From Research Influencers to Substance Use Policymakers: Bibliometrics Demonstrate Translation from Research to Policy

Abstract

Objective:

The public health impact of substance use (SU) is substantial, with tobacco use and excessive drinking leading as causes of death in the USA. To address this growing epidemic, governments have implemented a range of SU-related policies. The NIH’s Clinical & Translational Science Awards (CTSA) program, which aims to accelerate translation of research findings into health impact, may advance translation through its impact on the policy literature that informs policymakers, health professionals, and the public. Using innovative bibliometric tools, this study evaluates how CTSA-supported research published from 2006-2023 has influenced SU-related policy literature.

Method:

The authors identified 135K publications that acknowledged CTSA support. Those publications were queried in the Overton Policy database, which indexes references to research publications in global policy literature.

Results:

Thus far, CTSA-supported publications have been cited in 3,451 policy documents identified as SU-related according to Overton’s Topics field. SU-related Topics were classified into top categories of: Tobacco, Opioids, Cannabis, Alcohol, and General/Other SU. Policy documents came from 321 organizations across 49 countries-often governments, health agencies, or political think tanks, including the World Health Organization, Guidelines in Pubmed Central, and the RAND Corporation. The authors present case illustrations of individual research publications that have had notable influence on SU policy.

Conclusions:

By elucidating ways that supported publications are applied outside academia, bibliometrics offer a useful avenue for evaluating the translational impact of programs on specific areas of policy. Our findings showcase the impact that CTSA research has had on SU-related policy literature, a critical area of health policy.

INTRODUCTION

The public health impact of substance use (SU), including tobacco, alcohol and drugs, and substance use disorder (SUD) in the United States is substantial. In 2022 alone, 59.8% of Americans aged 12 or older (168.7 million Americans) reported using alcohol, illicit drugs, tobacco products, or vaping products in the past month. (SAMHSA, 2023) More specifically, 137.4 million Americans aged 12 or older reported past month alcohol use, 50.9 million Americans reported past month use of a tobacco product, 23.5 million Americans reported past month use of a nicotine vaping product, and 46.6 million Americans reported past month illicit drug use. (SAMHSA, 2023) Additionally, in 2022, a record 48.7 million Americans aged 12 or older met diagnostic criteria for a SUD in the previous year, including 29.5 million Americans with an alcohol use disorder and 27.2 million Americans with a drug use disorder. (SAMHSA, 2023)

Deaths attributed to SU/SUD in the United States are also considerable. Commercial tobacco use and excessive drinking are two of the leading causes of preventable death in the United States, with roughly 480,000 annual deaths related to cigarette smoking (CDC, 2023) and 140,000 annual deaths attributed to excessive drinking. (CDC, 2024) Further, the United States remains in the midst of a drug overdose epidemic. Deaths related to drug overdose have increased dramatically over the past two decades, with over one million Americans experiencing a fatal drug overdose since 1999. Further exacerbated by the COVID-19 pandemic, drug-involved overdose mortality reached an all-time high of 107,941 deaths in 2022, including 81,806 opioid-related overdose deaths. (Linas et al., 2021)

Public health impacts of SU/SUD are felt beyond the United States, evidenced by the global prevalence of SU, SUD, and SUD-related mortality. For example, globally in 2015, the age-standardized prevalence of heavy episodic alcohol use in the past month was 18.4%, followed by 15.2% for daily smoking, and 3.8% for cannabis use. (Peacock et al., 2018) Further, in 2015, age-standardized rates of mortality for smoked tobacco were estimated at 110.7 deaths per 100,000 population, 33.0 deaths per 100,000 for alcohol, and 6.9 deaths per 100,000 for illicit drugs. (Peacock et al., 2018) Of note, alcohol use is a leading risk factor for mortality globally (GBD 2016 Alcohol and Drug Use Collaborators,, 2018) and global drug use disorder mortality increased dramatically from 1990 to 2021 (from 1.84 deaths per 1,000,000 population in 1990 to 13.09 deaths per 1,000,000 in 2021. (Kim et al., 2025)

