UB Council updated on UB’s efforts to address opioid epidemic

UB’s efforts to partner with the community to address the opioid crisis was the focus of a presentation by Nancy Nielsen, senior associate dean for health policy in the Jacobs School of Medicine and Biomedical Sciences, at Monday’s meeting of the UB Council.

Nielsen told council members that UB has a “unique opportunity” to address the opioid epidemic, pointing to the university’s status as a “pioneer in the field of addiction medicine” with one of the first addiction medicine fellowships in the country, and the “national reputation” of the former Research Institute on Addictions (RIA), now the Clinical and Research Institute on Addictions (CRIA).

Moreover, 160 faculty members across the university are interested in and doing research on addictions, and the move of the Jacobs School to the downtown medical campus “creates a new opportunity, new space, new people we have not interacted with before, and externally new funding opportunities,” she said.

In assessing the issue, “What we found is this region — the people outside of UB —are hungry for leadership,” she said.

UB gathered information from regional service providers, state and local government agencies, hospitals, funding sources, the Catholic Health System and insurers to find out what they were doing to address the opioid crisis, “and they’re doing a lot,” she said.

But there’s a lack of coordination, she noted, and there was not sufficient access to care for patients who were already opioid-addicted.

“What we know is that this is a chronic, relapsing but treatable disease,” she said, and that treatment gaps exist for three specific populations: chronic pain patients, pregnant opioid addicts and adolescents.

There is treatment available, but it is underutilized, and the workforce at provider agencies is inadequate. “They are really hungry for more educational efforts, which we are planning to implement,” she said.

Nielsen noted that after examining the issue, UB decided there was no need to:

• Duplicate existing services in the community “as long as they’re being done well and are evidence-based.”
• Build a new facility for residential treatment, like the Betty Ford Center.
• Compete on routine services.
• “Own everything or control everything.”

UB, instead, “is focusing on what we do best,” Nielsen said. “That is research, education and clinical care.”

“We want to influence others and inform others in a collaborative way, not a control,” she said, and leverage the university’s wide range of expertise.

“What we’re trying to do in this partnership with the region is caring. What we’re doing is creating an addictions response network.”

UB’s restructuring of RIA into CRIA will broaden its focus to emphasize opioid addiction.

Nielsen pointed out the new focus will make the unit “more robust and more collaborative with the rest of the university.” The College of Arts and Sciences will spearhead the educational efforts, with plans for an undergraduate minor and a master’s degree in addiction studies.

So, what’s the plan going forward? A novel approach to addiction treatment that is based in a hospital’s emergency room.

In this model -- which the state Department of Health and Office of Alcoholism and Substance Abuse Services consider to be an approach that will be replicated across the state, Nielsen told council members -- ER physicians serve as the “gateway” to treatment, and addiction specialists serve as “consultants.”

Since there are not enough addiction specialists in the community, “the idea is to get primary care physicians to assume the ongoing treatment with medication-assisted treatment (MAT) when the patient is stabilized,” she said.

“This is a very hard sell,” Nielsen noted, because most physicians do not know how to administer MAT and even those who have been trained to do it are hesitant.

To facilitate this, UB is incorporating MAT training in all its primary care and emergency medicine residencies, she said.

She pointed to a recent article in The New York Times about a hospital in California that was beginning to administer buprenorphine to opioid patients in the emergency room. While the story’s headline referred to this as “rare treatment, it is not rare here,” Nielsen said. “We are doing that, and we’re actually doing it better than they’re doing it in California.”

That’s because patients who receive buprenorphine in a Western New York ER also have access to a network that UB’s Department of Emergency Medicine created with local service providers to provide 60 open slots in treatment programs each week.

“If a patient goes to ECMC (Erie County Medical Center) on a Sunday night with an overdose and they want to be treated, there is a slot available to them the next day,” Nielsen said, adding that preliminary studies show that about 85 percent of patients take that treatment slot.

“UB is the catalyst that both accelerates and enables change,” she told council members. “We are bringing all the best minds at UB to the table. What we’re going to do is what we do best, which is research, and teach, and provide clinical care.

“We believe that we will lead the nation in a regional approach in how to deal with addiction — where you don’t own everything, but you help lead it.”

Council members and others attending Monday’s meeting on the fifth floor of Capen Hall walked through a crowd of graduate students and faculty supporting the UB Living Stipend Movement, which is advocating for higher stipends for graduate students.

In his report during the meeting, Provost Charles F. Zukoski addressed the issue of student stipends, noting UB’s deans and departments continuously review graduate student programs and funding packages in order “to attract the very best students to UB and to ensure their success.”

He cited as an example the College of Arts and Sciences, which he said has an ongoing process for improving graduate student programs and outcomes, as well as reviewing stipends and fellowships. He noted that the English Department is increasing stipends for its doctoral students from $15,000 to $20,000 over four years, which he said exceeds the national average among public institutions in the Association of American Universities.

These stipends, Zukoski pointed out, are part of a larger funding package that includes health insurance and a tuition scholarship funded by the university, and averages $38,000 annually across the university, although the amount varies by school and department.

“The university very much values the talent and dedication of our doctoral students and their contributions to our educational and research programs,” he said. “We invest in these students as they are the core of our mission.”

UB’s official statement on graduate student stipends can be found here.