About

Alicia Lauren Agnoli, M.D., M.P.H., M.H.S., is an Assistant Professor in the Department of Family and Community Medicine at UC Davis Health. Her clinical interests include full-spectrum family medicine, LGBTQ+ health including gender-affirming care, and substance use disorders. She is committed to providing comprehensive and compassionate care for individuals across the lifespan and spectrum of health needs. Her research focuses on addressing issues of access to care, particularly for vulnerable populations and those with substance use disorders, as well as managing complex chronic pain and opioid-related risks. Dr. Agnoli also teaches students, residents, and fellows about the compassionate care of people with substance use disorders.

Research topics

• Medicine
• Internal medicine
• Family medicine
• Psychiatry
• Emergency medicine
• Anesthesia
• Environmental health
• Demography

Selected publications

• “Part of the policy”: A qualitative study of PCP attitudes toward urine drug testing for chronic opioid prescriptions

  Journal of Opioid Management · 2026-03-01

  articleSenior author

  OBJECTIVE: Guidelines for safer chronic opioid prescribing recommend regular urine drug testing (UDT); however, evidence on the best use of this testing is less clear, and wide variation exists in practice. Our objective in this qualitative study was to assess provider attitudes, barriers, and facilitators to ordering and interpreting UDT for patients prescribed chronic opioids. DESIGN, SETTING, AND SUBJECTS: Qualitative study among family and internal medicine physicians working at several clinics within a large community and academic health system. METHODS: Semistructured interviews were analyzed with qualitative thematic analysis. RESULTS: Themes were (1) perceived medical benefit outweighs concerns, (2) UDT requirement has a push-pull relationship with professional autonomy, (3) standardization of UDT as key to reduce bias, (4) systematic process eases confusion, and (5) desire for training for "gray areas." DISCUSSION: A key facilitator was also a key barrier: Guideline-required urine drug tests as the requirement both reduced conflict between primary care physicians (PCPs) and patients around ordering urine drug tests and reduced professional autonomy and shared decision-making. Education on ordering and interpreting urine drug tests was endorsed as important to facilitate use. CONCLUSIONS: PCPs generally view urine drug tests favorably but have mixed attitudes toward urine drug test mandates and desire comprehensive education on urine drug test management.

  PublisherDOI

• Opioid Stewardship

  Primary Care Clinics in Office Practice · 2025-11-07

  article1st authorCorresponding
  PublisherDOI

• Student-Run Clinic Mental Health Services

  Journal of Student-Run Clinics · 2025-06-04

  articleOpen accessSenior author

  Introduction: Student-run clinics (SRCs) are a critical healthcare resource in Sacramento for people experiencing homelessness, people who inject drugs (PWID), and uninsured people. University of California, Davis (UC Davis) School of Medicine-affiliated SRCs are staffed by volunteer students and physicians to serve the Sacramento community at no cost to the patient. Two of these clinics, Willow Clinic and Joan Viteri Memorial Clinic (JVMC), host a free, joint mental health care clinic to support the psychiatric needs of their overlapping patient populations. This descriptive report details the Willow Clinic and JVMC mental health clinic model, reflecting on the three years of operation to provide critical operational insights to other medical schools operating similar clinics in their communities. Methods: At Willow Clinic and JVMC, patients presenting for care at the general medical clinic were offered standardized mental health screening utilizing a Patient Health Questionnaire-9 survey and a Generalized Anxiety Disorder-7 survey. Those who screened positive in either tool were offered to be scheduled for a Mental Health Clinic (MHC) appointment. Patient feedback and MHC attendance trends were utilized to revise the clinic workflow iteratively. Results: In the SRCs, over 90% of patients are screened, but only 8.3% of patients screening positive attend MHC appointments. Though there are strengths in this approach relating to screening, the weaknesses relating to patient retention are iteratively being addressed to improve utilization. Conclusion: People experiencing homelessness, people who use injection drugs, and uninsured patients face a disproportionate burden of barriers to mental health care. The MHC, through two partner SRCs at UC Davis, provides an opportunity to reduce some of these barriers to mental healthcare. This innovative model has promoted health equity in the Sacramento community and is a possible model for other similar SRCs to better serve their communities.