To address the worsening drug overdose epidemic in the Unites States, federal and state governments have implemented a range of policies, resulting in rapid growth in the field of SU/SUD health policy. For example, states have widely implemented Prescription Drug Monitoring Programs, naloxone access legislation, Good Samaritan legislation, and legislation to regulate pain management clinics. (Haffajee R, 2020; Schuler et al., 2020) At the federal level, the Centers for Disease Control and Prevention issued clinical practice prescribing guidelines for opioids in 2016 and 2022. (Dowell et al., 2016; Dowell et al., 2022) Additionally, several key pieces of federal legislation have aimed to improve the accessibility and quality of SUD treatment, including: the Affordable Care Act’s Medicaid expansion which both expanded eligibility for Medicaid insurance and improved access to SUD treatment; the SUPPORT Act which required state Medicaid programs to cover all medications approved by the FDA for the treatment of opioid use disorder and requires the Medicare program to cover treatment services delivered in Opioid Treatment Programs (U.S. Congress, 2010, 2018); and the Consolidated Appropriations Act, (U.S. Congress, 2023) which eliminated the x-waiver requirement to prescribe buprenorphine, one of the FDA-approved medications for the treatment of opioid use disorder.

The CTSA Program and Public Health Policy

Given this rapid implementation of SU/SUD policy in the United States, it is important to better understand the role of research evidence in the policymaking process. We do this through an examination of research supported by the National Institutes of Health (NIH) Clinical & Translational Science Awards (CTSA) program. The CTSA, funded by the National Center for Advancing Translational Science (NCATS), consists of 66 academic health and research centers or “hubs” based at universities throughout the United States. CTSA hubs are charged with supporting clinical and translational research, workforce development, and community engagement to improve health. According to the Translational Science Benefits Model, (Luke et al., 2018) the success of translational science support programs can be measured by the benefits that disseminated research confers in the areas of clinical/medical, community/public health, economics, and/or policy/legislative. This study focuses on the impact of clinical/translational research on the latter-health policy and clinical guidelines. Recent research evaluating the impact of the CTSA program on public policy found that CTSA-supported research extended its impact beyond academic silos to influence public policy literature disseminated by health agencies, governments, and think tanks. (Llewellyn et al., 2023) Whereas that initial research examined clinical/translation science as a whole, this study focuses on an area of science with strong public interest and relevance, and with high potential for translation to public policy.

Although the CTSA program is inclusive of all health conditions and diseases (i.e. hubs are intentionally disease agnostic), opioid misuse and addiction emerged as strong areas of NIH interest as the drug overdose crisis accelerated. (Cottler et al., 2020) For example, NCATS and the CTSA program have been participating in the Helping to End Addiction Long-term^SM (HEAL) Initiative, (NIH, 2024a) which was launched by the NIH in 2018 to seek scientific solutions for the opioid public health emergency. As part of the HEAL Initiative, NCATS has focused on using translational science to advance new prevention and treatment strategies for opioid misuse/addiction and pain management and several CTSA hubs have received HEAL Initiative awards. (Cottler et al., 2020)

The rapid acceleration in SU/SUD policy stemming from the drug overdose crisis and the push to address SU/SUD research in the CTSA program provide a unique opportunity to better understand how clinical/translational research influences SU/SUD policy. Our study builds upon a large body of research that focuses on measuring the influence of research evidence on the policymaking process, including several studies measuring the influence of research on alcohol and/or drug policy. (Hanney et al., 2003; Grant, 2015; Kowalski et al., 2023, Lancaster et al., 2017, Masood et al., 2020, McCambridge & Mialon, 2018, Oliver et al., 2014, Ritter & Lancaster, 2013, Stafford et al., 2020, Verboom & Baumann, 2022) A bulk of this research investigates the influence of the alcohol industry on alcohol policy making (Kowalski et al., 2023; McCambridge & Mialon, 2018; Savell et al., 2016) finding that the alcohol industry misused research evidence to influence alcohol policy in Australia, Scotland, as well as in other countries. (McCambridge et al., 2013; Stafford et al., 2020; Kowalski et al., 2023) Historically, research evidence has been used to shape tobacco control policy, particularly the adoption of tobacco taxation and clean indoor air policy. (Warner & Tam, 2012; Newson et al., 2018) Finally, a U.S. based study found that research evidence was used to shape drug policy focused on the implementation of syringe exchange programs. (Allen et al., 2015)

