New HEAL Research Addresses Research Gaps

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Dear HEAL Community,

As fall and a new fiscal year arrives, HEAL research continues to press ahead to tackle the many challenges of the deadly opioid crisis. In the first 5 years of the initiative, we established a vibrant and responsive research program that is diverse, transparent, and which welcomes patients and community partners in the research process.

This research investment continues with newly funded science aiming to fill significant research gaps identified by our dedicated scientific teams. We know communities living with pain, addiction, and other conditions are counting on the results, and HEAL research will continue to address these needs as the crisis evolves.

Below are a few highlights of newly funded research, and I encourage you to visit heal.nih.gov to learn more.

Targeted Biology for New Pain Treatments

When HEAL launched in 2018, a main pillar was to accelerate development of effective non-opioid therapies for pain, and this commitment continues. HEAL uses a targeted approach to expand what we know about the biology of pain and addiction toward personalized treatments, since there are many different types of pain and the pain experience is unique among individuals. Newly funded HEAL preclinical pain research will pursue new ways to block pain (including using the body’s cannabinoid system, non-invasive stimulation technologies, and other approaches). We are also addressing a major challenge in pain research by bringing together basic and clinical scientists to work directly together on the same pain-related problem. Typical funding strategies don’t make this easy, so we are building that bridge.

But expanding underlying science knowledge is not enough. A major HEAL focus is advancing newly developed pain therapeutics to market quickly. As noted in a February 2023 report, pharmaceutical and biotechnology companies are not investing in pain and addiction therapies, for a range of reasons. As one way to address this gap, next month HEAL is hosting a Pain Partnering Meeting to convene HEAL scientists, investors, and NIH staff to address challenges within the commercial landscape of pain therapeutics. We expect newly emerged connections will accelerate the process of moving novel ideas into testing in patients – and ultimately to FDA approval.

Every Person Is Unique

HEAL research is whole person-focused because treating illnesses in isolation is unlikely to be effective or efficient. Looking for underlying commonalities is another strategy. Research is showing that fundamental processes like sleep play a role in many health conditions, including pain and opioid use disorder. Last year, for example, a small study showed that the insomnia drug suvorexant reduced withdrawal symptoms, lessened drug cravings, and increased the desire to not use opioids. Newly funded HEAL research will continue to explore sleep predictors of relapse and recovery – harnessing the power of a natural behavior for restoring health.

About 13 million Americans who live with chronic conditions that involve pain are prescribed opioids long-term – and for many it is a lifeline. However, some of these people develop physical and psychological dependence on opioids, putting them at risk. Newly funded research targets the needs of these individuals by tailoring personalized care approaches, including combination therapies that relieve pain but reduce risk of harm. Other new HEAL projects will continue our investment in the power of technology, testing neurostimulation strategies and digital therapeutics to address co-occurring substance use disorders, pain, anxiety, and/or post-traumatic stress disorder.

Community-Targeted Research

Research results are not meaningful or impactful if they remain in labs or journal articles. HEAL research studies benefit directly from patient and community engagement – the initiative is setting a new standard for the inclusion of lived experience in research. To optimize the generalizability of HEAL findings, the initiative encourages the use of Community Advisory Boards and community coalitions. Exemplar programs include the HEALing Communities Study (partnering with 67 American communities) and the Justice Community Opioid Innovation Network that spans 39 states and 141 counties. These two large-scale community research efforts are currently introducing what they have learned back to their community partners – toward making a real-world difference.

To effectively address the rapidly evolving opioid and overdose public health challenge, effective solutions require knowing what is happening on the ground. New research will help predict and respond to emerging threats in the drug supply, allowing community personnel to develop timely and informed responses to emerging drug threats.​ Other tools are being tested in various community environments to predict overdose hotspots.

Countering Health Systems Challenges

Building on awareness that pain and substance use disorders are influenced by sociocultural factors, HEAL is investing in new prevention research to understand and address how social determinants of health play a role in these chronic conditions. These factors are large and complex, but well-designed studies can zoom in to measure the effects of interventions, either alone or in combination. Newly funded HEAL studies will explore substance use after interventions that affect homelessness and neighborhood safety, poverty, and school disciplinary policies.

Population-based differences also limit the availability of pain management options and addiction care in many communities, such as in rural America. Rural residents are more likely than non-rural residents to be prescribed an opioid pain medication, to get treatment for opioid use disorder, and to use pain self-management approaches. New HEAL research aims to accelerate the use of evidence-based non-opioid chronic pain interventions in rural and remote communities with health disparities. Examples being tested include use of nurse care managers for patient-centered care and coordination and telehealth versions of various pain treatments. Other newly funded research is testing a range of ways to improve addiction care, including training more people to do this vital work.

In this message, I have shared brief descriptions of just a few of the more than 100 newly funded HEAL research projects. This initiative is highly collaborative, powered by science and people. We have a lot to be thankful for from the amazing work of you, the HEAL community. This initiative is a highly visible and successful research effort that American communities are counting on, for help and for hope.

The initiative remains a priority for NIH and the federal government. Starting next month, HEAL leadership will be administratively and collaboratively managed by the National Institute on Drug Abuse and the National Institute of Neurological Disorders and Stroke, the leading NIH institutes and centers supporting this necessary work and maintaining its cross-NIH, mission-driven nature. Although this is the last Director’s Message from me, communications about HEAL progress and updates will continue to keep you informed about our important work.

I thank you all for your dedication and energy to ending addiction long-term. It’s been an honor to lead this effort through its first 5 years.

As always, share information about HEAL with your networks and remember that we want to hear from you. It just takes a quick email to [email protected].