Opioid Disorder and Overdose | Featured Research

Using Data to Fight the Opioid Epidemic: Methodological Advances in Evaluating Abuse Deterrent Opioid Analgesics:

A visionary research and dissemination project funded by the U.S. Food and Drug Administration is advancing the science of studies of opioid analgesics. The Methodological Advances in Evaluating Abuse Deterrent Opioid Analgesics project is leveraging emerging advances in data connectivity and establishing new standards for methodological rigor, with a focus on abuse deterrent formulations.

The overall project goal is to develop and disseminate new “open source” epidemiologic tools to facilitate rigorous evaluation of abuse deterrent formulations (ADFs). The methodologic products from this project will be made available to the research community, in the expectation that researchers will apply them to improve the quality of studies in the area of opioids. PIs: Nabarun Dasgupta, MPH, PhD | Svetla S. Slavova, PhD  | Co-Is: Terry Lee Bunn, PhD; Patricia R. Freeman, PhD;  Stephen W. Marshall, PhD

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Helping NC Agencies Develop Evidence-Driven Opioid Overdose Prevention Initiatives

“Systems Science to Improve State Planning on Opioid Addiction and Overdose”: This project uses group modelling and other systems sciences tools to assist North Carolina’s Opioid and Prescription Drug Abuse Advisory Committee (NC OPDAAC) to formulate effective cross-agency initiatives in response to the escalating opioid overdose problem. PIs: Stephen W. Marshall, PhD; Kristen Hassmiller Lich, PhD |Co-I: Rebecca B. Naumann, PhD, MSPH; Administering Department and School: Epidemiology and the Research, Innovation and Global Solutions office at Gillings School of Global Public Health

Supported by the UNC Collaborative Sciences Center for Road Safety (CSCRS), this pilot project funded by the US Department of Transportation explores how linked databases can be used to explore the role of impairment from opioids in motor vehicle crashes on public roads. PI: Christopher Cherry, PhD | Co-Is: Rebecca B. Naumann, PhD, MSPH; Stephen W. Marshall, PhD

Evaluation of State-Mandated Acute and Post-Surgical Pain-Specific Opioid Prescribing Guidelines

This CDC-funded project examines the impact of state-mandated opioid prescribing guidelines for acute and post-surgical pain. The outcomes being studied are: 1) physicians’ opioid prescribing behaviors; and 2) opioid safety outcomes among patients, including fatal and non-fatal overdose. This project includes a process evaluation of the state law mandating opioid prescribing limits for acute and post-surgical pain, including recommendations to inform and improve future legislative initiatives. PI: Shabbar Ranapurwala, PhD, MPH | IPRC Co-Is: Stephen W. Marshall, PhD;  Nabarun Dasgupta, PhD, MPH; Rebecca B. Naumann, PhD, MSPH; Meghan E. Shanahan, PhD, MPH

Medicaid expansion and deaths due to opioid overdose, suicides, and homicides among formerly incarcerated persons

This ICRC project examines the effects of Medicaid expansion on the incidence of opioid overdose, homicide, and suicide, among recently released incarcerated individuals. It will also detail state-specific models from Kentucky and Rhode Island for implementing Medicaid expansion. The hypothesized benefits of Medicaid expansion include increased access to substance abuse and mental health services and increased opportunities for legal employment. Rhode Island observed a 60% decrease in opioid overdose deaths among formerly-incarcerated persons associated with Medicaid expansion and other interventions. The Office of the Surgeon-General has estimated that there 3 million adults who are eligible for Medicaid under the Affordable Care Act, but live in a state that has declined to expand Medicaid, and has stated that “Medicaid expansion is a key lever for expanding access to substance use treatment.” PI: David Rosen, MD, PhD | Co-Is: Shabbar Ranapurwala, PhD, MPH; Lauren Brinkley-Rubinstein, PhD

Policy evaluation of the NC Medicaid patient review and restriction (“lock-in”) program: examining impacts on opioid use disorder services and treatment

