This series spotlights the amazing students working with faculty from the YSPH Epidemiology of Microbial Diseases (EMD) department. We want to highlight the opportunity for other students outside our department to work with us. This month focuses on students who are conducting research on opioid use disorder. Here, MPH student Livia Cox tells us about the program and some of her exciting research in a Q&A format.

Please tell us a little about yourself and what inspired you to pursue a MPH in the Health Policy Department at the Yale School of Public Health?

Livia: When I was a first-year at Wesleyan University, I began working as an EMT on a rural ambulance in Middlesex County, Connecticut. Within months, it was clear that we were facing an opioid crisis far beyond what emergency care alone could solve. So, as a sophomore, I co-founded the Middletown Harm Reduction Initiative (MHRI), a nonprofit that has since grown to serve hundreds across Middlesex County, the majority of whom face homelessness and mental health challenges in addition to substance use. This experience also revealed the profound impact of policy decisions—like our county’s methadone ban—on real lives. My senior thesis, which successfully advocated for the reversal of that ban, cemented my commitment to public health reform. After college, a year-long Watson Fellowship enabled me to pursue this problem and its potential solutions from a global perspective. As an independent researcher, I traveled to eleven countries across five continents, embedding in Himalayan Buddhist monasteries, ambulance stations in the Caribbean rainforest, and brand-new overdose prevention centers in Northern Portugal. I visited addiction centers in London; I studied centuries-old Mayan herbalist traditions in Mexico. In each new place, I observed firsthand how culture and government policy together shape the ways that societies confront, manage, and transform the experience of pain—and shape the human response to suffering.

I chose Yale for its distinctive blend of theory and praxis, its exceptional faculty, as well as the opportunity to remain connected to Middletown and continue leading MHRI. At Yale, I’m expanding this work in meaningful ways: as a recovery coach in a Yale Medicine study using telehealth to connect individuals with opioid use disorder to treatment; collaborating with Connecticut State Senator Dr. Saud Anwar on harm reduction and overdose prevention policy across the state; and conducting qualitative research as a Downs Fellow in Vietnam on the lived experiences of females who inject drugs.

What is the current focus of your research?

My research advocates for reframing harmful substance use as a medical condition, dismantling the lasting impact of the "war on drugs”, and empowering harm reduction efforts to function without federal obstruction.

What are some of the most significant findings or innovations from your opioid use disorder research?

My research highlights the necessity of addressing stigma as a barrier to care, and it reveals that community-based harm reduction services, when culturally adapted, can significantly improve both health outcomes and trust in health care systems among people who use drugs.

Which emerging trends or technologies in opioid use disorder research do you find most exciting?

I’m particularly inspired by the potential of telehealth to improve access to medication-assisted treatment and virtual recovery coaching, the expansion of overdose prevention centers, and the adoption of harm reduction tools (e.g., drug testing strips, widespread dissemination of safer-use supplies). While these strategies reflect a practical, evidence-driven, and compassionate approach to addressing opioid use disorder, their full implementation remains unrealized. If these innovations were widely adopted, we would see a monumental transformation of care delivery.

Where do you see the field of opioid use disorder research heading in the next few years, and what role do you hope your work will play in this future landscape?

In the next few years, I am hopeful that the field will invest further in tackling a root cause of addiction: pain, both mental and physical. I envision a career as a physician and policymaker, dedicated to serving vulnerable populations and advocating to overturn federal legislation—like the antiquated "crack house statute”—that obstruct effective local harm reduction efforts.

How has the EMD Department supported your research and academic goals?

The support I’ve received across departments has been extraordinary. For my Vietnam project, Robert Heimer in EMD has offered unparalleled mentorship and insights. In Health Policy, Shelley Geballe’s guidance throughout my three-semester Practicum with Senator Anwar has been invaluable in helping me navigate the intricacies of legislative processes. At the School of Medicine, working with Mike Pantalon and Rebekah Heckmann's team on the Recovery Pad initiative has greatly broadened my perspective on innovative approaches to treatment. What stands out most, however, is the culture of kindness and collaboration that defines this community.

What advice would you give to prospective students considering applying to the EMD training programs at Yale?

Don’t be afraid to ask why. Public health is about more than improving systems—it’s about challenging, reforming, and reshaping them. Approach your work with curiosity and a critical lens, but also with kindness. The most meaningful change comes from rethinking what’s possible while honoring the humanity of those we serve.