HEAL Prevention Research: A Forward-Looking Approach to Saving Lives

Rebecca G. Baker, Ph.D.

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

Dear HEAL Community, 

Prevention interventions use science-based tools to avoid injury and disease, or to keep health conditions from getting worse. For HEAL, effective prevention reduces the burden of chronic pain and lessens the risk that millions of Americans who use opioids will develop opioid addiction. Although decades of work have shown that substance use prevention works, these approaches are not widely used. 

Lives are at stake, and the need is urgent: nearly 10 million Americans ages 12 and older misuse opioids, putting them at risk for harmful consequences like overdose and suicide. HEAL-funded prevention programs and projects are taking a practical, on-the-ground approach to testing a range of new and existing prevention tools to protect individuals and populations at risk.  

One Size Does Not Fit All  

Preventing addiction is much more complex than wearing a seat belt or getting a flu shot. Various HEAL prevention approaches are being tailored for individuals who may be at risk and during periods of life that feature significant change.  

The transition from adolescence into young adulthood is one important example. This is the time in life when rates of opioid misuse pdf  3.58 MB double (from 1.6% to 4.1%) as teens become young adults and their brains have not yet finished developing. HEAL prevention interventions are currently being tested in a range of settings where youth are at risk such as justice systems, behavioral health clinics, and emergency departments. To enhance real-world relevance, this research includes analysis of program costs and economic outcomes – important information for policy makers and community organizations that implement prevention programs.  

Another prevention strategy is to help people see their risk and change behavior before continued drug use affects their brain and makes it much harder to quit. Only about 20% of people who use opioids go on to develop severe addiction, and HEAL researchers are devising ways to prevent that transition using a team-based approach of primary care providers, health coaches, and care managers who counsel patients about opioid use. HEAL research is also testing the use of serious, yet highly engaging video games like PlaySmart to guide teens and young adults through real-life experiences to prepare them to make healthy decisions in their own lives at school and at home. 

Preventing and treating chronic pain and reducing exposure to opioids after surgery are other ways to prevent opioid use disorder and overdose. For example, HEAL researchers are testing psychologically based pain coping skills (using a mobile app called SurgeryPal) before, during, and after teens have spine surgery, which can set the stage for chronic pain, opioid use, and depression. In many cases, these youth may have never experienced serious pain and are at risk for opioid misuse. Another prevention opportunity is Cesarean delivery, or C-section, the most common major surgery done in the United States for which opioids are almost universally prescribed. However, 1 in 300 U.S. women who are prescribed opioids after a C-section go on to misuse opioids long-term. The number of opioid tablets prescribed can also vary between providers and hospitals, and researchers estimate that most women receive at least 10 more tablets than necessary. HEAL research is testing a patient-centered approach involving individualized counseling about pain management and opioid use that also gives women a choice about how many tablets they receive after they leave the hospital, from 0 to 20 tablets.  

Identifying Risk in Routine Healthcare Settings 

Many opportunities for prevention center on identifying risk. Often, that means finding people who may not know they can benefit from prevention (or are hesitant to accept help). Several HEAL research projects are identifying prevention opportunities at routine healthcare visits with primary care providers as a way to treat common mental health and substance use conditions. This approach, called collaborative care, uses treatment as a prevention strategy and includes a care manager who coordinates a patient’s appointments to help them create and follow a workable behavioral health treatment plan. It also includes regular consultations with a psychiatric specialist to help primary care teams deliver treatments they may not be familiar with. 

HEAL researchers are evaluating several versions of collaborative care. These include evaluating multi-component care models (medications, counseling, connection to community-based services) as well as pairing treatment for opioid use disorder and depression or post-traumatic stress disorder. Other HEAL prevention projects are encouraging use of primary care-based suicide screening tools like System of Safety and developing prevention interventions for people who use more than one type of drug

Encouraging continued use of effective addiction medications, like buprenorphine, is another form of prevention. For example, HEAL scientists plan to test whether medications for opioid use disorder like buprenorphine injected monthly can reduce use of other substances like methamphetamine. Other studies are testing various doses, types, and lengths of treatment for opioid use disorder, toward understanding how to personalize therapy. This research is also trying to determine whether it is ever safe to come off medication-based treatment, and if so, for whom and under what circumstances. 

Targeting Social Factors 

Many factors in life are out of our control, and this is especially so for individuals who are part of underserved, low-resourced populations. Poverty and lack of access to reliable transportation, healthy food, and stable housing can be significant contributors to misuse of opioids and other substances. Children who experience homelessness have the highest rates of opioid misuse among youth in the United States, and polysubstance use is common. Many have co-occurring mental health disorders such as depression, anxiety, and conduct disorders, and pursue high-risk activities, including risky sex. HEAL researchers are testing whether providing housing to youth in addition to opioid risk prevention services leads to better outcomes than prevention services alone.  

Other HEAL prevention research addresses risk within the child welfare system – since child neglect and lack of access to basic needs are known drivers of substance misuse. This research targets families – helping parents seek and get help for addiction and mental illness so their children can be spared harmful exposures. New HEAL prevention research projects plan to target community health centers that serve low-income populations. People who visit these centers have many risk factors related to opioid misuse, including mental health disorders, traumatic life experiences, homelessness, poor social environments, and others.  

Making Prevention Stick 

There is a lot we already know about preventing early use and misuse of substances such as alcohol, tobacco, cannabis, and other drugs. This knowledge has shaped the development of many prevention strategies – but they remain underused. In addition to increasing awareness about the value of prevention, there is still more to do. We don’t know if the same strategies work as well for opioids, and under what circumstances. An intervention to prevent misuse of opioids is much different than one that discourages people from using opioids at all, such as through shared prescription medications from family members or friends. 

HEAL is committed to learning how to apply opioid prevention strategies across life at times when risk of misuse is high. Effective strategies need to be durable but also tailored based upon population characteristics and community needs.  

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].