A new lecture series at Virginia Commonwealth University will address the opioid crisis, honoring the son of a VCU professor who died of an overdose.
The Adam Abubaker Memorial Lecture will bring experts and leaders together annually to focus on topics related to addiction medicine. Lecturers will present on prevention, treatment, and community health in a way that enhances the knowledge and understanding of addiction and substance use disorders.
Adam Abubaker was the son of Omar Abubaker, D.M.D., Ph.D., chair of oral and maxillofacial surgery in the VCU School of Dentistry. Adam was prescribed narcotics for pain after a high school shoulder injury, and Abubaker believes this led to his son’s heroin addiction and eventual overdose.
“Doctors and dentists, including myself, were part of this opioid epidemic,” Abubaker told VCU News last year. Since his son’s death in 2014, Abubaker has dedicated himself to spreading awareness of the dangers of opioids and over-prescription. The memorial lectureship will continue that work.
The Department of Psychiatry at the VCU School of Medicine will host the lectureship. Wright Center Director F. Gerard Moeller, M.D., is the division chair for the department and the director of the VCU Institute for Drug and Alcohol Studies.
“The opioid epidemic hasn’t gone away during the COVID-19 crisis,” said Moeller. “In fact, the pandemic is making the problem worse, as we’re seeing a surge in opioid overdoses. This lectureship will be a great addition to our addiction research and education programs at VCU – and an appropriate memorial for Adam and others who have died as a result of opioid addiction.”
To fund the lectureship, the MCV Foundation is raising a minimum of $100,000 to permanently endow it. Anyone interested in contributing to fundraising efforts for the lectureship can complete an MCV Foundation pledge form.
This story originally appeared in the MCV Foundation‘s Next magazine. To read the full story and other articles about life-changing innovations occurring on the MCV Campus, click here.
Those who survive an opioid overdose usually do so because they’re found in varying states of consciousness by family members, friends, caregivers or first responders before their breathing stops completely.
These survivors gain an additional opportunity at life, but oftentimes, because of the nature of their illness, they can’t use their new opportunities for change and recovery.
F. Gerard “Gerry” Moeller, M.D., director of the VCU C. Kenneth and Dianne Wright Center for Clinical and Translational Research, began contemplating these missed opportunities one day in 2017 after hearing from colleagues in the VCU Health Emergency Department.
“They came to me and said they were seeing overdose patients time and time again, and they felt like they just weren’t accomplishing anything,” Dr. Moeller said. “They were reviving the patients, but then the survivors weren’t getting into long-term treatment.”
Dr. Moeller, who is internationally known for his translational research on impulsivity and addictions, is keenly aware of the importance long-term treatment plays in pulling people out of a deadly spiral like the one his colleagues described to him, and he wanted to help.
His preliminary data showed that opioid overdose visits to the VCU Health Emergency Department went from approximately 270 in 2015 to more than 650 in 2017, and from all of those visits, as many as one in five patients experienced a repeat overdose or died within 12 months of their initial overdose.
Dr. Moeller knew these numbers demanded action toward finding the reason survivors weren’t getting the help they needed, and, most importantly, toward identifying a new approach to helping the survivors avail the opportunities they’d been given for a new life.
Why are survivors not getting help?
After an overdose victim arrives at the emergency department, he or she is stabilized, monitored for some time and then referred to a long-term outpatient facility where appropriate follow-up treatment, usually for addiction, can begin.
Dr. Moeller believes this referral is the critical moment in the treatment paradigm that can and should be changed. That’s because the overdose medication naloxone is very effective at saving lives, but it also causes acute opioid withdrawal, leading to nausea, vomiting, sweating, diarrhea, chills, cravings, impulsivity and poor decision-making.
“One of the behavioral definitions of impulsivity is the lack of ability to delay your gratification,” Dr. Moeller said. “So, if you’re in withdrawal, you have all these symptoms and you wish you were dead. You realize that when you walk out the door of the hospital you can get something that will make you feel better — it’s heroin, or it’s oxycodone, or it’s a pill. Even though you know you just almost died from an overdose, the threat of that happening again is in the future.”
Because of this impulsivity, which is often amplified because of the lifesaving medication, many patients never go to clinics when they’re referred for long-term treatment, opting instead to seek an immediate fix.
What can be changed to better encourage long-term care?
Instead of referring overdose survivors, who are likely experiencing acute withdrawal, to long-term care after they leave the emergency department, Dr. Moeller is testing the effectiveness of initiating long-term treatment before the survivors ever leave the hospital. The goal here is to counteract withdrawal symptoms and reduce impulsivity.
