Our department has tremendous expertise to contribute to the opioid public health emergency declared by President Trump in October. Addiction psychiatry is the single strongest area in our department and our addictions program is consistently ranked among the top 10 in the country. We have expertise across the entire age spectrum and in all areas of addiction, including a strong presence in opioid addiction. Below is a sampling of people and projects who are working on solutions in this area.
Rick Ries, MD, is the head of our Additions Division and has done a tremendous amount of work around opioids. He recently led a meeting with representatives from HRSA, SAMHSA, CSAT, Tribal representatives, Medicaid, and individual state representatives from the region to develop both individual and unified approaches to the opioid epidemic. He developed and helps facilitate an annual Northwest Tribal Opioid Symposium by the Muckleshoot Tribe attended by most Washington and some Idaho, Montana, Oregon and Alaska Tribes. With support from Danica Boyle, Dr. Ries leads UW Medicine’s plans to address addictions issues in response to directives around addiction from the BREE Collaborative and the Washington State Health Care Authority. He co-authored a terrific op-ed on medication-assisted therapy for opioid addiction with Andy Saxon, MD, where they describe why we should be treating people with buprenorphine, naltrexone, and methadone. He also edits the leading addictions reference text in the field (The ASAM Principles of Addiction Medicine).
Andy Saxon, MD, runs our Addiction Psychiatry Residency Program and works with Veterans at the VA Puget Sound Health Care System. He co-chaired the BREE Collaborative’s Opioid Use Disorder Treatment Workgroup and directs the Center of Excellence in Substance Abuse Treatment and Education (CESATE). He has done research on using buprenorphine and lofexidine to manage opioid withdrawal, and studied office-based treatment of opioid use disorder using buprenorphine before this type of practice became commonplace. Working with the NIDA Clinical Trials Network, he co-led one of the largest randomized comparisons of buprenorphine and methadone for the treatment of opioid use disorder that has ever been conducted, demonstrating that both medications were safe to use in people who had liver disease. A long-term follow-up from that study has demonstrated that ongoing medication treatment for opioid use disorder substantially reduces the risk of illicit opioid use.
Mark Sullivan, MD, PhD, is a national expert on the link between chronic pain and opioid addiction. He has developed, tested, and deployed a variety of web-based training resources concerning opioid therapy for chronic pain, and has received department funding to examine opioid prescribing, opioid deaths and hospitalizations, and socio-economic characteristics at the zip code level across Washington to help explain why opioid prescribing varies six-fold among Washington’s 39 counties and to identify causal relationships that could lead to life-saving interventions.
Dennis Donovan, PhD, directs the Alcohol and Drug Abuse Institute (ADAI) and works closely with Caleb Banta-Green, PhD, MPH, MSW, who has worked on the State’s Heroin and Prescription Opiate Addiction Task Force since June 2008. Dr. Banta-Green currently co-chairs the King County Task Force’s treatment implementation work group and in partnership with the AIMS Center, led by Anna Ratzliff, MD, PhD, and Anne Shields, MHA, RN, is providing training and technical assistance along with Mark Duncan, MD, to six Hub and Spoke programs throughout Washington State to expand access to opioid use disorder treatment with medications, including buprenorphine. We’ll include more about these efforts in the January newsletter.
A Hub and Spoke model is also being used in the Office Based Opioid Treatment (OBOT) program based at the Adult Medicine Clinic at Harborview to increase access to buprenorphine-induction services for the treatment of opioid addiction. The Adult Medicine Clinic, serving as the “Hub,” is partnering with seven new “Spokes” to provide low barrier buprenorphine for high cost patients. The project will result in new primary care capacity to treat opioid addiction, new opioid treatment capacity for South King County, and increased treatment access for homeless populations. The Opioid STR is the latest project in an ongoing collaboration between our clinical services at Harborview and the Washington State Department of Social and Health Services, Division of Behavioral Health and Recovery.
Mark Duncan, MD, Kari Stephens, PhD, and Dr. Ries run the UW Psychiatry and Addictions Case Conference (PACC) series, a weekly program designed to expand the mental health and addictions care capacity of health care professionals in remote, underserved areas of Washington. Since the program’s inception in July, 2016, 347 people have attended one or more sessions and 41 providers have presented 70 cases for review. In addition to the cases often involving opioid addiction, several of the educational presentations that precede the case presentations have specifically addressed opioid disorders. Dr. Duncan is also exploring how best to treat addictions in primary care. A paper recently came out in the New England Journal of Medicine that linked Collaborative Care to better outcomes in substance use disorders.
Susan Collins, PhD, and Seema Clifasefi, PhD, are co-directors of the Harm Reduction and Treatment (HaRRT) Center where they use community-based participatory research approaches to develop and evaluate interventions to help substance users reduce their substance-related harm and improve their quality of life. Although much of their research has focused on alcohol and smoking to date, the HaRRT Center’s harm-reduction treatment curriculum has been adapted for use with polysubstance-using patients. The curriculum includes information on safer opioid use to help educate patients on ways to stay healthier, even if they choose to continuing using substances. Dr. Collins is also a licensed clinical psychologist offering harm-reduction treatment in the Mental Health and Addictions Clinic at Harborview Medical Center.
Mary Larimer, PhD, is a national expert on addictions in college-aged populations and her group at the Center for the Study of Health and Risk Behaviors works on opioid addiction, namely herself, Christine Lee, PhD, and Jason Kilmer, PhD.
Therese Grant, PhD, directs the Fetal Alcohol and Drug Unit which includes the Parent-Child Assistance Program (PCAP), an evidence‐based home visitation case‐management model for mothers who abuse alcohol or drugs during pregnancy, including opioids.
This sample of work on addiction and opioid research and treatment highlights some of the ways in which we contribute to increase access to effective treatment and to save lives. We know this list is not complete and ask that you contact Becky Sladek (rsladek@uw.edu) if you are doing work in this space. We have received several inquiries for an overview of our opioid researchers and programs and would be thrilled to add to this list
