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HEAL Supplements to Improve the Treatment and Management of Common Co-Occurring Conditions and Suicide Risk in People Affected by the Opioid Crisis

NAMHC Concept Clearance

Presenter:

Michael C. Freed, Ph.D., EMT-B
Division of Services and Intervention Research

Goal:

In April 2018, the NIH launched the Helping to End Addiction Long-termSM Initiative, or HEALSM Initiative, an aggressive, trans-agency effort to speed scientific solutions to stem the national opioid public health crisis. In response to this initiative, the National Institute of Mental Health (NIMH), in partnership with other NIH Institutes and Offices, proposes to supplement relevant studies to improve the treatment and management of common co-occurring conditions and suicide risk in people affected by the opioid crisis.

Rationale:

In August 2019, the HEAL Initiative Multi-Disciplinary Working Group called for research studies that seek to improve the provision of care for people with common co-occurring conditions associated with the opioid crisis (e.g., people with mental health disorders, chronic pain, suicide risk, alcohol misuse/alcohol use disorder, and/or other substance use disorders). Clinicians in settings such as primary care routinely face patients with complex needs. Workflows and services need to be in place to help the modal patient, who often presents with some combination of treatable conditions, including opioid use disorder (OUD; or OUD risk), mental health conditions, suicide risk, chronic pain, alcohol use disorders, and other substance use disorders. Failure to adequately address co-occurring conditions may impede OUD treatment and increase OUD risk and other adverse outcomes such as suicide. A multi-pronged strategy that addresses co-occurring conditions may yield greater improvements in OUD outcomes as well as improved overall heath for treated individuals.

Supplements could enable investigators to evaluate the most effective OUD treatments, services, and prevention interventions for the significant number of people presenting with co-occurring mental health, pain, alcohol, and substance use conditions and who may also be at risk for suicide. NIH aims to support competitive supplements to improve the treatment and management of common co-occurring conditions and suicide risk in people affected by the opioid crisis. Supplement requests need not address all possible co-occurring conditions, but they must have clear and direct relevance to OUD and/or chronic pain.

High priority supplements will aim to:

  • Test and evaluate approaches to improve the treatment, management, and services for people with co-occurring conditions and suicide risk;
  • Examine the potential mechanisms through which co-occurring conditions impact service use (e.g., access, engagement), delivery/quality, and outcomes, in order to identify potentially targets for therapeutic and services intervention; and/or
  • Identify or validate putative change mechanisms that may account for secondary benefits of treatment (e.g., reduction of suicide risk following successful OUD treatment) and that can inform the development and testing of future prevention, treatment, or services interventions.