RAMS Alumni Spotlight: Dr. Sarah Bagley

In February 2022, Dr. Sarah Bagley from the 1st RAMS Cohort (2012-2014) graciously answered several questions about herself and her work since completing the RAMS Program.

Sarah Bagley, MD is currently an Assistant Professor of Medicine and Pediatrics at the Boston University School of Medicine and a primary care physician at Boston Medical Center. She is the Medical Director of the Center for Addiction Treatment for AdoLescents/Young adults who use SubsTances (CATALYST), a clinical program to provide integrated medical and behavioral health care for adolescents and young adults who use substances. 

Read on to learn more about Sarah!

Tell us about your clinical and research background. What led you to study substance use?

I completed residency in combined internal medicine and pediatrics and then an addiction medicine fellowship after that at BU. During my fellowship, I did my research training at the BU School of Public Health and got a Master of Science in Epidemiology, and then I had ongoing research training after receiving a career development award from NIDA. Before I was even drawn to medicine, I was always interested in public health and wanting to work with populations in communities that were vulnerable or didn’t have access to not just health care, but health too. I started as pre-med, but took a break in college because I wasn’t sure it was what I wanted to do and I really wanted to focus on public health. It was actually during that experience where I spent some time working at AIDS Project Rhode Island and started learning more about HIV and, as a result, learning more about substance use.

During that time when I worked between college and medical school, I spent some time in upstate New York working in a shelter with women and children who were affected by drug use. I started medical school and realized, “Isn’t there more in medicine that we can be offering to people who use drugs and alcohol? And yet it’s just so poorly integrated into health care settings.” This was 2004, when there were no fellowship programs. It was not standardized as part of the medical school curriculum and no one was really talking about it, but I was fortunate enough to have mentors throughout medical school and residency who did teach me how to integrate treatment of substance use disorders into medical settings or health care settings, and how they can have an impact on individuals and communities.

I feel privileged to be in this field where there are so many unanswered questions and work to do, and yet also so many opportunities because we have a lot of effective treatments and strategies for harm reduction that we can already offer, and they’re just poorly implemented. It’s just unbelievably gratifying, too, and I just think anyone who’s worked with people who use drugs or in recovery or trying to be in recovery … it’s really a joy and a privilege. The final thing is there is something – also because I really am interested in public health – in being able to focus on something where there is this intersection of policy, public health, medical care, opportunity for advocacy, research, and education. It all collides or intersects.

In what ways did your involvement with the RAMS Program assist you with your research career?

RAMS is so great. I was in the 1st cohort of RAMS scholars. When I began fellowship, I had no research experience when I was starting so it was actually this fundamental grounding experience for me, both because it connected me with peers in my cohort who were also in a similar stage and the connections with Jeffrey and Patrick and Michael Stein were also important. RAMS provided a platform for me to learn about how you think about research questions, design research projects, and then implement or execute a research project. The experience was really fundamental, as it provided support for the first research project that I completed and started me on this career and gave me the confidence to also think that I could pursue a career in addiction medicine and research, which if you had told me a year before all of this had happened, I don’t think I would have believed you.

And now we’re in our tenth cohort…

Yeah, it’s pretty amazing. I finished fellowship. I’m almost done with my K. It’s really amazing.

Did you move institutions post-fellowship? If so, what was the most challenging about this transition?

I did not. I looked a little bit but I stayed at BMC. I had really strong mentorship and was so fortunate to be able to be offered a position.

So you have been at BU/BMC…

Since 2012… I was at Brown for residency, so I came in 2012. So it’s been a really long time – July will be 10 years. It’s amazing. I was pregnant when I started fellowship so my daughter turns ten next year in September, and I guess that’s how long I can mark that I have been at BMC.

What would you consider an interesting or surprising finding from your research so far?

I think one thing that has become increasingly clear to me over the years is the importance in partnering with people in the community who are affected by substance use. I have learned a lot of humility over the years about partnering and the amount of time and effort that I need to put in, in order to build trust with people and ask them to participate and join as collaborators. I think that’s been pretty humbling to be honest, and I’ve learned a lot and changed my approaches to thinking about how to partner and how to develop projects.

