April 17, 2025
Breaking the Cycle of Addiction
Various teams at the University of Pittsburgh Health Sciences are going beyond decreasing opioid prescribing and are identifying and using evidence-based ideas to make a real difference in addressing the crisis.
TOPICS: Addiction | Chronic Disease | Research
Designs on Aging-Ready
By Strategic Communications
Health care fields have a complicated history with the opioid epidemic. Between overprescribing opioids and stigmatizing addiction, health care providers used to be considered part of the problem. But now, various teams across departments at the University of Pittsburgh are going beyond decreasing opioid prescribing and are identifying and using evidence-based ideas to make a real difference in addressing the crisis. The following are examples highlighting some of these efforts across the schools of the health sciences.
On the Front Lines
School of Public Health researchers Mary Hawk and James E. Egan note that people’s experiences are shaped most by their interactions with systems, communities and policies—highlighting that stigma and racism are significant barriers to addiction help and clinical care. As evaluators for the Allegheny County Health Department’s Overdose Data to Action Project (OD2A), Hawk and Egan are collecting robust data from local community partners, people who use substances and health care systems to align policies and systems with community needs.
“For too long, we have tasked people who use drugs to bear sole responsibility for preventing their overdose,” says Hawk, professor and chair, Department of Behavioral and Community Health Sciences. “We need to move things upstream and intervene at systems levels so that people, as individuals, aren't trying to keep themselves, friends or family from overdosing.”
Through collaborations and qualitative interviews, they are working to identify facilitators and barriers to existing community partner overdose mitigation efforts.
Providing clinical care for patients with drug use disorders has also grown due to the constantly changing landscape of illicit drug compositions. These compositions include fentanyl analogs, other nonmethadone synthetic opioids and toxic adulterants like xylazine that cause severe wounds. To increase access to low-barrier wound care, Raagini Jawa, assistant professor of medicine, School of Medicine, has created a xylazine clinic to provide wound care, self-care resources and xylazine test strips to the local community.
Additionally, the School of Pharmacy’s Grace Lamsam Pharmacy Program for the Underserved is bringing volunteer pharmacists, pharmacy students and community organizations, like the Birmingham Free Clinic, UPMC Second Avenue Commons Health Center and Street Medicine at Pitt, together to support optimal medication use for unhoused and low-income individuals.
“For too long, we have tasked people who use drugs to bear sole responsibility for preventing their overdose.”
Mary Hawk, Professor and Chair of Behavioral and Community Health Sciences
Pain Points
Chiropractic care is a growing approach to addressing chronic pain through nonopioid interventions. The recently announced School of Health and Rehabilitation Sciences’ Doctor of Chiropractic program—the first in the nation to be offered in a research-intensive public university—will focus on evidence-based training for spine and musculoskeletal conditions. It will also prepare students to work within interprofessional teams to broaden the clinical applications of chiropractic therapy.
Since May 2024, the Opioid-Free Pain Management Program for Surgical Patients at UPMC Shadyside has also been using nonopioid pain interventions to offer an opioid-free surgical care plan for patients who want to avoid opioid use before, during or after surgery.
“We are increasingly seeing patients who are coming in for surgeries and are requesting not to be given opioids during their care at the hospital,” says Shiv Goel, clinical associate professor of anesthesiology and perioperative medicine, School of Medicine, and UPMC Shadyside chief anesthesiologist. “These requests were the launching point for the program.”
The program makes use of nonopioid medications, regional anesthesia and complementary techniques like mindful breathing, aromatherapy and hypnosis to help patients manage anxiety and pain. Jacques Chelly, director of acute pain clinical research and professor of anesthesiology and perioperative medicine and of orthopaedic surgery, notes that the program is currently directed toward simple surgeries, like outpatient surgeries or procedures where patients are likely to be discharged within 24 hours. Bright gold wristbands ensure that all care providers are aware of the patient’s wishes during operative care.
The plan also includes patient education and a provider-patient dialogue for shared decision-making to develop the best opioid-free pain-management plan.
“Previously, there was an expectation that you weren’t going to have any pain after surgery, but that’s not realistic,” says Heather Margonari, lead coordinator for the opioid-free pathway and nurse practitioner for Pitt’s Center for Innovation in Pain Care. “Reassuring patients, and nurses, that the acute pain will go down after a couple of days helps significantly.”
Chelly, who also founded the acute interventional perioperative pain service at UPMC Shadyside, directs the Center for Complementary and Alternative Medicine and codirects the Center for Innovation in Pain Care, hopes to expand the program to cover all surgeries.
First-year dental students are also committing to considering nonopioid pain management strategies as a part of their curriculum. In the Costello Pain Care Pledge, students promise to evaluate all effective treatment options for acute pain. Developed in 2022, the pledge reinforces provider accountability to reduce opioid prescriptions for dental procedures.
Considerate Care
The School of Pharmacy is also using service learning as a teaching methodology. As part of their curriculum, first-year pharmacy students provide meaningful service through community organizations.
“They learn about policies and about the social determinants of health that impact the health of the populations they'll be serving,” says Sharon E. Connor, Grace Lamsam Pharmacy Program director and associate professor of pharmacy and therapeutics, School of Pharmacy.
Additionally, the National Institute on Drug Abuse provided funding to create the Helping to End Addiction Long-Term Measures Center, which is an interdisciplinary and multi-institutional team at Pitt, the UPMC Center for High-Value Health Care, Northwestern University and RTI International. The center aims to improve the quality of care for patients with opioid use disorder across the state by “getting patients the right treatment at the right time, and then making sure that the quality of treatment is high enough that they can move into stable recovery,” says the center’s principal investigator, Renee Cloutier, assistant professor of medicine, School of Medicine.