Five teams at the University of Michigan in Ann Arbor have received a combined $25.5 million in federal grants to address the nation’s opioid epidemic.
The grants are among 375 funding awards to teams in 41 states aimed at improving treatments for chronic pain, curbing the rates of opioid use disorder and overdose, and achieving long-term recovery from opioid addiction.
The funds were announced Friday by the National Institutes of Health as part of the Helping to End Addiction Long-term Initiative, or the NIH HEAL Initiative, launched in April 2018.
“It’s clear that a multipronged scientific approach is needed to reduce the risks of opioids, accelerate development of effective nonopioid therapies for pain, and provide more flexible and effective options for treating addiction to opioids,” says Francis Collins, director of the NIH who launched the initiative. “This unprecedented investment in the NIH HEAL Initiative demonstrates the commitment to reversing this devastating crisis.”
A team of U-M researchers were awarded $12.6 million to study comparative effectiveness of chronic back pain interventions. The researchers are from the Michigan Medicine Chronic Pain and Fatigue Research Center and other departments.
The money will fund the U-M Mechanistic Research Center, which will be part of the broader Back Pain Consortium Research Program. The center will follow patients with chronic low back pain as they try different therapies. About 80 percent of adults experience low back pain at some point in their lives, and the pain is the most common cause of job-related disability.
“We are looking for solutions outside of opioids,” says Afton Hassett of the department of anesthesiology, one of the co-principal investigators. “These funds are a dream come true because they give us the opportunity to, in a really objective manner, look at the most commonly recommended interventions for patients and truly understand who they work for and how they are working.”
The team hopes to use advanced data mining techniques to develop more personalized interventions for chronic pain.
Another project will create emergency department-based opioid risk screening and virtual counseling for teens and young adults. Past U-M research has shown the power of asking patients about their drug use when they’re visiting a hospital or emergency care. The approach uses motivational interviewing, or brief discussions designed to spur adolescents to cut back on use or seek addiction help when needed.
Based on the earlier success of this approach, the new funds will support a randomized controlled trial involving health coaches who will connect through video chat with young people during their emergency visits and through secure web chat through a patient portal.
The study will be done at the Michigan Medicine emergency department.
“Using health coaches and technology to interact with adolescents and young adults regarding their opioid use can allow for real-time tailoring within the rapidly changing opioid epidemic,” says Maureen Walton of the department of psychiatry at Michigan Medicine and one of the leaders of the research. “We hope this approach will produce a sustainable impact to prevent escalation of opioid misuse in young people.”
Both leaders are members of the U-M Addiction Center and the U-M Injury Prevention Center as well as the Institute for Healthcare Policy and Innovation.
Another U-M team will create telehealth-based treatment for adults who have both opioid use disorder and chronic pain. This combination of conditions can make overcoming opioid problems difficult even with addiction treatment medications.
Half of people who receive medications for opioid use disorder have chronic pain, and many with both conditions live far from major medical centers, including veterans living far from VA hospitals.
The new project will test a telephone-based talk therapy pain management program in people with both conditions to help them control their pain while staying on the medications that can treat opioid issues. The research will include a clinical trial of 100 veterans and 100 nonveteran community members to look at short- and long-term effects of the approach.
“We hope to provide information not only on the effectiveness of the intervention, but also the barriers and facilitators to future implementation of this approach for others,” says Mark Ilgen of the U-M department of psychiatry and VA Ann Arbor Healthcare System, director of U-M Addiction Treatment Services and co-leader of the project.
He and the other leader are members of the U-M Institute for Healthcare Policy and Innovation.
Since 1975, U-M researchers have carried out the Monitoring the Future study that asks tens of thousands of teens and young adults about their behaviors, attitudes, and values, including their use of substances ranging from tobacco and alcohol to opioids and other drugs. Some of those surveyed as students still take part in a long-term study through mail surveys.
Funding of $420,000 will allow researchers to look at national death records for drug and opioid overdoses among members of this long-term group and look at their responses to past surveys about substance use. The findings could be used to target groups for drug overdose prevention as well as look for factors that might break the link between adolescent drug use and later drug use overdose mortality such as social roles, quitting smoking, and low depressive affect.
Finally, $900,000 has been committed to design and test an intervention to support effective delivery of a health curriculum for drug use prevention in high school. Interventions rarely achieve public health outcomes without implementation support. Andria Eisman, research assistant professor in health behavior and health education at the U-M School of Public Health, focuses on designing strategies that are both effective and cost-effective. She plans to work with community partners to tailor the curriculum to meet the needs of youth who have experienced trauma and disadvantage and are at risk for drug use.
Several U-M teams also received HEAL Initiative funding in 2018.