Jennifer Carroll

Growing evidence suggests that law enforcement efforts to disrupt the illicit drug supply increases overdose risk for people who use drugs, producing new overdose events in the surrounding community. Research conducted by Dr. Jennifer J. Carroll, for example, demonstrates that law enforcement disruption in the form of seized drug supply or arrests made to remove key actors from the drug market may force people who regularly use drugs to seek out alternative dealers or different substances to avoid withdrawal. People who use illicit drugs are generally unaware of the actual content of a substance from a new dealer, or tolerance for the substance, which increases their risk of overdose. To date, however, research on this topic has been limited to national or statewide aggregated cross-sectional data, or qualitative methodologies. This is the first study to systematically assess whether seizures of illicit substances by law enforcement ?????????????????? specifically seizures of stimulants and opioids ?????????????????? affects the risk of overdose for people who use drugs in the surrounding community. Using street-level data on law enforcement drug seizures, along with fatal and non-fatal overdose events, our approach aims to use generalizable methodologies to create an open-source database of drug seizure events that can be replicated in multiple jurisdictions as part of ongoing surveillance. Through community partnerships and collaborative analysis that centers the expertise of people who use drugs, we aim to help communities understand how drug market disruptions affect public health, so that drivers of preventable overdose death can be mitigated.

Dr. Jennifer J. Carroll is a medical anthropologist who specializes in drug use and overdose prevention. She is an Assistant Professor of Anthropology at North Carolina State University and an Adjunct Assistant Professor of Medicine at Brown University. She holds a doctorate in anthropology and a Master in Public Health in epidemiology from the University of Washington. She has been conducting research on harm reduction and drug treatment efforts in Ukraine since 2007 and is currently writing a book on drug use and global health in Ukraine before, during and after the country's recent political revolution The assignment for Dr. Carroll will allow CDC to have essential expertise and consultation while working on the Opioid Response Strategy, Rapid Response Project, and other applicable tasks. Her expertise in the intersections of public health and public safety will greatly benefit DOP/PPEB. In concert with CDC Scientist and staff, Dr. Carroll will contribute to: 1. Scientific writing and review. Assist in the completion of scientific papers and projects. Specifically, work with CDC employees on the conceptualization, analysis, and/or writing of papers; review documents; review and revise CDC-generated research instruments for OMB packages or other purposes. 2. Provide training and mentoring to CDC scientists, partners, and/or funded recipients. Support CDC training needs in the area illicit opioids, injection drug use, and qualitative research methods. 3. Offer technical assistance to CDC staff, as needed, to support projects such as the Opioid Rapid Response Program, Narconomics feasibility study, ODMAP scale-up, or work with harm reduction partners. Specifically, Dr. Carroll may be called upon to consult on the creation of knowledge translation documents, evaluation tools, development of survey or interview instruments, and writing up guidance documents. Some travel may be required. 4. Consult with Opioid Response Strategy team as needed to offer technical assistance to cornerstone data analysis, document review, or scholarly writing.

Opioid-agonist medications for opioid use disorder (MOUD) are evidence-based treatments and the current gold standard of care for people living with opioid use disorder (OUD).1 Opioid agonist MOUD also protect against opioid overdose, which claimed the lives of nearly 3,500 North Carolinians in 2021. With overdose deaths reaching record numbers each year, ensuring that North Carolinians have sufficient access to MOUD is more important than ever. Despite this, many well-known treatment providers in North Carolina refuse to provide participants in their therapeutic programs with access to MOUD for philosophical and/or logistical reasons. Even though they do not offer evidence-based care, some of those providers enjoy significant financial support from the state. This project will be the first of its kind to thoroughly evaluate access to MOUD (or lack thereof) at substance use disorder treatment providers in North Carolina. We will first conduct a thorough inventory of self-advertised residential treatment providers across the state, whatever their licensure or accreditation. We will then conduct structured outreach to assess each treatment provider???s services and policies regarding on-site administration or facilitated off-site access to opioid agonist MOUD. We will also conduct outreach to all 49 recognized Adult Drug Treatment Court programs in North Carolina to determine policies governing the provision or use of MOUD among court participants. The findings from this study will identify current treatment gaps across the state of North Carolina, characterize the actual treatment capacity for addressing opioid use disorder within the state, and offer much needed guidance to policy-makers at the state and county levels as they prepare to allocate funds soon to be received from the global opioid settlement.

This project will conduct formative research to develop a model for HIV prevention among PWID by providing PrEP alongside MOUD and HCV care via telehealth at a syringe services program (SSP). We will enroll 30 HIV-negative PWID at an SSP run by our collaborators at the North Carolina Survivors Union (NCSU) in Greensboro, in Guilford County, NC. All participants will be eligible for PrEP, and will undergo screening to evaluate whether they are also candidates for MOUD and/or HCV treatment. The baseline visit will be conducted in-person with the study PI, Dr. McKellar, a licensed and experienced physician. Dr. McKellar, who already provides telehealth visits for Duke PrEP Clinic patients, will conduct subsequent visits remotely via telehealth. A local peer case manager trained in phlebotomy will obtain samples at the SSP for baseline and follow-up laboratory testing at a collaborating lab. We will follow participants for 6 months, then link them to local providers for continuation of PrEP and/or MOUD treatment ??? or they may continue with the Duke provider. We will conduct participant questionnaires at baseline, 3 months, and 6 months, and participant interviews at 1 month and 6 months to assess acceptability and feasibility from a patient perspective. In addition to consulting on the implementation of this telehealth clinic, Dr. Carroll will conduct interviews with SSP staff and the clinical team to assess implementation feasibility from a provider perspective. Questionnaires and interviews will be guided by the Technology Acceptance Model and Implementation Research Logic Model.

Non-fatal opioid overdose is the strongest predictor of a subsequent fatal overdose. Thus, non-fatal overdoses are pivotal opportunities, usually missed, to engage survivors in treatment and overdose prevention to reduce the likelihood of a future fatal overdose. The emergence of KT programs in Massachusetts provides the opportunity to conduct a rigorous natural experiment to assess their effectiveness to reduce opioid overdoses. Further opportunity exists to identify best practices, unintended consequences, implementation barriers and facilitators, and to develop evidence-informed guideline recommendations for these programs. The purpose of this study is to investigate the implementation and impacts of these novel outreach programs through a comprehensive inventory of active post-overdose outreach programs in Massachusetts; To identify best practices, unintended consequences, and implementation barriers and facilitators of post-overdose outreach through qualitative interviews with front line staff and recipients; to determine the effectiveness of KT programs in reducing opioid overdoses; and to develop post-overdose outreach program guideline recommendations useful to public health departments.