experts from across the nation.

“The faculty within the Penn State Consortium to Combat Substance Abuse will join with our current faculty to conduct innovative, interdisciplinary and translational research to illuminate risk factors for substance use, abuse and addiction; to educate their students and the public; and apply their knowledge to prevent and treat addiction,” said Penn State Vice President for Research Neil Sharkey.

The CCSA will be led by interim director Stephanie Lanza, professor of biobehavioral health and director of the Edna Bennett Pierce Prevention Research Center at Penn State.

A Penn State faculty member since 2004, Lanza has devoted her career to advancing research on the prevention of substance abuse through innovative quantitative methods. She has served as the principal investigator on research grants from the National Institute on Drug Abuse and the National Cancer Institute, and is an interdisciplinary researcher with an extensive network of collaborators both within and beyond the Penn State community. In her role as interim director, Lanza will be supported by the CCSA advisory board, comprised of representatives from Penn State centers and institutes whose missions encompass the systemic problems of substance abuse.

“Pennsylvania and the nation need more research into this troubling epidemic,” Lanza said. “I believe that the Penn State community can create lasting impacts through educating one another, our students and the public, and by undertaking research that advances evidence-based programs, policies and practices to better understand, prevent and treat opioid and other substance misuse and addiction.”

A national search for a permanent consortium director will be launched this fall.

University Police begins equipping officers with kit to treat opioid overdoses

Published on: October 3, 2018
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Penn State University Police Officer C. Luke Shivery

On the evening of Sept. 16, an emergency dispatcher requested assistance at a local fast food restaurant in Spring Township, Berks County, for the report of a cardiac arrest related to a suspected opioid overdose.

University Police Officer C. Luke Shivery at Penn State Berks happened to be on patrol just a short distance away and knew that police officers with the Township of Spring Police Department were on the scene of a crash elsewhere, so he told the dispatcher he would respond. Law enforcement agencies routinely assist each other with calls for service.

Upon arrival, an off-duty emergency medical technician (EMT) was removing the patient from a vehicle. Shivery retrieved an automated external defibrillator (AED), medical bag and naloxone kit from his patrol car. As Shivery prepared the naloxone for administration, the EMT administered CPR using a bag valve mask from Shivery’s medical bag. Shivery then administered a dose of naloxone, which is used for emergency treatment in suspected opioid overdose cases. As Shivery updated the dispatcher, the EMT administered a second dose of naloxone.

Spring Township police then arrived along with Township of Spring Fire Department and City of Reading Fire Department Emergency Medical Services, taking over medical assistance. The patient was placed into an ambulance where he was conscious and speaking.

“I’m definitely happy with the outcome. It’s a relief to know that things worked out well,” Shivery said, reflecting on the incident.

Shivery was the first officer with University Police to administer naloxone.

In 2017, after police stations at 22 Penn State campuses merged as one department under University Police and Public Safety, Penn State standardized first aid training through which police officers became first aid certified by the American Red Cross. Penn State also standardized first aid equipment for officers, which includes medical bags and AEDs.

Additionally, officers received training to administer naloxone, which is used for emergency treatment in suspected opioid overdose cases. The training included online and in-person training by certified first aid instructors.

University Police then began the process of equipping its police officers with naloxone. Currently, seven campus police stations are equipped with naloxone, including Beaver, Berks, Brandywine, DuBois, Behrend, Great Valley and University Park. Administrators continue to work with local and county agencies to equip officers with naloxone at the remaining campuses.

“We understand that we are a microcosm of our communities and the abuse of opioid products can spill over, at times, into our police officers’ jurisdiction, therefore we believe it is important to equip our officers with life-saving tools should they face a life-threatening situation,” said Charlie Noffsinger, assistant vice president of University Police and Public Safety at Penn State.

Funding opportunity: International Research Collaboration on Drug Abuse and Addiction Research

Published on: October 2, 2018
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NIH logo

This Funding Opportunity Announcement (FOA) encourages collaborative research applications on drug abuse and addiction that:

1. Take advantage of unusual opportunities that exist outside the United States to access talent, resources, populations, or environmental conditions in other countries that will speed scientific discovery

2. Describe how the research will significantly advance U.S. health sciences

3. Demonstrate specific relevance to the NIDA mission and objectives. To determine whether your research plan is relevant to the NIDA mission and objectives, review the NIDA Strategic Plan (https://www.drugabuse.gov/about-nida/2016-2020-nida-strategic-plan). Where feasible, applications should address NIDA’s international scientific priority areas (https://www.drugabuse.gov/international/research-priorities)

4. Include an investigator from a U.S. institution and a non-U.S. citizen partner living and working in another country.

Go to https://grants.nih.gov/grants/guide/pa-files/PA-18-773.html to view full funding announcement.

WPSU to address opioid addiction, recovery with special programming

Published on: September 19, 2018
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WPSU battling Opioids

Jaime Durst, from Centre County, said she was 28 years old when she began abusing drugs and alcohol.

“I don’t know how that started; it was just some of the people I was hanging with,” said Durst, who realized she needed to seek treatment for her opioid addiction. “All of a sudden it became really bad. I was desperate. I was like, ‘I need help,’ and it’s hard to ask for help.”

Durst’s story is one of several shared about opioids and recovery through “Battling Opioids,” a collaborative project between Pennsylvania’s public media stations, that aims to bring awareness and provide resources for individuals struggling with addiction. The stations jointly produced “Battling Opioids: A Project of Pennsylvania Public Media,” which will air at 8 p.m. on Thursday, Sept. 27, on WPSU-TV.

