Funded Projects

Project # Project Title Research Focus Area Research Program Administering IC(s) Institution(s) Investigator(s) Location(s) Year Awarded
1R01MH128904-01
Supporting Treatment Access and Recovery for Co-Occurring Opioid Use and Mental Health Disorders (STAR-COD) New Strategies to Prevent and Treat Opioid Addiction Optimizing Care for People with Opioid Use Disorder and Mental Health Conditions NIMH University of Massachusetts Medical School SMELSON, DAVID A Worcester, MA 2021
FOA Title: HEAL Initiative: Optimizing Multi-Component Service Delivery Interventions for People with Opioid Use Disorder, Co-Occurring Conditions, and/or Suicide Risk (R01 Clinical Trials Optional)
FOA Number: RFA-MH-21-145
Summary:

Opioid use disproportionally affects people with co-occurring mental health disorders. Although medication for opioid use disorder (MOUD) is the gold standard of care, engagement rates are low. Also, it is unclear whether addition of one or more behavioral interventions improves outcomes of MOUD treatment, particularly in patients with co-occurring mental health disorders. This project evaluates the effectiveness of the “Maintaining Independence and Sobriety through Systems Integration, Outreach and Networking (MISSION)” intervention—a multi-component, cross-disciplinary, team-based treatment approach that combines three evidence-based practices with MOUD—in people with co-occurring mental health disorders. The 4-year, five-arm, randomized controlled clinical trial will determine the therapeutic benefit of adding MISSION to MOUD and identify the MISSION components that yield the largest clinical improvement and offer the greatest return on investment.

3R01MH120124-02S2
Behavioral health Insurance coverage and outcome Risks of Co-occurring conditions among delivering women with opioid use and pain for HEAL: The BIRCH study New Strategies to Prevent and Treat Opioid Addiction Optimizing Care for People with Opioid Use Disorder and Mental Health Conditions NIMH UNIVERSITY OF MICHIGAN AT ANN ARBOR ZIVIN, KARA Ann Arbor, MI 2020
FOA Title: Notice of Special Interest: HEAL Supplements to Improve the Treatment and Management of Common Co-occurring Conditions and Suicide Risk in People Affected by the Opioid Crisis
FOA Number: NOT-MH-20-025
Summary:

Paralleling overall population trends, opioid use has escalated among pregnant and postpartum women, particularly among those with co-occurring perinatal mood and anxiety disorders, yet treatment remains underutilized. Since 2008, health insurance coverage changes led to a dramatic expansion of behavioral health coverage by increasing coverage and extending federal parity protections to more than 60 million Americans. Characterizing the clinical and economic impacts of these unprecedented extensions of behavioral coverage on maternal and infant outcomes among women with perinatal opioid use, chronic pain, and suicidality with and without co-occurring perinatal mood and anxiety disorders will inform future policy and targeted interventions

3U19MH121738-02S2
Buprenorphine Effect on Suicidal Behavior New Strategies to Prevent and Treat Opioid Addiction Optimizing Care for People with Opioid Use Disorder and Mental Health Conditions NIMH KAISER FOUNDATION RESEARCH INSTITUTE SIMON, GREGORY E Oakland, CA 2020
FOA Title: Notice of Special Interest: HEAL Supplements to Improve the Treatment and Management of Common Co-occurring Conditions and Suicide Risk in People Affected by the Opioid Crisis
FOA Number: NOT-MH-20-025
Summary:

Mortality and morbidity related to suicidal behavior and opioid use disorder (OUD) have increased significantly over the past decade. These two public health crises are intertwined at multiple levels. Medications for OUD, especially buprenorphine, have been shown to decrease opioid use and reduce the multiple negative consequences of OUD, including fatal and nonfatal overdose, criminal justice involvement, infectious complications, and misuse of other substances. In addition, small randomized trials of buprenorphine treatment in treatment-resistant depression (with or without co-occurring OUD) suggest that buprenorphine reduces depressive symptoms and suicidal ideation. This large study will evaluate the effects of starting buprenorphine treatment on self-harm and suicide attempt among people with opioid use disorder, including those with and without co-occurring mental health conditions or other known risk factors for suicidal behavior. Comprehensive health records data from four large health systems serving a combined member/patient population of approximately 11 million will be examined for the overall effect of buprenorphine treatment on subsequent self-harm or suicide attempt, including differences in effects between patient subgroups and specificity of effects to buprenorphine vs other medications.

