To reverse the opioid crisis that continues to grip the nation, the National Institutes of Health has awarded $945 million in total fiscal year 2019 funding for grants, contracts and cooperative agreements across 41 states through the Helping to End Addiction Long-term Initiative or NIH HEAL Initiative. The trans-NIH research effort aims to improve treatments for chronic pain, curb the rates of opioid use disorder (OUD) and overdose, and achieve long-term recovery from opioid addiction.
In 2016, an estimated 50 million U.S. adults suffered from chronic pain and in 2018, an estimated 10.3 million people 12 years and older in the United States misused opioids, including heroin.
President Trump's approach to the opioid crisis and HHS's strategy have both been based in the best science we have. We have effective tools, such as medication-assisted treatment, but we still need better ways to treat opioid addiction and manage pain in an effective, personalized way. This historic investment by NIH was made possible by funding secured from Congress by President Trump, and will support our work in the current crisis and lay the work for a healthier future."
Alex Azar, HHS Secretary
The NIH HEAL Initiative is leveraging expertise from almost every NIH institute and center to approach the crisis from all angles and disciplines, and across the full spectrum of research from basic to implementation science in the areas of:
- Translation of research to practice for the treatment of opioid addiction
- New strategies to prevent and treat opioid addiction
- Enhanced outcomes for infants and children exposed to opioids
- Novel medication options for opioid use disorder and overdose
- Clinical research in pain management
- Preclinical and translational research in pain management
"It's clear that a multi-pronged scientific approach is needed to reduce the risks of opioids, accelerate development of effective non-opioid therapies for pain and provide more flexible and effective options for treating addiction to opioids," said NIH Director Francis S. Collins, M.D., Ph.D., who launched the initiative in early 2018. "This unprecedented investment in the NIH HEAL Initiative demonstrates the commitment to reversing this devastating crisis."
The initiative will address multiple problems that are slowing or preventing progress on addressing the crisis, including:
Problem: Many people with OUD do not receive appropriate treatment for their disorder.
Scientific solution: The HEALing Communities Study and Justice Community Opioid Innovation Network (JCOIN) will integrate evidence-based interventions into community, justice and emergency room settings where people with OUD seek help. NIH will study which interventions or combination of interventions work best in which communities and implement them.
Problem: Many patients who receive medications for OUD do not stay on treatment long enough to achieve long-term recovery.
Scientific solution: NIH HEAL Initiative awards target novel, longer-lasting and innovative treatments for OUD. This includes using immunotherapies to prevent relapse and overdose, extended-release formulations and reducing drug cravings to give patients more options to sustain their recovery.
Problem: There are different types of pain and people experience pain differently, but it is not known which treatments will work best for which patients.
Scientific solution: HEAL research will advance our understanding of pain by identifying biomarkers, endpoints and signatures of pain conditions, as well as providing evidence-based non-addictive treatments for discrete pain conditions such as back pain, post-surgical pain and pain in hemodialysis patients.
Problem: Clinicians need to ensure that their patients' pain is under control while also balancing the risks of long-term opioid therapy.
Scientific solution: The initiative will develop non-addictive medications for pain and test new models of care in real world settings. This includes a controlled trial of acupuncture for chronic low back pain, with NIH working with the Centers for Medicare & Medicaid Services to inform coverage determinations.
Problem: There is no national standard for care of infants born exposed to opioids.
Scientific solution: Research through the NIH HEAL Initiative will inform treatment guidelines for clinical care of infants who are exposed to opioids in the womb. Long-term studies of these infants will improve our understanding of pre- and postnatal opioid exposure on brain growth and development.
"We need to ensure that people with chronic pain have effective treatment options that don't expose them to the risk of opioids," said Rebecca G. Baker, Ph.D., director, NIH HEAL Initiative. "Preventing opioid misuse and addiction through enhanced pain management and improving treatments for OUD and addiction are both critical parts of our trans-NIH response to the opioid crisis."