NIMH and the HEAL Initiative: Collaborating to address the opioid epidemic
All across the country, families and communities are wrestling with the opioid crisis. Opioid addiction and overdose are taking heavy tolls on society. The HEAL (Helping to End Addiction Long-term SM) Initiative is the National Institutes of Health’s all-in, coordinated response to the crisis, supporting research to deliver scientific solutions for patients, clinicians, and policy-makers as we all work together to end this crisis.
The National Institute of Mental Health (NIMH) has an important role to play in the HEAL Initiative and for a good reason. Among the millions of adults who misused opioids in the prior year, around 40 percent had a mental illness, and around 15 percent had a serious mental illness. People regularly using opioids are twice as likely to attempt suicide compared to those who do not use them. Beyond these sobering statistics, there are compelling personal stories of people with depression, bipolar disorder, and other serious mental illnesses who find themselves locked in a cycle of drug use and despair.
NIMH has long supported research with the goal of helping people with both mental illness and substance use disorder. These efforts include those by the Biomedical Development Corporation to explore the role of mHealth efforts in treating opioid use disorder. These researchers are studying the effectiveness of a software platform that helps patients track their symptoms and delivers evidence-based information through web- and smartphone-based channels. NIMH supports this project through our Small Business Innovation Research program, which aims to speed discovery, dissemination, and implementation of effective mental health treatments. The NIMH also sponsors the Mental Health Research Network, which leverages electronic health records at major nonprofit healthcare providers to conduct large-scale research on a number of topics, including the complex intersection between opioid use, depression, and suicide.
The NIH HEAL Initiative is a trans-NIH effort to enhance the response to the opioid epidemic. Accordingly, NIMH has been engaged with several new projects seeking to provide a research base for caregivers and policymakers working to end opioid addiction. Examples include the HEALthy Brain and Child Development study (RFA-DA-19-029; RFA-DA-19-036), an ambitious program to understand the neurodevelopmental effects of early exposure to opioids and other adverse childhood experiences; studies to develop and test novel devices to manage chronic pain syndromes (RFA-NS-19-016; RFA-NS-19-017; RFA-NS-19-018), and a series of clinical trials for prevention of opioid use disorders (RFA-DA-19-035; RFA-DA-19-034). All of these programs are multi-institute collaborations led by staff from our sibling institutes with robust NIMH support.
In addition to helping with these efforts, NIMH leads a collaborative project within HEAL focused on expanding access to effective interventions for opioid misuse within primary care facilities. Currently, only a small fraction of people with opioid use disorder have access to the most effective, scientifically supported treatments. Additionally, there is a shortage of specialty providers of mental health services, particularly in rural areas. The Substance Abuse and Mental Health Services Administration estimates that approximately half of U.S. counties lack even one practicing mental/behavioral health specialty clinician. Responding to this shortage, NIMH has supported research to improve health care delivery in underserved settings. Over and over, NIMH-supported scientists have shown that quality mental health care can be delivered effectively through a collaborative care approach in which primary care doctors and other non-specialists, care managers, and specialty consultants provide integrated mental health services. Based on over 80 randomized controlled trials, collaborative care models have proven effective at managing mental health conditions and have led Medicare and many private insurers to change their policies to cover collaborative care.
But what about those with both a mental illness and an opioid use disorder? Similar to other aspects of mental health care, there are effective treatments for opioid use disorder, such as Medication Assisted Treatment (MAT). When combined with mental illness-focused treatments, MAT has been shown to help those with both opioid use disorder and mental illnesses. However, we do not have data on the effectiveness of collaborative care models in facilitating delivery of MAT alone or in combination with treatment for mental illness.
With the HEAL Initiative, we have the opportunity to change that. Working with the National Institute on Aging, National Institute on Alcoholism and Alcohol Abuse, National Institute on Drug Abuse, National Institute of Nursing Research, National Institute on Minority Health and Health Disparities, as well as the National Center for Complementary and Integrative Health, the NIH Office of Behavioral and Social Sciences Research, and the NIH Office of Research on Women’s Health, we have released a request for applications (RFA-MH-19-525) to study the effectiveness and implementation of collaborative care for the treatment of individuals with opioid use disorder and mental illness. This important initiative will support studies to determine whether and how collaborative care can help these individuals, and how best to implement the collaborative care approach in a variety of settings.
Ashrafioun, L., Bishop, T. M., Conner, K. R., & Pigeon, W. R. (2017). Frequency of prescription opioid misuse and suicidal ideation, planning, and attempts. Journal of Psychiatric Research, 92, 1-7. doi: 10.1016/j.jpsychires.2017.03.011
Substance Abuse and Mental Health Data Archive. National Survey on Drug Use and Health, 2016. Retrieved from https://pdas.samhsa.gov/#/