Insights and Solutions: Research Initiatives

Principal Investigator: Ranjani Paradise, PhD, Director of Evaluation, Institute for Community Health

RIZE engaged the Institute for Community Health (ICH) to describe and document the state of hospital-based addiction care in Massachusetts. The project profiled a cross-section of diverse and existing care models, with associated best practices and challenges, and identified opportunities to improve care models and enhance harm reduction practices.

Working with RIZE, and expert advisors with direct knowledge of the local addiction care landscape, ICH refined the areas of inquiry and identified six hospital programs in Massachusetts to profile. Through interviews and document review, ICH described models at each of the hospitals and identified successful practices and challenges, including operational and financial considerations. ICH also conducted a literature review to document care models in other settings and summarized data from the Boston Overdose Linkage to Treatment Study to identify important elements of care from the perspectives of diverse community members at high risk for overdose. ICH synthesized all data and reported findings with recommendations to enhance harm reduction practices in hospital-based settings.

Read the report of these findings, published in February 2024.

Principal Investigator: Avik Chatterjee, MD, MPH, Addiction Specialist, Boston Medical Center

Overdose is the leading cause of death among people experiencing homelessness. Harm reduction policies, including naloxone distribution and syringe exchange, can decrease the mortality and morbidity associated with high-risk substance use. Yet access to harm reduction practices tends to vary from shelter to shelter. The goals of this project were to better understand what practices are in place, why and how they are used, and generate an actionable set of next steps to enhance or implement harm reduction practices in shelter settings. The study also aimed to document how these practices impact shelter guests’ substance use and their use of shelter services and learn from people with lived and living experience to better understand the attitudes toward and knowledge of harm reduction in shelter settings. The study also collected ideas from shelter staff and guests about which harm reduction practices are the most supportive of their needs. The team hired consultants with lived and living experience to provide meaningful feedback on study design, recruitment plan, interview script, interpretation of findings, and how best to present findings in a manuscript and in communication back to shelters. The findings and recommendations were compiled into a toolkit in fall 2024. RIZE also hosted a webinar to present and discuss the findings in partnership with Boston Medical Center.

Principal Investigators: Ranjani Paradise, PhD, Director of Evaluation and Research and Evaluation, Institute for Community Health & Dan Dooley, PhD, Director, Research and Evaluation Office, Boston Public Health Commission

The research project examined the experiences and service-seeking behaviors of diverse Boston residents in the 30 days following an opioid overdose in order to understand factors that influence access to treatment and identify opportunities for systems change. Guided by a research steering committee from three institutions – Boston Medical Center, Boston Public Health Commission, and Institute for Community Health – this project offered an in-depth qualitative review with input from the people directly affected, along with key stakeholders from local health care and public health programs. The combined perspectives allowed the research team to gain a deep understanding of barriers and identify actionable recommendations and inform policy and practice change for the health care and public health systems in Boston. The report is available here.

Principal Investigator: Peter Kreiner, PhD, Senior Scientist, Institute for Behavioral Health

This project explored how isolated physician networks can negatively impact care coordination and information sharing among physicians. It identified system-level factors associated with the development and sustaining of buprenorphine prescribing in a community, structural properties of prescriber patient-sharing networks in which waivered physicians are embedded, and how these properties vary in relation to community demographics, including racial/ethnic makeup. Identifying network properties associated with greater access to opioid use disorder (OUD) treatment and with increases in treatment access outlines opportunities for system change efforts to reduce racial/ethnic disparities in access to OUD treatment.

The report is available here.

Principal Investigators: Ronald Kulich, PhD, and David Keith, DMD, BDS

Until recently, dentists have been among the most frequent prescribers of short-acting opioids, with dentists prescribing more unused pills following dental procedures than prescribed by physicians after a wide range of medical/surgical interventions. Two-thirds of practicing dentists still believe that it is not within their professional role to screen patients for substance use disorders, a fact that is likely related to the slow adoption of prescription monitoring program utilization by general dentists. This project created a series of 10 validated controlled substance risk mitigation modules for Massachusetts practicing dentists, dental hygienists, and oral surgeons to promote safer controlled substance prescribing and to enhance appropriate screening, referral, and follow-up for high-risk individuals encountered in dental settings.