As West Virginia became the epicenter of the nation’s opioid epidemic, donor dollars brought Dr. Judith Feinberg to the West Virginia University School of Medicine to expand research focused on the intersection of addiction and infectious disease.
More than five years later, her work is making a difference by expanding testing and increasing access to treatments for diseases spread through injection drug use — HIV, hepatitis B and hepatitis C.
As the inaugural Dr. E.B. Flink Vice Chair for Research, Feinberg is responsible for cultivating a robust clinical research program within the Department of Medicine. In addition to tackling her own projects, she helps faculty members develop their interests, pursue competitive funding and gain experience as clinical researchers.
Feinberg came to WVU from the University of Cincinnati, where her work — which focused on HIV/AIDS for decades — shifted in response to the opioid crisis. In 2005, she was the first physician in metropolitan Cincinnati to identify injection opioid drug use as an emerging health threat, based on a spike in admissions for infective endocarditis — an infection of the heart lining that can occur when bacteria from contaminated needles enters the bloodstream. She later established Ohio’s third syringe exchange and its first true syringe services program, the Cincinnati Exchange Project.
Feinberg was attracted to WVU because of the potential to make a significant impact: West Virginia’s rates for opioid overdose deaths, babies born in withdrawal from maternal opioid use, and acute hepatitis B and C infection due to injection drug use are the nation’s highest.
“We really are struggling here,” Feinberg said. “That’s why I came here, because I really want to make a difference.”
‘Support and understanding’
Much of Feinberg’s work at WVU focuses on reaching out to people suffering from opioid use disorder through harm reduction programs, which address the negative consequences of drug use. A common harm reduction tactic is providing sterile syringes to people who inject drugs to prevent the spread of infections. Other strategies involve teaching people how to avoid and recognize an overdose and how to use naloxone to prevent a fatal overdose. Contrary to popular misconceptions, Feinberg said many studies show that such programs actually reduce drug use, prevent the spread of disease and increase entry into treatment programs by five-fold.
Feinberg said it’s important to understand that substance use disorder — whether it is opioids or alcohol — is a chronic relapsing brain disease, not a reflection of a moral failing or a lack of willpower. Drug use alters a person’s brain physiology, chemistry and anatomy to make the pursuit of drugs dominate his or her thoughts.
“They’re not thinking like the average person,” Feinberg said. “It’s like a hostile takeover of your brain. Your brain is hijacked by the drug. It just isn’t a normal thought process.”
Feinberg said stigmatizing drug use and punishing people with substance use disorder is counterproductive to getting them into treatment and impr-oving their health and public health in West Virginia. To ensure that harm reduction efforts are successful, service providers must establish trust by treating people with dignity and respect.
“People need support and understanding,” Feinberg said. “We, as a society, need to understand that this is a disease and that we need to treat these individuals like they have a disease. This is an illness. This needs care, needs chronic care, needs lifetime care, just like diabetes needs lifetime care. And then people will thrive.”
Stopping the spread of disease
Feinberg said the diseases commonly spread through injection drug use were once deadly, but they can now be prevented, cured or effectively managed with existing therapies. Hepatitis C can be cured by taking medication for eight to 12 weeks. A daily pill can prevent HIV, and vaccination can prevent hepatitis B; although they cannot yet be cured, both conditions can be controlled with medication.
Curbing the spread of these diseases begins with increased testing to identify those who are infected. A multiphase research study led by Feinberg and Dr. Gordon Smith, the Stuart M. and Joyce N. Robbins Distinguished Professor at WVU’s School of Public Health, aimed to increase testing for HIV and hepatitis B and C in seven southern West Virginia counties heavily impacted by the drug epidemic. In collaboration with local health departments and service agencies, the project sought to increase public awareness, help communities prevent drug use and deal with the consequences by developing harm reduction programs, provide testing to find those who were already infected, connect people to care and increase naloxone availability to decrease the overdose death rate.
Feinberg is analyzing the results of another study that offered curative hepatitis C therapy to active drug users, who are often barred from getting such treatment via insurance. The study was conducted in Morgantown — one of eight sites nationwide — in partnership with Milan Puskar Health Right, a community-supported free clinic that offers a syringe services program. Feinberg said preliminary results show that 61 of 62 people enrolled locally were cured of hepatitis C.
Health Right Executive Director Laura Jones said Feinberg’s work is essential to Morgantown and beyond because substance abuse ultimately affects an entire community’s health and well-being.
Another study targets pregnant women in the Morgantown area to determine how common it is for mothers with chronic hepatitis C to pass the infection to their babies. The participants all contracted hepatitis C through drug use and receive curative therapy after they finish breastfeeding their babies. Pediatric specialists follow the babies to see how they are affected — chronically, briefly but the disease clears, or not at all — so they can receive needed care.
Feinberg is also working with West Virginia Medicaid, which covers most state residents in need of hepatitis C treatment, to expand access to curative therapy statewide. Current Medicaid restrictions require treatment to be provided by a specialist; however, there is a very limited number of liver and infectious disease specialists in West Virginia, and most work in the state’s larger cities rather than the rural areas with the highest rates of chronic hepatitis C. But, through a new West Virginia Hepatitis Academic Mentoring Partnership, Feinberg is training primary care providers to provide treatment through intensive education sessions and ongoing support offered online. West Virginia Medicaid has agreed to release the medication to participating providers.
“We could actually stop West Virginia’s hepatitis C epidemic if we treated enough people and cured them,” Feinberg said. “But we’re never going to be able to do it unless family doctors can do it and nurse practitioners can do it.”
Feinberg’s research portfolio continues to expand. She received funding from the National Institute on Drug Abuse to co-lead a study of rapid-response fentanyl test strips as an opioid overdose prevention strategy. She is also the co-lead on another NIDA grant to conduct clinical trials of new approaches to managing substance use disorder; WVU and partner sites at the University of Pittsburgh and Pennsylvania State University form the Appalachian Node of the NIDA Clinical Trials Network.