According to provisional data from the Centers for Disease Control and Prevention, there were an estimated 5,655 drug overdose deaths in Pennsylvania in the 12-month period leading up to December 2017 — more than 15 per day — most of them from opioids. 

Stories will air on WPSU-TV beginning Sept. 20 and are available online through the “Battling Opioids” website.

  • “HealthSmart: Drugs and Young People”
    • Thursday, Sept. 20, at 10 p.m.
    • Young recovering addicts share their stories
  • “HealthSmart: On the Front Line of the Opioid Crisis”
    • Thursday, Sept. 20, at 10:30 p.m.
    • First responders are on the front line of the opioid epidemic
  • “Understanding the Opioid Epidemic”
    • Sunday, Sept. 23, at 11 p.m.
    • Stories of people impacted by the opioid epidemic and information from experts
  • “Broken: Women-Families-Opioids”
    • Monday, Sept. 24, at 9:30 p.m.
    • Explore how opioid addiction among women is breaking the family bond and changing the fabric of society
  • “Battling Opioids: A Project of Pennsylvania Public Media”
    • Thursday, Sept. 27, at 8 p.m.
    • A Pennsylvania’s public television collaborative sharing stories of recovery and hope
  • “HealthSmart: The Opioid Epidemic”
    • Sunday, Sept. 30, at 6 p.m.
    • Experts and people in recovery talk about what’s happening now and how they plan to get a handle on the drug crisis
  • “Heroin: A Commonwealth Crisis”
    • Sunday, Sept. 30, at 10 p.m.
    • A panel of experts explain what led to the heroin crisis in Pennsylvania and provide information on prevention and treatment

WPSU-FM also will produce opioid-related stories, including a special “Take Note” at 1 p.m. on Friday, Sept. 28, featuring Jason Snyder, a regional director of outpatient services for Pinnacle Treatment Centers. Snyder, who is in recovery, has lost two brothers to opioid overdoses.

Durst, also in recovery, is receiving medically assisted treatment through Addiction Solutions in Centre County.

“Since I’ve been on it, I’ve bought a house, I have my car, I’ve worked at my job for three-and-a-half years,” she said. “I’m a different person.”

“Battling Opioids” is a collaborative project between Pennsylvania’s seven public media stations: WPSU, WHYY (Philadelphia), WITF (Harrisburg), WLVT/PSB39 (Greater Lehigh Valley), WQED (Pittsburgh), WQLN (northwestern Pennsylvania) and WVIA (northeastern Pennsylvania).

Visit the WPSU website for more information on the project.

Seed grants to support opioid research announced

Published on: September 13, 2018
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Opiates

Penn State’s  Social Science Research Institute (SSRI), in collaboration with the Clinical and Translational Science Institute (CTSI), has awarded over $200,000 in funding to support 10 new interdisciplinary teams of Penn State researchers whose work is aimed at combating the opioid epidemic.

“These teams are developing novel translational research programs to advance solutions to the opioid crisis, from discovery-oriented research to dissemination and implementation science,” said Susan McHale, SSRI director and associate director of the CTSI.

The funded projects and research teams are:

“Alexa, I’m in pain!” A Real-Time Mindfulness Intervention to Control Pain: Delivery Through a Conversational Agent – Saeed Abdullah, College of Information Sciences and Technology; Stephanie Lanza, College of Health and Human Development; Sebrina Doyle, College of Health and Human Development; Robert Roeser, College of Health and Human Development; and David Almeida , College of Health and Human Development.

Predicting spatial-temporal patterns of opioid use with criminal and overdose data in Pennsylvania – Qiushi Chen, College of Engineering; Conrad S. Tucker, College of Engineering;

Glenn Sterner, Penn State Abington; and Joel Segel, College of Health and Human Development.

Using Integrated Databases to Examine Patient Outcomes in Children with a History of Neonatal Abstinence Syndrome – Tammy Corr, College of Medicine; Max Crowley, College of Health and Human Development; Douglas L. Leslie, College of Medicine; Jeffrey R. Kaiser, College of Medicine; Paul L. Morgan, College of Education; and Guodong Liu, College of Medicine.

Opioid Prescription Practices and Risk Factors for Persistent Use After Childbirth – Danielle Downs, College of Health and Human Development; Lisa Bailey-Davis, Geisinger Commonwealth School of Medicine; Tammy Corr, College of Medicine; Timothy Deimling, College of Medicine; Richard Legro, College of Medicine; Dhanya Mackeen, Geisinger Commonwealth School of Medicine; Jaimey Pauli, College of Medicine; and Mark Stephens, College of Medicine.

Perinatal Opioid Use and Maternal Nutrition and Health Status – Emily Hohman, College of Health and Human Development; Sarah Kawasaki, College of Medicine; Tammy Corr, College of Medicine; Jennifer Savage Williams, College of Health and Human Development; and Danielle Symons Downs, College of Health and Human Development.

The influence of adolescent social stress on morphine behaviors – Helen Kamens, College of Health and Human Development; Sonia Cavigelli, College of Health and Human Development; and Patricia Sue Grigson, College of Medicine.

An Innovative Approach to Tackle the Opioid Epidemic: Utilizing Twitter Data and Integrating Big Data Analytics and Spatial and Social Network Analyses – Zhen Lei, College of Earth and Mineral Sciences; Guangqing Chi; College of Agricultural Sciences; Cynthia Chuang, College of Medicine; Glenn Sterner, Penn State Abington; Ashton Verdery, College of the Liberal Arts; and Junjun Yin, Social Science Research Institute.

