We will determine:

• Understanding how overdose prevention centres (OPCs) work and who they work for? Using RAMESES guidelines, we'll conduct a realist review to determine what works, for whom, and under what circumstances in OPCs.
• What should we measure to find out if overdose prevention centres work? Following COMET Initiative guidance, we'll establish essential metrics for OPC evaluation (Core Outcome Set) through evidence review, international e-Delphi with stakeholders, and consensus meetings.
• Impact and Cost-Effectiveness Modelling: We'll develop an epidemiological and economic framework to assess target groups, effects, costs, and cost-effectiveness of OPCs in UK localities.
• UK Health and Social Care Integration: Through interviews with key stakeholders, we'll explore what model might work, how to optimize OPC integration within the existing UK healthcare landscape, ensuring maximum use, cost-savings, and alignment with service user needs.

Research Team: Dr Gillian Shorter & Professor Alex Stevens (Co-Principal Investigators), Professor Peter Vickerman (Co-Applicant), Dr Zarnie Khadjesari (Co-Applicant); Mat Southwell (Co-Applicant); Tanya Telling (Host), Ben Scher (Research Fellow), Dr Adelina Artenie (Research Fellow), Dr Jolie Keemink (Research Fellow); Andrew Dyer (Research Fellow), Lynn Jefferys (Advisor)

Partner institutions: Sussex Partnership NHS Foundation Trust, University of Kent, Queen’s University Belfast, University of Bristol, University of East Anglia, Coact, EuroNPUD

Funder: This study was funded by the National Institute for Health and Care Research (NIHR) [Programme Development Grant (NIHR 204582)]. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Selected Outputs:

Report: Want to know more about drug consumption rooms, overdose prevention centres, or safe consumption facilities? See the evidence, common misconceptions, community views, do they work, how they work, and more.

Journal article: Overdose prevention centres as spaces of safety, trust and inclusion: A causal pathway based on a realist review

Talks: at the United Nations Commission for Narcotic Drugs by invitation of Permanent Mission of Greece in Vienna and Permanent Mission of Portugal in Vienna; Stockholm University amongst others

Press: Overdose Prevention Centres have key role in tackling UK drug-deaths crisis, says new research featured in the Guardian, Independent, BBC Radio, HOPE Podcast, Korinthos News, Drink and Drugs News, Sky News, Belfast Live, Belfast Telegraph, BNN, Irish Examiner, View Digital, The National, Glasgow Times, BBC Sounds, PA, News Letter, Irish News, Frontline Podcast

Trials of psychological interventions generally exclude people with significant cognitive impairment because of the cognitive demands associated with the intervention techniques and the collection of patient-reported outcome data. Our research team has identified, following the MRC Framework, a psychological approach - Acceptance and Commitment Therapy (ACT) - which shows promise for stroke survivors with significant cognitive impairment. We have also identified a range of modifications and supports which can be incorporated into the ACT protocol to tailor it for the needs of people with cognitive impairments. It is important that this intervention is optimised and shown to be feasible for use in practice prior to investment in a large scale controlled trial.

This project is optimising the intervention via an iterative process involving:

• stakeholder workshops to gather feedback on the intervention and materials, using simulated patient cases to define patient eligibility criteria, and refinement of a logic model describing the implementation of the intervention in practice, and
• a survey and interviews to collect data from patients and carers who will provide feedback on the acceptability and feasibility of the proposed intervention.

Ongoing work in this area has included the establishment of regional centres for chronic pain rehabilitation, including the Belfast Centre for Pain Rehabilitation (BCPR) at the Belfast City Hospital (service website). The BCPR began during the Covid pandemic and has successfully offered a pain education programme (‘Pain Retrained’) to over 500 patients which are being analysed as part of a PhD trainee in Professor Vowles’ lab, Maura McCarron. The BCPR has also run more than ten three-week intensive pain rehabilitation programmes for individuals with highly complex and disabling chronic pain. This latter programme is the first of its kind on the island of Ireland and is achieving outcomes fully consistent with the established evidence base. Data collection of outcomes through one year follow-up is in progress.

