The Crusader

As a clinical pharmacist in the University of Houston College of Pharmacy, Associate Professor Douglas Thornton focuses his work on treating opioid use disorder though the effective use of medications and related health care services. As the director of the Prescription Drug Misuse Education and Research (PREMIER) Center, he and his team work to reverse the devastating effects of controlled substance prescription misuse on families, communities and the health care system. It is the first center at UH dedicated to prescription drug misuse research and education.

I grew up in southern West Virginia during the peak of the prescription side of the opioid crisis. You don’t realize what’s happening when you are growing up in it. West Virginia was targeted by the pharmaceutical manufacturers, because much of the population works in manual labor, so pharmaceutical companies knew many people in the Appalachian region would be able and willing to take medications to deal with their pain.

I went to pharmacy school at West Virginia University. Both my parents went to pharmacy school; my mom was a pharmacist, and my dad became a physician after he graduated from pharmacy school and medical school.

I did my residency at St. Mary’s Medical Center in Huntington, West Virginia. My work wasn’t focused on the opioid crisis at the time, but the area was one of the key cities being struck by the heroin side of the opioid epidemic.

I thought I wanted to work in emergency care, so I went to a high-need hospital in the area. One of the things I found was that there were many clinical scenarios in which we knew what to do, but patients weren’t doing it, weren’t being offered it or weren’t accessing it.

When I pointed this out, I was encouraged to pursue a Ph.D. in health services and outcome research. So, I attended a doctorate program through the University of West Virginia at a hospital in Morgantown, West Virginia.

Writing My Own Future

I still didn’t want to work in opioids per se. I was more focused on the bigger picture of creating guidelines and recommendations. I told my mentors from pharmacy school, I don’t want to be reading guidelines; I want to be writing guidelines.”

I applied for, and was accepted into, a National Institutes of Health predoctoral training program. They worked with us as doctoral students to figure out what we were passionate about and what we could speak to. While doing some self-reflecting during my third year, I realized there were a lot of people who were talking about the opioid crisis who had no idea what the problems within it actually are.

I grew up around it; I was trained as a professional working around it. Then I practiced at the front lines of it. It clicked that I should be doing something more. I got to work with several campus and state organizations and realized working in the opioid crisis was my calling.

When I first began my time in academia at the University of Houston, I knew no one, so I started going to community meetings. It was about meeting people where they were and figuring out what the needs of this community really are, because who was I to come in and say that I knew what Houston, or Harris County, or Texas needs? I needed to go hear that firsthand and meet people.

Meeting with some of those organizations, treatment facilities, researchers and clinicians motivated me to think, “OK, I can really build something here.”

Another faculty member, Marc Fleming, and I worked on a proposal for the Prescription Drug Misuse Education and Research (PREMIER) Center, which was approved in December 2018. The idea was that instead of us going out and trying to meet other researchers, clinicians and health facilities, we wanted to provide a resource to be leveraged and with which others could collaborate.

Meeting a Need

Fleming took another job in 2019, but the PREMIER Center and I have since gone on to work directly with the City of Houston, Harris County, multiple state agencies and multiple national agencies. The PREMIER Center has really grown and made a name for itself locally and nationally. We now have multiple faculty members in the center doing work for both pain and substance-use disorders, which is our mission statement.

We have been funded through different government agencies to do projects ranging from building interventions for physicians and pharmacists to conducting opioid prevention activities for 800 organizations across Texas. There are comparable centers doing this kind of work in big cities like Los Angeles, Boston and Chicago, but nowhere in the South.

We’ve done work that has been cited in multiple guidelines. Last year, we received funding from a national foundation to work with several national organizations to write our own guidelines for pharmacists about treating substance-use disorders through pharmacy.

It felt like a good, closing-the-circle moment. I thought back on why I went to grad school: My team and I are writing the guidelines I wanted to write.

Treatment for people with substance-use disorders has become one of the few bipartisan issues that people can get behind in the modern political climate, probably because it has gotten so bad that almost everyone knows someone who has been affected.

The low-hanging fruit right now is removing the financial barriers around access to treatment — things like prior authorizations, copays, and other real and perceived financial risks to patients. As a society, we also spend so much time getting people into treatment, but we aren’t maintaining them in treatment.

My hope is that we will find a way. We are a resilient people and a resilient state.