Kenneth Bossert has seen a shift in the ages and backgrounds of patients in his 15 years at the DART methadone clinic in downtown Buffalo but an unfortunate truth that remains: Many who continue to come to the Main Street facility are infected with the deadly Hepatitis C virus.
Patients will come in for methadone up to seven days a week, Bossert said, "but regrettably, you can provide them tremendous opportunities for other treatment and, if it requires them to leave the clinic, the probability of them completing that linkage is pretty low."
Enter Dr. Andrew Talal and two student researchers who have spent part of the summer conducting research that may one day allow more patients at DART, and across New York State, to take life-saving Hepatitis C medication when they come in for methadone – and check in with liver specialists like Talal through a telemedicine conference to get the medicines they need, and assure the process goes smoothly.
"This is a population that not only has been excluded from medical care but also from research," said Talal, a University at Buffalo medical professor and hepatologist who treats patients at Buffalo General Medical Center. He also leads liver disease research at the Buffalo Clinical and Translational Research Center.
Talal is leading a five-year, $7 million statewide project funded by the Patient Centered Outcomes Research Institute (PCORI) to find out if telemedicine can improve Hepatitis C treatment for patients who take methadone, and, if so, how it can work best.
He enlisted help in recent weeks from Bossert's son, Nicholas, who is about to enter his fourth year in the five-year physician assistant program at Daemen College in Amherst, and Narrisa Williams, a Harlem native raised mostly in Rockland County who will start medical school this fall at the University at Buffalo.
Nicholas Bossert, 21, of Lake View, took an interest in the medical field when being treated for knee and ankle injuries he suffered playing sports at Frontier High School.
Williams, 26, holds a bachelor's in religion from Princeton University and master's degrees in public health and bioethics from the University of Pennsylvania. Her goal from the start of her academic career was to become a doctor.
Talal underscored that the research Williams and Bossert have conducted – a novelty for DART – is an example of the power to pull in budding local and national health care talent to the growing Buffalo Niagara Medical Campus, and make a meaningful impact in Western New York.
The two young researchers started a process that will use analytics to determine which methadone patients might be most likely to take advantage telemedical Hepatitis C treatment. They pored over dozens of medical files and electronic medical records looking for trends in age, race, gender and educational backgrounds. They also zeroed in on answers to questions asked during the intake process, including "reason for starting illicit drug use" and "reason for seeking addiction treatment."
Both were shocked by what they found – and humbled by how much they learned.
Q. What themes emerged?
Bossert: For me, they brought to the forefront while I was interning in (addiction specialist) Dr. Richard Blondell's office. I was seeing patients every day and helping with physicals and brief medical histories, but when you're a student and say, "I'm going to go into this addiction clinic and do some work," you try not to, but you picture what a classic addiction patient would look like. Then you get to the clinic, those don't really meet who you thought. Some of these people were 40-, 50-year-old patients who were going into surgery three years ago and now are coming in for addiction treatment because they're shooting heroin.
In the DART clinic, when social workers ask the reason for illicit drug use, you see a lot of "Motor vehicle accident in 2002, now addicted to heroin." You'll see, "Prescribed hydrocodone for migraines, now addicted to heroin."
Williams: We've even seen what Nick described starting at a very young age, children, teenagers prescribed an opioid after wisdom teeth removal or a motor vehicle accident, something that sparked them to start using prescription opiates, first (legally), then illicitly, then progressing to something that was devastating and completely derailed them.
These preconceived notions you have of addiction and then you look at the charts. Some of these folks are fully functional, have been their whole lives, and then have some kind of traumatic incident and now they're in a place where they need treatment. We found there's a spectrum of patients, from very young who started taking a drug. We saw a couple where a birthday gift from a friend at 16 years old was to be injected.
Nick: In some cases, it was almost like a rite of passage.
Q. What did you learn about the how they came to the clinic?
Williams: Going into this, we thought (slipping toward heroin) was probably financial, that they couldn’t afford to get the substance they wanted.
Bossert: Or to hear, “Mom won’t have this drug abuse anymore; she expects me to come here.”
Williams: Those are the minority. We see more of “I’m fed up. I want more out of life.”
Bossert: You see the fear of death, that treatment is do or die.
Williams: One of the questions asked is “When is the last time you were able to abstain and how long?” For a significant amount of patients, it was either incarceration or pregnancy. ... It’s heartbreaking to see some of the histories of domestic violence or sexual abuse. These are very traumatic things. I don’t know if it’s correct to say, but it’s no wonder folks are trying to find some way to cope with what they’re dealing with.
Bossert: When you see some people say, “It’s the person’s fault that they’re doing drugs,” and you look at the intake reports and see the information, you ask, “Is it really – or is it maybe an event or environmental factor?”
Williams: This is getting beyond the taboo of what has traditionally been called a “difficult population,” and seeing that these are folks with a chronic problem. Just like you would treat diabetes, just like you would treat hypertension, what makes these folks less deserving of the same kind of resources, the same sort of attention?
Bossert: The addiction medicine sub-specialty was recently added to the UB medicine realm. I'm hoping there's more students out there to have the opportunity to get their feet wet in a sub-specialty that's not craved.
Q. How exciting or interesting is it to know that people in the place where you grew up are leading this kind of research?
Bossert: It's an opportunity to be here in an academic environment that's breaking down doors. I feel blessed to be part of the ride.
Q. How do you feel being in a place where some of the things you've been thinking about academically for years are available?
Williams: I have to echo the same thing. To see such a vibrant unity of academic research, clinical research and clinical partnerships, and being able to see these three aspects come together to improve the health of the community, that for me is beyond what I can get in the classroom.
Twitter: @BNrefresh, @ScottBScanlon