This body of literature highlights a three component approach to assess the influence of research on alcohol and drug policy, which is grounded in theories of research translation, utilization, and policy process. (Ritter & Lancaster, 2013) The three components include: 1) the use of research in policy documents, 2) the use of research in the policy process, and 3) the dissemination of research in the public sphere via the media. Our study contributes to this literature by using newly-developed bibliometric tools to provide an in-depth assessment of the first component, use of research in policy documents. We also expand the body of international work in this area by examining the use of research in policy documents in the context of a large translational science program in the United States.

This study specifically evaluates how CTSA-supported research has influenced SU/SUD-related policy literature from 2006-2023. We summarize the overall influence of the CTSA program on SU/SUD policy literature, including a detailed examination of the organizations that use CTSA-supported research to influence public policy, as well as the major SU/SUD categories reflected in the citing policy literature. To understand the types of CTSA-supported research that are relevant to SU/SUD policy, we then provide an overall summary of the cited clinical/translational research portfolio. Finally, to illustrate how clinical/translational research can be used to influence policy, we provide narratives of notable examples in our portfolio of the translational pathway from CTSA-supported research to SU/SUD-related health policy influence.

METHOD

Data Collection

This study includes publications authored by investigators who acknowledged support for their research from any of the 66 CTSA hubs operating across 33 states in the United States. Investigators are asked to cite their respective institutions’ CTSA grants in publications that result from support received during their research. Although this likely results in an underestimate of all supported research, it is a verifiable and reproducible measure of research supported by significant CTSA resources and is consistent with criteria for reporting supported products to the NIH. Data were collected in fall 2023. We compiled CTSA hub grant project numbers from NIH RePORTER, (NIH, 2024b) including past and present UL1, KL2, TL1, and supplemental awards funded by NCATS and its predecessor, the National Center for Research Resources. Using PubMed, (NIH, 2024c) we identified 134,607 publications that cited a CTSA grant since they were established in 2006 through 2023. We queried those publications in the recently developed Overton Policy Database, (Overton, 2024) which, at the time of writing, encompasses a growing database of over 11 million policy documents from over 1K nonacademic organizations around the world (for policy document inclusion criteria, see help.overton.io). A total of 19,673 publications (14.6% of the overall portfolio) were found to be referenced in policy literature indexed by Overton. Previous research using the CTSA publication portfolio has found that supported publications cited in policy differ from those that are not used in policy in that they have greater clinical relevance, higher rates of altmetric attention (i.e., nonacademic community/public attention), and higher rates of academic citation. (Llewellyn et al., 2023) We retrieved data for and direct links to approximately 24K indexed policy documents (exact counts are not feasible due to occasional duplicates or identically titled articles) that referenced those 19,673 publications in our portfolio. We then used Overton’s ‘Topics’ field to identify policy documents among those with content related to SU. The Topics field uses a machine learning approach to extract main themes from the full text of each policy document and maps these to Wikipedia pages that have significant overlap in language with the policy document (for more information see: https://help.overton.io/article/about-topics-entities-and-subject-areas/). Table 1 outlines the search term strategy for identifying Topics (i.e. matched to Wikipedia page titles) relevant to various SU categories. These include commonly used substances with the potential for misuse or addiction according to NIDA, (NIDA, 2024) as well as terms related to treatments for SUD. Because our portfolio falls under an umbrella of CTSA-supported research, it is expected to be more focused on public health content and it is less likely to return spurious search results for general terms such as ‘pain’ or ‘drinking’. However, the authors inspected all search results for direct relevance to substance use. Some terms related to schedule 1 and 2 controlled substances were searched but returned no results (e.g. peyote, ecstasy). Setting the threshold to 90% topic match returned a total 829,372 Topic designations associated with the 24K policy documents. Of these, 22,766 designations, composed of 361 unique Topic titles (see Supplementary Table 1 for full list), matched search criteria outlined in Table 1. With documents matching to up to dozens of SU-related Topic designations (i.e. one document may have content that is relevant to many Topics, e.g.: Addiction, Substance use, Substance use disorder, Opioid, Opioid use disorder, Opioid overdose, Oxycodone, Withdrawal, etc.), which may fall into multiple Substance Use categories, those designations appeared in 3,541 of the 24K policy documents in the overall portfolio. Data analysis hereafter concerns those 3,541 policy documents, which cite CTSA-supported research and included SU-related Topic designations. Those 3,541 policy documents were published from 2007-2023 and included a total of 8,282 references to 4,418 of the 19,673 CTSA-supported research publications. These data selection steps are summarized in Figure 1.

