Division of General Internal Medicine

Dr. Aaron Fox Awarded $3.5M to Improve Access to Buprenorphine Treatment

Aaron Fox, MD

Across New York City and throughout the United States, opioid addiction and opioid overdose deaths have increased rapidly; it is estimated that the rates for both have tripled over the past decade and continue to rise.  An estimated 2.5 million people in the United States have opioid-use disorder; those who inject opioids are at highest risk of overdose, with shared syringes also contributing to the spread of HIV and Hepatitis C Virus infection. The President’s Commission on Combating Drug Addiction and the Opioid Crisis has recommended declaring opioid use a national emergency. 

Still, only a small percentage of people with opioid-use disorder – estimated at less than 20% - are engaged in treatment at any time in the United States. Traditional models of addiction treatment rely on patients to enter a treatment facility or on the criminal justice system to mandate treatment.  Other approaches to treatment have proven more effective.

A new research study led by Dr. Aaron Fox, an Associate Professor of Medicine and a clinician-investigator in the Division of General Internal Medicine, seeks to improve the availability and access to bupenephrine treatment.

The NIH has awarded Dr. Fox a $3.5 million R01 grant to study over five years the effectiveness of buprenorphine treatment at syringe exchange programs to reduce opioid misuse and HIV risk.  The study will test a similar concept used in emergency rooms.

“When people show up in the emergency department with an opioid use disorder-related problem, starting buprenorphine treatment right there doubles their chances of entering and staying in treatment for at least 30 days,” said Dr. Fox.

Testing On-Demand Treatment at Syringe-Exchange Programs

Along with co-investigators Dr. Chinazo Cunningham, Professor of Medicine (General Internal Medicine), Brianna Norton, Assistant Professor, Department of Medicine (General Internal Medicine) and Moonseong Heo, Professor, Department of Epidemiology & Population Health, Dr. Fox will test the success of on-demand treatment at two syringe-exchange programs in the Bronx and Harlem.  At the New York Harm Reduction Educators (NYHRE) and the Washington Heights CORNER Project – people who inject opioids will be offered onsite buprenorphine treatment and referral for follow-up at a treatment program.

Dr. Sean Murphy, a health economist at Weill Cornell Medical College and the Center for Health Economics of Treatment Interventions for Substance Use Disorders, HCV, and HIV (CHERISH) will conduct an economic analysis of the buprenorphine treatment intervention. The research team hypothesizes that increasing treatment will accrue economic benefits by reducing overdoses, hospitalizations, and criminal justice involvement.

Buprenorphine treatment reduces illicit opioid use, HIV risks behaviors, and overdose deaths. Therefore, an important strategy for confronting the opioid overdose crisis is to improve access to evidence-based treatment and offer the supports necessary to encourage treatment engagement. Syringe-exchange services are now being offered all over the country – in at least 33 states in 2013, but now the number is likely higher - and these programs are important to reduce the harms that stem from injection drug use. Many participants attending syringe- exchange programs also request referrals for opioid use disorder treatment, but the referral process is limited by waiting lists and treatment availability. Adding buprenorphine treatment to the services available at syringe-exchange programs could be an effective way to encourage a population at high risk for opioid overdose or HIV infection to start evidence-based treatment.

“By offering buprenorphine treatment directly at the syringe-exchange programs, we hope to increase utilization of this safe and effective form of addiction treatment,” Dr. Fox said.

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