The National Behavioral Health Innovation Center announced today that Rick Rekedal, a former senior executive with DreamWorks Animation, and Dr. Walter Greenleaf, a pioneer and leading authority on virtual reality for medical use, have joined its staff.
“Walter and Rick are recognized internationally as leaders in their fields,” said Matt Vogl, executive director of NBHIC at the University of Colorado Anschutz Medical Campus. “Their knowledge and insight are powerful assets to our mission of finding bold new solutions to the country’s mental health crisis.”
In 2016, Rekedal completed over 20 years with DreamWorks as Chief Creative of franchise development and the global franchise director of the hit movie “Trolls.” Rekedal has also worked on properties such as “How To Train Your Dragon,” “Shrek,” “Kung Fu Panda,” and “The Lost World: Jurassic Park,” developing merchandising, interactive and licensing programs. Rekedal’s work has been recognized with two Annie Awards, two Kids Choice Awards and Toy of the Year. He is a frequent speaker and serves on advisory boards for The Wedgwood Circle; Michael W. Smith Group and Seabourne Pictures; and Belmont University’s film school.
Rekedal joins NBHIC as Senior Creative Advisor, consulting on how to elevate an open and urgent national conversation on mental health.
Greenleaf is a behavioral neuroscientist and a medical product developer who has been on the cutting edge of virtual reality and augmented reality applications in healthcare for more than 30 years.
In his role as NBHIC’s Director of Technology Strategy, Greenleaf brings his considerable knowledge to the Center’s approach to digital initiatives. He continues to work as a Visiting Scholar at the Stanford University Virtual Human Interaction Lab.
He has developed several clinical product streams, founded medical companies, and served as a scientific advisor and reviewer for the U.S. Public Health Service, National Science Foundation, National Institutes of Health, NASA and the U.S. Department of Education. He holds a PhD in Neuro and Bio-behavioral Sciences from Stanford University.
“Our approach is to seek out unexpected partners as we look beyond the current mental health system for new solutions,” said Vogl. “Walter and Rick fit that approach. Walter’s depth of knowledge in virtual reality and Silicon Valley are leading us to work with new technology partners in developing cutting edge tools for mental health treatments. Rick’s extraordinary creative abilities can help steer powerful human connections to combat the awful stigma that is so harmful to many people in need.”
Guest contributor: Lauren Baker, marketing and communications strategist for the National Behavioral Health Innovation Center at CU Anschutz.
Following an extensive national search, the chancellor of the University of Colorado Anschutz Medical Campus, Don Elliman, announced Tuesday the hiring of Dr. Jonathan Samet, MD, MS, as the new dean of the Colorado School of Public Health.
Dr. Samet, an accomplished medical professional and administrator, has occupied top positions in leading universities around the country.
He is currently distinguished professor and chair of the Department of Preventive Medicine at the Keck School of Medicine at the University of Southern California. He also directs both the USC Institute for Global Health and the Workforce Development and KL2 Program of the Southern California Clinical and Translational Science Institute.
“I am honored by being selected as the third dean of the Colorado School of Public Health,” Dr. Samet said. “A key goal will be to enhance the school’s impact on public health in the state and region through our research and training activities.”
Previously, he chaired the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health and was clinical division chief for Pulmonary and Critical Care Medicine at the University of New Mexico.
Chancellor Elliman said the new dean will strengthen and deepen the impact of the Colorado School of Public Health (ColoradoSPH).
“Since its establishment just nine years ago, the ColoradoSPH – a partnership of CU Anschutz, Colorado State University and the University of Northern Colorado – has made remarkable strides toward becoming one of the country’s premier institutions of public health,” Elliman said. “As its third dean, Dr. Samet, who brings the experience of a long and distinguished career in academic medicine and public health, is uniquely qualified to take the ColoradoSPH to new heights.”
Dr. Samet comes to ColoradoSPH with nearly 40 years of experience in education, health care and research.
Throughout his career, he’s fostered and mentored faculty members, created new lines of research, initiated curricular advances and maintained fiscal stability.
Along with teaching everyone from undergraduate to postdoctoral students, Dr. Samet has conducted a wide array of research into health issues. In many cases, he’s translated that research into action. His work led to advancing tobacco controls nationally and around the world, tightening air quality regulations and winning compensation for underground uranium miners suffering health problems.
