New Research Project Addresses Dual Epidemics of Drug Overdose and COVID-19

The COVID-19 pandemic collided with a growing overdose epidemic that killed more than 9000 people in Wisconsin from 2000-2019 from opioid overdose alone. People who inject drugs under-utilize preventive health care and experience stigma and discrimination in medical settings, making them particularly vulnerable to both overdose and vaccine preventable illnesses such as COVID-19.

Now, with a COVID-19 Response Grant from the Wisconsin Partnership Program, Rachel Gicquelais, PhD, MPH, assistant professor, UW–Madison School of Nursing, is taking an innovative approach to addressing the dual epidemics of COVID-19 and drug overdose with a focus on rural Wisconsin residents.

The project is co-led by Ryan Westergaard, MD, PhD, MPH, associate professor, Department of Medicine at the UW School of Medicine and Public Health, and includes a team of dedicated students, collaborators, and community partners including Vivent Health, Wisconsin’s primary network of syringe services programs.

Through the project, Dr. Gicquelais and her research team will increase understanding about the patterns of overdose risk in the wake of the pandemic and will test a novel mobile health intervention to reduce overdose risk and support vaccine uptake in people who inject drugs.

The Wisconsin Partnership Program met with Dr. Gicquelais to learn more about the project and what she hopes to accomplish through this work:

Q: Can you briefly describe your COVID-19 Response Grant on responding to the dual epidemics of COVID-19 and overdose, and what you hope to learn from this project?

A: Our project is in response to the increase in overdose deaths that we’ve been seeing, particularly since the start of the COVID-19 pandemic. Overdose mortality and non-fatal overdoses have been steadily increasing, but we’ve seen nearly a 30 percent rise in these numbers since COVID hit in early 2020.

With our grant we have proposed to characterize the epidemiology of that increase in overdose deaths, as well as understand how COVID-19 impacted people who use drugs in Wisconsin. We are also pilot testing an innovative mobile intervention that is delivered via smartphone to reduce overdoses and promote COVID-19 vaccinations.

Q: Why does this project focus on rural Wisconsin residents?

A: We have access to rich data among rural-dwelling people that we can build on for this project through the Rural Opioid Initiative, which is also co-led by Dr. Westergaard. With this study we have access to data from a large survey of people receiving services at syringe service programs operated by Vivent Health, one of our community partners in the research.

Our analysis will show how COVID-19 and overdose have impacted rural-dwelling people who inject drugs. We’re also going to have three study sites for the intervention aim. One is in Milwaukee which has been greatly impacted by the issue of fentanyl contamination in the drug supply, and we’re partnering with two of our previous study sites in Appleton and Eau Claire.

Q: What does the data collection and analysis component of this project look like?

A: We had about a thousand people who inject drugs participate in a survey in 2018 to 2019. From this survey, we are linking the data to several registries at the Wisconsin Department of Health Services to understand how this particular rural dwelling population weathered the pandemic in terms of their overdose rates, COVID-19 infections, hospitalizations, and vaccinations.

We are also trying to understand factors that are related to positive outcomes, like getting vaccinated for COVID, and ascertain what the disparity is between people who inject drugs versus the general population in Wisconsin in terms of how they were impacted by the pandemic.

Q: Can you explain how you will implement the intervention component? 

A: We are designing a 12-week intervention that can be delivered via a mobile health application. This mobile health app uses a platform developed by the UW–Madison Center for Health Enhancement System Studies, and they helped us design a specific version of the app for our study participants through the Rural Opioid Initiative.

Our group is currently testing an intervention called Prevention Navigation. This is a one-on-one intervention that incorporates motivational interviewing, counseling, and case management. People engage with a “prevention navigator” in-person at Vivent Health and can be connected to services that they need to reach health-related goals around overdose, housing, addiction, and many other things.

This project looks at how we can expand this intervention for overdose prevention and make it more flexible by delivering it through a smartphone app.

We’re also providing phones with  data plans to people who participate in the study, which will allow them to do the intervention at a time that works for them and use available tools and methods to reduce overdose risk, as some of these may require phone access. 

Q: How can this grant be understood from a health equity standpoint? 

A: Our wonderful community partner, Vivent Health, emphasizes health equity by providing essential services to support people who use drugs, who often face barriers accessing health care, medications, housing, and other essential services.

People can get supplies for safer drug use like naloxone and fentanyl test strips, and they can get referrals to treatment or other medical care as well.

We’re also working toward understanding how the pandemic has impacted people who use drugs in Wisconsin, and part of that is going to be looking at disparities specifically between people who use drugs and the general population in Wisconsin based on aggregate COVID data. We know that those disparities exist, but our study is going to allow us to quantify what they look like in Wisconsin.

With our strong partnerships and  interprofessional team, I’m confident we can communicate our findings with public health partners and think strategically about the next steps once we’ve characterized this disparity.

Q: What inspired your interest in analyzing and responding to these dual epidemics? 

A: I’ve been interested in substance use as a topic of research since back when I was in my undergraduate training. National recognition that overdose deaths were climbing started happening around the time I entered graduate school for my Master of Public Health, and I saw the effects of these rising numbers in every place that I’ve worked since.

When the pandemic began, I think it just created the perfect storm where many researchers working in overdose immediately realized the possible negative effects COVID could have on people with substance use disorders. So I was excited about this project because we’re trying to describe the impact of these dual epidemics of COVID-19 and overdose deaths on a population level, as well as take a first step in testing an intervention that might help people evaluate their overdose risk behaviors and make changes if they’re able to.

Q: What do you find most rewarding about your work? 

A: For many researchers there is one big health related problem that motivates you to come to work every day and serve the population that you’re dedicated to, and that’s certainly true for me with this work.

I also think that part of the reason our project can be successful is because we have a fantastic team with a lot of passion and energy for the work we’re doing. My co-PI, Dr. Westergaard, works in public health practice as the state epidemiologist, and this study has been such a wonderful opportunity to enhance our partnership with colleagues working in public health surveillance to add a dimension of data that would not be possible without them. It’s a great opportunity to leverage the public health infrastructure that’s so strong in Wisconsin.

Q: How has the Wisconsin Partnership Program’s support helped the project so far? What improvements in health do you hope to see, or contribute to, as a result of this project?

A: I’m confident that this project would not have happened without WPP’s support. I feel fortunate to be on a campus with strong internal funding opportunities because we were able to get the funds quickly and get things moving right away, which was important to us because overdose is increasing right now, so there is urgency to do this work.

This funding opportunity has allowed us to provide people who participate in our study with phones. We know from prior surveys that when people don’t have access to a consistent cell phone with a data plan, their ability to receive medical care and support is significantly limited. I’m excited about the prospect of providing phones, to deliver our intervention, and help facilitate participants in taking steps to achieve the goals that they might set in our intervention. 

Q: What improvements in health do you hope to see, or contribute to, as a result of this project?

A: I see this epidemiological characterization of how people who use drugs have been impacted by the pandemic, and the resultant increase in overdose mortality, as an important first step.

How do we increase access to vaccinations? How do we think more carefully and more broadly about overdose risk reduction programming? We look forward to having those rich conversations with our partners at the Wisconsin Department of Health Services and Vivent Health. Additionally with the mobile intervention, we have 60 people who are participating, and we hope to grow this into a bigger study based on the lessons learned here.

These pilot data are going to be critical to moving forward to that next step and designing a larger scale study that continues to address the health disparities that we’re seeing in people at-risk for overdose and COVID-19.