3R01MH112138-05S1
Evaluating opioids and suicide prevention in health care settings through the System of Safety New Strategies to Prevent and Treat Opioid Addiction Optimizing Care for People with Opioid Use Disorder and Mental Health Conditions NIMH UNIV OF MASSACHUSETTS MED SCH WORCESTER BOUDREAUX, EDWIN D; KIEFE, CATARINA I Worcester, MA 2020
FOA Title: Notice of Special Interest: HEAL Supplements to Improve the Treatment and Management of Common Co-occurring Conditions and Suicide Risk in People Affected by the Opioid Crisis
FOA Number: NOT-MH-20-025
Summary:

The project will apply natural language processing to a rich repository of suicide and other clinical electronic health record and vital statistics to detect opioid problem-related encounters in order to (1) explore the relation between suicide risk and opioid misuse and (2) test whether a Zero Suicide model?s intervention effect is moderated by opioid misuse and whether it can also help to reduce opioid-related harm. First, the team will extract opioid-related EHR data using a combination of diagnostic codes and natural language processing, validated by structured manual chart review using a standardized procedure. Next, they will analyze the interplay between suicide risk and opioid problems in encounters and patients within the repository. Third, they will assess the effect of Zero Suicide implementation on prospective fatal and non-fatal suicidal behavior in patients with an opioid problem and examine whether the implementation had an effect on the incidence of opioid-related outcomes, including intentional overdose.

3UF1MH121954-01S1
Improving Access and Treatment for Co-occurring Opioid Use Disorders and Mental Illness New Strategies to Prevent and Treat Opioid Addiction Optimizing Care for People with Opioid Use Disorder and Mental Health Conditions NIMH RAND CORPORATION WATKINS, KATHERINE E; KOMAROMY, MIRIAM Santa Monica, CA 2020
FOA Title: Notice of Special Interest: HEAL Supplements to Improve the Treatment and Management of Common Co-occurring Conditions and Suicide Risk in People Affected by the Opioid Crisis
FOA Number: NOT-MH-20-025
Summary:

The United States is in the middle of two intertwined epidemics. Suicide and overdose deaths are at record levels. Opioid use disorder and mental illness are major contributors to both, with the highest death rates seen in people with co-occurring disorders (COD). This competitive revision tests whether enhancements to the collaborative care (CC) model adapted for co-occurring disorders improves retention in medication treatment and decreases suicide and overdose risk. The three additional components include: (1) education of family members about addiction and medication treatment; (2) training for family members to administer naloxone and on how to reduce opioid risk behaviors, and (3) implementation of Caring Contacts, a suicide prevention intervention. This study will examine patient and family member attitudes toward overdose education and naloxone in the population with COD; examine and then intervene with family members around patients? use of medication; and test in the COD population the effectiveness of universal suicide and overdose prevention programs.

3R01DA051067-01S1
Treatment of Co-Occurring Opioid Use Disorder with Alcohol, Other Drug, and/or Mental Disorders: The Role of Innovative Models and Integrated Care New Strategies to Prevent and Treat Opioid Addiction Optimizing Care for People with Opioid Use Disorder and Mental Health Conditions NIDA BRANDEIS UNIVERSITY REIF, SHARON Waltham, MA; 2020
FOA Title: Notice of Special Interest: HEAL Supplements to Improve the Treatment and Management of Common Co-occurring Conditions and Suicide Risk in People Affected by the Opioid Crisis
FOA Number: NOT-MH-20-025
Summary:

People with opioid use disorders (OUD) have high rates of co-occurring alcohol, stimulant and other drug disorders, as well as mental disorders. Traditionally, treatment for OUD has been ?siloed? even though these high rates of co-occurring conditions emphasize the need for comprehensive treatment to address holistic needs. As the opioid crisis continues, attention to the whole person and access to comprehensive mental health and substance use treatment as well as primary care is needed. This study aims to better understand co-occurring mental health disorders, alcohol use disorders, and/or other substance use disorders among people with OUD, in the context of innovative integrated care networks for people with OUD. This study examines how innovative OUD treatment models work for individuals with co-occurring mental health and substance use by 1) assessing mental health treatment quality measures and outcomes; 2) testing how these innovative treatment models compare to other OUD treatment for people who have OUD and other substance use disorders; and 3) considering the ways people with OUD access co-occurring disorder care. The findings from this study will provide needed information to improve mental health, alcohol, and other substance use treatment for individuals with OUD, whether or not they are in OUD treatment and may provide information to help move the system from siloed efforts to truly integrated care

