Advancing Health Equity: New Research Directions

Dear HEAL Community,

Together, we are making progress toward ending addiction long-term with new approaches to managing pain and addressing opioid misuse and overdose. But at the same time, it’s important that these treatments are available to all who need them.

For many people, the experience of pain – and the consequences of inadequate treatment – are made worse by things out of their control. These include social and environmental factors such as poverty and lack of access to care – in part driven by systemic racism, stigma, and provider bias and discrimination against some patients. Health literacy and language barriers also make it hard for people to get adequate treatment for pain and substance use disorder. In the coming year, HEAL research will be looking at these issues head on.

Racial/ethnic health disparities in pain treatment are stark. Blacks/African Americans are less likely than Whites to receive pain treatment (including opioids when they are needed). Hispanic children who go to the emergency department for a broken bone are only half as likely than White children to receive opioid pain treatment for such injuries in which short-term opioids are appropriate. Generally, non-Whites are less likely to receive advanced diagnostic imaging to guide pain treatment and less likely to be treated with non-pharmacological rehabilitative approaches such as physical therapy or surgery.

We know all too well how inadequate pain treatment and opioid misuse are intimately connected. Structural inequities, including discriminatory practices, have also fueled substandard care for addiction treatment, and in turn driven an increase in overdoses among racial/ethnic minorities (as recently reported by the HEALing Communities Study).

Facing these serious gaps in pain and addiction care, it is our responsibility as a research community to look for scientific solutions.

HEAL is now inviting research applications on evidence-based interventions that target health disparities in pain management and social factors affecting behavioral health. What might we learn through this research investment? We are looking for specific ways to promote equity where it is lacking, toward improving treatment for at-risk populations.

Because health inequities are often borne of entrenched systems, HEAL research projects to advance health equity in pain and addiction treatment will explicitly target levels of influence like healthcare organizations, communities, and neighborhoods. And we are targeting the people who need it most, focusing on one or more NIH-designated populations that experience pain health disparities. These include Blacks/African Americans, Hispanics/Latinos, American Indians/Alaska Natives, Asian Americans, Native Hawaiians and other Pacific Islanders, socioeconomically disadvantaged populations, underserved rural populations, and sexual and gender minorities.

Importantly, this forthcoming body of research will be grounded by including perspectives from people with lived experience and advocacy groups; hospitals, clinics, and community health centers; and community-based organizations. We know that the best science stems from inclusive practices such as meaningful partnerships with patients at all stages of the research process. HEAL researchers are making our research more inclusive through several creative approaches:

• Developing culturally relevant recruitment and research materials, such as translating a module for non-opioid pain coping skills into Spanish and adjusting its design
• Building a Health Beliefs Toolkit that can be adapted to assess individuals’ knowledge of health, their perceived susceptibility to illness, and barriers (including personal values and beliefs) about taking part in a research study (in partnership with primary care providers, community health workers, peer counselors, agency representatives, and patient and non-patient groups)
• Including more Black/African American participants in a study involving teens and young adults that is testing technology-driven opioid misuse prevention interventions delivered via health coaches
• Increasing the size and responsibilities of Community Advisory Boards by adding focus groups for research participants and conducting interviews with people who choose not to participate in research about their experience seeking care for chronic low back pain
• Adapting for opioid use disorder a peer-led online community intervention for people living with HIV that aims to reduce stigma and increase health behavior change
• Enhancing recruitment of Black/African American and Hispanic participants in a study testing virtual reality for pain by using an artificial intelligence-based cohort-building tool in patients’ electronic health records

One exciting new project just getting off the ground aims to prevent inequity by design in people with both chronic pain and opioid use disorder. Systems providing care for these individuals are often especially fragmented and under-resourced. The HEAL-funded Integrative Management of chronic Pain and OUD for Whole Recovery (IMPOWR) program will use a team science approach to create patient-centered treatment interventions and workable models of care delivery for underserved communities in primary care, opioid treatment programs, and hospital settings. Each of these studies will have a built-in process for seeking input from people with lived experience, toward understanding the multiple barriers that need to be overcome to provide equitable care.

Effective strategies for managing pain and addiction long-term must consider an individual’s circumstances related to pain and substance use, including quality of life and recovery support. Addressing structural racism in research and healthcare is a big challenge, but there are many concrete research questions that will guide the way toward serving the needs of millions of people who live with debilitating health conditions that are made worse, or even created, by the environments in which they live.

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].