Table 1.

Search terms used to identify Overton-indexed policy documents with content related to Substance Use, classified into six most frequently appearing substance use categories. Policy Documents with overlapping content may be counted in more than one category.

Substance Use Category	Topic title contains:	Topic title does not contain:	# of Policy Documents
Tobacco/Nicotine	Nicotine Tobacco Cigarette/Cigar Smoke/Smoking Vape/Vaping Snus Cotinine Nicorette Varenicline	Other types of smoke, e.g. wildfire	1,136
Opioid	Opioid/Opiate/Opium Heroin Codeine Oxycodone/Oxycontin Hydrocodone Fentanyl Methadone Lofexidine Clonidine Tapentadol-phine/-orphone/-xone	Ceftriaxone-triopium	1,125
Alcohol	Alcohol Binge drinking Liquor Drunk/drinking	Non-alcoholic/Nonalcoholic Alcohol (chemistry)	783
Cannabis	Cannabi-Marijuana Nabiximols Dronabinol		409
Other Specified Substance	Cocaine MDMA Bath salts Benzodiazepine Gamma-Hydroxybutyric acid/GHB Lysergic acid diethylamide/LSD Hallucinogen/psychedelic Narcotic Stimulant Depressant Amphetamine Barbiturate Psilocybin Khat Mescaline Dextromethorphan Loperamide Pregabalin Phencyclidine Flunitrazepam/Rohypnol Salvia Anabolic steroid Cathinone	Dextroamphetamine Non-illicit benzodiazepine/amphetamine use	456
General/Unspecified Substance	Substance use/abuse/misuse Substance Drug use/abuse/misuse Drug injection/injectable drug Drug Psychoactive Driving under the influence Overdose Withdrawal Addiction	Other types of substance, e.g. chemical) Other types of withdrawal, e.g. BREXIT Non-substance addiction, e.g. gambling, screen Prescription/non-illicit drug references, e.g. FDA	2,235

Figure 1.

Flowchart summarizing data selection process beginning with all CTSA-supported Publications indexed in PubMed, to analytic sample of 3,541 Substance Use-related Policy Documents and the 4,418 CTSA-supported Publications that they cite.

Analytic plan

In Part 1, we conducted descriptive portfolio analyses of the 3,541 SU-related policy documents that cite CTSA-supported publications, including numbers and proportions of policy documents relating to the different SU categories plotted over time. We then analyzed the Source Outlets (organizations) publishing policy documents, including global mapping using Tableau 2019.2, and proportions of Source Outlet Types as indexed by Overton (i.e. Government, Intergovernmental Organization [IGO], Non-governmental Think Tank, & Other). We further classified each of the policy Source Outlets according to a supplementary coding scheme developed by this study’s authors to provide health- and translational-related context. For this coding scheme, we conducted a qualitative analysis of each outlets’ stated policy emphasis, utilizing a deductive coding approach drawn from official descriptions of each outlet’s mission and focus (as supplied by Overton). Using Excel spreadsheets, two authors manually examined and coded each outlet as emphasizing up to three policy categories, irrespective of Overton organization type (e.g., both a government health agency and a private health think tank would be coded as having a policy emphasis of “Health”). The coders independently agreed on coding for 86% of the outlets and reconciled coding for the remaining outlets through discussion and further investigation of the organization’s policy focus.

