Category: CTN

Dr Wood tells the forum recipe for research-centre success

Wood

In a talk at the 2017 National Institute of Drug Abuse meeting on June 17th, Dr Evan Wood pondered lessons learned and success tips derived from his team’s experiences of building an International centre on substance use. The key ingredients in the recipe for success of research centre on substance use were:

Emphasize research productivity. Integrate educational opportunities and mentorship at every step. Use interdisciplinary approach wherever possible. Integrate research alongside clinical care.

nida

From AIDS to opioids

Historically, the new BC Centre on Substance Use grew out of HIV research centre for excellence. The emergence of powder cocaine in 1990’s led to an HIV outbreak in needle exchange when it was believed to be under control. This helped the team to make a compelling case about their unique situation for funders like the National Institute for Drug Abuse. Next, a centralized database of people treated on anti-retroviral treatment (ART) contains all data on everybody living with HIV in the province. This database enables longitudinal survival analysis of HIV outcomes. Using this data, another prospective cohort study of injecting drug users has demonstrated how the viral load went down between 1996-2004. Furthermore, the first supervised injection facility in North America – Insight – has led to about a dozen of supervised injecting facilities in the area nowadays. In sum, the evolution of the centre from HIV treatment to HIV prevention and now to addiction treatment (because of the population of study) is a result of concentrated efforts by researchers, providers and the community.

Current priorities

The centre’s mission is to provide provincial leadership in substance use and addiction research, education and clinical care guidance and to seamlessly integrate these pillars to help shape a comprehensive, connected system of treatment and care that reaches all British Columbians. (taken from www.bccsu.ca)

Co-speaker presentations

International sites with rapidly evolving HIV epidemics in patients with substance use disorder present an opportunity for rapid scale-up of interventions once proven efficacious with a promise of large public health impact (text taken from www.drugabuse.gov). The three speakers in this session moderated by Petra Jacobs, entitled “Research on HIV and Substance Use Disorder: International Perspectives,” including Drs Wood and Korthuis, have presented several research projects supported by NIDA and other institutions. I have attended the session. The discussant, Dr Metzger, closed the session with concluding remarks.

Changing the ways of CPDD – College on Problems of Drug Dependence – June 12-16, #CPDD2016

Change is the ultimate law of life. Those that do not change and adapt, do not survive. In the life of scientific meetings, this means constantly improving the organisation of the events and tailoring them to the changing needs of the conference delegates. This year, the annual meeting of the College on Problems of Drug Dependence (CPDD) introduced several improvements and more are on the way in next years.

cpdd logo

photocredit: cpdd.org

 

Bye Bye Tote Bags

Many of us were used to the traditional design of the CPDD tote bags. Each year had a different colour. For years when conference visited a warm region, such as Phoenix, AR, the tote bag included a special layer for keeping the contents cool. The non-bag policy brought the desired recognition of sustainability and (un-)expected diversity among the conference bags – everyone was different.

Bye Bye Printed Programs

For years, the conference book was a comprehensive bible for the conference week. Everybody read it and most followed it. Although the College printed a limited number of copies, this year, the e-programs drained participants smartphones’ batteries. What more, they offered note-taking and photograph uploading that many appreciated. Welcome to the digital age.

Hello Mentors

Since the early days, the senior delegates offered mentorship to junior delegates. Mostly informal. Following the new trends adopted at other conferences, such as AHSR or NAPCRG, the CPDD sent out emails to all Members in Training (MIT), offering to match them with a potential mentor (mentor bios included). If both parties agreed, the match-maker introduced them via email. I have learned a lot from my mentor. Especially that the decision makers may not read addiction journals, also that the team identity strengthens sense of ownership among team members and that the road to the research success can be long and winding. Let’s hope that the beneficial mentoring program continues in future.

Hello Shorter Conference

With the increasing demands on scientists’ workloads, there is a chance that the upcoming conferences will be shorter.

See also my previous blog posts about CPDD from the previous years:

2015Getting the most out of the Conference of the College on Problems of Drugs Dependence #CPDD2015

2014: 76th Annual Conference of College on Problems of Drug Dependence: Decide to be fearless& fabulous 

2013: My itinerary for the Conference – College on Problems of Drug Dependence, San Diego, June 15-20 

76th Annual Conference of College on Problems of Drug Dependence: Decide to be fearless& fabulous

Not one, but two conferences in Puerto Rico made my trip fantastic. As usual, the NIDA International forum happened for the 15th time on the weekend before the Conference of the College on Problems of Drug Dependence. The lines below offer some insights from these meetings.