The new dean is past-president of the American College of Epidemiology and the Society of Epidemiologic Research. He was elected to the National Academy of Medicine, one of the highest honors in medicine, and holds a bachelor’s degree from Harvard College, an MD from the University of Rochester and a master’s degree from the Harvard School of Public Health.
“We are fortunate to have someone as accomplished and versatile as Dr. Samet taking the helm of the Colorado School of Public Health at this critical juncture in its growth,” Chancellor Elliman said. “I am grateful to Dr. Elaine Morrato who, as interim dean since December, has helped the school continue to build on its momentum while ensuring we are set up for a smooth handoff to new leadership.”
Dr. Morrato, DrPH, MPH, will continue as interim dean until Dr. Samet assumes his new post in October.
Spencer Milo is a U.S. Army combat veteran and Purple Heart recipient who served in both Iraq and Afghanistan.
In 2008, during a 16-month tour in Iraq where he saw action in Baghdad and Mosul, Milo suffered a concussion and other injuries when a routine convoy of U.S. Humvees encountered small arms fire. Dodging enemy fire, he was tossed around inside the turret and his vehicle crashed. A year later, he was told by doctors stateside that his injury had caused a brain tumor and was given a 6-months to live. Heavily medicated and bedridden for months, he started having seizures.
After his family fought for a second opinion, he eventually learned he had been misdiagnosed. Cleared for duty in January 2010, Milo chose to continue following his passion for military service and he deployed to Afghanistan.
Less than a year later, in January 2011, he was on combat patrol in Spin Boldak, a border town in Kandahar near Pakistan. That’s when an Afghan boy, a few feet away from Spencer, detonated himself as a suicide bomber. Thrown 15 to 20 feet by the blast, he charged back into the smoke to find his wounded platoon buddy and dragged him to safety. Among his injuries: small amounts of shrapnel to his left side and his face, injuries to his spine, hearing loss, post-traumatic stress (PTS), and traumatic brain injury (TBI).
Milo returned to the states for medical treatment at Fort Bragg and, after six months, was transferred to the National Intrepid Center of Excellence (NICoE) at Walter Reed National Military Medical Center, where he underwent four weeks of intensive treatments. He left with diagnoses for PTS, TBI, and 27 others. He says the care he received there, which included nontraditional treatments like art therapy, biking, yoga and a service dog named Nemo, saved his life.
Medically retired at age 28, he and his family moved to Colorado. After serving as Area Manager for Hire Heroes USA for four years, he is now Director of Veterans Programs, Communications and Strategic Development for the Marcus Institute for Brain Health (MIBH) at the University of Colorado Anschutz Medical Campus. The medical institute focuses on serving military veterans and retired elite athletes with primarily mild to moderate brain injuries, post-traumatic stress, depression and anxiety.
“These invisible wounds, there’s always one big thing that people want fixed,” Milo said. “I think customized care is going to be what distinguishes us, treating problems the current health system does not address. The whole family heals together, not just the patient.”
Neurologist James P. Kelly, MD, Executive Director of the MIBH, met Milo, who has associations in elite athletics, through involvement in a documentary on veterans and post-traumatic stress filmed in Colorado. They share a mutual ally in former President George W. Bush. The President painted Milo portrait and published a tribute to him this year in “Portraits of Courage: A Commander in Chief’s Tribute to America’s Warriors.” Kelly is a senior fellow at the George W. Bush Institute and former Founding Director at Walter Reed’s NICoE.
Milo has a bachelor’s degree in strategic communications from the University of Colorado Colorado Springs. An airborne Infantryman who was recognized as an exceptional leader in combat, Spencer held a number of command and control roles in military assignments in the United States, Europe and Asia.
He serves on the board of trustees for the Intrepid Fallen Heroes Fund as an Honorary Co-Chair, and his work with veteran service organizations also includes The George W. Bush Institute’s Military Service Initiative (MSI); Warrior Canine Connection; Parker’s Platoon; and Team Red, White and Blue.
The grants come from the Gates Grubstake Fund, which backs scientists at CU Anschutz who research regenerative medicine and stem cell technologies. The name of the fund comes from the Gold Rush. Investors would give prospectors seed money known as grubstakes to buy food and supplies so they could survive while they searched for gold. In exchange, the investors would get a share of future profits.