In Part 2, we describe the portfolio of CTSA-supported clinical/translational research that influenced the portfolio of SU-related policy literature. We used Dimensions (Dimensions, 2024) to examine the content of the 4,418 CTSA-supported publications that were cited in SU-related policy documents using journal outlets and the Australian and New Zealand Standard Research Classification (ANZSRC) 2020 Fields of Research designations. Among these publications we identified individual research “influencer” publications, i.e. CTSA-supported publications with among the highest numbers of references in our SU-related policy literature dataset. When Overton reveals that a publication is intentionally cited in a policy document, then it is likely that research has had a bearing on the content of the document and arguments being made. However, because the nature and extent of this influence may be highly variable, in Part 2 we critically evaluate both the quantity and quality of references within the context of the policy documents and their source organizations. To investigate the extent to which identified research may have influenced policy, we selected several example influencer publications to describe in depth. The selected publications were purposefully chosen to represent a cross-section of SU categories, time periods, research types, and types of CTSA support. We used Overton to retrieve and read the full text of the policy documents, including the context of their references to CTSA-supported research. We then describe the clinical/translational research in those original CTSA-supported publications and ways that the publications were used with intent to influence subsequent policy development.

RESULTS

Part 1: Assessing the Influence of the CTSA Consortium on SU-related Policy

To describe policy focus of 3,541 policy documents across time and across types of SU policy, Figure 2 depicts the numbers of policy documents relating to coded SU policy topic categories plotted over the past ten years. This time period was selected for Figure 2 because Overton data is reliably indexed from 2013 onward (due to digitization and online availability of public records) and available in full through 2022 at the time of data collection in 2023. This truncation was employed so that incomplete data indexing would not be interpreted as meaningful reductions in policy references during those years. Overall, documented SU-related policy literature that cites CTSA-supported research has risen since 2013, with a modest decline since 2019. Among the major categories of SU-related policy documents, tobacco/nicotine was the most commonly addressed substance overall. However, documents related to opioids increased over the study period, eventually overtaking tobacco as the top category.

Figure 2.

Numbers of policy documents referencing CTSA-supported publications by coded SU policy category and in total from 2013-2022 (Overton data being reliably indexed from 2013 onward and available in full through 2022).The Unspecified category refers to substance use not specific to a single substance. See Table 1 For SU policy category details. Policy Documents with overlapping content may be counted in more than one category.

To understand global policy scope, we next examined the countries of origin for the Source Outlets (n = 321 organizations) that authored the 3,541 policy documents published from 2007-2023. Figure 3 depicts a global map of Source Outlets/organizations that referenced CTSA-supported research in SU-related policy literature, shaded according to the number of references coming from each country. Representing no single country, IGOs are represented as a circle in the middle of the map and account for 419 of the policy documents with 783 references to CTSA research. The map does not include per capita or population information, but less populous countries may host fewer policy organizations. Global citation of CTSA-supported research in policy literature may also be affected by factors such as language, or country differences in policy literature generation, dissemination, and Overton indexing, (see: www.overton.io/blog/characteristics-of-overton-indexs-data) (Szomszor & Adie, 2022). Although the CTSA consortium supports investigators based in the United States, referencing policy documents came from 49 different countries, predominantly the United States (n = 1,878 documents, 4,416 references; 53%) and other English-speaking countries; 88% of the policy documents were written in English.

Figure 3.

Global map of source outlets/organizations that have referenced CTSA-supported publications in SU policy literature from 2007-2023, shaded according to the number of references from each country.

We next examined Source Outlet types indexed by Overton. The most common referencing sources from the “Government” category were the U.K. National Institute for Health and Care Excellence (n=945 references) and the Centers for Disease Control & Prevention (CDC) (423 references); from the “IGO” category was the World Health Organization (559 references); from the “Other” category was Guidelines in PubMed Central (1,043 references), and from the non-governmental “Think Tank” category was the RAND Corporation (337 references).

