Dennis Donovan Retiring as Director of the UW Alcohol & Drug Abuse Institute

August 29, 2018 by

donovan2017After twenty-five years, Dr. Dennis Donovan is stepping down as Director of the Alcohol & Drug Abuse Institute at the University of Washington.  He will continue his work in the CTN as the Co-PI (with Dr. Mary Hatch-Maillette) of the Pacific Northwest Node, member of the CTN Publications Committee, as well as selected other activities within the CTN, ADAI, and the UW, under his new status as Professor Emeritus.

Dennis M. Donovan has been the director of the Alcohol and Drug Abuse Institute since 1993 and a UW faculty member since 1981; he has been a Professor in Psychiatry & Behavioral Sciences and Adjunct Professor in the UW Departments of Psychology, Health Services, and Global Health.  He also directed the Substance Abuse and HIV/STI Scientific Working Group within the UW’s Center for AIDS Research. Dr. Donovan has been a Principal Investigator of numerous federally funded grants, including NIAAA’s Project MATCH, the NIAAA COMBINE Study, and NIDA’s National Drug Abuse Treatment Clinical Trials Network (CTN).  He has published more than 300 articles, chapters, and books in the area of alcoholism and addictive behaviors.

Before coming to ADAI, Dr. Donovan was affiliated with the Addictions Treatment Center at the Seattle Division of the Department of Veterans Affairs Puget Sound Health Care System for over 20 years, involved in clinical, administrative, training, and research activities. At the VA he directed the Inpatient Treatment Program and Assistant Director of the Addictions Treatment Center. Prior to moving full time to the University of Washington and ADAI, he served as the Associate Director and then Acting Director of the first Center of Excellence in Substance Abuse Treatment and Education (CESATE) within the Department of Veterans Affairs nationally. Among his many contributions within the VA system was the development of the first interdisciplinary fellowship in substance abuse treatment, including postdoctoral clinical psychologists, and post-masters nursing, social work, and occupational therapist trainees. In 2013, he was invited to serve on the Institute of Medicine’s (IOM) Committee for an Evaluation of the Department of Veterans Affairs Mental Health Services.

The University of Washington will launch a national search for a new director of ADAI soon; until then, Dr. Caleb Banta-Green, Principal Research Scientist at ADAI, will serve as interim director.

Dennis (aka “Dr. Pun-ovan”)’s retirement will be noted at a party on August 30 with many Seattle colleagues and friends on hand to wish him well.  Thank you, Dennis, for your decades of good work and good cheer at ADAI and for the CTN! Best wishes and happy kayaking!

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Gender Differences in Individuals with Opioid Use Disorder Receiving Inpatient Care

August 16, 2018 by

When looking at profiles of men and women with opioid use disorder (OUD), a number of gender differences become evident. Women report more issues with drug, medical, psychological, family/social, and employment problems, while men report more problems with legal and alcohol-related issues.

Additionally, while there was a 265% increase in prescription opioid overdoses for men between 1999 and 2010, women experienced a 400% increase. Building knowledge of gender differences in demographic and clinical characteristics could help improve outcomes for both men and women in treatment.

This analysis, co-authored by PN Node investigator Mary Hatch-Maillette, PhD (Alcohol & Drug Abuse Institute, UW), examined baseline gender differences in individuals with OUD receiving inpatient services, as part of NIDA Clinical Trials Network protocol CTN-0051, a randomized, controlled trial comparing extended-release naltrexone to buprenorphine. Participants (N=570) provided demographic, substance use, and psychiatric history information.

Results found that the women in the study, compared to the men, were:

  • significantly younger;
  • more likely to identify as bisexual, live with a sexual partner, and be financially dependent on someone else;
  • less likely to be employed;
  • more likely to report psychiatric history (anxiety/panic disorder, bipolar disorder, major depression);
  • more likely to engage in sexual and drug risk behaviors (exchanging sex for drugs, sharing injection equipment).

Women also reported shorter duration, but similar age of onset, of opioid use.

Conclusions: Findings underscore economic, psychiatric, and infection vulnerability among women with OUD, which may complicate treatment initiation, retention, and recovery. Gender-specific interventions focused on these areas of disparity for women with OUD should be considered, including integration of OUD care with treatment for co-occurring psychiatric disorders and trauma, couples-based risk reduction interventions which address relational dynamics, and interventions that address the unique needs of sexual minority women.

Citation: Campbell ANC, et al. Brief Report: Gender differences in demographic and clinical characteristics of patients with opioid use disorder entering a comparative effectiveness medication trial. American Journal on Addictions 2018 (in press).