Neural mediators and moderators of mindful yoga practice in opiate-dependent individuals –  Emma Rose, College of Health and Human Development; Diana H. Fishbein, College of Health and Human Development; Robert W. Roeser, College of Health and Human Development; Scott Bunce, College of Medicine; and Sarah Bowen, Pacific University – Oregon.

Linking accidental overdoses to medical professionals and pharmacies: A population-based social network analysis – Glenn Sterner, Penn State Abington; Oren M. Gur, Penn State Abington; and Sabahattin Gokhan Ozden, Penn State Abington.

PROSPER PLUS: Combining Effective Prevention Education with Supply Side Interventions to Reduce Opioid Misuse – Janet Welsh, College of Health and Human Development; Daniel Perkins, College of Agricultural Sciences; Derek Kreager, College of the Liberal Arts; and Glenn Sterner, Penn State Abington.

For more information on seed grant funding and other opportunities available through SSRI, visit their Funding Mechanisms website.

Opioids Misuse: Increasing Access to Transportation In Rural Communities

Published on: September 12, 2018
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USDA logo

You are cordially invited to attend a workshop hosted by the United States Department of Agriculture, the National Rural Transit Assistance Program, and the Federal Transit Administration (FTA). 

Where: West Virginia School of Osteopathic Medicine, 400 Lee Street N. Lewisburg, WV 24901

When: September 20, 2018

Time: 9:30 am—1:00 pm EST.

Livestream: Please visit this link on the date and time indicated to tune in:

https://livestream.com/accounts/10067614/

Workshop Flyer: PDF (2.17MB)

Planning to attend in person?

Please R.S.V.P. by sending an email to Betty-Ann Bryce: betty-ann.bryce@wdc.usda.gov. Use the subject line “Rural Transportation Workshop,” and provide your name, title organization, and contact information.

Certified Recovery Specialist program available to recovering addicts

Published on: September 12, 2018
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Addiction recovery

Do you have a history of addiction recovery and want to help others? Penn State Shenango will host “Certified Recovery Specialist Training,” a Penn State Beaver Continuing Education course, from 9 a.m. to 4 p.m. on Saturdays, beginning Oct. 6 and ending Dec. 15, in 108 Sharon Hall in downtown Sharon. An information session on the program will be held from 6 to 7:30 p.m. on Tuesday, Sept. 18, also in 108 Sharon Hall.

Pennsylvania has the fourth highest overdose death rate in Pennsylvania. Gov. Tom Wolf officially declared it a public health disaster, clearing the way for easier access to care and resources.

And of all the resources available to recovering addicts, a simple peer-to-peer program may be one of the most effective. Research has shown that peer recovery support services not only help addicts remain engaged in the recovery process, but they also reduce the likelihood of relapse.

“Although there is a long history of peers helping peers in recovery, the Pennsylvania Certification Board Certified Recovery Specialist credential is a relatively new version of this practice,” said Roxanne Atterholt, program coordinator of the human development and family studies program. “This credential is for trained drug and alcohol peers in recovery to help others move into and through the recovery process.”

Certified Recovery Specialist Training is a 54-hour program that meets education requirements specified by the Pennsylvania Certification Board. To apply for CRS certification, individuals must meet additional board requirements, including: a history of addiction with recovery, a high school diploma or GED, successful completion of a CRS exam, and the signing of an ethical code of conduct.

The cost is $995 and includes all necessary materials. Online registration is now open at https://beaver.psu.edu/recovery-specialist.

The Pennsylvania Certification Board requires candidates to complete the CRS exam application. The cost of the exam is $125, payable directly to the board with the application and requisite documents.

Financial assistance may be available for qualified individuals.

For more information about the CRS program or any program offered through Penn State Beaver Continuing Education, contact Jill Valentine at jak249@psu.edu or 724-773-3765.

United Nations World Drug Report Released

Published on: September 12, 2018
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United Nations World Drug Repor

Prevention strategies based on scientific evidence working with families, schools, and communities can ensure that children and youth, especially the most marginalized and poor, grow and stay healthy and safe into adulthood and old age. For every dollar spent on prevention, at least ten can be saved in future health, social and crime costs.

These global International Standards summarize the currently available scientific evidence, describing interventions and policies that have been found to result in positive prevention outcomes and their characteristics. Concurrently, the global International Standards identify the major components and features of an effective national drug prevention system. It is our hope that the International Standards will assist policy makers worldwide to develop programmes, policies and systems that are a truly effective investment in the future of children, youth, families and communities. This work builds on and recognizes the work of many other organizations (e.g. EMCDDA, CCSA, CICAD, Mentor, NIDA, WHO) which have previously developed standards and guidelines on various aspects of drug prevention.

The Standards have been recognized by Member States as a useful tool to promote evidence-based prevention in the following documents:

  • The Joint Ministerial Statement on the mid-term review of the implementation by Member States of the Political Declaration and Plan of Action;
  • Resolution 57/3 – Promoting prevention of drug abuse based on scientific evidence as an investment in the well-being of children, adolescents, youth, families and communities; and,
  • Resolution 58/3 – Promoting the protection of children and young people, with particular reference to the illicit sale and purchase of internationally or nationally controlled substances and of new psychoactive substances via the Internet.
  • Resolution 58/7
    Strengthening cooperation with the scientific community, including academia, and promoting scientific research in drug demand and supply reduction policies in order to find effective solutions to various aspects of the world drug problem (operative paragraph 2)
  • Resolution 59/6
    Promoting prevention strategies and policies (operative paragraphs 5 and 14)
  • Outcome Document of UNGASS 2016 on the World Drug Problem (paragraph 1.(h))
  • Resolution 60/7
    Promoting scientific evidence-based community, family and school programmes and strategies for the purpose of preventing drug use among children and adolescents

The documents are presently available only in English, but they are being translated in all UN official languages, and uploaded shortly. Russian translation is already available.

