Rebecca G. Baker, Ph.D.

Rebecca G. Baker, Ph.D., is the director of the NIH HEAL InitiativeSMRead more about Dr. Baker.

Dear HEAL Community,

HEAL’s mission is to find scientific solutions to help end addiction long-term. And although this goal is concrete, it’s not always simple. We recognize that people face real-world challenges accessing high-quality care for pain and addiction, and our research needs to take this into account. As I’ll describe below, HEAL is funding several studies to accelerate research to practice to improve health, as well as to prevent unnecessary loss of life from overdose.

One way we are doing this is through research conducted in places where people seek care. These studies are working to identify (and overcome) roadblocks that prevent effective treatments from being used by providers and patients. For example, the HEAL-funded Pragmatic and Implementation Studies for the Management of Pain to Reduce Opioid Prescribing program is a set of studies that is looking at the use of non-opioid pain treatment approaches in existing primary care or other outpatient settings, and many of these studies involve volunteers from underserved populations. A few examples are use of combined acupuncture and guided relaxation for people with chronic sickle cell disease pain and use of phone-based physical therapy by low-income individuals who receive care at federally qualified health centers.

Large insurers, such as Medicare, won’t cover treatments without solid evidence to show that they work, and insurance coverage is the key to adoption by community providers. One way HEAL is addressing this need is a HEAL-funded study testing the value of acupuncture for older adults – with the purpose of informing coverage decisions. Importantly, this study involves participants representing the ethnic and racial composition of Medicare enrollees.

I’ve spoken before about how the largest study of its kind in addiction science, the HEALing Communities Study, is bringing research to individuals and families in 67 communities in four states hit hardest by the opioid epidemic. This large project is working directly with a diverse array of communities to tailor use of available and effective treatment and overdose-reversal interventions appropriate for local environments, building on local strengths. While this research is ongoing, already we’ve seen uptake of health-related information and resources about how everyone can help to stem overdoses – and also positive steps toward connecting people with evidence-based treatment through communication campaigns to combat stigma.

I’ll also highlight a study across correctional institutions in Maryland (part of the Justice Community Opioid Innovation Network program) that is comparing two types of treatments for opioid use disorder for people leaving jail. These individuals often do not have access to treatment and are at high risk for overdose. In this case, the research team is measuring not only individual-level health benefits and changes in criminal activity, but also cost savings and sustainability within correctional health systems.

Several HEAL-funded studies are looking at ways to empower primary care providers and nurse care managers to identify patients at high risk for progressing from moderate to a more severe opioid use disorder, or to capture patient preferences for non-opioid strategies to manage pain. HEAL-funded research is also testing primary care delivery of treatment for opioid use disorder and other substance use disorders, as well as assessing risk factors for mental illness and suicide. This popular collaborative care model has been shown to improve clinical outcomes and increase access to care and follow-up.

HEAL has a unique responsibility to meet the needs of people with pain, addiction, or both. This next year, we will develop and test combined interventions (such as psychotherapy, medications for opioid use disorder, exercise, and pain self-management) in a way that can be readily put into place by healthcare systems. This research will focus on the whole patient, seeking to address all the health conditions a patient is experiencing. This strategy requires a flexible clinical study approach but is more likely to be generalizable to real-world settings. Our research will be further strengthened by taking into consideration health equity and strategies for genuine engagement with people with lived experience, diverse representation of participants, and investigative teams.

Please stay tuned for more updates about HEAL efforts to bring the results of research to people as quickly as possible, to help the millions of people who need it today.

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].