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PrEP Survey Protocol in Development for PNW Node

August 2, 2018 by

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Dr. Mary Hatch-Maillette will be the Co-lead Investigator of the new protocol CTN-0082, Implementation Survey of PrEP and Opioid Use Related Services In STI Clinics and MSM-Centered Community Based Organizations (CBOs), along with Dr. Susan Tross of the Greater New York Node.

While HIV incidence in the broader population in the US decreased by 18%, between 2008 and 2014, among men who have sex with men (MSM), it increased by 6%. Pre-exposure prophylaxis (PrEP) is at the cutting edge of HIV prevention worldwide, yet widespread use and promotion of PrEP has not been widely adopted. Also, despite of current evidence on efficacy of Naloxone and MAT interventions to prevent opioid overdose and treat opioid use disorders (OUD), appropriate models to implement in MSM-Centered CBOs are yet to be identified. Information (e.g. access, readiness, capacity, barriers, resource gaps, etc.) is needed to assist in the effort to increase awareness and use of PrEP and adoption of OUD interventions.

The PrEP Survey study aims to identify health department STI clinics and and/or HIV- centered community-based organizations delivering services to assess: 1) program directors’ and providers’ knowledge/awareness of, interest in, perceived challenges / facilitators to and strategies for, offering PrEP and OUD interventions 2) and MSM’s knowledge / awareness of, interest in, perceived challenges/facilitators to and recommended strategies for, being offered PrEP and OUD interventions.

Clinical sites where the study will be implemented have not yet been announced.

UW & WSU Symposium on Marijuana Research in Washington

June 5, 2018 by

On May 18, 2018, the University of Washington’s Alcohol & Drug Abuse Institute hosted its 3rd Symposium on Marijuana Research in Washington, this year in collaboration with colleagues from Washington State University.

The keynote speaker, Washington State Attorney General Bob Ferguson (pictured below), spoke about issues of federal vs. state marijuana laws, and about Washington’s law protecting local jurisdictions’ right to exclude marijuana retail stores even if the product is legal in the state.

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Scientists from the UW and WSU presented panels in three focus areas:

  • Marijuana and Vulnerable Populations
  • Cannabinoids: Therapeutic Potential
  • Marijuana Use & Other Substances: Substitution, Combination, or Both?

The event drew approximately 200 researchers, state and local officials, and community partners.

Video, slides, and speaker information  are available at: http://adai.uw.edu/mjsymposium/.

ADAI received funds from Washington’s Marijuana Dedicated Fund to support marijuana research and information dissemination, described in a report covering activities from July 2015-June 2017.

Mary Hatch-Maillette Named Co-Director of the Pacific NW Node

April 27, 2018 by

The Pacific Northwest Node is delighted to announce that in March 2018, Dr. Mary Hatch-Maillette was named Co-Director of the Pacific Northwest Node. Having joined the University of Washington’s Alcohol & Drug Abuse Institute in 2003 to work on CTN-0018, Safer Sex for Men, she has since held a variety of local and national roles in seven additional CTN protocols and two platform studies, including the BEing Safe in Treatment (BEST) study.  In addition, she maintains a private psychotherapy practice in Seattle. Her primary research interests are in substance use treatment and HIV risk behavior.

Now one of the longest-serving members of the Pacific Northwest Node and a CTN “veteran,” Mary has co-authored 45 papers, posters, and presentations for the CTN.  She is excited to join the CTN leadership and continue the PNW Node’s tradition of blending science and practice in the treatment of substance use disorders.

SAMHSA TIP 63: Medications for Opioid Use Disorders

February 28, 2018 by

The goal of treatment for opioid addiction or opioid use disorder (OUD) is remission of the disorder leading to lasting recovery. Recovery is a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential.

SAMHSA’s new Treatment Improvement Protocol (TIP), “Medications for Opioid Use Disorder (TIP 63),” helps behavioral healthcare professionals broaden their understanding of the three FDA-approved medications—methadone, naltrexone, and buprenorphine—used to help treat Americans with opioid use disorder, as well as the other strategies and services needed to support recovery for people with OUD.

Download the new TIP or order print copies onlinehttp://bit.ly/2ExvUkz

TIP 63 had significant input from researchers, clinicians, and information specialists affiliated with the Pacific NW Node. Ron Jackson, MSW, LISW and Andrew Saxon, MD served on the Expert Panel to help develop the TIP via a consensus-driven, collaborative process that blends evidence-based, best, and promising practices with the panel’s expertise and combined wealth of experience.