The Gates Center and CU Innovations hope the grants do something similar for recipients, said Heather Callahan, the Gates Center’s entrepreneur-in-residence and a portfolio manager with CU Innovations. The grants are for projects that are in the early stages of work and will provide support for researchers until they are ready to seek larger grants and potentially money from investors.
“This amount of money can hopefully bring researchers to an inflection point or a point where they are able to get additional funding to move on to the next step,” Callahan said.
In the big picture, the Gates Grubstake Fund will support innovation at CU Anschutz and lead to the development of new therapies or devices that help patients. Researchers could commercialize their discoveries by working with private companies or create spin-off companies, Callahan said.
The program is open to researchers affiliated with the University of Colorado. There were 26 applications for grants this year, up from three applications last year. Callahan said the number and quality of applications are good indications of the work being done at CU Anschutz.
“It made it clear that we have a pipeline, and there’s robust research in regenerative medicine,” she said.
The three winning projects could lead to treatments for multiple sclerosis, age-related macular degeneration, and the wounds and skin ulcers that are a complication of diabetes.
Protecting the nervous system
David Wagner, PhD, is an associate professor at the CU School of Medicine (SOM) whose research could lead to new therapies that regenerate parts of nerve cells. One application for his research could be treating multiple sclerosis (MS), an autoimmune condition in which immune cells called T cells attack the nerves, specifically the myelin sheath that protect neurons. Wagner’s lab has identified a T-cell type that attacks the brain and spinal cord, as well as a drug candidate that might stop the disease and undo the damage.
“People with MS have such debilitating problems because myelin loss causes severe damage in brain and spinal-cord control centers,” Wagner said. “Controlling the inflammation may restore myelin, but should restore some or all of the damaged areas. Theoretically, this will re-establish normalcy.”
The therapy is in the early stage of development. A drug candidate has been identified, and it would take many years of clinical testing before a medication is available, Wagner said.
Jeffrey Olson, MD, is an associate professor of ophthalmology in SOM who is developing a medical device that could treat age-related macular degeneration, which is the leading cause of blindness in the industrialized world. The tiny device would be implanted in patients’ eyes and trap and destroy the proteins that cause the blindness.
Olson said he has done preliminary studies using prototypes and seen positive results. If the device comes to market, it would be a breakthrough for patients—only about 10 percent of people with macular degeneration have the form of the disease that can be stopped before it causes blindness. The current treatment requires patients to receive monthly injections in their eyes to treat the disease. Olson thinks the device could work in most patients with the condition and remove the need for continuing injections.
It could also lead to major savings for patients and Medicare. Current treatments cost about $22,000 per year per patient, which adds up to $5 billion annually. Medicare spends more money on that treatment than any other medication, Olson said.
Healing wounds with nanoparticles
Kenneth Liechty, MD, is a SOM professor who researches wound healing and regenerative medicine. His grant is for research on nanoparticles, which are nanometers in size and smaller than human cells. Liechty is trying to show that nanoparticles can decrease the inflammation around wounds, which slows the healing process. His lab is testing a conjugate of cerium oxide and regulatory microRNA, which he’s named Nanoceria.
Liechty has focused on the slow-healing open sores and wounds from which many diabetic patients suffer. His lab has shown that chronic inflammation accompanies diabetic wounds and impairs the healing process. Tests on mice with diabetes have shown the nanoparticle can correct the impaired wound healing. Liechty said it could take three to five years before human trials could begin as additional optimization and toxicity studies are needed.
Two armed-robbery suspects tried to evade police in a crowded parking lot. Doug Abraham rammed the vehicle to immobilize it and one of the suspects jumped out with a gun. Abraham fired on him, missing, and followed him on foot into a department store. The driver continued in the vehicle, pursued by other officers. Abraham was alone, the radio wasn’t working and he couldn’t get backup.
Apprehending the suspect without injury earned Abraham the Distinguished Service Cross for Heroism from the Aurora Police Department in 1980. Now, as retiring Chief of Police for the University of Colorado Anschutz Medical Campus, Abraham is thankful that most police officers will never have to face a life-or-death decision like he has.
An alumnus working in the community
He says that while the role of police officers was once to catch the bad guys and solve crimes, now the trend is toward preventative measures and community relationships. Abraham is recognized among his peers as being particularly gifted in these areas. As an alumnus of the University of Colorado Denver’sSchool of Public Affairs (SPA), he cites the master’s program, as well as his early work in the Aurora PD, for preparing him for what would become the emphasis of his career.