International Standards on Drug Use Prevention

Appendix I – References

Appendix II – Description of the methodology utilized for the collection, assessment and utilization of the scientific evidence

Appendix II Annex I –  List of mediating variables

Appendix II Annex II – Instruments for the assessment of evidence

Appendix II Annex III – List of interventions and possible study designs

Appendix II Annex IV – Summary of the quality assessment

Appendix II Annex V – Summary results of ‘good’ and ‘acceptable’ studies

College students may face pressures from opioid epidemic's secondary effects

Published on: August 13, 2018
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Opioids

About one in five college students reported in a survey that they knew someone who was addicted to pain medications, and nearly a third said they knew somebody who overdosed on painkillers or heroin, according to a team of undergraduate Penn State Lehigh Valley researchers.

This secondary exposure to opioid abuse may shine a light on the collateral damage that is often left out of the current debate about the epidemic, said Jennifer Parker, associate professor of sociology, Penn State Lehigh Valley.

“Since the beginning of the opioid epidemic, public debate and prevention strategies have focused on the primary victims, misusers themselves, while surprisingly little attention has been paid to the burdens felt and experienced by those who are intimately or socially tied to them,” said Parker, who advised the group of researchers presenting at the American Sociological Association’s annual meeting today (Aug. 11) in Philadelphia.

According to the researchers, most of the 118 students who completed a survey admitted that they had been in some way exposed to people who misuse drugs and alcohol. Of those, 20.5 percent said they currently know someone who is addicted to pain medication. About 32.5 percent said they knew somebody who overdosed on either painkillers or heroin.

Erica Hughes, an undergraduate student in health policy administration, added about 15 percent of the students reported worrying that someone they knew may be misusing pain medication.

“I was surprised by how many students report close ties to people who are addicted to or have overdosed on opioids,” Hughes said. “It makes me sad to think that so many are carrying around this worry because being a student in today’s world is already hard enough.”

Hughes added that dealing with issues connected to their exposure to the effects of opioid abuse may be particularly difficult for college students. Many college students already face increased pressure from rising tuition costs and student debt, along with fears about the job market, she added.

Amanda Borges, a 2018 graduate in health policy administration, said that the findings might raise awareness about the extent of the opioid crisis and offer insight into better ways to address it.

“The general public should know how devastating this crisis has been and how it impacts all communities and social classes including college students,” said Borges.

Gathering information on all aspects of the opioid crisis may help better allocate resources to help communities, added Kirsten Mears, also a 2018 graduate in health policy administration.

“The more we know, the better we are able to help and identify how particular communities, especially our poorest, may have certain disadvantages in this epidemic because of lesser resources and lack of health insurance,” said Mears.

According to the researchers, gender may also play a role in how college students report their exposures to the opioid problem. For example, women were twice as likely to report having intimate ties to those who misuse or overdose on opioids, the researchers said.

Shanice Clark and a team of 15 undergraduate students in health policy administration also contributed to the study.

The researchers collected data from surveys filled out by students at a university in a region particularly hard hit by the opioid crisis.

Of the approximate 130 surveys were passed out, participants completed 122. Of those, the researchers determined that 118 surveys were both completed and valid. 

The researchers said that future research should look at whether secondary exposure to opioids impacts the students’ mental and physical health, as well as their academic performance.

Penn State forms addiction legal resources team at Dickinson Law

Published on: July 30, 2018
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Addiction Legal Resources Team

With the number of opioid overdose deaths continuing to rise in Pennsylvania, a group of Penn State Dickinson Law students and faculty are becoming advocates and providing resources for those who are affected by addictions.

Led by Matthew Lawrence, assistant professor of law at Dickinson Law and assistant professor in the Department of Surgery at Penn State College of Medicine, the group of six students are working to develop and disseminate legal resources, promote informed policy making, and facilitate scholarly research in the states of Pennsylvania, West Virginia, Ohio, North Carolina, Rhode Island, and Florida.

“The project, called the Addiction Legal Resources Team (ALRT), had its genesis in a paper I wrote exploring legal barriers families face when trying to advocate for a loved one who has substance use disorder,” said Lawrence. “While conducting a search for a research assistant to continue this work, I was overwhelmed by student interest in finding outlets to contribute to address the crisis. Several of our law students had a personal connection with the opioid crisis or work experience with addiction programs in their home states.

With the support of Dickinson Law Dean Gary Gildin, Lawrence was able to support six students part-time this summer.  “Thanks to their passion, experience, and home-state connections, the team has exceeded my expectations and developed several meaningful efforts in our first few short months. They’ve also inspired my own scholarship in this area,” Lawrence said.

ALRT student team members Bryan Caffrey, Andrea Jenkins, Evan Marmie, Tori Remington, Alex Short, and Wyatt Weisenberg are working on various projects in each of their home states. Team members are disseminating and developing legal resources for patients and families navigating the legal system to assist them with obtaining insurance coverage for addiction treatment. They are also advising Penn State researchers on legal questions encountered in their research. The team meets weekly, with some students using Dickinson Law conference rooms to videoconference with the rest of the team to discuss projects, deadlines, and new collaborations. Students then pursue individual projects during the week. 