In addition, field reviewers for this TIP included Meg Brunner, MLIS from the CTN Dissemination Library and ADAI, Alison Newman, MPH (ADAI) and Mary Catlin, RN, MPH, CIC, (DOH and ADAI). The field review allows people who work in addiction, mental health, and adjacent fields to gauge the TIP’s relevance, utility, accuracy, and accessibility.

CTN Dissemination Library - What's New

The goal of treatment for opioid addiction or opioid use disorder (OUD) is remission of the disorder leading to lasting recovery. Recovery is a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential.

SAMHSA’s new Treatment Improvement Protocol (TIP), “Medications for Opioid Use Disorder (TIP 63),” helps behavioral healthcare professionals broaden their understanding of the three FDA-approved medications—methadone, naltrexone, and buprenorphine—used to help treat Americans with opioid use disorder, as well as the other strategies and services needed to support recovery for people with OUD.

Download the new TIP or order print copies onlinehttp://bit.ly/2ExvUkz

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News from the Pacific Northwest Node

December 19, 2017 by

Grant News: The Alcohol & Drug Abuse Institute at the University of Washington, home of the CTN Pacific Northwest Node, is pleased to join the Addiction Technology Transfer Centers Network as the new Northwest Regional ATTC, serving Alaska, Idaho, Oregon, and Washington.  The work of the NWATTC will encompass information dissemination, training and technical assistance, and systems consultation for SUD and healthcare organizations and their personnel—all intended to increase awareness and implementation of empirically-supported behavioral health treatment and recovery practices.  Read more about the ATTC Network and its new initiatives.

People News: The PNW Node says farewell and good luck to Elizabeth Witwer, MPH, relocating to the East Coast for a research position at the Guttmacher Institute, where she had worked previously.  During her time with the PNW Node, Ellie worked with colleagues on the new Practice Based Research Network SIG that aims to  expand the number of NIDA CTN protocols relevant to and engaging primary care practices, and to increase the ability of community-based practices to participate in CTN studies.  Drs. Laura-Mae Baldwin (Pacific Northwest Node) and Rowena Dolor (Mid-Southern Node) are co-chairs. Read more about the PBRN SIG.

In a “Conversation with Michelle Peavy,” CTN researcher and psychologist Michelle Peavy discusses the role of research in improving the delivery of effective treatment to clients at Evergreen Treatment Services, an opioid treatment program in Seattle.  Dr. Peavy is one of the co-authors of the recent primary outcomes article for CTN-0051, the X:BOT study.

Recent publications from the Pacific Northwest Node:

Opioid Treatment Drugs have Similar Outcomes once Patients Initiate Treatment

November 15, 2017 by

subvivMedication-assisted treatment is superior to placebo and counseling-only treatment for opioid use disorders, according to a new article by CTN researchers.

This study, CTN-0051, (X:BOT) aimed to estimate the difference in opioid relapse-free survival between Buprenorphine-naloxone (BUP-NX) and extended-release naltrexone (XR-NTX).  It was a 24-week, open-label, randomized controlled, comparative effectiveness trial held in 8 U.S. community-based inpatient services, with outpatient follow-up for participants, all of whom were users or heroin or prescription-type opiates.  Evergreen Treatment Services in the PNW Node was one of 8 participating sites.

While both medications are used to treat OUD, they are pharmacologically and conceptually distinct interventions for preventing opioid relapse, and, until now, a study directly comparing them to each other had not been done.

Half of the participants (283) were randomized to receive XR-NTX (Vivitrol), a monthly injection, with the other half (287) assigned to receive BUP-NX (Suboxone), which came as a film patients placed under their tongues (“sublingual”). Participants were followed for 24 weeks of outpatient treatment, with “relapse”  considered to be 4 consecutive weeks of any non-study opioid use as measured by urine toxicology or self-report, or 7 consecutive days of self-reported use.

As expected, patients randomized to XR-NTX had a substantial induction hurdle: XR-NTX can trigger severe withdrawal in patients if they have not detoxed from opioids first, and detox can be extremely difficult for opioid users (treatment with Suboxone can be started sooner, while the patient is still experiencing some withdrawal). As a result, fewer participants successfully initiated treatment with XR-NTX (72%) than with BUP-NX (94%).

Among all participants who were randomly assigned (“intention-to-treat” population, n=570), 24-week relapse events were greater for XR-NTX (65%) than for BUP-NX (57%). However, most or all of this difference (89%) was due to patients in the XR-NTX group dropping out of detox before receiving the medication.