While a division chief in Aurora PD, Abraham was in the first cohort of SPA’s master’s program in executive leadership in policing and criminal justice, taking classes with practitioners from all levels of government. Abraham is still friends with half his CU Denver classmates, including Mike Phibbs, current Chief of Police of the Auraria Campus Police Department.
“I became friends with Doug Abraham almost 15 years ago while in graduate school, and he has been a great friend and mentor ever since,” Phibbs said. “I don’t think my transition to campus law enforcement would have been nearly as successful without his help and guidance.”
Relationships make policing successful
At CU Anschutz, Abraham and his 29 full-time law-enforcement officers make many traffic stops, but write few tickets. It’s an approach that’s indicative of Abraham’s take on police work in general. Give out warnings for first offenders, change behavior, develop a relationship with the community, and let folks know the police are also on campus to help them find solutions to their concerns.
“For the young pups coming into a career in police work, don’t ever lose the comfort you have with talking with people,” Abraham said.
After nearly three decades of working with communities in Aurora, including 12 and half years at the CU Anschutz Medical Campus, Abraham has learned that city neighborhoods are harder to influence than a university campus. A neighborhood is a small slice of a city’s population, he said, and it’s often characterized by a transient residents who have their own interests and ways of problem solving. On a densely-populated university campus such as CU Anschutz Medical Campus, meanwhile, most of the roughly 55,000 daily visitors are the same and they typically have a vested interest in the success of the campus.
He likens the differences to owning vs. renting a car.
“If you rent a car and it has a shimmy in the front end, you return it to the rental company, get a new one, and go about your business. If the car you own has the same shimmy, you fix it, because that’s the car you have to drive tomorrow and the next day,” Abraham said.
The Aurora PD was one of the first police forces nationally to adopt a policy of community policing, where an officer’s performance was qualitatively rated based on problem-solving skills rather than his or her arrest record. The practice promoted relationship-building in the community, which is exactly what made Abraham such a perfect fit for his leadership position at the CU Anschutz Medical Campus. “For the young pups coming into a career in police work, don’t ever lose the comfort you have with talking with people,” he said. “Open up opportunities to interact, because that’s when you find out what’s happening on campus. Relationships make policing successful.”
Life in retirement
As for his retirement, Abraham has many plans. He and his wife just bought a country home and are working to remodel it. “I’ve got two grandkids that I would love to spend more time with,” he said. “It’s a tough career on families, and my wife has toughed it out for 42 years. I’ve got three daughters and we’re all doing great, so I’m very fortunate to have a family that is very supportive.
“I’m looking forward to a new normal,” the chief said.
A career spent in a laboratory might seem less exciting, but not for Spritz. While he once was an accomplished mountain climber and survived two avalanches while backcountry skiing, he says his passion is not for taking risks—it is for the thrill of doing something new.
“I think that science is an incredibly adventurous thing. You’re always pushing beyond what’s known,” Spritz said. “I’m not an adrenaline junkie. Other people might call me that. I’ve just always been attracted to adventurous things.”
In Spritz’s eyes, there have been few bigger adventures in recent decades than the quest to understand genetics and use that knowledge to cure diseases. After more than 40 years, he still marvels at how his career unfolded, and how far the science has come.
Spritz, 66, is one of the world’s leading vitiligo researchers. For almost two decades, he’s been conducting groundbreaking work understanding the genetics behind the skin pigmentation disorder that causes white patches to appear on the face, body and hair. An estimated 50 million people worldwide have the condition.
Spritz didn’t set out to become a geneticist. Two decisions he made while he was still a self-described “brash young man” shaped the course of his career.
Spritz is from Philadelphia, but he felt the mountains’ call at a young age, and he became an accomplished mountain climber in his youth. Successful ascents in the Alps, including the notoriously dangerous north face of the Eiger, earned him the respect of the climbing elite, and in the 1970s he was invited to join an expedition to climb Mount Everest.
Spritz declined because he was in medical school and did not want to disrupt his career. “I absolutely made the right choice,” he said.