“The students are working together and with me to chip away at the issue and do something helpful. One major focus has been on insurance coverage for treatment, specifically resources related to the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA),” explained Lawrence. MHPAELA is a federal law that ensures group health plans and health insurance issuers who provide mental health or substance use disorder benefits offer coverage that is comparable to medical/surgical benefits coverage. Many individuals affected by substance use disorder are unfamiliar with the law and the challenging appeals process when receiving an insurance coverage denial.

“Our goal as a team is to research and present information for individuals or their family members who might be suffering from substance use disorder, helping them find medical treatment and navigate a rather convoluted regulatory landscape,” said ALRT student team member Bryan Caffrey.

The students are also conducting legal research in each of their home states and are developing policy memos for dissemination to scholars and collaborators. For example, they are sharing their work with the Parity of 10 project, which advocates MHPAEA in mental health and drug abuse cases.

The program has been a beneficial educational experience for the students as well. “One thing I’ve learned that is very important when it comes to researching health care policy and implementation is the important way that the administration of statutes comes into effect. It’s not simply enough to look at statutes, which might be natural for law students, but also look to how administrative agencies and corporations that administer healthcare have turned those statutes into actual practical policies that affect people every day in their lives,” Caffrey said.

Another student wrote a policy memo regarding several state and local programs and Lawrence encouraged him to circulate it more broadly. The memo ultimately appeared on Harvard Law School’s Bill of Health blog, and that student has been invited to contribute additional memos to the blog.

“The project has led to the students thinking more about the community side of the addictions crisis, focusing on the family and how to outreach and apply our legal research,” said Lawrence. “I can’t emphasize enough how much this effort has been inspired and driven by this passionate and talented group of students and what a privilege it has been to work with them. We are looking forward to continuing the addiction legal resources team’s work into the fall semester and beyond.”

ALRT project supporters and collaborators beyond Dickinson Law include Parity at 10, Partnership for Drug Free Kids, Legal Action Center, Penn State’s Social Science Research Institute, Partnership for Better Health PA’s Opioid Prescribing Task Force, and Penn State College of Medicine’s Department of Public Health Sciences and Department of Surgery. The ALRT can be reached at ALRT@dsl.psu.edu.

Family-Focused Approaches to Opioid Addiction Improve the Effectiveness of Treatment

Published on: July 24, 2018
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Family

– Written by Helena J.V. Rutherford, Ph.D., Yale School of Medicine, Declan T. Barry, Ph.D., Yale School of Medicine, and Linda C. Mayes, MD, Yale School of Medicine
– Edited by Rebekah Levine Coley, Ph.D., Boston College
– For more information, contact Martha Zaslow, Ph.D. Director for Policy, Society for Research in Child Development, at mzaslow[at]srcd.org

[Download a PDF]

In treating opioid addiction, moving from an individual approach to a family-focused approach to treatment can have lasting benefits for children and parents, and decrease health care costs. In 2017, the U.S. Department of Health and Human Services declared opioid addiction a public health emergency. Opioids—which include prescription medicines for pain relief, synthetic drugs such as fentanyl, and heroin(1) —lead to an average of 115 deaths by overdose per day in the United States.(2,3)The medical and legal response has mainly focused on individual needs, yet opioid addiction has wide-ranging impacts not only on individuals, but also on their families and children. New evidence finds that family-focused approaches can improve upon models that treat individuals, expanding benefits and cost efficiencies, and improving the health and development of children.

Opioid Addiction Affects Whole Families, With Important Implications for Children
Parents’ opioid addiction affects children’s development from the prenatal stage through adulthood. These effects occur both directly, through biological and neurological processes, and indirectly, through compromised parenting and family stress.

  • Since 2000, the number of infants born with neonatal abstinence syndrome has increased fivefold; these infants experience opioid withdrawal after exposure in utero. Neonatal abstinence syndrome increases hospital stays at an estimated annual cost of $1.5 billion,(4,5) and can induce tremors, seizures, irritability, disrupted sleep, and intense crying in infants.(6)
  • Neuroscience research suggests that parents with addiction show compromised functioning in areas of the brain critical to caregiving, including areas that regulate stress and process emotions.(7,8) In turn, parents with addiction struggle with the stresses of childrearing, leading to less sensitive and supportive parenting, which may hinder children’s social and emotional development.(8)
  • Parents with substance use disorders often raise children in chaotic and impoverished households,(9) contexts that have been shown to impede children’s development and lead to detrimental health outcomes in adolescence and adulthood.(10,11)
  • Over the long term, parents’ opioid addiction, coupled with chaotic home environments, increase the chances that children will engage in substance use,(12,13) setting the stage for intergenerational drug abuse and lifelong health consequences for children.(14)
  • In some states, under child-endangerment laws, parents who use opioids and other illicit drugs during pregnancy are automatically referred to child protective services.(15) These laws can result in parental incarceration and children’s removal from their home. Applying such approaches indiscriminately without adequate opportunities for treatment can harm family stability and children’s mental health.(16,17)

Current Treatment Options Are Limited
The gold standard treatment option for adult opioid addiction is the controlled administration of prescribed methadone or buprenorphine, termed opioid agonist treatment.(18,19) For pregnant women, this treatment optimizes maternal and neonatal outcomes after birth.(19) Yet access is limited by cost constraints and lack of coverage through Medicaid and private insurance.(18) Even for parents who have access, opioid agonist treatment programs often overlook the impact of opioid addiction on children and families. Similarly, programs rarely attend to the cooccurrence of addiction and other mental health issues.(20) Other treatment approaches that are often easier to afford, such as medically supervised discontinuation of opioid use during pregnancy, have high relapse rates and less maternal engagement in prenatal care, and do not provide postnatal parenting support essential for healthy child development.(21)