For those who agree to participate, Dr. Moeller’s team, working inside the emergency department, makes contact and provides a medication called buprenorphine that reverses the withdrawal symptoms. Patients are then given a referral within 72 hours to the outpatient clinic, where they continue medication and counseling for addictions.
In addition to administering buprenorphine as early as possible before survivors leave the hospital, the long-term care component of the study is vitally important to the recovery of survivors. In Richmond, referrals to long-term outpatient care guide participants to the VCU Health MOTIVATE Clinic, where social workers, nurses and physicians monitor patients’ progress weekly, provide behavioral counseling sessions in individual and group settings, and administer buprenorphine monthly.
Improving the likelihood that overdose victims reach this long-term component of care is essential, Dr. Moeller said. “Addiction really is a chronic medical disorder. Like diabetes and hypertension, a one-time treatment is not going to solve the problem, so patients need chronic medication and behavioral treatments like group therapy to help them with lifestyle changes.”
Dr. Moeller will serve as principal investigator on the trial and will work with Robert Lipsky, Ph.D., director of translational research in the Department of Neurosciences at Inova Fairfax Hospital, and Warren Bickel, Ph.D., professor of psychiatry and director of the Addiction Recovery Research Center at Virginia Tech Carilion Research Institute. The trial is funded in part by a $500,000 Virginia Catalyst grant from the Virginia Biosciences Health Research Corporation.
If the results show what Dr. Moeller expects, which is a significant drop in repeat overdose and death rates compared to previous data, this trial will establish a new paradigm for treatment of patients after opioid overdose that can be utilized nationally to help survivors get the help they need before it’s too late.
The MCV Foundation encourages and stewards gifts to support research like Dr. Moeller’s that fight all types of diseases. If you’re interested in learning about the tools the Foundation has available to use in making those gifts, visit their giving page.
I’m working on innovative ways to measure brain function and structure with magnetic resonance imaging. As an MRI physicist, I design unique scans to noninvasively image tissues or measure physiological mechanisms in the human body. This can include measuring brain activity during mental tasks, visualizing cortical and white matter structures and measuring the quantity of neurotransmitters in different regions of the brain. We are particularly interested in the effects of substance use on the brain and how addiction drives the continuing use of potentially harmful substances like opioids, cocaine and alcohol.
2. What do you hope to achieve with this research?
By measuring differences between a person who is addicted to harmful substances and someone who is not, we can see which parts of the brain are driving addictive behavior and tailor treatments based on the data we collect. In addition, we can see how treatments for substance use are working in restoring the person’s function to what we see in people who are not addicted to drugs or alcohol.
3. How will this research make a difference?
Drug and alcohol use, particularly opioid use, are at epidemic levels in the U.S. Here, we have the opportunity to provide high-quality imaging-based research to help our VCU and VCU Health colleagues who are researching drug use by giving them important data to help them investigate and find the best treatments. VCU has an astounding collaborative environment with the VCU Institute for Drug and Alcohol Studies and the Collaborative Advanced Research Imaging facility that houses a research-dedicated MRI system. Having CARI here helps tremendously in getting the data we need to investigate several conditions including addiction, liver disease and heart disease.
4. Tell us about how you are investigating this.
We use two main techniques: functional MRI and magnetic resonance spectroscopy. In fMRI, when part of the brain is activated — by a mental or physical task, or even at rest — the exchange of oxygenated and deoxygenated blood in addition to blood flow changes can be measured. This can then be processed to image areas of activation in the brain. We can also use this to measure how different regions of the brain communicate with each other over a period of time. In MRS, we can measure the amount of certain metabolites or neurotransmitters in the brain. We are particularly interested in the neurotransmitters glutamate and gamma-aminobutyric acid, as they are usually altered with drug and alcohol use.
5. What’s the biggest challenge right now?
When people usually think of MRI, it is of a radiologist viewing a scan in order to make a diagnosis. While this is certainly true, there is an abundance of quantitative data that can come from these scans. This quantitative approach requires a dedicated team to carefully process gigabyte-sized data sets for each participant scanned. This can be anything from looking at changes in cerebral blood flow, visualizing white matter tracts or even measuring the amount of fat in the liver in chronic alcohol use. While it is a challenge and takes time to process a lot of data, it is very rewarding and fun to come up with new ways to measure things inside the body in a way that couldn’t be done before.