“It’s mostly out of my system,” Spritz said. But he’s not through going on adventures, and last fall he hiked across South Georgia, an island near Antarctica. Peter Hillary and Jamling Tengzing Norgay, the sons of the first two men to climb Everest, were on the trek. They were filming a documentary for National Geographic about Shackleton, who had to cross the mountainous island to rescue his stranded crew. In the company of climbing royalty, it was natural to think about Everest, but Spritz saw the risk.
“I’m 66 years old. While I’m not like most 66-year-olds, I know I could get high enough to get into real trouble,” Spritz said. Now, he gets his thrills through amateur auto racing, which he points out is far safer than climbing or extreme skiing. His next trip will be to the Himalayas for another trek.
Spritz made his second career-defining decision “literally one day while walking down the street,” he said. He had planned to become a surgeon and had made arrangements to start down that path, but realized genetic research was a better fit for someone seeking to push scientific boundaries.
“I was incredibly lucky, because I did that at exactly the right moment in history, at the beginning of recombinant DNA research,” Spritz said. “I was lucky to get in on the ground floor.”
It led to a fruitful career. In the late 1970s, researchers were just discovering how to isolate, identify and sequence human genes. The biggest early discovery Spritz was part of was finding and sequencing a mutation that affects hemoglobin, the molecule that carries oxygen in the blood. It was the first time a mutation had been sequenced.
Still making discoveries
“Despite the fact that vitiligo has been known for hundreds of years, there’s never been a drug developed for it,” Spritz said. “That might change in the near future.”
Spritz has not stopped researching—or making discoveries. In October, Spritz and his lab published a paper in Nature Genetics finding 23 genes linked to susceptibility for vitiligo. The lab tested 4,680 people with the condition and 39,586 control cases. The study attracted the attention of pharmaceutical companies, which Spritz said is good news because a medication to treat vitiligo could be a major step forward from the current steroid and ultraviolet light treatments.
“Despite the fact that vitiligo has been known for hundreds of years, there’s never been a drug developed for it,” Spritz said. “That might change in the near future.”
Much more research would be needed before a drug could be developed, and then it would have to go through rounds of safety and efficacy testing. Spritz said enough work has been done that complex relationships between genes “are coming together in a way that kind of makes sense,” which has allowed vitiligo researchers to “leap frog” ahead faster than Spritz expected.
People with other conditions might benefit as well. In the mid-2000s, Spritz established that vitiligo was an autoimmune disease, in which the body attacks its own skin pigmentation cells. Research has shown people susceptible to vitiligo have increased odds of other autoimmune conditions such as Type I diabetes, rheumatoid arthritis and Addison’s disease. Vitiligo research could lead to progress understanding those conditions, and vice versa.
That would be the next chapter in an ongoing scientific adventure.
“It’s amazing to me how far we’ve come, how naïve we were and yet how prescient we were at the same time,” Spritz said. “We are asking and answering the kinds of questions we couldn’t have imagined when I was a student. I think that’s incredibly inspirational – and we’ve hardly started.”
“There are a lot of primary care physicians in rural areas across the state who are facing significant challenges when it comes to the opioid epidemic,” Tenney said. “It’s the rural providers, the ones that have less time and access to resources, who need the most help.”
Tenney is one of many University of Colorado Anschutz Medical Campus researchers and faculty working on the epidemic. She believes using online training programs and telemedicine offer effective ways to reach rural doctors and help them fight the epidemic.
Taking opioid education online
Together with colleagues in the ColoradoSPH Center for Health, Work & Environment, Tenney developed one of the first internet-based classes teaching doctors about alternatives to prescribing opioid painkillers such as Vicodin and OxyContin to manage non-cancer chronic pain patients.
“We decided early on that we wanted to develop an online training so that we could reach providers all across the state who didn’t have access to big conferences or the time to go,” she said.
After a few years of work, she sees signs of success. More than 3,000 doctors have taken the course since it debuted a few years ago. Follow-up surveys showed doctors were using the information in their practice, had begun checking the state’s database of prescription drugs, and had started discussing with patients how to safely use, store and dispose of opioids.
“It’s been really encouraging to see the results and what’s happening in terms of education,” Tenney said.
Telemedicine and treatment
Opioid abuse by the numbers
188 people died in Colorado from misusing opioids such as Vicodin and OxyContin in 2016
Colorado ranks 15th in the nation for opioid abuse—down from second in 2011
Tenney is now co-chair of the Colorado Consortium for Prescription Drug Abuse Prevention’s provider education work group. One of its missions is to find ways to reach and educate all prescribers in rural areas and mountain towns including doctors, dentists and even veterinarians. Now, they are working to use telemedicine to help doctors help their patients overcome addiction.