Results of supplementary coding for those Source Outlets’ policy emphases are summarized in Table 2, ranked by the number of references from each outlet to CTSA-supported publications. Results showed that the majority of SU-related references to CTSA-supported publications (n = 2,892 references) came from Government agencies and institutes focused on Health policy, followed by Government organizations focused on Cross-Cutting policies (2,049 references). However, referencing organizations focused on a diverse range of policy areas from international/foreign policy, to political advocacy, to legislation, as well as cross-cutting policy interests that encompass multiple policy areas from Table 2. Figure 4 visualizes the coded policy emphasis category and the Overton source type, ordered by number of policy references from organizations with each designation.

Table 2.

Policy Emphasis Categories for Source Outlets Referencing CTSA-Supported Publications in SU-related Policy Literature, 2006-2023, Ordered by Number of References

Policy Emphasis Category	Description	Examples	No. of References
Health	Government health agencies; food, nutrition, and drug safety groups; health-focused think tanks and foundations, health guidelines	Guidelines in PubMed Central World Health Organization Centers for Disease Control and Prevention	4,766
Cross-cutting	Local, state/province, and national/federal governments and government agencies concerned with a broad range of policies; generalized think tanks and NGOs with no specific area of policy emphasis	RAND Corporation U.S. Government Publishing Office Government of Canada	2,517
Foreign & International	Organizations concerned with foreign policy, globalization, international/inter-governmental cooperation and relationships	Inter-American Development Bank Organisation for Economic Cooperation and Development	705
Equity, Development, & Humanitarian	NGO/IGOs, foundations and think tanks focused on poverty, equity, development, and humanitarian concerns; development banks	United Nations American Civil Liberties Union Urban Institute	632
Economic	Treasuries; banks; economics-focused think tanks	World Bank National Bureau of Economic Research	482
Sciences & Humanities	Academic organizations/ societies that involve scientists/academics, humanities, or education	The Royal Society of Canada Science Advice for Policy by European Academies	354
Social	Agencies and think tanks focused on social and cultural policies and social welfare	Finnish Institute for Health and Welfare Mathematica Policy Research	322
Legislative	Legislative bodies (parliament, congress, house, senate) and their advisory groups; legal think tanks	U.S. House of Representatives-House Committees U.K. Parliament Select Committee Publications Parliaments and Congresses	308
Political	Think tanks focused on research and advocacy aligned with political partisanship	Cato Institute R Street	212
Technology & innovation	Agencies and foundations related to technology and innovation, artificial intelligence, and computing	Canadian Agency for Drugs and Technologies in Health American Telemedicine Association	170
Environmental	Environmental agencies and organizations concerned with climate, toxicity, and chemical weapons	Environmental Protection Agency The Netherlands National Institute for Public Health and the Environment	31
Criminal & Judicial	Judiciary bodies, agencies concerned with crime and law enforcement	United Nations Office on Drugs and Crime United States Department of Justice	20
Security & Defense	Agencies and organizations concerned with national and international security, criminal justice, defense, and terrorism	Institute for Defense Analyses US Department of Homeland Security	18

Abbreviation: CTSA, Clinical and Translational Science Award.

Figure 4.

Proportions of coded policy emphasis categories and Overton source types, ranked by number of policy documents with each designation published from 2007-2023. Policy Documents with overlapping content may be counted in more than one category.

Part 2: CTSA Research Influencing SU Policy

Among the 4,418 CTSA-supported research publications that were cited in SU-related policy documents, the most common journal outlets were the New England Journal of Medicine (95 publications), the Journal of the American Medical Association (94), and Drug and Alcohol Dependence (82). The most frequently designated ANZSRC Fields of Research were Biomedical and Clinical Sciences (2,914 publications), Health Sciences (1,785), and Clinical Sciences (1,442). As referenced research may have highly variable influence on policy literature, we identified several “influencer” publications, or individual articles that have had notable influence on different areas of SU policy literature and serve to illustrate the translational pathway from research to influence on policy. The following are narrative descriptions of the links that we examined between the research and policy literature and the nature of the citing documents and their source organizations:

