Substance use and overdoses are an epidemic in this country, and Rhode Island is not immune. But efforts to combat substance use are often highly misunderstood. This week’s episode sheds light on some of those efforts, commonly referred to as harm reduction and overdose prevention strategies.  

Our guest expert is Dr. Brandon Marshall, a professor of epidemiology from Brown University’s School of Public Health who’s research covers substance use, infectious diseases, and the social determinants of health of urban populations.  Dr. Marshall leads the development team at the Brown University School of Public Health for Prevent Overdose RI, the statewide overdose data dashboard.

With our co-hosts Dr. Jim McDonald and Dr. Philip Chan, Dr. Marshall  directly addresses some of the common misconceptions that people have about prevention efforts like safe injection sites, needle exchange programs, and the availability of naloxone, which is a medication that can reverse the effects of a drug overdose. 

Listen to this week’s episode to learn what Rhode Island is doing to address substance use, and find out how local efforts compare to what’s going on around the globe.  

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by Kassandra Frederique, Executive Director of the Drug Policy Alliance


Over the past year, we have witnessed visceral examples of how the systems that purport to protect and support us too often cause harm, especially to communities of color. Yet not enough attention has been given to the central role played by the war on drugs in creating this harm, and to how ending it is integral to reimagining public safety within our communities.”

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Dating violence is a serious issue on many college campuses throughout the country.

Unfortunately, substance misuse can make a troubled relationship even more volatile.

A study that surveyed 72 female college students, titled “Daily and situational reports of substance use and dating violence among college students: A 10-week prospective study,” took a closer look at this issue. In addition to physical violence, the study included “psychological aggression and sexual coercion.”

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NIH-supported pilot study found team-based approach may improve buprenorphine care.

A collaborative approach to treating opioid use disorder that relies heavily on community pharmacists is feasible and may increase adherence and participant satisfaction, according to a pilot study published  in Addiction.

Most people with opioid use disorder who would benefit from medication do not receive it. Buprenorphine is a safe and effective medication that has been used in opioid addiction treatment for nearly two decades, but providers must complete training and receive a special waiver in order to prescribe buprenorphine to treat opioid use disorder. In the United States, fewer than 10% of primary care providers are authorized to prescribe buprenorphine, and more than 20 million people in the United States live in a county without a buprenorphine-waivered physician. This lack of access is a significant barrier to treatment, especially to people in underserved communities.

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The Providence/Boston Center for AIDS Research Substance Use Research Core (CFAR SURC) is the only CFAR Core in the nation that focuses specifically on the intersection of substance use and HIV. The SURC is composed of 16 faculty members, who are leaders in the field of substance use and HIV research, and is led by co-Directors Christopher Kahler, PhD (Brown University) and Karsten Lunze, MD, MPH, DrPH (Boston University). 

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Sara Becker, PhD, Associate Professor of Behavioral and Social Sciences and of Psychiatry and Human Behavior, has won the 2020 G. Alan Marlatt Mid-Career Research Award from the Addictive Behaviors group of the Association for Behavioral and Cognitive Therapies. Dr. Becker was a COBRE Research Project Leader studying contingency management as a way to improve patient abstinence from opioids when combined with FDA-approved pharmacotherapy. Dr. Becker received independent funding in 2018.

By Mary A. Burke and Riley Sullivan

“Since the early 2000s Rhode Island has been among the states hardest hit by the opioid crisis. In response, the state has made it a priority to expand access to medication-assisted treatment (MAT) for opioid use disorder (OUD), which refers to the use of the FDA-approved medications methadone, buprenorphine, and/or naltrexone in conjunction with behavioral therapy. MAT is strongly supported by scientific evidence and endorsed by US public health officials and yet fails to reach many OUD patients. Using administrative data covering medical treatments and selected health outcomes for more than three-quarters of the Rhode Islanders covered by health insurance from mid-2011 through mid-2019, this report considers MAT’s efficacy in preventing opioid overdoses in Rhode Island and sheds light on the barriers to receiving MAT.”

New England Public Policy Center Research Reports (2020 | 20-3) 

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The government eased access to drug addiction treatment during the pandemic. Now that could go away.

When the Covid-19 pandemic forced much of the US to lock down in the spring of 2020, officials and experts worried the necessary social distancing measures would make another public health crisis — the opioid epidemic — worse. Addiction treatment is traditionally done in person, and restrictions on gatherings and closed businesses would make it much less accessible.

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“Findings from this study and previous clinical trials of long-acting, injectable formulations of buprenorphine for opioid use disorder have shown this medication can decrease opioid use and opioid-related overdose deaths. This study found that greater utilization of this medication was associated with less opioid use and higher probability of opioid abstinence, improved or maintained low levels of opioid withdrawal symptoms, low pain levels, improved or maintained positive health related quality of life outcomes, minimal depression, and higher employment rates as compared to the values observed prior to entering the clinical trials for long-acting, injectable buprenorphine that preceded this study. At the same time, these findings should be taken in context. Because of the way this study was structured, it can’t be known what portion of these positive outcomes were driven by medication effects, versus participants’ intrinsic motivation, or other factors. This however does not diminish the growing evidence base highlighting benefits of long-acting, injectable formulations of buprenorphine. This class of medications can help support opioid use disorder recovery as a stand-alone treatment, but may be most effective when used in combination with psychological treatments like Cognitive Behavioral Therapy, and/or mutual-help groups like Narcotics Anonymous or SMART Recovery.” 


Brendan Jacka, PhD, is an Investigator in Epidemiology at the Centers for Epidemiology and Environmental Health at Brown University. His pilot project, titled, “Trauma and stressor-related disorders among layperson opioid overdose responders”, seeks to understand the traumatic effects of responding to a drug overdose on community member responders in Rhode Island. This study is one of the first in the United States to examine and characterize stressor-related disorders related to overdose exposure in community members.

David Sobel, PhD, is a board-certified urologist at the Minimally Invasive Urology Institute and Kidney Stone Center at The Miriam Hospital.  He is also an assistant professor of surgical urology at The Warren Alpert Medical School of Brown University. His pilot project, titled, “Evaluation of a nonopioid recovery pathway after percutaneous nephrolithotomy (PCNL)”, will examine the feasibility and acceptability of a nonopioid recovery pathway after PCNL, a minimally invasive procedure performed by urologists for larger stone burden in the kidney. His hypothesis is that a novel nonopioid pathway after PCNL is both feasible and safe and will reduce postoperative prescriptions for opioids without impacting clinical outcomes, patient satisfaction or outpatient resources.

Brendan and David’s pilot projects will aid the COBRE’s mission by helping to understand the mechanisms underlying opioid use disorder and by developing innovative solutions to help combat the opioid crisis.

For more information about Brendan’s project, click here.

For more information about David’s project, click here.