Evolving with the Changing Opioid Crisis

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Dear HEAL Community,

The national crisis of opioid misuse, addiction, and overdose that affects families and communities nationwide continues to evolve. Although this crisis began with misuse of prescription opioid medications, polydrug use and powerful synthetic opioids such as fentanyl are now driving record-breaking increases in overdose deaths. These alarming trends call for us to adapt and redouble our research efforts toward our goal of ending addiction long-term.

The NIH HEAL Initiative’s research efforts will advance the newly released Department of Health and Human Services (HHS) Overdose Prevention Strategy to address the needs of people with pain and addiction at risk of drug overdose. Our current and planned research activities will advance the four priorities of the HHS strategy: harm reduction, primary prevention, evidence-based treatment, and recovery support.

Harm Reduction

Preventing overdose deaths is our ultimate goal. Many people who use drugs do not receive treatment and are at risk from overdose, infectious disease, and other consequences of drugs. We have a collective responsibility to minimize the harmful effects of drug use. This includes distribution of the lifesaving overdose-reversal agent naloxone, providing resources for safe drug injection through syringe service programs, or testing drugs for fentanyl and powerful synthetic opioids.

Currently, the HEALing Communities Study and many other HEAL-funded research programs employ harm reduction strategies such as distribution of naloxone and conducting training for community members on how to obtain and use this life-saving medication. Planned HEAL research investments to keep people safe go further. Many people use fentanyl test strips to test drugs for powerful fentanyl and prevent overdose. Future research on community and clinician perspectives on fentanyl screening and drug checking will identify next steps for technology development, research, education, and practice, with the goal of saving lives. Finally, HEAL is also expanding efforts to enable rapid-response data collection, which is a key tool for targeted delivery of naloxone and medication-based treatments in community hotspots.

Primary Prevention

One of the critical ways to prevent overdose deaths is by preventing opioid misuse and addiction in the first place. Current research underway in HEAL tackles primary prevention from many angles. Some of this work focuses on youth and other populations at high risk for opioid use. These studies are using a range of approaches such as role-play during video games, mobile apps that personalize the goal of staying in treatment, emergency department peer support specialists, and primary care-based suicide prevention modules. HEAL also recognizes the central role that many factors affecting an individual’s life situation shape health outcomes, including chronic pain and increased risk for opioid misuse and overdose. Forthcoming HEAL research centered around social determinants of health will combine interventions at individual and community levels. We anticipate HEAL research toward this goal will create paths for integrated prevention services across settings, spanning the continuum of risk from initial exposure early in life to living safely in recovery.

Access to effective, non-opioid options for treating pain is another important way to prevent opioid misuse addiction and overdose. HEAL clinical research in pain management is a broad effort that is leading this search for non-addictive strategies through several programs that either amplify existing research or are evaluating the safety and efficacy of new pain treatments. For example, through the Pragmatic and Implementation Studies for the Management of Pain to Reduce Opioid Prescribing (PRISM) research program, HEAL scientists are looking across a wide range of therapies to influence clinical practice including conducting pragmatic, “real-world” research to guide implementation of treatment within existing health systems. In another example, the Back Pain Consortium (BACPAC) research program is a patient-centered strategy to address the need for effective and personalized therapies for chronic low back pain. Developing an integrated model of chronic low back pain is a key step toward understanding drivers of the condition that will illuminate new therapeutic options to reduce pain and improve function, while also reducing the risks of opioid medications for pain.

Evidence-Based Treatment

Only one in five people with substance use disorders have received treatment for addiction. As a HEAL research community, we are seeking scientific solutions to the opioid crisis, but close partnerships with providers and community stakeholders are needed to integrate these results into treatment strategies. The HEALing Communities Study, the largest implementation science study ever funded in addiction research, is laser-focused on reducing drug overdose deaths by building connections between community resources and evidence-based treatments. The Justice Community Opioid Innovation Network is also a tremendous resource as we respond to the opioid overdose crisis. This research program provides high-quality and evidence-based care for opioid use disorder among justice populations, a group especially affected by the COVID-19 pandemic. Both of these large research efforts, along with others in HEAL, are poised to deliver results that will inform overdose prevention in a range of communities, and each has risen to the many challenges of the pandemic period.

Other promising areas of new HEAL research include biological therapies (vaccines, gene therapy, and novel formulations) for addiction, overdose, and prevention of relapse. It is critical that development of these treatments be conducted in a way that meets the needs of people who need help: as I noted earlier, HEAL is urging its researchers to be inclusive and recruit participants that reflect the burden of addiction and poorly treated pain.

Recovery Support

Finally, we know that recovery from addiction is an ongoing process of finding a path to health. Helping people find this path and stay on it is a priority for HEAL, in line with other federal activities and resources outlined in the HHS Overdose Prevention Strategy. HEAL research is underway to enhance community infrastructure for recovery support, as well as addressing how to integrate supports with other health services, including medications for opioid use disorder.

Many HEAL research programs employ the use of peer support specialists to enhance engagement of people who could benefit from treatment in a range of settings. Other exciting, and urgently needed, HEAL investments on the horizon include explicit attention to research-adoption partnerships to help communities identify and use evidence-based treatments and resources that support lasting recovery.

Saving lives now is the urgent priority for addressing the current, very deadly phase of the opioid crisis. Through a multifaceted approach comprising harm reduction, primary prevention, evidence-based treatment, and recovery support, I am excited about the potential of HEAL research to generate frameworks for individuals to live long and healthy lives free from addiction.

As always, share information about HEAL with your networks and remember that we want to hear from you. It just takes a quick email to [email protected].