Family-Focused Treatment Models Can Fill Gaps and Improve Children’s Well-Being
Because opioid addiction affects not only parents but also children and families, we need family-focused treatment models that attend to the needs of, and optimize outcomes for, both parents and children. Current treatment approaches fall short in meeting these goals, yet there are successful models that can inform improvements in treatment. Specifically, evidence suggests the need for coordinated and family-focused treatment models, particularly those that promote effective parenting. Numerous family-focused models have proven effective. Research shows that:

  • Evidence-based programs that combine opioid agonist treatment with efforts to help opioid-addicted parents regulate their emotions, lower their stress, and find pleasure in their caregiving role have led to decreases in the severity of maternal addiction as well as improved well-being for mothers and children.(22,23,24)
  • Among families with infants born with neonatal abstinence syndrome, strategies to empower mothers by supporting their direct involvement in the care of their infants have resulted in reduced hospital stays, decreased hospital costs, and less treatment involving pharmacologic withdrawal for newborns.(25)
  • Other promising approaches seek to extend family-focused support to opioid-addicted women during pregnancy to lay the groundword for mother-child relationships and decrease substance use before babies are born.(26)

Critical Next Steps for Targeting Opioid Addiction and Improving the Lives of Children and Families
Family-focused approaches have beneficial effects on multiple family members and may reduce overall health care costs. We now need carefully planned expansions of family-focused treatment models with continued evaluations to determine when and for whom such treatments are appropriate and most effective, and how integrated care models can best maximize the efficacy of opioid agonist treatment and address co-occurring medical and psychiatric conditions.

Opioids and non-opioid analgesics affect different types of stress

Published on: July 17, 2018
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Opioids and stress

Mu-opioids and non-opioid analgesics appear to differentially affect the psychological and physiological components of psychosocial stress, according to a recent study funded by NIDA, NIGMS, and NIMH.

In a between-subject design, healthy young adults (18-40 y) were randomly assigned to receive either 2 or 4 mg of hydromorphone (mu-opioid analgesic), 1000 mg of acetaminophen (non-opioid analgesic), or placebo and were tested in the Trier Social Stress Test (TSST) and a non-stressful control task (NSCT). Physiological responses to stress included heart rate, blood pressure, salivary cortisol and pupillometry, and psychological measures included subjective reports of mood and stress.

TSST successfully increased all measures of physiological stress and increased anxiety and negative mood compared to the control task. Hydromorphone (4 mg) dose dependently decreased cortisol stress response, but acetaminophen did not. Both hydromorphone and acetaminophen reduced ratings of how challenging participants found the task. This suggests acetaminophen, the non-opioid analgesic, affects psychological responses to stress, not physiological, whereas hydromorphone affects both. Only the mu-opioid system was involved with physiological stress responses in humans, which builds upon similar results in preclinical studies. The results here contribute a greater understanding of the role of opioid and non-opioid systems in the complex physiological and psychological responses to social stress.

'Share Your Opioid Story' website bringing awareness, buzz of opioid epidemic

Published on: July 3, 2018
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SYOS logo

Watch the WJAC-TV news coverage of the “Shair Your Opioid Story” website, featuring SSRI Director Susan McHale and Justice Center for Research’s Glenn Sterner.

Penn State researchers hope website humanizes, helps others affected by opioids

Published on: June 25, 2018
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Opiates

Stories can speak as loudly as statistics.

That is the purpose behind “Share Your Opioid Story,” an initiative designed to raise public awareness of the impact of the opioid epidemic in Pennsylvania and empower Pennsylvanians affected by the epidemic to talk openly about the effects of opioid addiction. Stories of individuals, family members, and friends affected by the epidemic can be found — and shared — online at shareyouropioidstory.com.

“Share Your Opioid Story” is being coordinated by Glenn Sterner, a postdoctoral scholar in the Justice Center for Research at Penn State and assistant professor of criminal justice at Penn State Abington, beginning this fall.

“The goal of the project is to portray a more human side of the opioid epidemic and the impact it has on individuals, family members, friends and communities regardless of someone’s background,” said Sterner. “We want to lessen the stigma surrounding the crisis and enable people to talk about it more openly, all while helping those most affected get the help they desperately need.”

“Dr. Sterner’s impactful work clearly supports Penn State’s land-grant mission to serve the citizens of the Commonwealth and the nation,” said Nick Jones, Penn State executive vice president and provost. “The rapid growth and spread of the opioid epidemic and its tragic consequences demand Penn State’s attention, and this project is one of many meaningful endeavors through which the University is addressing this crisis.”

Funding for “Share Your Opioid Story” comes from the Independence Blue Cross Foundation with additional support from the Pennsylvania Department of Drug and Alcohol Programs. The project is being launched in conjunction with the unveiling of the foundation’s “Someone You Know” initiative — a multimedia campaign in southeastern Pennsylvania featuring a mix of print and outdoor advertising, personal videos and print stories from people affected by opioid addiction that the foundation hopes will inspire others seeking help with addiction and recovery.

“Through bold, direct and highly personal stories, we hope to raise public awareness that substance misuse is not a problem that people should be ashamed to discuss,” said Lorina Marshall-Blake, president of the Independence Blue Cross Foundation, in a release announcing the campaign. “With simple and inspiring messages … we hope to help remove the stigma that often prohibits people from seeking help and starting on the path to recovery.”

