US Health Officials’ New Plan to Fight the Opioid Crisis: Stop Chronic Pain Before It Starts

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The opioid overdose reversal drug naloxone.Photo: Spencer Platt (Getty Images)

On Tuesday, the National Institutes of Health revealed its new plan to tackle the opioid crisis, which it dubbed the Helping to End Addiction Long-term, or HEAL, initiative. Among the ideas presented are research programs devoted to better understanding chronic pain, developing new non-opioid painkillers and addiction treatments, and speeding up the clinical trial process to test out these potential drugs.

The plan was detailed in the pages of the Journal of the American Medical Association (JAMA) by Francis Collins, NIH director, Walter J. Koroshetz, director of the NIH’s National Institute of Neurological Disorders and Stroke, and Nora Volkow, director of the NIH’s National Institute on Drug Abuse.

The plan is comprised of two main parts: funding for projects that will help develop or facilitate treatments for opioid addiction and overdose, and funding for programs meant to improve the management of pain via research into how acute pain becomes chronic pain (with the hope that someday we can stop that from happening), as well as the development of new, nonaddictive pain treatments.

“Like most other pioneering scientific initiatives, HEAL will focus on a range of objectives, from short-term goals to research priorities that will take longer to bear fruit,” the authors wrote. “Yet, all will be aimed at the same ultimate vision: a nation of people with far less disabling pain and opioid addiction.”

For instance, though there are three approved drugs to help people wean off opioids (methadone, buprenorphine, and naltrexone), Collins and the others note that most people living with opioid addiction never actually get started on these treatments, and of those who do, 50 percent relapse within half a year.

“Research to reformulate these medications to improve adherence, as well as to develop new, more flexible therapies, is needed to help those who have opioid use disorder,” the authors wrote.

The NIH will also fund efforts to create drugs capable of better reversing overdoses caused by more potent opioids like fentanyl. The current reversal drug of choice, naloxone, often requires multiple doses to save people from fentanyl overdoses, has a relatively short half-life, and is less effective if other drugs like alcohol are in a person’s system.

The HEAL initiative will sponsor a study meant to test out a variety of evidence-based strategies across aspects of addiction prevention and screening, acute treatment, and long-term recovery in communities heavily affected by the crisis. It will also fund a study into neonatal opioid withdrawal syndrome, otherwise known as the phenomenon of newborns born physically dependent on opioids because of their mother’s drug use while pregnant. The study will try to track how often this actually happens, assess the current strategies used to prevent or treat it, and set the baseline for larger-scale studies that will lead to established treatment guidelines.

While the NIH plan will rely on evidence and research to combat the opioid crisis, elsewhere in the government, the response has been less scientifically sound. President Trump himself has called for tactics widely maligned by drug policy experts, such as the harsher prosecution of drug dealers, while agencies such as the Center for Medicare and Medicaid have passed down restrictive prescribing rules that patient advocates and doctors say will only harm stable chronic pain patients and further encourage the use of illicit, more deadly opioids.

The funding for the new NIH initiative, according to the authors, will largely come from the $500 million that Congress added to the agency’s coffers in the 2018 budget.

[JAMA]