Johns Hopkins center marks three decades of injury research

CIRP director Andrea Gielen talks about latest work on the opioid crisis

Before the field of injury prevention existed in any formal capacity, Johns Hopkins epidemiologist Susan Baker was already conducting research into injuries, pioneering studies on drunk-driving accidents, chokings, and playground safety. Building a national reputation for her work, Baker in 1987 received funding to create the Johns Hopkins Center for Injury Research and Policy.

"Injury prevention expertise can help urban planners, architects, and community organizations, so the public can be active as well as safe."
Andrea Gielen, Center for Injury Research and Policy director

Over the past three decades, the center's multidisciplinary team at the Bloomberg School of Public Health has contributed critical research on the country's leading causes of injuries, along with prevention strategies—airbags, smoke alarms, bike helmets, and childproofing, to name a few—that save lives every day.

As the center celebrates its 30th anniversary this year, it will host a range of special events. The schedule kicks off Monday, Jan. 23, with "Road to Zero," a seminar on driving research and policy featuring Mark Rosekind, former administrator of the National Highway Traffic Safety Administration.

To get some insight on where the center stands in 2017, and particularly in regards to its recent work on the opioid epidemic, the Hub spoke with the center's director Andrea Gielen. With honors and awards including the American Public Health Association's Award for Excellence in 2013, Gielen has steered the center for the past 12 years.

How would you say the center has evolved since its start?

Thirty years ago we knew very little about how injuries happened and how to prevent them. The hard work of a fairly small cadre of dedicated researchers and practitioners, along with bright and passionate students, led to the robust field we have today. We know many of the risk and protective factors for the leading causes of injuries—motor vehicle crashes, poisonings, fires and burns, drowning, domestic violence, and others—and have discovered many prevention measures to save lives.

Today, our center continues to have a three-part mission of research, practice, and education. Our work emphasizes translating research on injury problems and solutions into practice. We're now more fully engaged than ever with health departments here in Maryland and across the country, facilitating the use of data to inform policy decisions and create innovative programs.

In 2017, what are some of the newer issues the center is looking into?

Disparities in injury rates and access to prevention are important. To help low-income families, we have created safety resource centers that provide low-cost safety products and free safety education to local communities.

We're also looking at how to ensure that injuries don't rise along with the increases we're seeing in healthy physical activities like biking and walking. Injury prevention expertise can help urban planners, architects, and community organizations, so the public can be active as well as safe.

Perhaps the biggest new challenge is the rapid rise in prescription drug overdoses, largely driven by opioids. A number of us in the center have been working closely with experts in other fields to bring injury prevention strategies into the comprehensive approach.

With the opioid issue, where exactly does injury prevention play a role? And how did you center get involved working in that area?

Many people don't think of opioid poisonings as an injury problem, but they are counted as injuries in our vital statistics reporting systems, and they actually share commonalities with other injury problems such as motor vehicle and firearm injuries—the use of a product that can result in acute damage to the human body. And the tools for prevention are similar.

Our first major work on this issue was to identify those prevention opportunities. We co-led a national group of experts a few years ago to review what is known about prescription opioid misuse, abuse, addiction, and overdose and to make recommendations for turning this epidemic around. The group convened at the invitation of our center and JHU's Center for Drug Safety and Effectiveness, along with the Clinton Foundation.

The 2015 final report—which has been shared widely with policymakers across the country—takes an evidence-based approach. From an injury prevention angle, we focus on the widely utilized "3 Es"—engineering, enforcement, and education. The report recommends enforceable policy solutions like prescription drug monitoring programs, engineering strategies for product packaging, and prevention education.

Can you tell us about your work on the safe storage of drugs and specifically opioids?

Our early research in Baltimore found that in virtually all homes we visited, there were medications accessible to children putting them at risk for accidental ingestions and poisonings. In response, we developed education programs on the use of cabinet locks and latches. In addition, one of the great successes in injury prevention of the 20th century was engineering child-resistant packaging of medications.

But the opioid crisis introduces a whole new level of concern, because child-proof solutions won't reduce pilfering of pills by teens and adults. Pilfering is an important part of the story, with most recreational users getting pills from family or friends. Last year, we challenged senior mechanical design engineering students at JHU to address this and they designed a new pill dispenser that is tamper-resistant, personalized with fingerprint technology, and can only be opened by a pharmacist. We're working now to produce and market that design.

This work is critically important because a national survey we conducted with JHU's Center for Mental Health and Addiction found that more than half of adults with a recent opioid prescription had or expected to have leftover medication, and six in 10 of them said they were keeping pills for future use. Moreover, nearly half of the sample did not recall receiving information on proper storage or disposal.

There's a real need for better public and patient education. We're currently finishing a CDC-funded study in West Virginia and Maryland, in which we created a patient decision aid to help people make informed decisions about opioid use, storage, and disposal.

What other opioid-related work will your center be taking on in the future?

We're very enthusiastic about a recent CDC-funded initiative: Our center was selected to be the "coordinating center" for a network of injury control research centers in West Virginia, Michigan, and Iowa. We'll work to update the 2015 report I mentioned before, create state-specific recommendations, and convene stakeholder meetings in specific states to disseminate the new recommendations to those who can make change happen.