“Too often we hear that stigma around substance use disorder leaves people feeling isolated and can keep them out of treatment,” added Jennifer Smith, secretary of the Pennsylvania Department of Drug and Alcohol Programs. “Addiction is a disease, and like any other medical condition, people with a substance use disorder deserve compassion and support as they take steps towards recovery. We must all work to change the conversation around addiction so people seeking treatment and living in recovery feel safe, supported and empowered. This campaign is an important, much-needed step towards breaking this stigma.”

“Share Your Opioid Story” also provides links to a host of local, state and federal resources for individuals who need assistance themselves or are looking for information to help someone else struggling with opioid addiction. To learn more, visit shareyouropioidstory.com or email the project at shareopioidstories@gmail.com.

Opioid crisis funding opportunities

Published on: June 12, 2018
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Opioids

Funding opportunities to address the opioid crisis are available from the National Center for Advancing Translational Sciences, National Institute on Drug Abuse, Substance Abuse and Mental Health Services Administration, National Institute on Disability, Independent Living and Rehabilitation Research, National Institute on Minority Health and Health Disparities, Office for Victims of Crime, and Patient Centered Outcomes Research Institute.

Research supports restrictions on opioid-containing cold medicines for children

Published on: May 25, 2018
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Cough syrup

Prescription cough and cold medicines containing the opioid hydrocodone are more likely to cause serious side effects in children than those containing codeine, according to a new study from Penn State College of Medicine. The research supports recent U.S. Food and Drug Administration (FDA) restrictions on prescription hydrocodone- and codeine-containing cough medicines for children and suggests that opioids in general should not be prescribed for coughs and colds in pediatric populations.

Historically, most of the guidance around children’s prescription cough and cold medications has focused on the opioid codeine. The American Academy of Pediatrics has recommended against the use of codeine-containing cough and cold medications in children for two decades due to safety concerns, and in 2017 the FDA ruled that codeine should not be used to treat cough or pain in children younger than 12 years old.

In January 2018, the FDA expanded its restrictions, announcing that prescription cough medicines containing either codeine or hydrocodone can only be labeled for use in adults 18 and over because the risks of opioid-containing cough products outweigh the potential benefits in children.

The new study supports the FDA’s decision, according to Dr. Ian Paul, a physician and professor of pediatrics and public health sciences at Penn State College of Medicine.

The study grew out of a larger safety surveillance project by Paul and colleagues at the Rocky Mountain Poison and Drug Center in Denver, looking at adverse events associated with over-the-counter pediatric cough and cold medications.

During this project, the surveillance system also detected serious side effects in children who had ingested prescription cough and cold medications that combined typically over-the-counter ingredients with opioid medications. Despite the public attention around codeine in children’s cold medications, the researchers noted that many of the adverse events were more likely to be linked to hydrocodone-containing prescriptions. This discovery led them to conduct the new study.

Using the surveillance data, the researchers analyzed adverse events in children under 12 years old that were associated with cough and cold medications including both an opioid and an over-the-counter ingredient. Between January 2008 and December 2015, there were 98 cases involving an adverse event at least potentially related to codeine or hydrocodone. In most of the cases, the medications were either prescribed to the children or accidentally ingested without supervision.

The sedative properties of opioids, which are particularly worrisome in children, were frequently reported but were more common in children who took hydrocodone. Drowsiness, lethargy, and respiratory depression were reported in 86 percent of hydrocodone cases compared with 61 percent of codeine cases.

There were also three deaths reported, all of which were associated with hydrocodone combined with an antihistamine.

The research appeared recently in the journal Clinical Toxicology.

“You could argue from this data that the adverse events profile from hydrocodone-containing cough and cold medication ingestion appears to be more concerning than that from codeine-containing drugs,” Paul said. The message? “Healthcare providers should never prescribe opioid-containing cough and cold products to children. Ever.”

Paul also emphasized that children usually don’t need prescription medications for a cold.

“Parents of children with colds should remember that they typically resolve in their own with time. Supportive measures, like using non-aspirin pain relievers such as acetaminophen and ibuprofen, can help a child’s comfort. There’s some evidence that honey is effective for children one year of age and older and that topical vapor rub can be used for children ages two and up. And they can use nasal saline and humidified air to help a child get through the illness.”

Other researchers on this project were Kate M. Reynolds and Jody L. Green, both at the Rocky Mountain Poison and Drug Center at the Denver Health and Hospital Authority.

This study is funded through an unrestricted grant provided by the Consumer Healthcare Products Association Pediatric Cough Cold Task Group. Green reported grants from Consumer Healthcare Products Association Pediatric Cough Cold Task Group, during the conduct of the study and grants from McNeil Consumer Healthcare, outside the submitted work. Paul reported personal fees from Pfizer and Johnson and Johnson, both outside the submitted work.

Opioid crisis requires social and behavioral research solutions

Published on: May 18, 2018
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NIH logo

Each day, more Americans die from drug overdoses (175) than from motor vehicle accidents (110). Many of these overdoses are accidental, and some are intentional, but nearly all are the result of social and behavioral factors. In response to the opioid crisis, the NIH convened a meeting on March 5-6, 2018, “Contributions of Social and Behavioral Research in Addressing the Opioid Crisis.” This meeting was part of the NIH Cutting-Edge Science Meeting Series to End the Opioid Crisis, and was led by the Office of Behavioral and Social Sciences Research (OBSSR) partnering with the National Institute on Drug Abuse (NIDA), the National Institute of Neurological Disorders and Stroke (NINDS), the National Center for Complementary and Integrative Health (NCCIH), the National Institute on Minority Health and Health Disparities (NIMHD), and the NIH Immediate Office of the Director (IMOD).