3U01MH114087-02S1
Patient perspectives on clinical approaches to prevent opioid related suicide attempts New Strategies to Prevent and Treat Opioid Addiction Optimizing Care for People with Opioid Use Disorder and Mental Health Conditions NIMH Henry Ford Health System AHMEDANI, BRIAN KENNETH Detroit, MI 2020
FOA Title: Notice of Special Interest: HEAL Supplements to Improve the Treatment and Management of Common Co-occurring Conditions and Suicide Risk in People Affected by the Opioid Crisis
FOA Number: NOT-MH-20-025
Summary:

This study will evaluate the implementation of the Zero Suicide framework across six health systems serving over nine million people in collaboration with the Mental Health Research Network. The project will incorporate the voice of the patient and provider stakeholders as part of the implementation of the Zero Suicide framework in three health settings from the NIMH-funded parent award as well as the Southcentral Foundation which is an Alaska Native-owned, nonprofit health care organization serving nearly 65,000 American Indian/Alaskan Native people living in and around Anchorage, Alaska. The team will first systematically engage patients, providers, national consumer advocacy groups, and MHRN scientists in formulating research questions to address the prevention of opioid-related overdoses in people with Opioid Use Disorders (OUD) or people without diagnosed OUD who are using opioids for pain management. Next, the team will utilize semi-structured interviews to determine how people with OUD or people without diagnosed OUD who are using opioids for pain management are experiencing the implementation of the Zero Suicide framework in four diverse health systems. Experiences will be recorded using 80 semi-structured phone interviews in a diverse sample of patients who have survived an opioid-related overdose (50% intentional; 50% unintentional), as well as 20 Addiction Medicine, Primary Care, and/or Specialty Pain Medicine providers.

3UH3DA050174-02S1
Revision to the HOME Trial: Suicide Treatment Education and Prevention (HOME + STEP) New Strategies to Prevent and Treat Opioid Addiction Optimizing Care for People with Opioid Use Disorder and Mental Health Conditions NIDA OHIO STATE UNIVERSITY SLESNICK, NATASHA ; KELLEHER, KELLY J Columbus, OH 2020
FOA Title: Notice of Special Interest: HEAL Supplements to Improve the Treatment and Management of Common Co-occurring Conditions and Suicide Risk in People Affected by the Opioid Crisis
FOA Number: NOT-MH-20-025
Summary:

Homeless youth have high rates of alcohol and drug use, comorbid mental health conditions, and are at high risk for suicide. However, few preventive interventions have been proven for reducing substance use or addressing suicide among homeless youth. Resolution of youth homelessness through housing and prevention services, often referred to as ?Housing First? (HF), will be tested in the HOME (Housing, Opportunities, Motivation and Engagement) study, which aims to reduce opioid use and progression to opioid use disorder (OUD). This study will include suicide screening, treatment, education and prevention (STEP) to the model to examine whether HF provides secondary benefits for reducing suicidal ideation and behaviors among high risk homeless youth. STEP includes ongoing suicide screening procedures and Cognitive Therapy for Suicide Prevention (CTSP) for those at high risk for suicide. Youth (N=240) will be randomly assigned to receive HF + STEP + opioid and related risk prevention services (strengths-based outreach and advocacy; HIV Prevention; and motivational Interviewing) or to receive STEP + opioid and related risk prevention services, alone. Results from this study will inform the design and implementation of other national models of HF to address prevention of substance use and suicidal ideation and behaviors among homeless youth.

3R01MH112148-03S1
Improving the Identification and Management of Suicide Risk among Patients Using Prescription Opioids New Strategies to Prevent and Treat Opioid Addiction Optimizing Care for People with Opioid Use Disorder and Mental Health Conditions NIMH UNIVERSITY OF CONNECTICUT SCH OF MED/DNT ASELTINE, ROBERT H Farmington, CT 2020
FOA Title: Notice of Special Interest: HEAL Supplements to Improve the Treatment and Management of Common Co-occurring Conditions and Suicide Risk in People Affected by the Opioid Crisis
FOA Number: NOT-MH-20-025
Summary:

The project will address gaps in both risk identification and clinical management by utilizing comprehensive clinical data from a mature health information exchange containing more than 2.3 million patients across the spectrum of clinical care (hospitals, primary care, specialty care, community health centers, urgent care) to develop a statistically robust method to measure suicide risk associated with prescription opioid use. First, the team will couple data fusion techniques with machine learning-based approaches in identifying the clinical and demographic characteristics associated with elevated risk of suicidal behavior among prescription opioid users. Second, the team will develop clinical profiles of patients with higher risk of suicidal behavior associated with prescription opioids, and to incorporate these profiles in a clinical decision support platform that can be used for identification and intervention at the point of care. The clinical decision support tool developed under this proposal will provide a generalizable platform that could be extended to other more conventional opioid related outcomes such as OUD and overdose.