The consortium is considering expanding an initiative named Project ECHO (Extension for Community Health Outcomes in Colorado). It uses video conferencing to bring together small groups of doctors. Experts discuss best practices or the latest research, and doctors can present tough cases to their peers.
The meetings could replicate in-depth, interdisciplinary case conferences, which are common at medical schools and large hospitals but less common for rural physicians.
“In a lot of these communities, they don’t have these types of resources,” Tenney said.
Despite the challenges, doctors are committed to fighting the epidemic while making sure their patients have the medications they need to be well.
“The medical community knows they need to take action,” Tenney said. “I think we’re making a lot of progress in preventing opioid misuse and abuse. On both the prevention and treatment side, I think there’s still a lot to do.”
Providers interested in learning more about how to prevent opioid misuse can visit ucdenver.edu/chwe/preventingrxabuse to learn more about the Center for Health, Work & Environment’s online training.
CU Anschutz faculty and staff no longer have to be alone in their search for answers to their health questions.
Running March 8 through April 5, Biometric Screenings will offer free body composition measurements, blood glucose testing and a full lipid panel to catch the culprits of health woes. Screenings will be held on the CU Anschutz campus on March 9, March 13, March 22 and April 3.
All CU Health Plan members and covered spouses will receive this trio of tests with no additional charges or out-of-pocket payments. CU Health Plan has you covered. Members and spouses must bring along their plan ID card to the clinic to receive coverage. Student employees are not eligible for Biometrics Screenings as CU Health is not the primary student insurance provider.
Need more clues? Additional tests including blood typing and a full blood chemistry analysis with prices ranging from $12 to $50 a test. Preview your screening options and prices.
Results can be shared with a primary care physician* through My Health Connection, an interactive platform that keeps private medical information in a secure place minus the paper trail. Screening participants will be sent information to create an account after their screening. (*Limited to providers affiliated with UCHealth’s Epic Electronic Medical Record and the Colorado Regional Health Information Organization.)
For more information, consult a handy FAQ and take the steps towards a healthier lifestlye.
Guest Contributor: RyAnne Scott, Manager of Communications and Outreach, Employee Services, University of Colorado, Office of the President
Doctors should be able to rely on new technology to fight opioid misuse, University of ColoradoSchool of Medicine (SOM) Assistant Professor Jason Hoppe, DO, believes. But so far, existing systems such as online databases that track prescriptions have not lived up to their promise.
Dr. Hoppe, an emergency room physician and medical toxicologist, wants that to change, and he thinks a pilot project at the CU Anschutz Medical Campus might be a step in the right direction. Hoppe and a team of physicians and software developers have linked the state’s online opioid prescription database, the Colorado Prescription Drug Monitoring Program (PDMP), and University of Colorado Hospital’s electronic medical records system.
The new connection already saves doctors in the Emergency Department time. With a single click, physicians can see if a patient might be at risk for misuse, abuse or diversion of controlled medications, or if a patient might be going from provider to provider trying to get new prescriptions. It also could stop a doctor from prescribing medications that could be lethal when mixed with an opioid. So that single click could save a life or prevent or stop addiction, Hoppe said.
The federally funded project is an example of how CU Anschutz faculty and researchers could have a national impact on the opioid abuse epidemic. The project could lead to better software that helps doctors and hospitals across the country improve patient safety, identify people vulnerable to addiction, and stop prescription medication misuse.
Diagnosing a digital disconnect
Software that tracks prescription medications has been available for years. Since 2008, Colorado has had an online statewide database that records whenever a pharmacy dispenses a controlled substance. That includes opioids such as Vicodin and OxyContin, as well as other potentially addictive medications, such as stimulants like Adderall and benzodiazepines. Doctors and other health care providers can review a patient’s history before writing a prescription.
Hoppe said such databases could also be effective tools for identifying people who try to persuade multiple doctors to write prescriptions for opioids or addictive medications. Doctors could then refer them to treatment. Databases also can warn doctors if a patient takes a dangerous combination of medications, and in the future software could create risk profiles that could identify a patient susceptible to addiction.
“I think there are positives, and there is evidence that shows they improve patient safety,” Hoppe said. “But there are a lot of barriers to using it.”