The goals of the meeting were to specify key actionable social and behavioral science findings that can be brought to bear immediately to address the opioid crisis, and identify critical short-term research priorities that have the potential to improve the opioid crisis response. To advance these goals, participants described current research findings and identified high priority scientific gaps and recommendations organized in five panels:

Panel 1: Sociocultural and socioeconomic underpinnings of the crisis;

Panel 2: Behavioral and social factors preventing opioid initiation and mitigating the transition from acute to chronic opioid use;

Panel 3:  Incorporating nonpharmacologic approaches to the treatment of opioid abuse and chronic pain management;

Panel 4: Challenges and barriers to implementing prevention and treatment strategies; and

Panel 5: Effective models of integrated approaches.

These panels generated several “key things we know” and “key things we need to know” to address the opioid crisis that will be included in a meeting summary that will be posted this month. I was impressed by the breadth and diversity of social and behavioral research findings that, if implemented, could have an immediate impact on reducing opioid use. This meeting agenda, participant list, and video recording, are available on the NIH HEAL (Helping to End Addiction Long-term) Initiative web page. The meeting summary will be posted on this web page later this month.

With an additional $500 million appropriated for opioid addiction research, the NIH will nearly double the funding available to study opioid addiction, from $600 million in 2016 to $1.1 billion in 2018. The “Contributions of Social and Behavioral Research in Addressing the Opioid Crisis” meeting provides a useful framework for integrating social and behavioral research questions in the HEAL Initiative. OBSSR will continue to work with the NIH Institutes and Centers involved in the NIH Health Initiative to ensure that developing research initiatives address some of the key research priorities identified by this meeting. The social and behavioral sciences already have contributed substantially to the knowledge base needed to address this crisis. What is needed now is greater implementation of what we already know and a serious, concerted research effort to answer key research questions to improve our ability to address this crisis.

Penn State is represented at congressional briefing addressing opioid epidemic

Published on: May 4, 2018
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Stephanie Bradley

Penn State researcher Stephanie Bradley, director of the Evidence-Based Prevention & Intervention Support Center (EPISCenter), was one of five experts on a panel who recently briefed Congress on the rising opioid epidemic and efforts to combat the problem through evidence-based prevention programs and public health approaches.

The congressional briefing highlighted a report from Trust for America’s Health and the Well Being Trust, “Pain in the Nation: The Drug, Alcohol and Suicide Epidemics and the Need for a National Resilience Strategy.” According to the report, deaths from drugs, alcohol and suicide accounted for one million deaths from 2006 to 2015. With the rapid rise of heroin, fentanyl and carfentanil use, the report predicted death rates could double to two million by 2025.

The report also found that there were disproportionately large increases in drug deaths among racial and ethnic minority groups, particularly among black Americans, who experienced an increase of 39 percent in drug deaths between 2015 and 2016. Additionally, Latinos saw drug death rates increase 24 percent, while the rate for whites increased 19 percent during those same years.

The report calls for a national resilience strategy that takes a comprehensive approach focusing on prevention, early identification of issues, and effective treatment, which is also the approach advocated by the EPISCenter.

The center’s expertise includes translating high-quality research to ensure communities and policymakers have access to the most recent and rigorous research around what works in preventing youth substance use and other problem behaviors. Bradley’s presentation focused on prevention science, effective upstream prevention programs, and the need for prevention infrastructure at federal, state and local levels.

“While the congressional briefing focused on deaths of despair, I explained that substantial research has identified upstream risk factors in early childhood and adolescence that increase risk for multiple problem outcomes, including but not limited to substance use and depression,” Bradley explained. “Proven, effective prevention strategies target early risk indicators, such as family conflict, low attachment to school, perceived norms about antisocial behaviors, and coping skills. When risk-focused strategies are used we are able to address a wider array of possible outcomes for youth and families. This means we have the opportunity to prevent a number of problems from occurring, many of which may not be on our radar today but could be issues in a few years.”

Bradley says that while the opioid crisis is drawing attention and resources, it is also allowing the EPISCenter opportunities to highlight the role that early prevention can play in stemming the epidemic. “We’ve worked previously with Trust for America’s Health and Well Being on legislation recommendations for state and local prevention infrastructure, and members of the center regularly meet with policymakers to discuss upstream prevention programs and practices that are effective at preventing all types of problem behaviors, including the misuse of prescription opioids.”

The EPISCenter is also partnering with University of Pittsburgh’s PA Heroin Overdose Prevention Technical Assistance Center to support their work on prevention strategies.

Additionally, Bradley served as a member of Opioid Prevention Subcommittee of the Governor’s Advisory Board for Health, to which she and subcommittee member Alice Yoder of Lancaster General Health submitted a white paper on upstream prevention strategies. This white paper was recently shared with the PA Opioid Command Center for consideration.

Bradley is also a member of the Penn State Advisory Board for Combating the Opioid Epidemic, and is often called to serve on panels, town halls and trainings on this issue. Penn State’s Social Science Research Institute is providing leadership for this advisory board, which includes experts from 15 interdisciplinary research centers and institutes, representing seven colleges and four campuses, as well as several offices.

The EPISCenter represents a collaborative partnership between the Pennsylvania Commission on Crime and Delinquency (PCCD), and Penn State’s Prevention Research Center and College of Health and Human Development. The EPISCenter is funded by PCCD, the Department of Human Services, and the Department of Drug and Alcohol Programs.