Of the 474 participants who did successfully begin treatment, however, researchers found that:

  • 24-week relapse events were similar for both XR-NTX and BUP-NX (about half of both groups relapsed). In other words, both medications were equally effective.
  • Self-reported opioid craving was initially less with XR-NTX than with BUP-NX, but by week 24, participants reported similar levels of craving.
  • With the exception of mild-to-moderate XR-NTX injection site reactions, treatment-emergent adverse events, including overdose, did not differ between treatment groups.

Conclusions: In this population of opioid users, it was more difficult to initiate patients to XR-NTX than BUP-NX, and this negatively affected overall relapse. However, once initiated, both medications were equally safe and effective. Future work should focus on facilitating induction to XR-NTX and on improving treatment retention for both medications.

Related:

Citation: Lee JD, et al. Comparative Effectiveness of Extended-Release Naltrexone Versus Buprenorphine-Naloxone for Opioid Relapse Prevention (X:BOT): A Multicentre, Open-Label, Randomised Controlled Trial. The Lancet 2017 (in press).

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12-Step Sponsorship Associated with Positive Outcomes for Stimulant Users

March 30, 2017 by

Mutual support groups are free, readily available, and cost-effective resources for supporting long-term recovery from substance use disorders.

In particular, 12-step programs like Alcoholics Anonymous, are popular and generally seen as an integral part of an international shift toward a chronic-care model of addiction treatment and recovery.

One frequently theorized mechanism for the efficacy of 12-step groups is social support, or the “fellowship” aspect, particularly “sponsorship,” in which a 12-step participating in long-term, stable recovery voluntarily serves as a role model and supportive guide to a fellow participant in earlier recovery.

Previous studies on 12-step sponsorship have focused almost exclusively on Alcoholics Anonymous and individuals with alcohol use disorders. This secondary data analysis by Dennis Wendt and others from the Pacific Northwest Node, however, explored predictors and outcomes of having a 12-step sponsor among individuals receiving treatment for stimulant use disorders, inclusive of four types of 12-step groups (Narcotics Anonymous, Alcoholics Anonymous, Cocaine Anonymous, and Crystal Meth Anonymous).

The analysis used data from the CTN Stimulant Abuse Groups to Engage in 12-Step (STAGE-12) protocol (CTN-0031), a multisite randomized trial in which participants receiving treatment for stimulant use disorder (N=471, 59% women) were randomized into treatment as usual (TAU) or a 12-step facilitation (TSF) intervention (STAGE-12).

Logistic regression analyses explored the extent to which participants obtained sponsors, including the extent to which treatment condition and other predictors (12-step experiences, expectations, and beliefs) were associated with having a sponsor.

The relationship between end-of-treatment sponsorship and follow-up substance use outcomes was also tested.

Results found that participants were more likely to have a sponsor at the end of treatment and 3-month follow-up, with the STAGE-12 condition having higher sponsorship rates.

Twelve-step meeting attendance and literature reading during the treatment period predicted having a sponsor at the end of treatment. Sponsorship at the end of treatment predicted a higher likelihood of abstinence from stimulant user and having no drug-related problems at follow-up.

Conclusions: This study extends previous research on sponsorship, which has mostly focused on alcohol use disorders, by indicating that sponsorship is associated with positive outcomes for those seeking treatment from stimulant use disorders. It also suggests that sponsorship rates can be improved for those seeking treatment from stimulant use disorders through a short-term TSF intervention.

Citation: Wendt DC, et al. Predictors and Outcomes of Twelve-Step Sponsorship of Stimulant Users: Secondary Analyses of a Multisite Randomized Clinical Trials. Journal of Studies on Alcohol and Drugs 2017;78:287-295.


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Congratulations to Molly Carney, Director of ETS!

March 21, 2017 by

Molly Carney, PhD, MBA of Evergreen Treatment Services

The Pacific Northwest Node is excited to announce that one of our CTP directors, Molly Carney, of Evergreen Treatment Services, will be receiving the Excellence in Advocacy – Individual Achievement award at the National Council for Behavioral Health meeting this April in Seattle!

The National Council for Behavioral Health is the unifying voice of America’s mental health and addictions treatment organizations. Its annual Awards of Excellence honor the advocates and leaders advancing public policies that support improved quality of and access to care, organizations that promote excellence and build health communities, and the achievements of individuals with mental illnesses and addictions, their family members, and the professionals who care for them.

Molly Carney, PhD, MBA, is trained as a clinical psychologist and has worked in substance use disorder treatment since 1986, most recently as director of Evergreen Treatment Services, a private, nonprofit agency offering medication-assisted treatment for adults with opioid use disoders since 1973.

The Pacific Northwest Node says “Congratulations and thank you for your outstanding service!” to Dr. Carney!