Taking Aim at Opioid Abuse
With a pair of NIH grants, SPH faculty member Basmattee Boodram looks to identify effective interventions amid the ever-intensifying opioid epidemic
While the nation’s eyes largely fell off injection-drug use in the early 21st century, Basmattee Boodram’s gaze remained set on the target.
And for good reason.
An associate professor in the UIC School of Public Health’s Division of Community Health Sciences, Boodram noticed a generation coming of age in the U.S. with little, if any, memory of how injection-drug use had devastated communities across the nation during the closing decades of the 20th century. For Boodram, whose research sits at the intersection of substance abuse and infectious diseases, the resurrection of injection-drug use and the damage it inflicts, from chronic diseases like hepatitis C to taxing societal burdens like homelessness and unemployment, was only a matter of when, not if.
“You could see this coming,” Boodram says. “And now, it’s here.”
In recent years, injection-drug use among young people from non-urban areas has climbed with several studies linking the trend to the simultaneous rise in prescription opioid misuse among suburban and rural teens and twentysomethings. That has sparked a rise in hepatitis C cases, with an estimated 41,200 new infections occurring in 2016 alone.
“Hepatitis C is the major disease coming out of the opioid epidemic and it’s these people, a good number from suburban and rural areas who engage in risky practices like syringe sharing, who will continue to push hepatitis C cases up,” Boodram says, adding that hepatitis C elimination strategies focusing specifically on the estimated 1.3 million Americans who inject drugs are urgently needed. “My role is to break the chains of hepatitis C transmission and minimize the impact of the disease moving forward.”
To accomplish that, however, Boodram first must enter the dark cave of injection-drug use and the opioid epidemic sweeping across the U.S. landscape.
Boodram, who first arrived at UIC in 2002 as a PhD student, currently has a pair of National Institutes of Health (NIH) grants designed to power interventions and drive much-needed change.
In the first project starting this fall, “Contextual Risk Factors for Hepatitis C among Young Persons Who Inject Drugs,” Boodram is conducting a longitudinal study of 420 young people who inject drugs and approximately 1,200 of their drug-injecting network partners. Over the five-year study, Boodram will examine the role of social networks, social geography, and social norms related to drug use and sexual behaviors as well as stigma surrounding drug use and adverse outcomes such as overdoses or death.
Boodram says the novel research, one simultaneously retrospective and forward-looking, will improve understanding of the key contextual and structural factors driving hepatitis C incidence and high-risk practices, while also informing the development of innovative strategies to reduce hepatitis C and other adverse health burdens among young persons who inject drugs.
“This baseline study looks at a new generation of persons who inject drugs, examining who they are and why they’re transitioning into injection,” Boodram says.
With very little data on the dynamics of injection-drug use over individuals’ history, Boodram believes her study into networks, geography, and norms can spur targeted interventions to a problem plaguing communities across the U.S.
“When we know what needs to be done, we will be able to respond faster and modify interventions accordingly,” Boodram says.
As the director of SPH’s Community Outreach Intervention Projects (COIP), a unit that has long focused on opioid abuse in Chicago, Antonio D. Jimenez says Boodram’s specific focus on individuals in their late teens and early twenties will prove particularly valuable.
“It’s an opportunity to get to these users sooner and address this public health crisis before it roots itself deeper in our communities,” Jimenez says.
In Boodram’s second NIH project, an interdisciplinary, inter-institutional effort with Argonne National Laboratory, Loyola University’s Stritch School of Medicine, the Food and Drug Administration, and the University of Chicago’s Computational Institute among others, Boodram is serving as the principal investigator on the first comprehensive, empirical data-driven computational model for a U.S.-based population of individuals who inject drugs.
The joint effort – called the Consortium for Modeling and Analysis of Treatments and Interventions, or C-MATI – aims to develop open-source computational models that forecast disease, intervention, and treatment outcomes. For example, the group is using Chicago’s drug-injecting populace, an estimated 32,000 persons who inject drugs, to hypothesize the most effective treatment strategies for the elimination of hepatitis C.
“It’s essentially a city in a computer and a way to examine the impact of an intervention before rolling it out,” Boodram says, adding that policy makers, researchers, and clinicians across the U.S. will be able to use the open-source software to inform the rollout of prospective interventions in their communities, which might range from hepatitis C treatment scale-up to syringe service programs.
“And when you’re dealing with some of the challenges we’re seeing related to the opioid epidemic and the spread of viruses like hepatitis C,” Boodram says, “you want all the resources you can get your hands on to spark more effective interventions and turn the tide in a different direction.”