  PublisherOA PDFDOI

• Dose trajectories associated with non-fatal overdose among patients co-prescribed opioids and benzodiazepines: Retrospective cohort study

  Drug and Alcohol Dependence · 2025-10-17

  articleOpen access

  To assess opioid and benzodiazepine prescribing trajectories associated with overdose. Retrospective cohort study of Optum Labs Data Warehouse data which includes de-identified medical and pharmacy claims and enrollment records for commercial and Medicare Advantage enrollees. The database contains longitudinal health information on patients, representing a mixture of ages and geographical regions across the United States. The cohort comprised adults prescribed opioids for 80% of a 180-day baseline period ending with at least 10 days of overlapping opioid and benzodiazepine coverage from July 1, 2016 to December 31, 2021 (N=182,477). The primary outcome was an opioid or benzodiazepine overdose resulting in emergency or hospital services through December 31, 2022. Time-varying covariates included: 1) short-term trajectory based on recent change in mean daily morphine milligram equivalents (MME) or diazepam milligram equivalents (DME); and 2) long-term trajectory based on 180-day trend. For both opioids and benzodiazepines, overdose risk was increased with both decreasing and increasing short-term and long-term trajectories relative to stable doses. Compared to stable dosing, short-term decreases in MME and DME were associated with similar magnitudes of increased overdose risk [adjusted hazard ratios (aHRs) 1.41 (95% CI: 1.31-1.52) vs. 1.23 (95% CI: 1.12-1.35), respectively), as were long-term decreases in MME and DME [aHRs 1.29 (95% CI: 1.21-1.38) vs. 1.36 (95% CI: 1.24-1.48), respectively). Among co-prescribed patients, decreasing short- and long-term trajectories of either opioids or benzodiazepines were associated with a similar increase in non-fatal overdose risk. • Among 182,477 patients prescribed long-term opioids with concurrent benzodiazepines followed for a mean of 2.4 years, the rate of non-fatal opioid or benzodiazepine overdose was 1.26 per 100 person-years. • Compared to stable dosing, overdose risk was significantly elevated after an increase or decrease in opioid or benzodiazepine dose. • Short- and long-term decreases in opioid and benzodiazepine trajectories were associated with elevations in overdose risk of similar magnitude, suggesting no safety advantage of initial dose reduction with either drug class. • Overdose risk was significantly higher in patients prescribed higher recent average opioid and benzodiazepine doses, after initiation of buprenorphine formulations licensed for opioid use disorder treatment, and in patients with baseline mental health or substance use diagnoses.

  PublisherDOI

• ‘Why would I go somewhere where I’m not welcome?’ Dehumanisation of people experiencing homelessness in medical settings and the healing potential of a structurally competent model: a qualitative study

  BMJ Public Health · 2025-03-01 · 1 citations

  articleOpen access

  Introduction: People experiencing homelessness (PEH) face myriad barriers to healthcare, including preventative sexual health services. A street medicine team in one Northern California county observed low uptake of sexually transmitted infection (STI) screening among PEH. We conducted this study to understand the factors contributing to PEH's decision to seek or accept STI screening. Methods: This is a qualitative study using semistructured interviews and demographics surveys among PEH. The interviews focused on understanding facilitators and barriers to STI screening and experiences in healthcare settings more broadly. Interviews were audio-recorded, transcribed and analysed using a thorough memoing process and matrix-based analysis. Results: We enrolled a total of 50 adult, English-speaking PEH: 24 men, 26 women; 52% white, 28% Black/African American, 22% Native American, 4% Asian, 22% Hispanic/Latino. Qualitative analysis revealed a theme of 'dehumanising' prior experiences in healthcare environments including judgement, dismissal of medical concerns, and denial of treatment. Participants reported similar experiences outside of medical settings, which together shaped their self-worth and factored into their decision to delay seeking routine and urgent forms of care, including STI screening. Approximately half of the participants had received medical services from the street medicine team. PEH perceived the street medicine team to foster trust by physically, emotionally and structurally 'meeting patients where they are'. Conclusion: Prior experiences of exclusion within and outside of healthcare settings informed PEH's decision to avoid seeking healthcare until extremely urgent, and to deprioritise services like STI screening. In order to develop interventions to increase STI screening and other preventative health services, it is critical to understand the structural elements underlying relationships between PEH and healthcare systems, and the relevance of social exclusion beyond medicine. This street medicine team exemplifies features of structural competency, a model that may be integrated in other settings and in medical education to promote more equitable and inclusive healthcare.

