OHIO researcher receives more than $1 million in funding from the National Institute on Drug Abuse

Berkeley Franz, Ph.D., a researcher in 91̽��’s Heritage College of Osteopathic Medicine and the Appalachian Institute to Advance Health Equity Science (ADVANCE), was awarded over $1 million by the National Institute on Drug Abuse for two separate studies that are aimed at helping provide resources to combat the opioid epidemic.

The first study will test whether a novel training intervention can reduce the stigma surrounding a prescription drug used to treat opioid use disorder and the hesitation some health care professionals have with prescribing it. According to the Substance Abuse and Mental Health Services Administration, Buprenorphine is a narcotic used to treat pain, but it also is used to treat opioid use disorder by managing withdrawal symptoms and reducing opioid cravings.

Franz, who is the principal investigator on the $697,561-funded study, will collaborate with Janet Simon, an associate professor in OHIO’s College of Health Sciences and Professions (CHSP), as well as researchers from The Ohio State University, the University of North Carolina, and former OHIO colleague Lindsay Dhanani, who is now at Rutgers University.

This study builds on a previous study Franz and Dhanani conducted that found physician bias is more acute in Ohio’s rural counties than in urban counties and that rural areas had fewer harm reduction services, such as syringe exchanges and Buprenorphine prescribers, suggesting that rural patients with opioid use disorder face increased challenges to finding effective treatment. The findings from this study led them to expand their look into stigma surrounding opioid use and treating opioid use disorder.

“Prescribing medications like Buprenorphine helps save peoples’ lives,” Franz said. “Compared with abstinence-only treatment, patients who receive Buprenorphine are much less likely to experience a fatal overdose, and medication use also lowers the transmission rate of infectious diseases such as HIV and HCV. This type of medication keeps people from experiencing withdrawal and is considered a form of harm reduction. It is extremely effective at keeping people alive and allowing them to have a better quality of life.”

Franz said there has been significant pushback on prescribing this type of medication to people with opioid use disorder because the drug has been characterized as just another opioid. However, paired with access to treatment, Buprenorphine remains a life-saving tool that allows for those with opioid use disorders to have the opportunity to seek treatment. Although this drug is more commonly used in some communities, physicians in rural settings rarely prescribe it.

For the study, the research team will measure the attitudes of physicians, nurses, and physician assistants regarding prescribing the drug and then will develop and pilot a training intervention among federally qualified health centers in rural areas of Ohio that serve uninsured and underserved communities.

“It’s hard to change people’s behaviors,” Franz said. “But we have an incredibly effective medication that is currently underutilized — we have to better inform medical professionals of the benefits of medication. Patients living in rural areas experience significant barriers in accessing Buprenorphine, so we’re hoping that by providing a better understanding of the use of this drug, there will be more support for the use of this type of medication over time.”

The training program they will develop will last approximately one hour and will be held online. Once the initial training is complete, medical professionals will then complete a booster module and will have an hour with an addiction medicine professional and other prescribers to answer questions and discuss concerns regarding Buprenorphine prescribing. The training will provide education on how the medication works as well as perspectives from health care professionals who have prescribed it and found success in the management of opioid use disorder.

The second study focuses on developing tailored implementation strategies to help safety net hospitals, which disproportionately serve urban and rural underserved communities, offer transitional opioid services for patients being discharged. Franz is the principal investigator, along with Ji Eun Chang, on this $713,981-funded study. They are working with CHSP professor Cory Cronin, ADVANCE, and researchers from New York University.

In previous studies of hospital engagement with the community, Franz and Cronin found that some hospitals offer substance use services immediately to patients who are admitted to the emergency room for an overdose or complication from opioid use.

“By initiating treatment in the hospital, people with opioid use disorder have a better chance of getting the help they need right away rather than having to navigate the process on their own,” Franz said. “Services like this aren’t always in place in underserved rural or urban areas, so what we’re doing is developing particular support programs that can be implemented effectively in hospitals both big and small.”

Franz and her team plan to figure out ways that resources like this can be implemented in major urban hospitals but also smaller rural hospitals that have less staff and resources. To do this, they are analyzing implementation barriers within five very different hospitals, including organizations in Athens and Zanesville, Ohio, Chicago, New York City, and San Antonio, Texas.

With expertise in secondary, national data on the U.S. hospital population, including understanding hospital and community characteristics and trends in hospital/community relationships, Cronin is focusing on the data analysis portion of the study, providing insight and understanding to the inner workings of hospitals and who within the organization will be able to provide important perspectives and information.

“This study is focusing on a critical health problem that cuts across communities,” Cronin said. “But in my opinion, problems like this have the potential to be more impactful to rural communities where there is less of an infrastructure established to address them.”

The study will look at hospitals that have these types of services available now and how they implement them efficiently or challenges that are in their way. They will then convene an expert panel to come up with strategies for hospitals that don’t have these programs or want to expand them.

“It's important to highlight differences in organizational responses so that people with power — organizational leaders, policy makers — can direct resources in ways that address disparities,” Cronin added. “Opportunities to share information between hospitals may generate ideas and approaches that have worked for others.”

Franz is an associate professor of community-based health and held the Osteopathic Heritage Foundation Ralph S. Licklider, D.O. Endowed Faculty Fellow in Population Health Science in the Heritage College of Osteopathic Medicine. In addition to these studies, she leads a productive research program on racial/ethnic disparities in health, including in the context of the COVID-19 pandemic, and recently published a recent paper in Public Health on the social and demographic predictors of COVID-19 vaccine hesitancy.

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