Integration of addiction treatment into primary care: the portals of entry

Is abstinence related with good health? Is decreased drug use related with good health?
Tae Woo Park and Richard Saitz asked these questions in a secondary analysis of data from a clinical trial of 589 patients using cocaine or cannabis with very low dependence proportion among the sample (ASSIST score >27). To answer their questions, they used clinical measures of good health, such as, SIP-D, PHQ-9, and EUROQoL. Health outcomes were associated with decreases in illicit drug use in primary. However, abstinence and decreased use may represent very different magnitudes. Self-reports related dysphoria could also play a role in the differences. It takes a long time to make improvement in those consequences? 6 months of follow up observations may not be enough. Patient-preferred outcomes are paramount: do they want to have a score lower than XY on PHQ-9? What outcomes are important for them?
The TOPCARE (www.mytopcare.org) project implemented guidelines for potential opioid misuse (Jan Liebschutz). Her slides blew up half-way through the presentation but she delivered the talk excellently. Nurse care management was a component of the guideline implementation trial. Academic detailing (45min, with opioid prescribing expert) included principles of prescribing brochure and difficult case discussion. Is academic detailing effective? The Cochranesystematic review of literature found small-to-medium variable effects. The preliminary results of the project show that the nurse manager programme is a no brainer.
Rich Saitz commented on the sad state of affairs in the addiction treatment, where only 10% of people with addiction are in treatment. Integrated care is the best thing since the sliced bread, but where’s the evidence? His research showed no added benefit of integrated versus care as usual. Why? Maybe, addiction is not a one thing, but we treat it like one thing. Dr Tai provoked the audience with a question: “Do our patients with addiction have the capability to participate in the treatment planning and referral?” If they seek medical care for their broken leg and we refer them to an addiction specialist, will they go? most likely not.
But it is the same with hypertension. Referral is a process and not a once-off thing. Although they may not follow our advice at the first visit, a rapport built by a skilled professional over a series of discussions can help them get the most appropriate care.

Does the efficacy of medications for addiction decrease over time?

An old saying among doctors states “One should prescribe a new medication quickly before it loses its efficacy”. Elias Klemperer pooled the data from several Cochrane systematic reviews on addiction medicines, such as, NIRT gum, Acamprosate, or Buproprion. Their effectiveness decreased over time. The changes in methodologies might have caused the decline; also the sponsorship of trials, target populations or publication bias.

Write, wrote, written

Primary author is in the driver’s seat, others are passengers. Primary author pulls the train. Dr Adam Carrico(UCSF) asked us “What are you really passionate about?” Find it and use your passion for those themes to drive your writing habit. Decide to be fearless& fabulous. Develop a writing routine. Put together a queue of writing projects and don’t churn out 2 products at the same time, one of them will suffer. Schedule writing retreats with colleagues. Set Timelines for writing grant and programme time for reviews by trusted people, give people a warning that this is what you’re planning to do. The JAMA June 2014 issue offers useful tips on how to write an editorial.

Dr Knudsen reported on the editorial internship of the Journal of Substance Abuse Treatment – JSAT, which started in 2006, with Dr McGovern (current editor) and Knudsen as the 1stfellows. Success rate of the fellowship applications is 2/30-45, prior involvement is appreciated (peer reviewer, submission). The new 2014 fellows are: Drs Madson and Rash. In the one year of the fellowship, the fellows typically review 12-15 manuscripts, some years, as a managing editor of a special issue. The Drug and Alcohol Dependence journal has a similar scheme.

Check out the http://www.cpddblog.com/

Dennis McCarty won the 2014 NIDA International Program Award of Excellence

 June 14, 2014 ― Professor Dennis McCarty, Ph.D., professor in the Department of Public Health and Preventive Medicine at Oregon Health & Sciences University (OHSU), and director of the Substance Abuse Policy Center in the Center for Health Systems Effectiveness, has been awarded by the 2014 National Institute on Drug Abuse (NIDA) International Program.

The award is for Excellent Mentoring. Dr. McCarty mentors clinicians and researchers who test emerging drug abuse treatments in community settings through the Western States Node of the NIDA Clinical Trials Network, which he codirects. He extends his mentoring to state and local policymakers through his role as director of the Substance Abuse Policy Center in the Center for Health Systems Effectiveness, which works to link policy, practice, and research on substance abuse treatment.

Dr. McCarty also is scientific director of the University of Amsterdam Summer Institute on Alcohol, Drugs and Addiction. I met Dennis in Amsterdam in 2011. He lectured for several days on different policy models and evidence based treatments. Two years later, on March 1, 2013, I joined Dennis as a NIDA CTN INVEST Fellow. INVEST is International Visiting Scientists & Technical Exchange Program for drug abuse research. Oregon Health & Sciences University hosted my six months fellowship during which I assessed the use of Screening and Brief Intervention (SBIRT) for alcohol use disorders among patients receiving agonist medication for opioid use disorders. Visit this post to read more about how I got here. I did not think that the summer school would lead to a fellowship in Portland, OR and I’m most grateful that it did.