  PublisherOA PDFDOI

• Predictors of Incident Benzodiazepine Co-prescription Among Patients Prescribed Long-term Opioids

  Journal of General Internal Medicine · 2025-07-16

  articleOpen access

  BACKGROUND: Opioid and benzodiazepine co-prescription is associated with overdose, particularly among patients prescribed long-term opioids. OBJECTIVES: Identify predictors of incident benzodiazepine and opioid co-prescription using two separate and complementary large-scale patient cohorts. DESIGN: Two retrospective cohort studies: (a) statewide dataset based on California's prescription drug monitoring program (PDMP, 7/1/2016-12/1/2018) and (b) national sample of commercial and Medicare Advantage enrollees from the Optum Labs Data Warehouse (OLDW, 7/1/2016-12/1/2021). PARTICIPANTS: Patients prescribed long-term opioids, with opioid coverage for ≥ 80% (≥ 144 days) of a 180-day baseline period absent baseline benzodiazepine or buprenorphine prescriptions. OLDW cohort excluded patients without continuous enrollment, with cancer diagnoses or use of hospice or prolonged inpatient skilled nursing care. MAIN MEASURES: Incident benzodiazepine and opioid co-prescription (≥ 20 days of co-prescription during any 30-day period). KEY RESULTS: Of 617,946 and 223,885 patients, incidence rates of co-prescription were 4.6 and 3.9 cases per 1000 patient-months in the PDMP and OLDW cohorts, respectively. Important predictors included patients prescribed > 150 mg morphine equivalents daily during baseline (PDMP, adjusted hazard ratio: 1.74 [95% CI: 1.67-1.81]; OLDW: 2.66 [2.47-2.86]), and initiated buprenorphine indicated for treatment of opioid use disorder, with (PDMP: 1.68 [1.49-1.89]; OLDW: 2.10 [1.71-2.59]) or without continued treatment (PDMP: 1.35 [1.18-1.56]; OLDW: 1.64 [1.27-2.11]). Co-prescription was positively associated with short-term (60-day) decreases in opioid dose (PDMP: 1.07 [1.04-1.10]; OLDW: 1.06 [1.01-1.12]) but negatively associated with long-term (180-day) decreases (PDMP: 0.81 [0.78-0.85]; OLDW: 0.78 [0.73-0.84]). Patients with anxiety diagnoses were at elevated risk for co-prescription (OLDW: 2.16 [2.06-2.27]), although risk was lower if accompanied by treatment with serotonergic anxiolytics (0.63 [0.59-0.67]). CONCLUSIONS: High baseline opioid dose, buprenorphine initiation, short-term decrease in opioid dose, and anxiety without prescriptions for serotonergic anxiolytics were positively associated with co-prescription. A longer-term decrease in opioid dose and anxiety treated with serotonergic anxiolytics were negatively associated with co-prescription.

  PublisherOA PDFDOI

• Evaluation of Flexible Buprenorphine Dosing in Patients with Chronic Pain

  Journal of Pain & Palliative Care Pharmacotherapy · 2025-12-13

  article

  Buprenorphine is a mixed agonist-antagonist, safer for long-term use compared to full agonist opioids. There is no literature to describe utilization of flexible buprenorphine dosing regimens in the chronic pain population. This was a retrospective single center, observational study. Inclusion criteria were age 18 and older, diagnosis of chronic pain, and prescribed buprenorphine. Patients with a diagnosis of opioid use disorder (OUD) were excluded. Buprenorphine regimens analyzed included: scheduled buprenorphine, scheduled plus as needed (PRN) buprenorphine, PRN buprenorphine alone, and scheduled buprenorphine plus PRN full µ-opioid agonist. The primary outcome was the percent of patients on each buprenorphine regimen. The secondary outcome was duration of buprenorphine therapy. Overall, 691 patients were reviewed, with 401 meeting inclusion criteria. Scheduled buprenorphine was prescribed to 340 patients (84.4%), while 37 patients (9.2%) were prescribed scheduled plus PRN buprenorphine. Patients exposed to flexible dosing remained on treatment longer than those on scheduled buprenorphine alone (HR 3.50, CI 2.07-5.92, NNT 9.0). Flexible buprenorphine dosing was utilized for chronic pain. Patients on scheduled plus PRN buprenorphine were on treatment longer than those on scheduled buprenorphine alone. Scheduled plus PRN buprenorphine can be considered for patients with chronic pain.

  PublisherDOI

• Advance care planning readiness, barriers, and facilitators among seriously ill Black older adults and their surrogates: A mixed methods study