I think similarly in my clinical work, too, just trying to think about everything that I do – Are there ways for me to involve patient’s families or just simply be responsive to the questions they may have too? On one hand, we actually do know so much about how to improve outcomes related to substance use, but yet it’s so poorly implemented and engagement is poor. So really taking a step back and being “Why is that?,” and maybe one of the reasons is we don’t have enough patient involvement in the clinical and research work that we do. So I am left with the question of how can we change that so that whatever work we are doing is relevant to lives of the people or the communities that we are trying to hopefully make a difference.

Tell us about some directions you see your research going in.

One thing that has been on my mind is thinking about how there’s been an increased attention to post-overdose care. There are programs that have emerged all over the country providing post-overdose care, and they are, in general, public health responses to a public health problem but aren’t vigorously evaluated in terms of understanding their effectiveness. I’ve therefore been fortunate to be part of some research teams at BMC that are trying to look at that. So, I think that because of my background and interests in thinking about youth, I see taking that next step as thinking about post-overdose care for youth and the different settings and different kinds of teams that need to be developed and implemented in communities in order to care for youth who are impacted by overdose. This would include younger children – both thinking about teenagers who might have had the overdose but also younger children who might be exposed to the overdose of a parent or grandparent or other family member. So, then what’s the right intervention to mitigate the harms? I think that’s one direction that I’m really interested in.

I think another direction is about different interventions for families that can be offered in treatment settings, because families are often left out of treatment planning both for youth and adults. What are the effective interventions that can be implemented in health care settings that support family members, and that both improve treatment outcomes for people with substance use disorders, but also for family members themselves who have higher rates of anxiety and depression and sort of control their chronic illnesses.

What has been a particularly challenging IRB issue you have had recently?

I haven’t had any recently. I haven’t been putting in super complicated studies, and I work with a really great research staff, so I think they probably deal with a lot of the things before it becomes an issue. There may be things, but I never hear about them because the people I work with are so great!

Have you ever had an experience with a revise and resubmit decision and/or a rejection, and if so, what errors did you make and what would you have changed/what did you change?

Yeah, plenty of all of those. I think with thinking about revise and resubmits for manuscripts, one thing that I have learned is the importance of being really respectful in my responses and remembering that people who are doing reviews are volunteering their time. So, even as an author, if you don’t totally agree with what the comment is, it doesn’t mean that we can’t be respectful in our response and gracious in how we think about how we want to answer their question or query. I think that the one thing that I’m still learning about rejections – I’m thinking about a paper and a grant that have both been rejected in the last year – is finding ways to be motivated to go back to the idea. For a paper, making sure you resubmit it, and if there are helpful comments that you maybe got in the rejection, that you make some changes. Don’t just let it sit on your desk. I remember Patrick talking about that actually, pretty clearly in RAMS.

Similarly for grants, if your grant isn’t discussed or isn’t going to be funded, I think needing to take a little time away from it is important because it’s emotionally exhausting. It happens to everyone and it never feels great. Then, try to take a step back and think “Is this still an idea that I am excited to work on?” which the answer has to be “yes” otherwise it doesn’t make sense to do it. Then thinking, “Okay this is something that I still think is important.” If so, then I need to find other funding mechanisms or other ways to think about trying to do this work.

A very human response in this line of work where that happens all the time…

It happens all the time, but then you hear about all the acceptances… like you know when your colleague is published and you know when they get a grant. The reality is, you have to do a lot of that (i.e., rejection, revision, and resubmission) and there’s a lot of pain that goes along with it.

How has COVID-19 inspired you to focus on new work?

I think one really important impact of COVID has sort of been a real worsening and exacerbation of teen mental health. Interestingly, the substance use data from Monitoring the Future that was released last month actually showed that there were decreases in substance use among teens, which doesn’t make sense in terms of what we are seeing clinically. I think, it has for me anyway, highlighted the need for the highest risk youth who have sort of more severe mental illness and substance use disorders, like the need for more high-quality data to understand how we should be treating them. Actually, there’s very limited data to guide us on those questions, in what to do. So, I’m just more inspired to focus on this really high-risk group.

Tell us one thing about yourself that readers might find interesting.

I spent some time during residency helping to build a kayak.

Interview conducted by Sophia Ly, MS