Reaching For The Top
In 2019, UNM President Garnett S. Stokes launched an ambitious plan to recruit university faculty to propose interdisciplinary solutions to pressing social problems. Tackling these Grand Challenges, she said, would enable the university to have a tangible impact on people and society.
President Stokes selected three Grand Challenges: Sustainable Water Resources, Successful Aging and Substance Use Disorders. The latter two are closely interwoven with ongoing research initiatives at the UNM Health Sciences Center.
Janice Knoefel, MD, a geriatrician with a clinical practice at the UNM Memory & Aging Center, heads up the Successful Aging initiative, while Brandi Fink, PhD, an assistant professor in the Department of Psychiatry & Behavioral Sciences, co-leads the Substance Use Disorders Grand Challenge with Katie Witkiewitz, Regents’ Professor in the Department of Psychology.
“The Health Sciences Center was very fortunate to have two of its proposals selected as Grand Challenges,” says HSC executive vice chancellor Richard S. Larson, MD, PhD. “This clearly reflects our commitment to conducting high-impact research that will translate into improved health care for New Mexicans.”
Each of the Grand Challenge teams has received funding to launch pilot programs to test out potential solutions, Larson says.
The Successful Aging proposal has a special urgency because New Mexico’s population is rapidly aging, according to Knoefel. “We all are getting older,” she says. “There are some things we can’t prevent. But a lot of what people think of as aging is really disease. We’ve known that for a long, long time.”
The proposal grew out of an informal process begun within the UNM School of Medicine in Fall 2018 by David Scrase, MD, a fellow geriatrician who earlier this year was appointed secretary of the New Mexico Human Services Department, Knoefel says.
Scrase convened a series of meetings with faculty whose shared expertise centered on treating older patients. When President Stokes issued her call for research, “We were well-positioned to go for the Grand Challenge, because we had already started meeting,” Knoefel says.
The proposal put forward on behalf of Successful Aging started with prevention, reaching out to people before they have age-related cognitive impairments and urging them to exercise and maintain social connections, Knoefel says. “The whole emphasis is on compressing disability,” she says. “We want to keep people as functional and healthy as possible.”
For those who are starting to show deficits, it is important to know who they are. “We would start to identify individuals at risk through health assessments at senior centers,” she says. The College of Nursing has been conducting such assessments for more than 20 years, she says, but these efforts could be expanded to include medical and pharmacy students.
“Once we have identified people who have needs, we have to do further assessment,” Knoefel says. This could entail home visits from physical and occupational therapists trained to ask, “What can we recommend as professionals to keep people optimally independent?
And finally, when dementia and other cognitive impairments require intensive care, it’s important to pay attention to the caregivers, Knoefel says.
“Our idea was to really start to test out if care management actually makes a difference for the caregiver,” she says. When caregivers feel overburdened, the people they’re caring for make much higher use of health care resources and emergency department visits.
Substance use disorder, including alcohol, opioids and other substances, has taken a grim toll on New Mexico families, says Fink, who maintains a clinical practice focused on addiction treatment alongside her research interests.
Some 66% of the opioid overdose deaths are due to prescribed opioid medications, she says, while data from the Office of the Medical Investigator show that in every Albuquerque zip code eight to 12 people die each year from an opioid overdose. “It’s an equal-opportunity offender,” Fink says.
“What we’re looking to do is coordinate and integrate interventions across multiple systems to really try to reverse the trend,” Fink says. “Part of the way we’re going to do that is to target the most affected communities for intervention, while increasing the scientific basis for interventions.”
The Grand Challenge has set a high bar for success, Fink says. By 2030, it seeks to reduce alcohol, opioid and other substance mortality by 45% and substance-related consequences (including overdose, injury, and accidents) by 40%. It further seeks to cut crime, incarceration and recidivism by 20%, adverse childhood experiences by 20%, and overall economic costs of substance-related illness and death by 20%.
“To accomplish these goals, we will engage schools and communities, general medical settings, specialty treatment settings and the criminal justice systems,” Fink says. One of the overarching aims is to enhance resilience against substance use through prevention efforts, especially in Native American and rural communities, she says.
It is also important to improve screening and treatment for substance use disorders in general medical and specialty treatment settings. And there is a pressing need to improve access to substance abuse treatment for those who have become involved with the criminal justice system, Fink says.
The Substance Use Disorders team, which includes collaborators from throughout the Health Sciences Center and across Main Campus, has already garnered funding for nine pilot projects.
“As part of our Grand Challenge, with our money we are funding a pilot study to evaluate the implementation of Senate Bill 221, which requires opioid overdose counseling and naloxone co-prescribing,” Fink says. Prescriptions for naloxone, which rapidly reverses the symptoms of an opioid overdose, have sharply increased, and the number of overdose reversals has grown by nearly two-thirds, she notes.
In another initiative, Fink plans to engage with providers who have received a mandatory notification letter when a patient has died from an opioid drug they have prescribed.
“We’re looking at using those as opportunities to provide additional trainings, provide anxiety and depression screens and train providers to rely on those screens in writing an opioid prescription,” she says.
And, she wants to implement an opioid stewardship program, to monitor opioid prescribing patterns and intervene with prescribers when necessary. “These are easy things to put in place,” Fink says. “And they have a big impact.”