The word "prevention" written on a piece of paper and tacked to a bulletin board

Prevention is a critical tool for addressing the opioid crisis. Yet rarely is there one course of events that leads to risky use of substances or addiction. That makes it hard to predict with absolute certainty who might develop an unhealthy outcome. To learn more about prevention as it relates to opioid use disorder, HEAL spoke with Amy Goldstein, Ph.D., and Barbara Oudekerk, Ph.D., of the National Institute on Drug Abuse, who lead HEAL’s Preventing Opioid Use Disorder program. Below is an abbreviated version of this conversation.

It is true that there are many evidence-based strategies to prevent early use and misuse of substances such as alcohol, tobacco, cannabis, and other drugs. But we don’t know if the same strategies work as well for opioids, and in what scenarios. Also, there are also different situations in which people may be exposed to opioids, such as opioids being prescribed as part of pain management. So an intervention to prevent misuse of opioids for these people will look different than one that discourages people from using opioids at all, such as through shared prescription medications from family members or friends.

Even if we learn that existing substance use prevention strategies work well to prevent opioid use, there are other challenges. We need to learn how to make these interventions accessible to all people who might benefit from them. That’s another area of research.

Ultimately, the main goal of preventing opioid use disorder is to develop place-based, accessible, sustainable interventions. These strategies need to address risk for opioid misuse and use disorder at vulnerable points in time. And it’s essential that they work for populations significantly affected by the opioid crisis. To do this, HEAL is investing in research across four broad strategic areas:

  • First, we need to identify risk for (and pathways to) opioid misuse to better understand who will benefit from opioid prevention services, and when.
  • Second, we need to look at social and structural factors that are often out of an individual’s control but have a major impact on behavioral health and health equity.
  • Third, we need to continue to develop and test interventions across a variety of settings and populations.
  • Fourth, we need to ensure effective approaches are used by, and affordable to, communities who need them.

The transition from adolescence into young adulthood is one important opportunity for intervention. This is the time in life when rates of opioid misuse double (from 1.6% to 4.1%) as teens become young adults. Also, research continues to show that adolescents who use other substances (such as cannabis or alcohol) have risk for misusing opioids in the future.

HEAL funded the Preventing Opioid Use Disorder in Older Adolescents and Young Adults Cooperative – what we call the HEAL Prevention Cooperative. These researchers across the country are testing 10 strategies for preventing opioid misuse and use disorder. They are all working closely with a variety of systems and organizations who are in contact with youth who experience risk for opioid and other substance misuse. For example, interventions are being conducted among populations receiving services through child welfare systems, justice systems, school-based health centers, behavioral health clinics, emergency departments, and social service systems (e.g., housing, family services). Two projects are testing interventions among young people in tribal communities: the Cherokee Nation in Oklahoma and urban American Indian and Alaska Native populations nationwide.

Although these research projects focus on preventing opioid misuse among young people, it’s important that we think about prevention across the lifespan. As the HEAL prevention portfolio grows, we expect to fund research across a range of ages, continuing to focus on underserved populations with risk for opioid use disorder and that experience health disparities more broadly. 

We are designing research so that prevention interventions can be rapidly adopted and durable in communities. For example, one HEAL-funded project is examining factors that influence policymakers’ priorities for addressing substance use among youth. This research found, unsurprisingly, that budget issues influence most policymakers. Yet it is relatively uncommon for research studies to measure economic outcomes for interventions that are being tested. We built into the HEAL Prevention Cooperative studies a way to estimate costs of programs and economic outcomes that will provide data of value to those who make decisions about program implementation. You can learn more about some of this work in the September 30, 2022, webinar From Programs to Policy: The Role of Economic Evaluation in Prevention

We want to invest in prevention strategies that make sense for real-world use (see “Embedding Opioid Use Disorder Prevention into Everyday Life”). We hope that building research into existing systems with their own infrastructure and funding streams will make it easier and more practical for those programs that are proven to be effective to keep going after a research project has ended. We are also looking at potential factors that slow down or speed up the likelihood that interventions will be adopted and scaled-up by communities where they will be useful.

One thing that’s really important is that this HEAL research is being conducted in close partnership with people who might benefit from the research results. Community engagement helps to ensure research is addressing the most important, relevant questions toward developing meaningful practices and policies that affect health outcomes, including minimizing risky opioid use.

First, we expect to continue developing innovative prevention strategies that can be delivered through systems or organizations that already serve populations with known risk. For example, we are planning to fund research to develop and implement interventions to prevent opioid misuse in community health centers. 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.          

We are also planning to fund research that better illustrates the roles of social determinants of health on opioid misuse and informs the design of interventions that address structural and social risks. It’s clear that the quality of our social environments can shape our risk trajectories, but also affect how likely we might respond to interventions. For example, HEAL researchers are testing whether providing housing in addition to opioid risk prevention services leads to better outcomes than prevention services alone.

In 2020, 9.5 million Americans 12 years and older misused opioids in the past year. It’s fair to assume that the vast majority of these individuals could have benefited from services to prevent misuse (see “Prevention Is Treatment at a Different Time”). That’s a huge opportunity, and we’d like to see this number significantly increase.

If you are interested in conducting HEAL prevention research, we’d love to hear from you! You can sign up for emails, watch our webinar series, read more about the HEAL-funded Preventing Opioid Use Disorder program and HEAL research spotlights, learn more about the HEAL Prevention Cooperative, and attend our annual meetings.