Principal Investigator:

Ranjani Paradise, PhD, Director of Evaluation, Institute for Community Health (ICH)

Research Project:

Evaluation of Mobile Methadone Programs

This project will evaluate current and emerging mobile methadone programs in Massachusetts. Methadone treatment is an effective treatment for opioid use disorder; however, under federal regulations, methadone is only available through Opioid Treatment Programs (OTPs) and patients have to make regular visits to an OTP to receive their medication. This can present a significant barrier to access for some patients. The Bureau of Substance Addiction Services (BSAS) in Massachusetts has been investing in alternative models for methadone delivery, including mobile vans. There are five mobile methadone programs already established or in development in Massachusetts. There is limited research on mobile van methadone models and their patient outcomes. To enhance access to methadone, evaluating implementation and outcomes of varying service approaches is essential. This project aims to conduct a two-year evaluation of the five mobile methadone programs in Massachusetts; RIZE will co-fund this study with BSAS. The evaluation will be conducted by the Institute for Community Health and will follow the Consolidated Framework for Implementation Research, utilizing both qualitative and quantitative methods to assess program impact.

Principal Investigator:

Traci C. Green, PhD, Professor and Director of the Opioid Policy Research Collaborative

Research Project:

Xylazine Test Strip Validation Study and Launch of Network One: New England Community Drug Checking Innovations Network

This project will study and validate the accuracy of xylazine test strips. Xylazine, sometimes referred to as “tranq,” is a non-opiate, long acting, and sedating veterinary medication that has been increasingly detected in the Massachusetts drug supply. Data from the Massachusetts Drug Supply Data Stream (MADDS) estimates that about one-third of New England’s illicit drug supply contains xylazine. Xylazine use is linked to painful skin ulcers and, when combined with synthetic opioids, such as fentanyl, can cause heavy sedation and further decreased respiratory function which can increase overdose risk. Opioid overdose reversal drugs like naloxone (Narcan) do not reverse xylazine’s effects, because it is not an opiate. In response to the evolving and volatile nature of the drug supply, new drug checking technologies are emerging, including xylazine test strips (XTS). Validity and feasibility of new drug checking tools are rarely tested using “real world” drug samples or tested by people who use drugs (PWUD) and programs supporting their health and wellness. To be confident about the accuracy of XTS, more field testing is necessary to validate their results and determine the proper protocols for a test strip to detect xylazine in a drug sample. This project will partner with community drug-checking programs to compile the necessary data to validate the strips and to create instructions and messages that community members can rely on to save lives. The project will test 300 to 400 samples over a six-month period and develop protocols for test strips to detect xylazine in a drug sample. MADDS, in collaboration with community drug-checking sites across Massachusetts and similar programs in neighboring states, will launch Network One: New England Community Drug Checking Innovations Network, to support this effort. Participating sites will receive stipends of up to $4,000 based on the number of samples tested and a small gift card incentive will be given to individuals who bring in drug samples to get tested.

Principal Investigator:

Avik Chatterjee, MD, MPH, Addiction Specialist, Boston Medical Center

Research Project:

Understanding the Barriers and Facilitators to Harm Reduction in Shelter Settings

Overdose is the leading cause of death among people experiencing homelessness. Harm reduction policies, including naloxone distribution and syringe exchange, can decrease the mortality and morbidity associated with high-risk substance use. Yet access to harm reduction practices tend to vary from shelter to shelter. The goals of the projects are to better understand what practices are in place, why and how they are used, and to generate an actionable set of next steps to enhance or implement harm reduction practices in shelter settings. The study will also strive to document how these practices impact shelter guests’ substance use and their use of shelter services and will learn from people with lived and living experience to better understand the attitudes toward and knowledge of harm reduction in shelter settings. The study will also collect ideas from shelter staff and guests about which harm reduction practices are the most supportive of their needs in shelter. The team will hire two consultants with lived and living experience to provide meaningful feedback on study design, recruitment plan, interview script, interpretation of findings, and how best to present findings in a manuscript and in communication back to shelters. Interviews will undergo analysis focusing on overcoming barriers to disseminating and implementing harm reduction practices in shelter settings. After the interview analysis, the findings and recommendations will be prepared for publication.