3UG1DA040316-06S3
Suicide Prediction and Prevention for People at Risk for Opioid Use Disorder New Strategies to Prevent and Treat Opioid Addiction Optimizing Care for People with Opioid Use Disorder and Mental Health Conditions NIDA HENNEPIN HEALTHCARE RESEARCH INSTITUTE BART, GAVIN ; ROSSOM, REBECCA CLARE Minneapolis, MN 2020
FOA Title: Notice of Special Interest: HEAL Supplements to Improve the Treatment and Management of Common Co-occurring Conditions and Suicide Risk in People Affected by the Opioid Crisis
FOA Number: NOT-MH-20-025
Summary:

People with opioid use disorder (OUD) are at increased risk of depression and other mental health conditions, and a significant proportion of opioid-related deaths are likely suicides. Nearly 50% of patients who die by suicide make a healthcare visit in the month prior, most often to primary care. Yet systematic screening of patients with OUD for suicide risk is rarely done. Clinical decision support tools within the electronic health record can improve healthcare prevention measures and important clinical outcomes. This primary care-based clinic-randomized trial will integrate a clinical decision support tool for suicide risk prediction with a clinical decision support tool for the identification, diagnosis, and treatment of opioid use disorder. By integrating these two tools, the study will identify patients with opioid use disorder who have increased risk for suicide, ultimately increasing engagement in both OUD treatment and outpatient mental health care

1UF1MH121944-01
The Whole Health Study: Collaborative Care for OUD and Mental Health Conditions New Strategies to Prevent and Treat Opioid Addiction Optimizing Care for People with Opioid Use Disorder and Mental Health Conditions NIMH UNIVERSITY OF PENNSYLVANIA MANDELL, DAVID S.; BOGNER, HILLARY R.; KAMPMAN, KYLE M. Philadelphia, PA 2019
FOA Title: HEAL Initiative: Effectiveness Trials to Optimize, Implement, Scale, and Sustain the Collaborative Care Model for Individuals with Opioid Use Disorders and Mental Health Conditions (U01 Clinical Trial Required)
FOA Number: RFA-MH-19-525
Summary:

This study will refine and test a collaborative care model for patients with opioid use disorder (OUD) and major depression, post-traumatic stress disorder, or an anxiety disorder in primary care. The primary aims of the study are: (1) prototype and test elements of the research team’s collaborative care models; (2) conduct a randomized study of three collaborative care conditions to determine which is most effective in improving outcomes for people with OUD and mental health conditions: Augmented Usual Care, Collaborative Care, or Collaborative Care + Social Worker; (3) measure clinician and organizational-level factors associated with implementation to increase success; (4) conduct a cost evaluation of each collaborative care model; and (5) work with smaller and rural practices to develop and test effective strategies to manage OUD. Successful completion of this study will provide evidence regarding the elements of integrated collaborative care required to maximize outcomes for individuals with OUD and psychiatric disorders.

1UF1MH121949-01
Patient-centered team-based primary care to Treat Opioid Use Disorder, Depression, and Other conditions New Strategies to Prevent and Treat Opioid Addiction Optimizing Care for People with Opioid Use Disorder and Mental Health Conditions NIMH KAISER FOUNDATION RESEARCH INSTITUTE DEBAR, LYNN L.; BRADLEY, KATHARINE ANTHONY Oakland, CA 2019
FOA Title: HEAL Initiative: Effectiveness Trials to Optimize, Implement, Scale, and Sustain the Collaborative Care Model for Individuals with Opioid Use Disorders and Mental Health Conditions (U01 Clinical Trial Required)
FOA Number: RFA-MH-19-525
Summary:

Some medications for opioid use disorder (MOUD) can be provided in primary care (PC). Systems of team-based PC show promise for improving access and retention in OUD treatment. One such model, collaborative care (CC), includes a care manager, supervised by experts, who help provide evidence-based high-quality OUD care. While CC improves outcomes of depression, other mental health and substance use (MH/SU) disorders and pain, it is unknown how to optimally integrate CC for OUD with other MH/SU disorders. This pragmatic trial tests whether our model of CC for OUD and comorbid conditions increases engagement in MOUD treatment and improves depression symptoms in PC patients with OUD and depression. Innovative pragmatic elements include inclusion of all eligible patients in participating PC clinics, random recruitment and consent, and measurement of main outcomes using only secondary data. These pragmatic elements avoid studying only motivated patients and avoid activating patients randomized to usual care.

