Innovative NIH Research Initiative Targets Opioid Addiction and Pain

Innovative NIH Research Initiative Targets Opioid Addiction and Pain

A new, innovative opioid research plan has been launched by the National Institutes of Health (NIH), aimed at helping end the nation's devastating opioid addiction epidemic.

Called the "HEAL Initiative," (Helping to End Addiction Long-term), the research plan is backed by the special $500 million appropriations made to the NIH from Congress last year specifically to address the opioid crisis.
The new program was announced by NIH Director Francis Collins, MD, PhD, along with Walter Koroshetz, MD, director of the National Institute of Neurological Disorders and Stroke, and Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA), in the Journal of the American Medical Association (JAMA).

The announcement called the initiative an "aggressive, trans-agency effort to speed scientific solutions to stem the national opioid public health crisis."

The National Institute of Neurological Disorders and Stroke (NINDS) is a part of the U.S. National Institutes of Health. It conducts and funds research on the brain and nervous system disorders and has a budget of just over $1.5 billion.

NIDA is a United States federal government research institute whose mission is to "lead the Nation in bringing the power of science to bear on drug abuse and addiction."

In a nutshell, the Initiative bolsters research across NIH agencies to:

  • Improve Treatments for Opioid Misuse and Addiction: More than 2 million Americans have OUD. Millions more misuse opioids, taking opioid medications longer or in higher doses than prescribed. NIH will support research to provide new strategies for the prevention and treatment of opioid misuse and addiction that will help people with OUD achieve and maintain a meaningful and sustained recovery.
  • Enhance Pain Management: More than 25 million Americans suffer from daily chronic pain. NIH will support research to understand how chronic pain develops, making patients susceptible to risks associated with opioid use. NIH will work with partners from the biopharmaceutical industry to develop a data sharing collaborative, new biomarkers for pain, and a clinical trials network for testing new pain therapies.

Initiating new opioid and pain research

The NIH and its agencies will initiate new research into opioids and how they function, relevant aspects of pain management including alternatives to opioids, and investigate various approaches to addiction treatment.

"This Initiative will build on extensive, well-established NIH research, including basic science of the complex neurological pathways involved in pain and addiction, implementation science to develop and test treatment models, and research to integrate behavioral interventions with Medication-Assisted Treatment (MAT) for opioid use disorder (OUD)," the NIH announcement said.
The JAMA discussion points out that there are effective medications for OUD (methadone, buprenorphine, and naltrexone), but only a small percentage of individuals who would benefit from these medications actually receive them.
"Even among those who have initiated these medications, about half will relapse within 6 months," the announcement said. "Research to reformulate these medications to improve adherence, as well as to develop new, more flexible therapies, is needed to help those who have OUD. Similarly, although the opioid antagonist naloxone can effectively reverse opioid overdose, its relatively short half-life compared with those of synthetic opioids (fentanyl and its analogs) frequently requires multiple doses to reverse respiratory arrest, and its effectiveness declines when opioids are combined with other drugs (alcohol, benzodiazepines).”

New drugs, new therapies

"HEAL will catalyze the development of extended-release formulations of existing medications to treat OUD, longer-acting formulations of opioid antagonists or partial agonists, new therapies to counter opioid-induced respiratory depression, and novel medications and immunotherapies to treat OUD and prevent and reverse overdoses," the announcement said.

The HEAL Initiative plans to evaluate and introduce an "innovative therapy-development pipeline" through new public-private partnerships.

"In collaboration with biopharmaceutical groups, the Food and Drug Administration, and the Foundation for the NIH, the NIH will collect and evaluate treatment assets from academia and biopharmaceutical and device companies to coordinate and accelerate the development of effective treatments for pain and addiction," they said.

An NIH spokesperson told MedPage Today that,

"HEALing Communities will test the integration of MAT into an array of settings including primary care; emergency departments; specialty care settings including prenatal care, infectious disease, and behavioral health; the criminal justice system; and other community settings."

The HEAL Initiative is much more complex and far-reaching than we've been able to cover here. It's quite likely unprecedented - a coordinated federal health initiative like never before. Read the details here and the JAMA article here.

"Extraordinary focus by all segments of society is required to respond to the nation's opioid crisis," the NIH announcement said. "Now is the time to channel the efforts of the scientific community to deliver effective - and sustainable - solutions to this formidable public health challenge."

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