With Dennis, I have learned about things I thought did not exist. For example, about researchers who enjoy writing. Writing up research projects is a task that many new researchers fear the most. Dennis is a master writer and his craft is contagious; I’ve discovered a need in me, a strong urge to write a lot and in many different formats. Dennis received the award today, at the 19th annual NIDA International Forum in San Juan, Puerto Rico. The 2014 Forum focused on “Building International Collaborative Research on Drug Abuse.”

Four other experts were awarded 2014 NIDA International Awards of Excellence. Mr. O’Keeffe, a professor at Virginia Commonwealth University, was honored for Excellence in International Leadership. The award for Excellence in Collaborative Research went to Dr. Chawarski, Ph.D., Yale School of Medicine, and Dr. Kasinather, Ph.D., Universiti Sains Malaysia. A special award was presented to Dr. Dewey, Ph.D., Virginia Commonwealth University, in recognition of his service to the addiction research community as founder of the Friends of NIDA, and his research on how opioids and marijuana change brain and contribute to tolerance and addiction.

NIDA International Awards of Excellence winners are selected based on contributions to areas essential to the mission of the NIDA International Program: mentoring, international leadership, and collaborative research. Anybody can suggest a nomination to NIDA. Read more at www.drugabuse.gov/international/awards-excellence.

The NIDA International Program connects people across continents to find evidence-based solutions for addiction, and drug-related HIV/AIDS. NIDA is part of the National Institutes of Health – the principal research agency of the U.S. Government and a component of the U.S. Department of Health and Human Services.

Story first released by OHSU Newsroom: http://www.ohsu.edu/xd/about/news_events/news/index.cfm

Clinical trials are about human dynamics: RCT course in Belfast, May 7-8

As a trialist, the pressure of working on a trial is much bigger than being in a small group educational session. Challenges of implementing a trial are multiple, mainly influenced by the values of outcomes for different people. Whose question is the trial answering? If you’ve ever found yourself puzzled by these issues, you may find some solace in reading my notes from a courseon clinical trials. 


7 instructors and 21 participants – all from Northern Ireland (except 2 Dubliners), 2 medics, three 1-st year PhD students and some professors – talked about clinical trials for two days last week at Queens University Belfast. The aim of the course wasn’t to learn everything, but to think laterally about trials. Professor Clarkecovered the basics of starting trials: formulating a clear research question, deciding on comparisons and placebos and dealing with confounding factors. The 7 main ways of dealing with confounding are:
  1. Matching
  2. Exclusion
  3. Stratified sampling
  4. Standardisation
  5. Multivariate modelling
  6. Randomisation

The pleasures and terrors of trial recruitment were described by Dr Maguire. Everybody struggling with meeting the recruitment targets should read the top 10 tipsfor recruiting into trials at the All-Ireland Hub for Trials Methodology Research website. Trialists should plan for what they’re going to do if things don’t go the way they planned. Recruiters can also become tired and it’s good to think ahead about what would possibly prevent them from recruiting. Even small rewards to recruiters, such as cream eggs, can increase their satisfaction. Satisfaction=Retention. Research networks for General Practitioners can facilitate recruitment.

Dr McAneney introduced us to the role of social networks in clinical trials. We are all connected.  All the users of Facebook can be linked by 3.74 steps. Networks make the trials work or crash. Networks allow diffusion of innovation. Decisions of participants and researchers are influenced by networks.

Prof McAuleyhelped the participants to write the protocol and funding application for their first trial. Publishing a trial protocol sets the bar pretty high for researchers – transparency and accountability are keyIf it’s not possible to publish the protocol in a peer-reviewed journal, then post it online. Every protocol is changed over time and they should be listed on the first page. The CONSORT diagram is an essential part of a protocol. It’s the only slide that’s projected during meetings of grant reviewers.

Dr Shorterand Prof Buntingcontinued with tips for analysing outcomes. The essence of any research is control. Although power calculations for trials seem difficult, they involve only a short sequence of basic steps. Categorical outcomes require more data and more participants than continuous outcomes. Analysis of clinical trials assumes that our participants are all from the same population. The classical assumption of trials analysis was that individual differences do not matter, they were ignored. Another assumption that things are measured perfectly never holds.

Finally, Dr Dunlopfinished the course presentations with ethics and data storage.