The West Virginia Model

Experts at WVU Medicine address the state’s opioid epidemic with new treatment and prevention methods.

Addiction, or substance use disorder, is a chronic disease. Like many chronic conditions, it is no respecter of persons—striking people of all ages, genders, races, ethnicities, and socioeconomic backgrounds. And like some chronic diseases, such as diabetes, choices are involved in the development and perpetuation of the disease. It is important to note, however, that this condition is amenable to treatment and not a moral failing.

WVU Medicine experts are working diligently to turn the tide of the opioid epidemic and the stigma surrounding it by treating those already in the throes of addiction, advocating to lawmakers on their behalf, finding new opioid-free ways to treat chronic pain, and researching ways technology could be used to prevent relapses in those who are in recovery.

Dr. James Berry

Treatment at the WVU Medicine Chestnut Ridge Center
The Comprehensive Opioid Addiction Treatment (COAT) program at WVU Medicine has become a highly successful model for medication-assisted opioid addiction treatment. The program, which was developed at WVU Medicine, combines group therapy; individual therapy; mutual-support programming, such as Narcotics Anonymous; and Suboxone, a prescription medicine that combines buprenorphine and naloxone. By providing structured peer support, addressing motivations for drug use, and using medication to suppress symptoms of addiction, this model has helped thousands of people enter recovery and build productive lives since it began in 2004.

“Using buprenorphine products to manage opioid addiction has transformed the field of addiction treatment,” says Dr. James Berry, addiction psychiatrist and medical director at WVU Medicine’s Chestnut Ridge Center. “Prior to their availability, the vast majority of patients with heroin or pain pill addiction were only given the option of detoxification, which has proven to be woefully unsuccessful. This treatment is a dramatic improvement from the over 90 percent dropout rates of detoxification, but still unacceptable as many of these patients will go on to relapse and possibly die.”

The COAT model has gained national attention. Health professionals from across the country, who often refer to the program as simply “the West Virginia model,” regularly travel to Morgantown to learn about it. The program was so sought out by patients that it once had a waiting list of several hundred people.

In an effort to increase access to this evidence-based treatment and cut down the waiting list, the program opened a location near the Cheat Lake area of Morgantown in 2016. WVU Medicine addiction specialists also travel the state training providers and supporting them through teleconferencing.

In March, the WVU Medicine Center for Hope and Healing opened in Morgantown. The Center works with adults struggling with addiction through medically managed withdrawal and medication-assisted treatment in a residential treatment setting. The 28-day program offers person-centered care that also includes individual treatment plans, family support services, and mindfulness-based practices.

“Not only have we not been able to provide this type of treatment, but the whole state has not had a facility like this before,” Berry says. “This will be a huge asset for us to help people along their path to recovery.”

Prevention Through Opioid-Sparing Treatments
As part of an ongoing commitment to battle opioid addiction, the WVU Rockefeller Neuroscience Institute (RNI) marked a major milestone in November 2018, when it enrolled the first patient in a randomized clinical trial that will test the effectiveness of an injectable non-opioid, non-steroid micropellet to treat sciatica.

The phase III clinical trial uses a clonidine micropellet, which is half the size of a grain of rice and is placed in the lower back to combat sciatica pain for up to one year.

Dr. Ali Rezai

“Innovative technologies that act directly at a target location like this micropellet are crucial to reducing the need for systemic medications and opioids for chronic pain,” says Dr. Ali Rezai, executive chair of the WVU Rockefeller Neuroscience Institute.

Rezai is not directly involved in the trial since he serves as a scientific advisor to Sollis Therapeutics, the Ohio-based interventional pain company developing the micropellet. “Our hope is that we can look back on this day and say we made a significant advance in the ongoing efforts to treat chronic pain and combat the opioid crisis,” he says.

With more than five million people in the U.S. affected by sciatica—one of the most common causes of back and leg pain—the Sollis micropellet can potentially provide patients with a pain-relief solution and an alternative to addictive opioid pain medications. Unfortunately, in many cases, currently available treatment options for the pain management of sciatica and other back pain have inadvertently led to opioid abuse. “Having the opportunity to investigate new non-opioid treatments for sciatica and a range of pain conditions is directly aligned with the WVU Medicine Center for Integrative Pain Management’s mission to combat the opioid crisis in West Virginia and nationwide,” says Dr. Richard Vaglienti, principal investigator and director of the Center for Integrative Pain Management.

In West Virginia, where the number of opioid-related deaths is on course to set a record for overdose deaths this year, the micropellet procedure—if successful—could one day be a game-changer.

“Knowing that even a single day of opioid usage is associated with a probability that the patient will be taking opioids a year later underscores the need for innovations like ours to impact the opioid crisis,” says Dr. Gregory Fiore, president and CEO of Sollis Therapeutics. “We are pleased to team up with the researchers at the WVU Rockefeller Neuroscience Institute and other sites nationwide.”

WVU President Gordon Gee says the work of the doctors and researchers at the Rockefeller Neuroscience Institute will “help make all of our lives better.” “This kind of ground-breaking research would not be possible without the assistance of many people, including Gov. Jim Justice, Rep. David McKinley, and Senators Shelley Moore Capito and Joe Manchin, all of whom have been fully supportive of these initiatives,” Gee says.

Treatment and Prevention in the Future
Looking ahead, researchers at RNI are investigating the use of wearable technology to head off relapses in patients who are in treatment for substance abuse disorders.

The Institute has developed a data collection program that uses a smartphone app and wearable technology, similar to an activity tracker or smart watch, to monitor and collect continuous data from patients while they are at home and out living their daily lives. The patient interacts with a smartphone-based application to fill out surveys and perform a series of tasks while the wearable device collects physiological data, such as heart rate, physical activity, body temperature, respiration, and sleep.

All of this data ends up in the RNI Cloud, allowing data analytic teams to monitor patient outcomes and predict times for interventions, potentially heading off relapses. Key collaborations are ongoing with cutting-edge wearable device manufacturers. “It’s exciting to develop this infrastructure and partner with companies to provide the best technology to improve the lives of our patient population,” says Victor Finomore, director of human performance and applied neuroscience at the Rockefeller Neuroscience Institute. “If this proves successful, it has the potential to revolutionize the way we treat substance abuse disorder.”

What are opioids?
The Centers for Disease Control and Prevention (CDC) defines opioids as “natural or synthetic chemicals that interact with opioid receptors on nerve cells in the body and brain, and reduce the intensity of pain signals and feelings of pain. This class of drugs includes the illegal drug heroin, synthetic opioids such as fentanyl, and pain medications available legally by prescription, such as oxycodone, hydrocodone, codeine, morphine, and many others. Opioid pain medications are generally safe when taken for a short time and as prescribed by a doctor, but because they produce euphoria in addition to pain relief, they can be misused.”

What does the opioid epidemic look like in West Virginia?
According to the CDC, West Virginia led the nation in the number of drug overdose deaths in 2017 with 57.8 per 100,000 people. Rounding out the top five were West Virginia’s neighbors: Ohio (46.3 per 100,000 people), Pennsylvania (44.3 per 100,000 people), the District of Columbia (44 per 100,000 people), and Kentucky (37.2 per 100,000 people).
West Virginia has also experienced what the CDC calls a “statistically significant” increase in drug overdose death rates—11.2 percent—from 2016 to 2017. Ohio, Pennsylvania, and Kentucky also had statistically significant increases in their drug overdose death rates.

written by Angela Knopf