“Lock-in” programs aim to reduce opioid use disorders (OUD) and overdose by identifying high-risk beneficiaries and attempting to control their access to opioid drugs. While these programs are widely used (almost every state has a Medicaid “lock-in” program (MLIP)), little is known about their clinical and public health effects; this project will examine whether the NC MLIP is effective in connecting diverse beneficiaries to a wide range of OUD treatment services and increasing naloxone dispensing. PI: Rebecca Naumann, PhD, MSPH | Co-Is: Stephen W. Marshall, PhD

Chronic Pain Management, Opioid Misuse, and Risk of Blood-Borne Infections

The overall objective of this project is to leverage a unique combination of “big data” and qualitative data to generate high-quality evidence about optimal strategies to taper or end long-term opioids use. This includes using a combination of NC insurance claims, health system, cause of death, and blood-borne infection diagnosis data, supported by enhanced complementary qualitative interviews. PI: Brian Pence, PhD | Co-Is: Shabbar Ranapurwala, PhD, MPH; Christopher L. Ringwalt, DrPH, MSW


The goal of this project is to evaluate and advance strategies to prevent opioid overdose in North Carolina. Projects supported under this contract include evaluation of the Department of Public Safety’s opioid overdose prevention efforts, examination of Office of Chief Medical Examiner’s opioid overdose surveillance processes, and other state-based prevention efforts. PI: Rebecca Naumann, PhD, MSPH | Co-Is: Anna Austin, PhD, MPH; Shabbar Ranapurwala, PhD; Mike Fliss, PhD

Opioid Disorder & Overdose | Selected Prior Research

Randomized Controlled Trial of an Emergency Department Care Coordination Program in Thirteen Emergency Departments of the Carolinas HealthCare System 

This CDC-funded project involved identifying individuals who frequently used emergency departments to treat their non-cancerous chronic pain (NCCP). A total of 411 patients were randomized to either the intervention or control group. The intervention consisted of placing an alert in the medical record and letters sent to patients and their community providers. The alert informed physicians that the patients had made multiple visits to emergency departments to treat their NCCP and suggested that the physician refer the patient to a community-based provider for treatment. The researchers found that the intervention reduced the number of emergency department visits and opioid prescriptions among the intervention group. PI: Christopher L. Ringwalt, DrPH, MSW

Evaluation of Iowa prescription monitoring program 

This CDC-funded project was subcontracted through the University of Iowa Injury Prevention Research Center and involved using statewide health insurance data and an interrupted time series analysis to examine the impact of Iowa’s prescription monitoring program on physicians’ prescribing practices in Iowa. Results were shared widely with public health researchers and practitioners at the APHA annual conference and the Society for Advancement of Violence and Injury Research conference. PI: Shabbar Ranapurwala, PhD, MPH

Evaluation of a Community-Based Initiative to Prevent Opioid Overdose 

This CDC-funded collaborative project between the IPRC and the Pacific Institute for Research and Evaluation involved an evaluation of Project Lazarus, a state-wide initiative to prevent opioid overdose and strengthen provider education and policies to limit emergency department opioid dispensing, which are associated with lower overdose mortality. Project Lazarus is a model of community engagement that has been successfully adopted in rural communities throughout North Carolina and in other states. The program is intended to help communities prevent overdoses, promote responsible pain management practices, and support substance abuse treatment. The program addresses and prevents drug overdose deaths through a variety of methods, including providing Project Lazarus Rescue Kits for individuals, families, health departments, and law enforcement personnel. The kit contains two doses of nasal naloxone as well as educational information on how to revive someone who has overdosed. Evaluation results (“A Statewide Evaluation of Project Lazarus: Seven Strategies to Reduce Opioid Overdose”) were shared at the Society for Advancement of Violence and Injury Research conference in September 2017 in Ann Arbor, Michigan. PI: Christopher L. Ringwalt, DrPH, MSW