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The many ways Stanford Medicine is responding to the opioid crisis

At Stanford Medicine, programs to help patients struggling with substance-abuse disorders, research into addiction, and educational programs to increase awareness about addiction and treatment are aimed at reducing dependence on opioids.

- By Gordy Slack

Clinicians, researchers and educators at Stanford have launched a number of programs to address the opioid crisis.
Victor Moussa/Shutterstock.com

In addition to strengthening the Stanford School of Medicine’s curriculum focused on opioid and other addiction disorders, Stanford Medicine’s broader clinical, research and campus community is committed to addressing the deepening opioid crisis in myriad ways.

Below are some examples: 

Clinical response

The Addiction Medicine Dual Diagnosis Clinic is an outpatient center for adult patients with substance-use disorders, behavioral addictions and co-occurring psychiatric disorders, such as depression, anxiety and psychosis. About a fourth of patients with mental health disorders also struggle with addiction. Addressing the conditions together is often key to effectively managing either. The clinic’s care resources include medication-assisted treatment.

An inpatient addiction medicine consult service helps hospitalized patients with addiction, regardless of their primary reason for hospitalization. For example, the addiction experts can help transition people with opioid addiction onto medications to treat opioid use disorder. The service recently added a licensed social worker and peer recovery counselors to its core psychiatric faculty.

Stanford Medicine’s safe prescribing program includes an opioid reduction strategy, as well as patient education and support classes. Additionally, data collected about individual patients’ physical, psychological and social functioning give clinicians insight into how best to reduce opioid use when indicated and provide targeted treatments for patients with opioid use disorder.

Research response

Researchers at the Wu Tsai Neurosciences Institute’s NeuroChoice Initiative examine fundamental questions underlying addiction from numerous points of view, bridging molecules and neural circuits with individuals and even policy. The initiative connects a diverse set of faculty, deepening interdisciplinary understanding of the neural mechanisms behind addictive choice by combining conceptual, experimental and clinical approaches.

The research of Xiaoke Chen, PhD, associate professor of biology, focuses on brain circuits underlying motivated behavior and how changes in these circuits can lead to addiction and other pathologies. The fear of — and suffering caused by — withdrawal from opioid use can be just as compelling in habit formation as is the euphoria more commonly associated with it. Chen identified a neural pathway underlying opioid withdrawal and demonstrated that switching off this pathway erases drug memory and prevents relapse.

Brian Kobilka, MD, professor of molecular and cellular physiology, and his colleagues are studying opioid and cannabinoid receptor sites in search of molecular compounds that could be the foundation of safer, more targeted pain medications. Their work suggests it may be possible to engage the pain-suppressing properties of opioids without causing their adverse effects — addiction, tolerance and respiratory suppression.

The Collaborative Health Outcomes Information Registry, or CHOIR, is a software platform designed by Stanford researchers with the National Institutes of Health and used at academic sites in the United States, Canada and Israel. It’s an open-source, web-based program that combines patient-reported outcomes data with electronic health records to track pain patients’ progress and the effectiveness of various chronic pain treatments. The platform helps physicians more precisely tailor pain treatments to each patient’s needs.

Five Stanford research projects since 2019 have received more than $9 million in grants from the NIH’s Helping to End Addiction Long-Term (HEAL) initiative. The funding allows researchers to examine the biological and behavioral processes in adolescents with high-impact chronic musculoskeletal pain, explore the connection between brain circuits involved in opioid use and sleep regulation, and study the delivery of ketamine to the brain as a treatment for chronic pain.

Stanford researchers created a mathematical model that projects outcomes for different addiction-reduction strategies. By predicting the complex consequences of alternative policy choices — including the likely number of overdose deaths — the model can be a policymaking tool.

Educational response

Robert Moore North, also known as Well House, is a substance-free undergraduate residential community whose leadership team includes several faculty members in the Department of Psychiatry and Behavioral Sciences. Its resident fellows are Stanford Medicine staff with backgrounds in health promotion, addiction recovery and mental health. Well House residents commit to live substance-free and to promote an environment based on care and respect for oneself and others in the community.

Medical students can enroll in a family medicine clerkship in which they serve in a primary care clinic for chemical dependency, seeing patients with unhealthy dependency on prescription medications, including opioids, stimulants and benzodiazepines. Students also serve in a community clinic that primarily assists homeless and housing-subsidized populations.

The School of Medicine offers a one-year postdoctoral fellowship program that trains physicians to treat substance use disorders and other addictions at a variety of treatment settings. Launched in 2013 with one fellow, the program has grown to five fellows each year.

Stanford Medicine integrates research, medical education and health care at its three institutions - Stanford University School of Medicine, Stanford Health Care (formerly Stanford Hospital & Clinics), and Lucile Packard Children's Hospital Stanford. For more information, please visit the Office of Communication & Public Affairs site at http://mednews.stanford.edu.

2021 ISSUE 2

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