The US continues to be mired in an evolving opioid use disorder (OUD) and substance use disorder (SUD) epidemic. To confront the ongoing epidemic and emerging threats, the 2022 US National Drug Control Strategy (NDCS) was the first to include harm reduction interventions (e.g., naloxone distribution, drug test strips, syringe services programs). In 2023, the US declared illicit fentanyl, adulterated or associated with xylazine, as an emerging threat. Further, NDCS released a National Response Plan naming the Department of Veterans Affairs (VA) to address (1) evidence-based testing strategies; (2) evidence-based prevention, harm reduction, and treatment interventions; and (3) evaluation and research. The VA has responded to these calls by enhancing its harm reduction interventions by infusing them in not only SUD specialty care services but throughout its clinical environments (including outpatient mental health, primary care, and pain clinic settings). Further, it has adapted its treatment paradigms to confront illicit fentanyl and its adulterants (xylazine) in both SUD specialty care and non-SUD health care settings.
The objectives of this symposium are to: (1) provide an epidemiological overview of the state of fentanyl adulterated or associated with xylazine and interventions to address its harms; (2) describe harm reduction interventions and their importance in addressing fentanyl, xylazine, and other emerging drug threats; (3) describe the VA’s opioid overdose education and naloxone distribution harm reduction strategies; and (4) describe how innovative models of care can address evidence-based testing, prevention, harm reduction, and treatment needs.
Adam Gordon, MD, Chairperson, Presenter
My professional mission is to improve the access and quality of care of patients who have vulnerabilities, including those with substance use disorders. I am the Elbert F. and Marie Christensen Endowed Research Professor, tenured Professor of Medicine and Psychiatry, at the University of Utah School of Medicine and the Section Chief of Addiction Medicine at the VA Salt Lake City Health Care System. I am a board-certified internal medicine and addiction medicine physician and I am a Fellow in the American College of Physicians (FACP) and a Distinguished Fellow in the American Society of Addiction Medicine (DFASAM).I founded and am the Director of the Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA) and I am the Director the Vulnerable Veteran Innovative Patient-Aligned-Care-Team (VIP) Initiative. I am a Core Faculty member of the VA Salt Lake City Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, a Department of Veterans Affairs Health Services Research and Development (HSR&D) Center of Innovation (COIN). I am the Editor-in-Chief of Substance Use & Addiction Journal (IF:3.5).My interest in opioid and substance use disorder research is longstanding: I have a 25+ year history of conducting research on the quality, equity, and efficiency of health care for vulnerable populations, including those with substance use disorders. My methodologic skills include health services, clinical trial, large database, and implementation science research. I have received efforts on over 100 federal peer reviewed grants from the NIH, VA, AHRQ, PCORI, SAMHSA, and foundations. I have authored over 350 peer reviewed articles (cited >11,000 times, H-Index = 60) and hundreds of scholarly presentations and abstracts. As evidence of how my research has impacted clinical care and my profession, I was awarded one of VA HSR&D’s highest honors by receipt of the 2021 VA Health Services Research and Development (HSR&D) “Health System Impact Award” and received the 2022 David C. Lewis, MD Service to Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) Award.I have mentored undergraduate, graduate, MD, and PhD trainees, VA and K- Career Development Awardees, and junior through tenured faculty. In addition, my post-doctoral mentees have received research Career Development Awards and have obtained large research awards. I am a named mentor on over a dozen current or prior VA, NIH K-, or institutional K-awards. I have been honored locally and nationally for my mentorship abilities: I was named as an inaugural VA Health Services Research and Development National Mentor Network (MNet) mentor, received the “Allen Humphrey Excellence in Medical Student Research Mentoring Award” from the University of Pittsburgh School of Medicine, and I was the recipient of the 2013 W. Anderson Spickard, Jr. Excellence in Mentorship Award from AMERSA.
Joseph Liberto, MD, Presenter
Dr. Joseph Liberto is the National Mental Health Director, Substance Use Disorders. He has served over 30 years in VA, occupying several leadership positions in the areas of clinical care delivery, administration, education and research. He has also held past positions as the Addiction Psychiatry Fellowship Program Director and the Associate Director of Graduate and Post-Graduate Education for the University of Maryland School of Medicine's Department of Psychiatry. In his career Dr. Liberto has served as a member and co-chairman of VA Task Forces for the development of treatment guidelines related to substance use disorders. He has also served in several addiction-focused roles supporting VA national SUD efforts including research identifying barriers to and facilitators of sublingual buprenorphine treatment in the VA. He is also a past President of the American Academy of Addiction Psychiatry.
Elizabeth Oliva, PhD, Presenter
Dr. Elizabeth Oliva received her doctoral degree in Developmental Psychopathology and Clinical Science from the University of Minnesota, where her graduate work examining the etiology of substance use from adolescence to early adulthood was funded by a National Science Foundation Graduate Fellowship. She completed her pre-doctoral clinical psychology internship at UCSD/VA San Diego. Dr. Oliva is the VA National Opioid Overdose Education and Naloxone Distribution (OEND) Coordinator and conducts research on VA OEND implementation and post-overdose care. Additionally, she is a Senior Evaluator for the VA Program Evaluation and Resource Center (PERC; one of three VA Office of Mental Health and Suicide Prevention evaluation centers) and an Investigator at the VA Center for Innovation to Implementation at the VA Palo Alto Health Care System. Dr. Oliva helped develop and implement the VA Stratification Tool for Opioid Risk Mitigation (STORM) and is an Associate Editor for the Substance Use & Addiction Journal.
Grant Baldwin, PhD, Presenter
Dr. Grant Baldwin is the Director of the Division of Overdose Prevention at CDC’s National Center for Injury Prevention and Control. He leads the division in monitoring trends in the drug overdose epidemic and other emerging drug threats, identifying and scaling up prevention activities to address the evolving drug crisis, and supporting local drug-free community coalitions. Prior to this appointment in October 2019, Dr. Baldwin served as the Director of the Division of Unintentional Injury Prevention for 11 years, where he helped raise the profile of motor vehicle injury prevention, advanced work in older adult fall prevention and traumatic brain injury prevention and established the initial CDC response to the prescription opioid overdose epidemic.
As the scope, scale, and complexity of America’s drug overdose epidemic changed, the Division of Overdose Prevention was created to serve as a necessary and essential focal point to CDC’s more expansive and diversified work in the area. Dr. Baldwin has served at CDC for 28 years. Dr. Baldwin received his PhD in Health Behavior and Health Education at the University of Michigan. He received an MPH in Behavioral Sciences and Health Education from Emory University, and is currently adjunct faculty at Emory University. Dr. Baldwin has given keynote addresses and provided remarks at over 160 state, national, and international conferences and meetings; has authored or coauthored more than 80 peer-reviewed publications; and has received awards of excellence for his leadership and teaching.