The University at Buffalo has more than 150 faculty members and scientists investigating addiction, from exploring its basic scientific mechanisms to developing new approaches to patient care. The current opioid crisis, both regionally and nationally, has inspired a renewed effort across the university to pursue interdisciplinary approaches in combatting substance use disorder (SUD) and other types of addiction. Researchers study the neurological factors that increase addiction vulnerability, the effects of prenatal substance use, the impact of SUD on families and society, and best practices for prevention and treatment, among dozens of other ongoing projects.
UB faculty, scientists and administrators have been core members of the Erie County Opioid Task Force, comprised of representatives from hospitals, addiction service agencies, law enforcement, the judiciary, educators, the public, government and clinicians. A marker of this group’s success is the 17 percent reduction in opioid-related deaths last year—perhaps the only region of the state where a decrease occurred.
Other outcomes of the Erie County Opioid Task Force include creation of consensus guidelines for the management of acute pain, approved by the county medical society and specialty society representatives. Local insurers have partnered with the Jacobs School and the county health department to present educational seminars on safe pain management and screening and management of people who are addicted to opioids.
The “Buffalo Model” for addressing the needs of people suffering from opioid SUD is a unique partnership, and may become a model for the nation. It involves having emergency physicians serving as the “gateway” to medication-assisted treatment (MAT), with guaranteed handoff to treatment by addiction medicine specialists in local agencies, then transitioning maintenance care to primary care physicians. The program seeks to break down barriers that impact patients at a motivationally important point in their disease and facilitate rapid access to treatment.
The Department of Orthopaedics convened a region-wide effort to decrease opioid prescribing post-operatively. This partnership with community orthopaedists is conservatively anticipated to result in a million fewer doses of opioids prescribed this year.
The Jacobs School of Medicine and Biomedical Sciences is a pioneer in addiction medicine, with one of the first approved addiction medicine fellowships in the country. Fellows are trained yearly, providing a well-educated work force for this high-need field. The fellows are also exposed to evidence-based pain medicine through interaction with the School’s pain medicine fellowship program.
More than 900 participating students from all of UB’s health science disciplines (medicine, nursing, social work, pharmacy, dentistry, public health) participate in interprofessional exercises to learn how to recognize and address opioid addiction in a variety of settings. Students from other schools (law, urban planning, college of arts and sciences, engineering) also take part. Medical students learn about the history of addictions, pharmacology of opioids and neurobiology of addiction through classes, a third-year family medicine clerkship and a fourth-year elective in addiction medicine.
Jacobs School residents in all primary care fields, as well as in OB/GYN, psychiatry and emergency medicine, are trained in screening techniques to detect SUDs and learn to use medication-assisted treatment (MAT) for opioid use disorder. Screening, Brief Intervention and Referral to Treatment (SBIRT) training was provided for community physicians, nurse practitioners and physician assistants.
The Jacobs School has an active “Mini-Medical School” to inform the public on health issues. Recent topics include the history of addictions in the US, current knowledge of the neurobiology of addiction, factors contributing to the rise of opioid addictions and deaths, and currently available treatment modalities.
Addiction Treatment Services (ATS) is an outpatient clinic providing treatment for individuals with alcohol and substance use disorders, located within UB’s Clinical and Research Institute on Addictions on the Buffalo Niagara Medical Campus. ATS is certified by the NYS Office of Alcoholism and Substance Abuse Services (OASAS) and is the only treatment program in the state designed specifically for addiction research. Clinical research trials conducted at ATS have led to innovative new treatment methods for practitioners.
The School of Pharmacy and Pharmaceutical Sciences Opioid Prescriber Training Program successfully trained more than 38,000 licensed prescribers, nearly 40 percent of licensed prescribers in New York State. The program was a collaboration between the pharmacy school’s Office of Continuing Pharmacy Education, Jacobs School faculty and the New York State Department of Health (NYSDOH).
Pediatrics faculty recently opened a new clinic for adolescents at risk of or suffering from SUD, which integrates behavioral health and social work expertise. Psychiatry faculty are heavily involved in integrating behavioral help into other local treatment sites, serving both pediatric and adult populations. The Jacobs School’s gastrointestinal division helps provide treatment for hepatitis C to patients in methadone treatment centers in New York City and Buffalo, in what is becoming a national model of care delivered by telemedicine.
UB is working with physicians, public and mental health officers, and addiction treatment centers in 28 counties in New York State to train health care practitioners in MAT for opioid addiction, including a number of high-need areas that were identified to have the greatest need for assistance because of their high opioid death and hospitalization rates.
Multiple schools and departments across UB research the causes and effects of the nation's opioid epidemic. For example, the Department of Pharmacology and Toxicology studies how the brain reacts and becomes addicted to opioids and released a key finding on which brain cells play key roles in regulating the motivation for heroin. The School of Nursing found that having a college education can be linked to opioid misuse among baby boomers, and the Dept. of Sociology learned that the poorest Americans are most likely to use prescription opioids and most users view opioids in a positive light because of their ability to fight chronic pain.
Many factors contribute to the development of addiction, including prenatal exposure to substances, family history, and the environment where a person is raised. UB researchers have conducted longitudinal studies on the role of prenatal alcohol use on children’s behavior. Now, they have found that prenatal marijuana use can affect infant size and behavior. Parents’ alcohol use and attitudes about alcohol can also play key roles future behavior. The Dept. of Psychology has found that letting kids sip and taste alcohol can contribute to later alcohol problems, despite the common belief the behavior is harmless. And researchers in the School of Nursing showed that parents’ alcohol use can set the stage for teenage dating violence.
How certain systems in the brain are affected by substance use, and how these changes may be reversed, is the subject of numerous research studies at UB. Researchers from the Dept. of Pharmacology and Toxicology have discovered new information about the molecular changes that occur in the brain when an individual takes cocaine, and how these molecules can be targeted to reduce drug-seeking behaviors during withdrawal. Other studies have shown that exercise is an effective strategy in treating addiction because it alters the brain’s dopamine system and that aerobic exercise can help beat cocaine addiction, in particular.