  Palliative & Supportive Care · 2025-01-01 · 3 citations

  articleOpen accessSenior author

  OBJECTIVES: Advance care planning (ACP) supports communication and medical decision-making and is best conceptualized as part of the care planning continuum. Black older adults have lower ACP engagement and poorer quality of care in serious illness. Surrogates are essential to effective ACP but are rarely integrated in care planning. Our objective was to describe readiness, barriers, and facilitators of ACP among seriously ill Black older adults and their surrogates. METHODS: We used an explanatory sequential mixed methods study design. The setting was 2 ambulatory specialty clinics of an academic medical center and 1 community church in Northern California, USA. Participants included older adults and surrogates. Older adults were aged 60+, self-identified as Black, and had received care at 1 of the 2 clinics or were a member of the church congregation. Surrogates were aged 18+ and could potentially make medical decisions for the older adult. The validated ACP engagement survey was used to assess confidence and readiness for ACP. What "matters most" and barriers and facilitators to ACP employed questions from established ACP materials and trials. Semi-structured interviews were conducted after surveys to further explain survey results. RESULTS: = 12) were confident that they could engage in ACP (4.1 and 4.7 out of 5), but many were not ready for these conversations (3.1 and 3.9 out of 5). A framework with 4 themes - illness experience, social connections, interaction with health providers, burden - supports identification of barriers and facilitators to ACP engagement. SIGNIFICANCE OF RESULTS: We identified barriers and facilitators and present a framework to support ACP engagement. Future research can assess the impact of this framework on communication and decision-making.

  PublisherOA PDFDOI

• Improving access to syphilis screening among unhoused people in Yolo County

  International Journal of Medical Students · 2024-10-16 · 1 citations

  articleOpen access

  Background: This study aimed to increase syphilis screening rates amongst unhoused residents of Yolo County, California, through the implementation of plan-do-study-act (PDSA) cycles. Yolo County has a strategic goal to eliminate congenital syphilis cases. Homelessness is a known risk factor for syphilis. Methods: The primary researcher was embedded in a street medicine team. Using quality improvement tools like stakeholder interviews, workflow diagrams, and best practices from literature, we outlined the team's workflow for syphilis screening and developed ideas to improve uptake and expand capacity. The most effective cycle implemented gift card incentives for syphilis screening. During the patient intake we offered the option to receive a syphilis test, informing the patient of the gift card incentive. Results: Prior to gift card incentives, the team screened 1.6 patients on average per clinic for a total of 30 patients screened in April to June of 2022. After the gift card incentive was implemented, the team screened 3.0 patients on average per clinic, screening a total of 223 patients from July 2022 to May 2023. The intervention produced an 87.5% increase in screening rates (P=0.0094). The data showed a significant increase in syphilis testing upon implementing the gift card incentive program. Conclusion: These findings contribute to evidence supporting the use of patient incentives for public health prevention measures. This model could be applied to other populations to increase health screening participation. More research is needed on the effect of gift card incentives on confirmatory testing and treatment rates for syphilis.

  PublisherOA PDFDOI

• ASSESSING READINESS OF BLACK OLDER ADULTS TO DISCUSS ADVANCE CARE PLANNING WITH THEIR SURROGATES

  Innovation in Aging · 2024-12-01

  articleOpen access

  Abstract Advance care planning (ACP) is a tool to identify health care goals in serious situations or if anticipating end-of-life circumstances. ACP is not always utilized by those who might most benefit from it and appears underutilized by black older adults for unclear reasons. This study explores 3 aims to better understand the readiness of black older adults to complete ACP including examining patient readiness to participate in ACP using the stages of change model, types of barriers and promoting factors to patient participation in ACP, and patients and surrogates’ concordance on ACP readiness. A sub-analysis explores how readiness for ACP participation varies based on the patient-surrogate relationship. A mixed methods design used surveys and qualitative interviews to assess black older adults aged 60 – 91 and their associated surrogate selected from outpatient clinics within an academic hospital and a local community church in Sacramento, CA. Participants included 30 older adult respondents with 12 surrogates consisting of 7 adult children and 5 spouses/partners. Results suggest variation of end-of-life care discussion readiness where 63% of surrogates report already completing this discussion but only 45% of patients with surrogates report similar findings. Variation also occurs with patient readiness to discuss end-of-life care with adult children (17% of patients with children surrogates report not thinking about having these discussions yet) compared to those with a spouse/partner surrogate (100% of patients with partners/spouses have already had discussions). Additional research may help increase understanding of themes of patient and surrogate readiness and engagement in ACP.

  PublisherOA PDFDOI

Frequent coauthors

• Joshua J. Fenton

  29 shared

• Elizabeth Magnan

  Center For Policy Research

  28 shared

• Ronald N. Adler

  Harvard University

  25 shared

• Brian S. Alper

  Computable Publishing

  25 shared

• Alan Drabkin

  Harvard University

  25 shared

• Wayne Altman

  25 shared

• Alan Ehrlich

  EBSCO Industries (United States)

  25 shared

• Daniel J. Tancredi

  University of California, Davis

  25 shared

Labs

• Department of Family and Community MedicinePI

Education

• MD, MPH

  Tufts University School of Medicine

  2012

Awards & honors

• Clinical Research Forum 2022 Top 10 Clinical Research Achiev…
• TUSM Global Health Program International Travel Scholarship…
• Senior Thesis Prize, Princeton University, Department of Ant…