There is also work ongoing with the newly established Paediatric Complex Pain Service with Children’s Health Ireland. This service is the only pain rehabilitation service for under 18’s in Ireland and will run the island’s first ever intensive pain rehabilitation programme for youth with chronic pain in the Autumn of 2024. Professor Vowles has advised the service since its inception and his work has been supported through a grant from the Children’s Health Foundation for developing intensive interdisciplinary pain rehabilitation.

Recently, he published several papers relevant to this topic including a comparative meta-analysis of unidisciplinary and interdisciplinary pain rehabilitation (Vowles et al., 2020), assessment measure revision based on the latest statistical approaches such as Item Response Theory (Vowles et al., 2024), as well as consensus statements on how pain rehabilitation fits with the European Pain Federation’s research strategy (Fullen et al., under review [submitted 23 August 2024]).

Professor Vowles is also an Investigator in a recently funded trial that will identify specific treatment mechanisms influencing the outcomes following behavioural treatments for chronic pain. This trial is pre-registered (NCT02133976) and the study protocol is under review as of summer 2024 (Burns et al., under review). This trial is due to conclude in 2029.

Based on his work in the area of co-occurring chronic pain and harmful opioid use, Professor Vowles and colleagues developed an integrated behavioural intervention for co-morbid chronic pain and harmful opioid use. The funded pilot evaluation (pre-registered: NCT02423772) indicated the intervention was feasible, associated with excellent retention in treatment (exceeding 80%), and strong treatment effects in terms of reducing both pain’s interference on functioning and risk of opioid misuse (Vowles et al., 2020). Based on the pilot trial, a fully powered trial was funded in 2019 and will continue through 2025. That trial will recruit individuals with co-morbid chronic pain and opioid use disorder and randomize them to the integrated treatment or an active pain education control condition. Details of the trial were pre-registered (NCT04648228) and the trial protocol has been published (Vowles et al., 2023). Data collection was completed in July of 2024 and the final cohorts of participants will be in the twelve-month follow-up period through summer of 2025. It is anticipated that data analysis complete by the end of 2025.

Professor Vowles’ colleagues have also begun a funded trial of the same integrated treatment to individuals presenting to a specialist addiction treatment service. That trial is also pre-registered (NCT05571917) and the trial protocol is published (Hurlocker et al., 2024). This trial is due to conclude in 2028.

Other work in this area has included evaluations of co-morbid chronic pain, harmful opioid use, and alcohol use disorder (Edwards et al., 2022, Vowles et al., 2022,  Witkiewitz and Vowles, 2023).

Professor Vowles was one of 44 recipients of a UK wide UKRI-funded fellowship (Press Release link). His fellowship entails working within the Northern Ireland DoH to aid in the use of research data in policy work to develop an integrated care pathway for NCDs from community through to speciality care. This fellowship is specifically to evaluate the role of pharmacist independent prescribing in this care pathway. As part of this fellowship, which is funded through early 2025, Professor Vowles has worked with the DoH Chief Pharmaceutical Officer, Professor Cathy Harrison, and her team to determine where the evidence supports pharmacist independent prescribing in NCD and to draft policy documentation for consideration by the Northern Ireland Assembly.

References

Department of Health (2012). Long-term conditions compendium of Information: 3rd edition.

Accessed 5 April 2023. Available at: https://www.gov.uk/government/publications/long-term-conditions-compendium-of-information-third-edition.

World Health Organization (2020). WHO reveals leading causes of death and disability worldwide: 2000-2019. Accessed 13 April 2023. Available at: https://www.who.int/news/item/09-12-2020-who-reveals-leading-causes-of-death-and-disability-worldwide-2000-2019

Their research has shown that classical music and scents such as lavender in dog shelters calms the animals, and that shielding zoo-housed gorillas from visitors with camouflage netting over the viewing windows, prevents great apes from becoming agitated. The impact of this research extends to guidelines and regulations set by the American Veterinary Medical Association, the UK’s Department for Environment, Food and Rural Affairs, the British and Irish Association of Zoos and Aquariums and the Australian Government's National Health and Medical Research Council.
Commercial impact includes CDs of music composed specifically for dogs, now widely available to buy on the open market, and being utilised in 1700+ rescue shelters and by over 150,000 pet owners around the globe.

• The Guardian: Animal welfare: Classical music soothes the wanderlust of zoo elephants
• ABC Australia Environment and Nature - Zoo visitors stress gorillas
• New Scientist: Dogs prefer Bach to Britney