Tobacco –

The research publication ‘Potential deaths averted in USA by replacing cigarettes with e-cigarettes’(Levy et al., 2018) was published in the journal Tobacco Control in 2018. The authors acknowledged support for the research from the Yale Center for Clinical Investigation CTSA hub. The study examined a strategy of replacing the status quo of cigarette smoking with e-cigarette vaping as an alternative, contending that this substitution would yield substantial gains in life years. As of data collection, this article was cited in 46 SU-related policy documents from 21 different source organizations in 6 countries. The most frequent were the Reason Foundation (9 policy documents), R Street (6), and the Heartland Institute (6), all of which were coded as Political, non-governmental Think Tanks based in the USA. Many of these policy documents, such as the 2018 policy brief ‘A Question of Taste: The Public Health Case for E-Cigarette Flavors’ (Bentley, 2018) from the Reason Foundation, advocate for deregulation of e-cigarettes citing public health evidence (including the Levy article) favoring vaping over cigarette smoking for harm reduction.

Opioids –

The research publication ‘Changing dynamics of the drug overdose epidemic in the United States from 1979 through 2016’ (Jalal et al., 2018) was published in the journal Science in 2018. The authors acknowledged support for the research from a KL2 training grant from the University of Pittsburgh Clinical and Translational Science Institute CTSA hub. The study examined 38 years of substance overdose mortality data, finding an overall exponential growth curve that may indicate that the recent opioid crisis is part of a greater, longer-term process. As of data collection, this article was cited in 50 SU-related policy documents from 18 different source organizations in the USA. The most frequent were the Cato Institute (25 policy documents), a Political Think Tank, and the RAND Corporation (4), a Cross-cutting Think Tank. Many of these policy documents, such as the 2019 policy blog ‘More Research Shows It's Not The Prescriptions, It's The Prohibition’ (Singer, 2019) from the Cato Institute, advocate for decreased government regulation of opioid prescriptions, arguing against their direct role in the opioid epidemic, and citing sources such as the Jalal article.

Prenatal exposure –

The research publication ‘Prenatal Substance Abuse: Short- and Long-term Effects on the Exposed Fetus’ (Behnke & Smith, 2013) was published in the journal Pediatrics in 2013. The authors acknowledged support for the research from the University of New Mexico Clinical and Translational Science Center CTSA hub. The study reviewed data on the prevalence of prenatal substance use exposure, how to identify exposure, and short- and long-term outcomes of exposure, to help pediatricians promote infant and child health. As of data collection, this article was cited in 26 SU-related policy documents from 15 different source organizations in 5 countries. The most frequent were state and national governments and Mathematica (5 policy documents), a US-based Think Tank focused on Technology & Innovation and Social policy. Several of these policy documents address the intersection of child health and adult SUD or misuse. For example, the 2023 policy report ‘Regional Partnership Grants to Increase the Well-Being of, and to Improve the Permanency Outcomes for, Children Affected by Substance’ (Mathematica, 2023), was prepared for the U.S. Department of Health and Human Services Administration for Children and Families to aid children whose health has been affected by SU.

DISCUSSION

This study characterizes the aggregate influence of the national, government-funded CTSA program on SU-related public policy documents, a body of literature with important implications stretching from legal, international, and political, to medical and public health policies. (Peacock et al., 2018; SAMHSA, 2023) Building on prior work measuring the influence of research on alcohol and drug policy (Kowalski et al., 2023, Lancaster et al., 2017, Masood et al., 2020; McCambridge & Mialon, 2018; Verboom & Baumann, 2022), we described the major SU categories reflected in the citing policy literature, the organizations around the world that use CTSA-supported research to inform policy literature globally, and the portfolio of CTSA-supported research that forms the basis of the translational pathway from research to health policy impact. Noteworthy examples of this pathway concretely demonstrate ways that CTSA research ‘influencers’ can mold public policy discourse.

Time and topic area analyses revealed that the prevalence of various SU categories in policy literature has shifted in emphasis over time. Initially, tobacco/nicotine was the most frequently addressed substance, but opioids have become more prevalent in recent years, corresponding to the timing of the opioid crisis. Although overall SU-related policy literature has increased since 2013, declines since 2019 could be related to a time-lag in Overton indexing or possibly to shifts brought on by the COVID-19 pandemic. Analysis of the source organizations that authored the policy documents demonstrated the world-wide reach of CTSA-supported publications (see Figure 3), especially among English-speaking countries and IGOs. Further analysis of the types of organizations that cite CTSA work showed that while governments are the largest Overton source type category, IGOs and Think Tanks that emphasize different types of policy are also common (see Figure 4). Our analysis of influencer articles showed how public-facing organizations utilize clinical/translational research findings when forming persuasive arguments around health topics of public interest.