Principal Investigator:

Traci C. Green, PhD, Professor and Director of the Opioid Policy Research Collaborative

Research Project:

Supply Caretaking Research and Case Study

This project envisions a safer supply of drugs, accomplished through a grassroots approach and local harm reduction policy levers. Because the current drug supply is chaotic and harmful, this project explores the concept of safer supply as harm reduction in Massachusetts. Canadian and European harm reduction initiatives have explored safe supply by focusing on the active drug and stabilizing its source and purity by replacing the unknown one with a known, pure, and regulated one. These approaches, while laudable, are not legal in the US. Safe supply focusing on active cuts can empower people who use and who supply drugs to protect themselves and their local communities from the volatility of the supply. Racial, geographic, and socioeconomic disparities are exacerbated by entrenched and segregated drug markets that are over-policed and under-resourced in harm reduction and treatment options. By taking a grassroots approach and capitalizing on lessons learned from relationships with communities normally wary of traditional syringe service programs, this project will harness existing skills and build solidarity to work toward documenting how caretaking of the local drug supply works and could function as part of a future intervention strategy. Through ethnographic observations and qualitative interviews, this project will develop a case study and lessons learned from a location where concerted efforts to develop supplier outreach and reduce supply-related harm has been undertaken and worked. Findings will be coupled with novel drug checking data and analyses to identify other locations in Massachusetts where a supply caretaking approach, including possible intentional shifts toward a safer supply, could be introduced and studied in the future.

Principal Investigators:

Ranjani Paradise, PhD, Director of Evaluation and Research and Evaluation Scientist, Institute for Community Health (ICH)

Research Project:

“To better understand the state of hospital-based addiction care in Massachusetts.”

RIZE engaged the Institute for Community Health (ICH) to describe and document the state of hospital-based addiction care in Massachusetts. The project will profile a cross-section of diverse and existing models of care, with associated best practices and challenges, and will identify opportunities to improve care models and enhance harm reduction practices.

Working with RIZE, and expert advisors with direct knowledge of the local addiction care landscape, ICH has refined the areas of inquiry for this project and identified six hospital programs in Massachusetts to profile. Through interviews and document review, ICH will describe the models at each of the hospitals and will identify successful practices and challenges, including operational and financial considerations. ICH will also conduct a literature review to document care models in other settings and will summarize data from the Boston Overdose Linkage to Treatment Study to identify important elements of care from the perspectives of diverse community members at high risk for overdose. ICH will synthesize all data and will report findings with recommendations for how to enhance harm reduction practices in hospital-based settings.

Principal Investigators:

Ranjani Paradise, PhD, Assistant Director of Evaluation and Research and Evaluation Scientist, Institute for Community Health (ICH) & Dan Dooley, PhD, Director, Research and Evaluation Office, Boston Public Health Commission (BPHC)

Research Project:

“A qualitative examination of racial inequities in receipt of substance use disorder (SUD) treatment post-opioid overdose.”

The research project examines the experiences and service-seeking behaviors of diverse Boston residents in the 30 days following an opioid overdose in order to understand factors that influence access to treatment and identify opportunities for systems change. Guided by a research steering committee from all three institutions, this project offers an in-depth qualitative review with input from the people directly affected, along with key stakeholders from local health care and public health programs. The combined perspectives allowed the research team to gain a deep understanding of barriers and identify actionable recommendations. This applied research project was designed to generate information to inform policy and practice change for the health care and public health systems in Boston to improve access to substance use disorder (SUD) treatment and address inequities.

Principal Investigator:

Peter Kreiner, PhD, Senior Scientist, Institute for Behavioral Health (IBH)

Research Project:

“Racial disparities and the role of prescriber networks in the development and sustaining of buprenorphine prescribing by waivered physicians for OUD treatment in Massachusetts communities.”

The project explored how isolated physician networks can negatively impact care coordination and information sharing among physicians. The project identified system-level factors associated with the development and sustaining of buprenorphine prescribing in a community, structural properties of prescriber patient-sharing networks in which waivered physicians are embedded, and how these properties vary in relation to community demographics including racial/ethnic makeup. Identifying network properties associated with greater access to OUD treatment and with increases in treatment access outlines opportunities for system change efforts to reduce racial/ethnic disparities in access to OUD treatment.

Principal Investigators:

Ronald Kulich, PhD Professor, TUSDM and David Keith, DMD, BDS

Research Project:

Controlled Substance Risk Mitigation in Dentistry: Testing a Validated Curriculum for Practicing Dentists, Dental Hygienists, and Oral Surgeons” evaluates a series of 10 validated controlled substance risk mitigation training modules to Massachusetts practicing dentists, dental hygienists, and oral surgeons.