Hoppe cited national statistics to support his view. Doctors only check the databases in their states 12 to 20 percent of the time before they write a prescription for a controlled substance.
The critical element is time. Doctors need to quickly diagnose and treat patients while simultaneously reading and updating electronic medical records (EMR). Switching to a different software program to check the state database takes several steps and distracts both doctors and patients.
“If you’re in a busy primary care clinic or emergency department, and you’re seeing patients for only five minutes, and it takes you five minutes to load the system, you’re unlikely to use it,” Hoppe said. If doctors think a patient needs an opioid painkiller and do not see signs that raise concerns about possible misuse or abuse, they often write prescriptions without checking the state’s database. Then they have to move on to the next patient.
Testing the link
Opioid abuse by the numbers
329 people died in Colorado from misusing prescription opioids in 2015
224,000 Coloradans misuse prescription drugs each year
Colorado ranks 15th in the nation for opioid abuse—down from second in 2011
An obvious solution would be to integrate the state database and EMR systems. Hoppe said doing that took about a year. To overcome technical problems, the team worked with Epic, the software company that sells one of the most widely used EMR systems. UCHealth uses Epic’s software and is part of the project.
The initial rollout is small, Hoppe said, with doctors in the SOM’s Emergency Medicine Department and the University of Colorado Hospital being the first users.
“We have to see how it does, how people like it, and if we can make it solvent in terms of cost,” Hoppe said. The U.S. Department of Justice funded the pilot project, and the software will have to show results before receiving more financial support.
Users at CU Anschutz like the system so far, Hoppe said, and it already has made his job easier.
“I use it for 90 percent of patients now that it’s just one click,” he said.
Ultimately, Hoppe would like to see the system or a similar one used nationally, but it won’t happen overnight. He said it could take several years and millions of dollars before every hospital and doctor’s office has quick access to their state’s prescription drug database. Health care providers will need to find money for an expensive upgrade. They also will have to work with many software companies to overcome the challenges of connecting hundreds of systems.
But Hoppe remains optimistic. Doctors need a system that works better, and the severity of the opioid epidemic provides urgency. The software CU Anschutz helped develop and the lessons learned from the pilot program could cut the number of opioid addictions, save lives and help end a crisis.
“There’s a lot of pressure to integrate these systems,” he said. “This gives us a big tool to help.”
Lindsey Kato takes the opioid epidemic personally — the Colorado School of Public Health (ColoradoSPH) alumna has lost eight friends to heroin overdoses. She said most of those friends began abusing prescription opioid painkillers such as Vicodin and OxyContin in high school. Then they graduated to heroin, an even more lethal and addictive opioid.
Kato grew up in Juneau, Alaska, a community hit hard by opioid abuse and a surge in heroin use. “I still continue to lose friends,” said Kato, who in December received her Master of Public Health degree. “I want to understand how did I end up here, and how did my friends end up there.”
For Kato, “here” meant the University of Colorado Anschutz Medical Campus, where she studied epidemiology. That led to a job with the Colorado Department of Public Health and Environment (CDPHE). In May 2016 and while still a student, she began working as the department’s heroin strategies coordinator. The job helps bridge the public health and law enforcement communities, which in the past have not always seen eye-to-eye on how to deal with addiction.
Kato’s responsibilities included collecting all the data about arrests for heroin or opioid possession and distribution that Colorado law enforcement agencies could provide. She also studied the progression from prescription medications to street drugs, leading a project that conducted surveys in nine Denver-area methadone clinics. The CDPHE will publish the survey findings next month in a report titled “Heroin in Colorado.”
Kato’s work is an example of how CU Anschutz faculty, students and alumni help fight opioid abuse. Epidemiologists in the ColoradoSPH study demographic trends and social impacts in the hopes of helping individuals, families, communities and government officials come to grips with the epidemic. Other researchers at CU Anschutz study alternative pain treatments, develop continuing education programs for rural doctors and integrate databases used by doctors, dentists and pharmacists.
Understanding prescription opioids’ connection to heroin
The State of Colorado considers opioid and prescription drug abuse a public health crisis, and it relies heavily on CU Anschutz to coordinate the response, with the university providing the Colorado Consortium for Prescription Drug Abuse Prevention’s director and the chairs of many of its work groups.
