An Ambitious Research Plan to Help Solve the Opioid Crisis

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In spring 2018, Congress added an additional $500 million to the NIH budget to invest in science to find solutions to the opioid crisis. The Helping to End Addiction Long-term (HEAL) initiative is being kicked off today with the announcement of several bold projects across NIH, focused on two main areas: improving opioid addiction treatments and enhancing pain management to prevent addiction and overdose. The funding that NIDA is receiving will go toward the goal of addressing addiction in new ways and better delivering existing forms of care to populations that need it.

Developing new addiction treatments and overdose-reversal tools is one of the major projects we will be funding. Three medications are currently FDA-approved to treat opioid addiction, one medication (lofexidine) has just been approved to treat physical symptoms of opioid withdrawal, and naloxone is available in both injectable and intranasal formulations to reverse overdose. But a wider range of options is needed in all three areas. These may involve not only new formulations of existing drugs (e.g., longer-acting depot formulations of opioid agonists or longer-acting naloxone formulations that are more suitable to reverse fentanyl overdoses) but also compounds that target different receptor systems or immunotherapies to treat symptoms of withdrawal and craving in addition to the progression of opioid use disorders. The Focused OUD Medications Development Research Project will consist of a series of high-impact studies that will ideally lead to about 15 Investigational New Drugs (INDs), which would then produce around 5 New Drug Applications (NDAs) submitted to the Food and Drug Administration (FDA).

Much research already points to the benefits of increasing the provision of OUD treatment with justice-involved populations, so this is another area that will receive HEAL funds. The Justice Community Opioid Innovation Network will create a network of researchers who can rapidly conduct studies aimed at improving access to high-quality, evidence-based addiction treatment in justice settings. It will involve implementing a national survey of addiction treatment delivery services in local and state justice systems; studying the effectiveness and adoption of medications, interventions, and technologies in those settings; and finding ways to use existing data sources as well as developing new research methods to ensure that interventions have the maximum impact.

The National Drug Abuse Treatment Clinical Trials Network (CTN) facilitates collaboration between NIDA, research scientists at universities, and treatment providers in the community with the aim of developing, testing, and implementing addiction treatments. As part of the HEAL initiative, the CTN Opioid Research Enhancement Project will greatly expand the CTN’s capacity to conduct trials by adding new sites and new investigators. The funds will also enable the expansion of existing studies and facilitate developing and implementing new studies to improve identification of opioid misuse and OUD and engagement and retention of patients in treatment in a variety of general medical settings, including: primary care, emergency departments, obstetrics/gynecology, and pediatrics.

A great tragedy of the opioid crisis is that so many effective tools already exist but are not being deployed effectively in communities that need them. Only a fraction of people with OUD receive any treatment, and of those, less than half receive the medications that are universally acknowledged to be the standard of care, or they only receive medications for too short a duration. As part of its HEAL efforts, NIDA will launch a multisite implementation research study called the HEALing Communities Study, in partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA). The HEALing Communities Study will support research in up to three communities highly affected by the opioid crisis, to evaluate how the implementation of an integrated set of evidence-based interventions within healthcare, behavioral health, justice systems, and community organizations can work to decrease opioid overdoses and to prevent and treat OUD. Lessons learned from this study will yield best practices that can then be taken and applied to other communities across the nation.

The HEAL Initiative is a tremendous opportunity to focus taxpayer dollars effectively where they are needed the most: in applying science to find solutions to the worst drug crisis our country has ever seen.

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Dr. Nora Volkow, Director

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 opioid crisis

One sure way to reduce opioid addiction:

Legalize cannabis.

Which you have been lying about for decades.

 Opiods and butran

I took hydrocodione for 4 plus years for rib and back pin and fibromyalgia and scar tissue on the inside of my stomach. One day i had a headache and reached for it instead of tylenal. I said no not going there went to the de told him to take me off the daily meds and only use them if i have aurgery because i didnt want to be addicted. He gave me another med with no opiod. Later on as pain got worse my dr put me on Butran patches and i change them weekly. Helps my pain and no high at all. The reason others do use it is the 800.00 price tag without good insurance dont need a study for that. Butran gave me a life back.

 Pot instead of opioids- seriously?

When it comes to alleviating severe pain from trauma, the opioids are a true blessing. Marijuana does not even hold a candle in comparison. It's a joke! And worse, a ruse to promote another drug into the American landscape.

Yet we've got to serious about all this. The medical profession per se is NOT to blame for the opioid crisis. This crisis was caused by a drug loving sub-culture that was primed and ready to accept and divert an abundance of opioids for recreational purposes. It's only a relatively small percentage of patients who are becoming addicted (and many of those are former drug users who were vulnerable to begin with).

The vast majority of this opioid crisis came about from others seeking and diverting those pills for their own recreational pleasures! And then they become addicted. There's too much tendency to blame the "big bad corporation" for problems caused by the loose behavior of some irresponsible individuals. Understand that over the last half a century, we developed a vast and pervasive drug-using subculture.

And many of these ongoing and rising suicide rates that we see even among our favorite celebrities is not merely out of depression, but in my opinion, rooted in the negative affects of past addiction catching up with them.

Yet, please do not let the devious methods of the pot lobby infiltrate and obscure any rational discussions about a very serious problem.


...more talk about FDA solutions and infrastructures that will take years of research and approval systems within an already disintegrated healthcare landscape - without any substantive improvement in social determinants of health if and when they are implemented. We are tired of the research trying to validate an issue - we already know what's going on - look in the schools and playground, look down the hall and in our clinics. … Do we not realize that drugs and research will NOT impact this epidemic?? It's a heart matter, needing medical, social, and spiritual intervention. … Licensed professionals - the boots on the ground - need to spear-head any enduring solution to an addiction enemy. … Besides, the enemy will morph itself within the guise of addiction before a new drug is introduced! It has already beat narcan (naloxone). Addiction - that dog will hunt. Please do not be dismayed by the muse of government. What it will take is a true protocol-driven statute that aligns all existing sectors, including payer systems, to compensate cohesion. Collaborative care is the solution. [Edited to conform to comment rules.]