Strengths, Limitations & Future Directions

The CTSA program aims to accelerate the translation of bench side research findings to public health benefits, such as policies that could ease or counteract the public health burden of SU/SUD (Luke et al., 2018). Whereas previous research has examined the relationship between research and policy-making via key informant interviews (Allen et al., 2015) or case studies (McCambridge, et al., 2013) within specific areas of SU, this is the first research to use quantitative and qualitative methods to investigate how broader clinical/translational research helps to shape SU-related policy literature across all types of substances. Specifically, we conducted an in-depth analyses of the influence of clinical/translational research on policy documents (Ritter & Lancaster, 2013, component 1), although our study does not directly examine the use of research in the policy-making process itself or the role of the media in dissemination of research in the public sphere (components 2 & 3). For instance, we found that some of the leading influencer publications in our supported research portfolio addressed controversial topics (e.g. government drug regulation) that may be most open to contentious debate in the public sphere. Given that policy documents are not necessarily peer-reviewed, it is important to investigate arguments and organizations closely for accuracy and potential biases, such as sources of funding (e.g., industry funding). For example, a closer look at some Think Tanks citing CTSA research (see University of Bath Tobacco Tactics website, www.tobaccotactics.org) shows that the Reason Foundation, R Street, and the Heartland Institute all take funding from the tobacco industry, raising questions about whether research could be misused, or selectively used, to support tobacco industry policy positions. Although all research has the capacity to be misused to selectively support industry or vested interests, as has been clearly demonstrated by the tobacco industry, our research could be usefully extended to examine the processes by which research is critiqued and applied to policy implementation and clinical practice.

A strength of this study is the use of innovative bibliometric tools to discover and evaluate the connections between research and specific types of policy documents, a body of publicly available literature that influences policymakers, clinicians implementing health policy, and the larger public. Modern bibliometrics move past traditional citation metrics to shed light on the ways that supported publications are applied beyond academic silos. Overton is limited in its ability to completely index all policy literature from all countries, especially beyond the most recent decades. Thus, it is not currently feasible to make detailed inferences regarding spatiotemporal and sociopolitical factors within the category of SU-related clinical/translational science-although this would be a fascinating direction for future, even larger-scale research. Overton does, however, represent the most comprehensive tool currently available and opens a new and needed frontier in bibliometric science. Although only a subset of CTSA-supported publications are cited in Overton policy documents, the richness of available policy data invites closer examination of particular SU-related questions using the blueprint we have laid for evaluating the pathway from research to policy literature. For example, future research could include an in-depth examination of the changing policies around opioid prescribing or decriminalization/legalization of cannabis in some US states.

Conclusion

This study investigated how health research shapes SU-related policy literature, which, in turn, has the potential to guide evidence-based policies of critical importance due to the social, economic, legal, and health concerns associated with SU/SUD. This study leverages largescale, global policy data in combination with careful inspection of individual documents and documented links between documents. By elucidating ways that supported publications have influence beyond the bounds of academia, bibliometrics offer a promising avenue for evaluating the translational impact of programs on specific topical areas in public policy. Governments, IGOs, think tanks, and other policy-relevant organizations require information and evidence to implement sound regulations and guidelines around SU/SUD (Dowell et al., 2016; Dowell et al., 2022; Haffajee R, 2020; Schuler et al., 2020). Important public health concerns such as these can be better addressed with an understanding of how research influences the literature that informs those who form public policies.

Public Health Significance Statement:

This study investigated how clinical and translational research publications are used in Substance Use-related policy literature from around the world. This body of literature plays an important role in informing and influencing stakeholders within a policy area of critical importance with regard to social, economic, legal, and health concerns. Public health concerns like SU/SUD can be better addressed with an understanding of the role of research in the process of evidence-based policy-making.