In 2015, 160 people in Colorado died of heroin overdoses, up from 37 in 2000 and 91 people in 2012, according to the state health department.
The idea that painkillers prescribed by a doctor or dentist could lead to heroin addiction surprises people, Valuck said. Some think it might be harmless to share meds with family members in pain or keep unused pills in the medicine cabinets. But that can lead to disaster — according to national statistics, about 69 percent of opioid abusers started that way.
The connection between the two epidemics seems to make sense. Heroin is in the same family of drugs as prescription opioids, and the nervous system reacts to them in similar ways. They share harsh withdrawal symptoms that cause people to become violently ill. Addicts become desperate to prevent withdrawal, Valuck said, and some will begin buying pills from drug dealers to avoid the pain.
“People who go through withdrawal say they would rather die than go through that again,” Valuck said.
Anecdotal evidence from law enforcement officers and health care providers supports the connection between the epidemics. But government officials and public health experts developing strategies for combatting the epidemic needed better data. One of Kato’s tasks for the state health department was to collect data about why and how people became addicted to heroin.
“We had a hunch about the connection between prescription drug abuse and heroin,” Kato said. “We wanted solid evidence, and we wanted to understand heroin abuse from the perspective of people who have experienced heroin addiction.”
Researching in methadone clinics
Heroin and opioid abuse in Colorado
160 people died of heroin overdoses in 2015
37 died of overdoses in 2000
70 percent of recovering heroin users abused prescription opioids
329 people died from misusing prescription opioids in 2015
To conduct the study, Kato and five ColoradoSPH students interviewed patients in nine methadone clinics around Denver. The clinics help patients recover by distributing methadone, which mitigates opioid withdrawal. The medication itself is a long-acting opioid, but unlike heroin or prescription opioids, it does not get users high. Patients receive their doses at clinics, and doctors supervise their treatment.
Kato and the team administered an in-person survey with 46 questions. They asked the clinics’ clients about their backgrounds and why they began using drugs. Kato also sought to find what recovering addicts thought about their treatment and what helps them stay sober.
Interviewers often started at 5 a.m. to meet people who went to the clinic before work. They conducted 713 surveys in 25 days.
What Kato found shocked her, especially what she saw during her first visit to a clinic.
“We couldn’t tell who was a client from who worked there,” Kato said. “Society paints a certain picture of addiction, we think of particular demographic, and that’s the stigma around methadone clinics. But it was so diverse — there were people in suits who looked like they could be professors, classmates or even your grandmother.”
Kato also found that about half of the recovering patients had college educations, more than a third were employed, and the majority rented or owned homes. The data confirmed what Kato saw happen to her friends. About 70 percent of the clients cited prescription pain medication use as one of the main reasons for transitioning to heroin.
Their stories shared certain traits—sometimes people got hooked as kids, sneaking a family member’s meds. Some became dependent on legitimately prescribed painkillers for a medical problem. When doctors stopped prescribing, they would borrow or steal pills from friends or family.
At that point, Kato found prescription drug abusers reached a crossroads. Some sought treatment, while others turned to drug dealers. Some of the latter were able to limit their addictions to prescription medications. Others couldn’t and tried heroin.
Someone in this situation isn’t necessarily trying to find a better high, Valuck said. Heroin is cheaper and easier to find on the drug market than prescription meds, and he said it is not uncommon for people to sell their prescription medication and use the money to buy heroin.
Creating a unified response
Controversy still lingers around methadone. Doctors and public health experts consider methadone a legitimate and effective treatment. Valuck said giving patients carefully managed doses that decrease over a few years has proven safer and more effective than making them quit cold turkey.
“We couldn’t tell who was a client from who worked there…. They could be professors, classmates or even your grandmother.”
Law enforcement officers historically have not been involved in drug treatment, Kato said. She believes that police see the crimes committed by drug addicts and often identify with victims affected by these crimes, rather than identifying or empathizing with the individuals experiencing addiction.
The difference in perception shows the different approaches between those who see drug abuse as a criminal matter or a medical issue. Kato plans to spend her career working to bring the sides together to help coordinate an effective response. Already, she’s seeing attitudes change among leaders in the law enforcement community.
“They have come to terms with knowing they’re not going to solely arrest their way out of this problem,” Kato said. “They are actively seeking to understand the process of addiction and how they can be involved in a public health approach.”