Helping to End Addiction Long-Term Initiative by NIH Launched to Address Opioid Epidemic

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The HEAL Initiative will focus on addiction prevention through an improved understanding of mechanisms underlying the development of chronic pain.
The HEAL Initiative will focus on addiction prevention through an improved understanding of mechanisms underlying the development of chronic pain.

National Institutes of Health (NIH) Director Francis Collins, MD, PhD, announced on April 4, 2018, the launch of the Helping to End Addiction Long-Term (HEAL) Initiative.1,2 This transagency effort seeks “to speed scientific solutions to stem the national opioid public health crisis.”

The agency has devoted $1.1 billion for research on mechanisms of pain, opioid misuse, and addiction for fiscal year 2018, an >80% increase in funding from 2016. This move was facilitated by the long-awaited increase in the research budget signed into law on March, 23, 2018.

The science-friendly budget, which adds $3 billion (8.3% increase) to the NIH's budget over last year's, was voted by Congress despite radical cuts for research funding that had been initially proposed by the White House.3

The HEAL Initiative seeks to tackle opioid addiction on 3 fronts: basic research to further elucidate the neurobiologic mechanisms involved in both addiction to opioids and pain; implementation research, with the development of new models for both pain and opioid use disorder (OUD); and research on effective combinations of Medication-Assisted Treatment (MAT) and behavioral treatment approaches to OUD.2

NIH-funded research that has contributed to addressing the opioid epidemic in recent years includes the development of naloxone hydrochloride nasal spray (Narcan) for the reversal of opioid overdose and compiling evidence supporting the use of buprenorphine for the treatment of OUD. In addition, an increasing body of studies indicates the effectiveness of nonpharmacologic approaches to pain management (eg, acupuncture, mindfulness meditation, and yoga).

In partnership with biotechnology and pharmaceutical sectors, the HEAL Initiative will focus on addiction prevention through an improved understanding of mechanisms underlying the development of chronic pain and of factors that may increase the risk for OUD developing. A data-sharing collaborative, a network of clinical trials “that will allow multiple new and repurposed compounds to be tested simultaneously for effectiveness,” and the identification of biomarkers of increased risk for transition from acute to chronic pain, will be leveraged to address these goals. In collaboration with the NIH's Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative, which supports the development of improved neuroimaging technologies and of proteomics, genomics, and other –omics, the HEAL Initiative endeavors to identify new molecular targets for the treatment of chronic pain as well as biomarkers that may predict treatment response. Another avenue of research supported by the HEAL Initiative is the identification of genetic and social factors that predispose to OUD.

The development of immunotherapies seeking to prevent synthetic opioids and heroin from passing the blood-brain barrier, research into effective MAT/nonpharmacologic combined approaches, and the evaluation of treatments for and consequences of neonatal opioid withdrawal syndrome, will all contribute to designing better treatments for opioid misuse disorder and addiction.

At the launch of the HEAL Initiative at the National Rx Drug Abuse and Heroin Summit, Dr Collins declared, “Over the last year, NIH has worked with stakeholders and experts across scientific disciplines and sectors to identify areas of opportunity for research to combat the opioid crisis. The focus of these discussions has centered on ways to reduce the over prescription of opioids, accelerate development of effective non-opioid therapies for pain, and provide more flexible options for treating opioid addiction. NIH is committed to bringing the full power of the biomedical research enterprise to bear on this crisis.”

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References

  1. National Institutes of Health. NIH launches HEAL Initiative, doubles funding to accelerate scientific solutions to stem national opioid epidemic [news release]. April 4, 2018. Accessed April 4, 2018.
  2. National Institutes of Health. NIH HEAL Initiative. April 2018. Accessed April 4, 2018.
  3. Science Magazine. Trump, Congress approve largest U.S. research spending increase in a decade. March 23, 2018. Accessed April 4, 2018.
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