3R34AA025480-02S1
IMPLEMENTING MEDICATION-ASSISTED THERAPY FOR SUBSTANCE USE DISORDERS IN MENTAL HEALTH New Strategies to Prevent and Treat Opioid Addiction Optimizing Care for People with Opioid Use Disorder and Mental Health Conditions NIAAA Rand Corporation WATKINS, KATHERINE E SANTA MONICA, CA 2019
FOA Title: Administrative Supplements to Existing NIH Grants and Cooperative Agreements (Parent Admin Supp Clinical Trial Optional)
FOA Number: PA-18-591
Summary:

Substance use disorders (SUDs) can have devastating consequences for people with serious mental illness (SMI). SUDs can increase morbidity and mortality and are associated with higher healthcare and social costs, homelessness, and incarceration. Unfortunately, despite the availability of effective treatments, most individuals with co-occurring SMI and SUD (COD) never receive SUD treatment. We propose to evaluate system, provider, and patient-level facilitators and barriers and develop an implementation strategy and toolkit to promote the use of medication-assisted treatment (MAT) for people with COD. Aims 1–3 seek to assess organizational capacity (at the system and provider level); organizational readiness (at the provider level); and perceived needs, attitudes, and preferences (at the patient level) to identify barriers and facilitators. In Aim 4, we will use findings from Aims 1–3 to guide development of the implementation strategy and toolkit, using stakeholder input and a systematic process for strategy development.

1UF1MH121942-01
Collaborating to Heal Addiction and Mental Health in Primary care (CHAMP) New Strategies to Prevent and Treat Opioid Addiction Optimizing Care for People with Opioid Use Disorder and Mental Health Conditions NIMH UNIVERSITY OF WASHINGTON FORTNEY, JOHN C.; RATZLIFF, ANNA; SAXON, ANDREW J. Seattle, WA 2019
FOA Title: HEAL Initiative: Effectiveness Trials to Optimize, Implement, Scale, and Sustain the Collaborative Care Model for Individuals with Opioid Use Disorders and Mental Health Conditions (U01 Clinical Trial Required)
FOA Number: RFA-MH-19-525
Summary:

Medication-assisted treatment (MAT) represents the gold-standard intervention for opioid use disorder (OUD). However, only 20% of Americans with OUD received any formal or informal addiction treatment in the past year. Lack of access and engagement in MAT is driving poor OUD outcomes, especially in rural areas lacking specialty addiction services. The Advancing Integrated Mental Health Solutions (AIMS) Center at the University of Washington has successfully helped over a thousand primary care clinics across the country implement collaborative care for mental health disorders. The study will determine whether collaborative care can be used to successfully treat mental health disorders and OUD concurrently in primary care settings. Clinics offering collaborative care will randomize sites to add OUD to their collaborative care program or remain unchanged. Clinics not offering collaborative care will randomize sites to implementing collaborative care for OUD and mental health disorders simultaneously or for mental health disorders only.

1UF1MH121954-01
Improving Access and Treatment for Co-occurring Opioid Use Disorders and Mental Illness New Strategies to Prevent and Treat Opioid Addiction Optimizing Care for People with Opioid Use Disorder and Mental Health Conditions NIMH RAND CORPORATION WATKINS, KATHERINE E.; KOMAROMY, MIRIAM Santa Monica, CA 2019
FOA Title: HEAL Initiative: Effectiveness Trials to Optimize, Implement, Scale, and Sustain the Collaborative Care Model for Individuals with Opioid Use Disorders and Mental Health Conditions (U01 Clinical Trial Required)
FOA Number: RFA-MH-19-525
Summary:

In 2015–2016, there were over 2 million adults with an opioid use disorder (OUD); 62% had a co-occurring mental illness and 24% had a co-occurring serious mental illness. Despite the effectiveness of treatment, many individuals never receive it, and when treatment is provided, quality is low. This is a critical treatment gap in a vulnerable and stigmatized population. Collaborative care (CC) aims to address these gaps by improving access, quality, and outcomes in primary care patients with common mental health conditions. However, CC has never been tested with co-occurring disorders (COD). In the team’s CC model for COD (CC-COD), the CC team includes a behavioral health psychotherapist, medications for OUD, pharmacotherapy for depression and post-traumatic stress disorder (PTSD), motivational interviewing (MI), problem-solving therapy, and Seeking Safety. A multisite, randomized pragmatic trial will be conducted to adapt, harmonize, and then test whether CC-COD improves access, quality, and outcomes for patients with comorbid OUD and depression and/or PTSD.