Q&A with Geisel professor Lisa Marsch

by Vignesh Chockalingam | 2/21/17 2:00am

Geisel School of Medicine psychiatry professor and director of the Dartmouth Center for Technology and Behavioral Health Lisa Marsch recently testified before Congress’ Bipartisan Task Force to Combat the Heroin Epidemic about her research on the nation’s opioid crisis. The task force was formed in 2015 by Rep. Ann Kuster ’88 and former Rep. Frank Guinta, both of New Hampshire. The state has the country’s highest rate of opioid overdoses per capita. Marsch’s research focuses on understanding the roots of the opioid crisis and researching effective methods of addressing it, such as treatments and improving access to care.

How did you end up at Dartmouth?

LM: I came to Dartmouth about five and a half, almost six years ago now. Actually, I was running a research center in New York City. It’s very different to live in Manhattan versus living in Hanover, but I came here because I was really attracted to the community of creative and talented people who are also cooperative. It was nice to see that community around campus — it seemed like a great place to make connections across the schools. So we sit in the medical school, but get to reach out to folks in computer science and The Dartmouth Institute [for Health Policy and Clinical Practice] and [the] Thayer [School of Engineering] and elsewhere around campus to really engage in a broad interdisciplinary community and some collaboration.

What was your first role at Dartmouth?

LM: I came in as a faculty member in the department of psychiatry, which is in the medical school, and I actually started here at the Center for Technology and Behavioral Health. Right before I moved here, I had learned that the Center of Excellence Grant Application I had applied for to the National Institutes of Health was going to be funded. So when I decided to come to Dartmouth, I asked that the NIH award this Center of Excellent Grant to Dartmouth so we could start the center here. We started the Center for Technology and Behavioral Health at Dartmouth at that time. We were very happy that we just got a renewal of that Center grant about a half a year ago.

Have you always been interested in substance abuse [research]?

LM: Well, you know, I got exposed to it the first time with addiction research in a group I worked with in Baltimore, Maryland with the Johns Hopkins School of Medicine when I was a student. And I was so struck by the rigor of the science and the rigor of the clinical trials they were doing there, trying to evaluate different treatments for addiction, how difficult it was to change drug addiction, just this chronically lapsing nature of drug addiction. You know you see women come in saying, “I have to stop using because I’m losing my children.” You see these people facing very serious consequences but being unable to stop. It was such a compelling phenomenon to see this intense desire to stop something and not being able to do so. So I started my career in addiction treatment research mostly doing clinical trials, testing different treatment models, both medication and behavioral treatments of addiction. I did a lot of work with teenagers who were addicted to heroin and other opioid drugs and trying to test models of care for that really young group of kids involved with heroin use. And then the technology piece for me came about because, like a lot of science, what we know works best isn’t often what people use in real world settings. So, the most effective treatments of addiction are not what we routinely deploy in our systems of care. So the technology piece was a way to try to develop systems that with fidelity could deliver the best practices of what we know is the state of the science of therapies for drug addiction and to do it in a way that can scale.

So that was how it all started: to try to help accelerate the impact of science on addiction by using technology. And then it’s evolved from there in lots of different directions. But we still have a critical mass of activity in substance use disorders.

One of the things we have at our Center for Technology and Behavioral Health is that we’re part of a national clinical trials network that the National Institute on Drug Abuse supports. So we have partners all over the region in Vermont, New Hampshire and Maine that are a part of this national research infrastructure. We do all kinds of work in the addiction space through that, including the project that I briefly described — the Congressional briefing last week — which is heavily focused on the opioid crisis in the country with a particular focus on New Hampshire, which unfortunately has the highest rate of overdoses per capita in the entire U.S.

Can you talk more about the opioid crisis and testifying before the Congressional Committee?

LM: So basically, we were asked by the NIDA to conduct what is called a “hot spot study,” which is really a rapid study to try to get a sense of what is happening in New Hampshire given this alarming rate of overdoses that we see happening, especially in the southern part of the state. We have the number one ranking. People say we’re ground zero for the opioid issue in the U.S. Because we are a part of this national clinical trials network, we can pretty quickly learn from not only active users — we met with 75 of them separately — but also first responders and emergency department personnel and law enforcement and all kinds of different stakeholders about what they’re observing in their different communities to try to understand the different factors that could be giving rise to this disproportionately high rate of overdoses. That’s what I was asked to talk to Congress about. It was really great to see that it’s a very bipartisan issue. The task force was co-chaired by a Democrat and a Republican representative in the House. They basically said, “We are the most rigorously bipartisan task force in the entirety of Congress,” because there is this strong commitment to the importance of this issue and its impact on our nation. It was a great opportunity and great to hear the questions they were asking about, what they’re trying to learn if they think about levers they can use to try to help tackle this crisis.

What do you think federal and state governments can do to address the opioid crisis?

LM: Well, they’re doing a number of things. But there are more opportunities of course. One thing that is terrific is this “21st Century Cures Act” that basically allots a billion dollars — half a billion this year and half a billion next year — to heavily increase treatment, evidence-based, medication-assisted treatment for opioid addiction but also to put some of the resources for prevention efforts. Every state can apply for this money and can have this influx of resources to expand options for treatment for people who are managing this problem, which was terrific. The state’s application is due sometime this week, so the funding will be turned around pretty quickly before the end of this fiscal year. But I think there is tremendous opportunity for enhancing research. There are some really effective treatments for addiction. There are lots and lots of opportunities to make addiction treatment much more potent, much more perfected. But importantly, at an implementation level, how do you actually get out there in a big way the most effective treatments? That is a challenge: lack of access. How do we meet this enormous need that we see? Really understanding optimal models for scaling up access to care models is really key. We need more research but also more translation of the science into what is happening in our communities, so really incentivizing adoption of the most effective practices.

Do you have a positive outlook on the future of this issue?

LM: Boy, I hope so. If you look at the statistics, the rate of overdoses is increasing. There’s no evidence of the graphs leveling off at this point, so we’ve got to do something in a pretty dramatic way to change the trajectory of all of this. The good news is that there are a lot of people working on it: many, many federal links, not just the National Institute on Drug Abuse and the Center for Disease Control and Prevention and on and on. There are lots of entities trying to allocate resources and activities to try and tackle this, and lots of community-based initiatives, state-level initiatives and foundation funding. I think one of our big opportunities is to increase the efficiency of all of this with all of this funding flowing into this. There are a lot of efforts that could be duplicated if we are not trying to coordinate the efforts to accelerate what the impact could be.

What do you see the future of your research as being?

LM: I think we are going to heavily continue to focus on scaling up access to effective models for addiction treatment and centrally leveraging technologies as part of that. The data are so compelling from the research we and others have done in this space to show that you can really dramatically increase access to effective resources in entirely new ways that aren’t traditional models of care with technology systems. I think a big interest of mine is not just to focus on silent problems, like drug addiction and isolation, because we know that a lot of these things cluster together.

This interview was edited and condensed for clarity and length.