The Wright Center for Clinical and Translational Research will provide funding and research infrastructure for this opioid clinical trial. Dr. Moeller, the Center’s director, will serve as principal investigator on the trial!
Monday, Dec. 4, 2017
Virginia Commonwealth University today announced that it is leading a clinical trial to test SUBLOCADE™ (buprenorphine extended-release) injection for subcutaneous use (CIII), a once-monthly injectable formulation of buprenorphine for the treatment of moderate-to-severe opioid use disorder.
The VCU-led clinical trial will test innovative methods to prevent repeat opioid overdose by recruiting patients into treatment immediately after they recover from an overdose. During the 18-month clinical trial, VCU researchers will study SUBLOCADE-assisted intervention in adults diagnosed with opioid use disorder who have been successfully treated for an opioid overdose in the emergency department and immediately brought to outpatient treatment.
The research will involve collaboration with Virginia Tech Carilion Research Institute and Inova Fairfax Hospital.
“The main goal of the research is to develop a new treatment paradigm for patients after an overdose,” said F. Gerard Moeller, M.D., professor of psychiatry, pharmacology and toxicology, and neurology at VCU School of Medicine and director of the VCU Institute for Drug and Alcohol Studies. Moeller will serve as principal investigator on the trial. He will be joined by Robert Lipsky, Ph.D., director of translational research in the Department of Neurosciences at Inova Fairfax Hospital, and Warren Bickel, Ph.D., professor of psychiatry and director of the Addiction Recovery Research Center at Virginia Tech Carilion Research Institute.
The clinical trial is jointly funded by the Virginia Biosciences Health Research Corporation, Virginia Commonwealth University and Indivior Inc., which is headquartered in Richmond. Indivior has been developing medications to treat opioid use disorder for more than 20 years and is providing SUBLOCADE for use in the trial. Funding for the clinical trial is housed at the C. Kenneth and Dianne Wright Center for Clinical and Translational Research, where Moeller serves as director. The Wright Center will also provide research infrastructure for the clinical trial.
“We look forward to collaborating with VCU, Inova Fairfax Hospital and Virginia Tech Carilion Research Institute to study the effects of SUBLOCADE in the emergency environment together with behavioral therapy in outpatient treatment to possibly prevent repeat opioid overdoses and potentially change the standard of care for those who are recovering from opioid overdose,” said Christian Heidbreder, Ph.D., chief scientific officer at Indivior.
Standard treatment for an overdose until this point has started with first responders administering an opioid overdose reversal drug to a patient following an overdose. The reversal drug saves the patient’s life, but it also puts the patient into withdrawal as they are transported to a hospital, where they are typically monitored for a few hours before being sent home with a referral for outpatient addiction treatment.
“Unfortunately, the relapse rate is high,” Moeller said, adding that patients typically are not receptive to a referral for addiction treatment when they are in withdrawal.
The proposed new paradigm would allow treatment to begin in the emergency room, with an active referral and immediate transportation to the outpatient clinic. At the outpatient clinic, patients would receive SUBLOCADE and meet with a behavioral therapist.
“We know that treatment programs work when they combine medication with continuing addiction health care and support,” said Bickel, whose research since 1983 has helped lead to opioid replacement therapies that are currently in use.
“It would be a new treatment paradigm for patients after an overdose.”
Patients will be recruited for the trial from VCU Medical Center’s Emergency Department and will receive follow-up care at the VCU Health MOTIVATE Clinic. Virginia Tech is collaborating on development of behavioral biomarkers of addiction related to impaired decision-making. Inova is contributing research on personalized medicine and pharmacogenomics of opioid overdose.
“This research could have a major impact on a public health emergency,” Moeller said. “It would be a new treatment paradigm for patients after an overdose, with the goal of reduction of repeat overdoses and deaths.”
Virginia Commonwealth University is a major, urban public research university with national and international rankings in sponsored research. Located in downtown Richmond, VCU enrolls more than 31,000 students in 220 degree and certificate programs in the arts, sciences and humanities. Seventy-nine of the programs are unique in Virginia, many of them crossing the disciplines of VCU’s 13 schools and one college. The VCU Health brand represents the health sciences schools of VCU, the VCU Massey Cancer Center and the VCU Health System, which comprises VCU Medical Center (the only academic medical center and Level I trauma center in the region), Community Memorial Hospital, Children’s Hospital of Richmond at VCU, MCV Physicians and Virginia Premier Health Plan. For more, please visit www.vcu.edu and vcuhealth.org.