NIH quest to address pain includes UW Medicine researchers

In the wake of the opioid epidemic, the National Institutes of Health (NIH) is launching a massive initiative to help people with opioid addiction and to explore safer treatment options for chronic pain. The University of Washington School of Medicine will receive at least 10 awards totaling about $40 million.

The “Helping to End Addiction Long-term” (HEAL) Initiative is funding $945 million in 375 funding awards to researchers in 41 states. “This unprecedented investment in the NIH HEAL Initiative demonstrates the commitment to reversing this devastating crisis,” said NIH Director Dr. Francis  Collins, who launched the initiative in early 2018.

The surge in opioid prescriptions has fueled an addiction crisis that has taken more than 400,000 lives over the past 20 years.

Among the recipients at UW Medicine: 

Department of Psychiatry & Behavioral Sciences (and VA Puget Sound Health Care System)​: $14.8 million

Researchers John Fortney, Anna Ratzliff, and Andrew Saxon will engage at least 24 primary-care clinics across the nation to integrate care for opioid-use disorder and co-occurring disorders such as anxiety.

Ratzliff said many people with pain end up with anxiety and depression. “We want to treat the whole person to get the person all the way healed. We are trying to deliver this treatment in primary care, where barriers to access are lower and there is less stigma, she said.

Ratzliff and her team said that medication-assisted treatment with buprenorphine, methadone and naltrexone represents the gold-standard intervention for opioid-use disorder, and significantly reduces risk for overdose and death.  But only 20 percent of Americans with opioid-use disorder received any formal or informal addiction treatment in the past year, they said. Even in addiction treatment settings, just 32 percent of patients with opioid-use disorder received medication-assisted treatment. 

UW Medicine has helped more than 1,000 primary-care clinics across the country to implement collaborative care for mental health disorders.  Now they will examine the collaborative care model to concurrently treat opioid-use disorder and mental health.

Department of Psychiatry & Behavioral Sciences and Alcohol and Drug Abuse Institute: $4.5 million

Dennis Donovan, professor emeritus of psychiatry and behavioral sciences, and Mary Hatch-Maillette, research scientist at UW’s Alcohol and Drug Abuse Institute, are investigators with the National Institute on Drug Abuse’s Clinical Trials Network.  Within the network are several research projects ongoing or in development.

• Expanding medication treatment for opioid-use disorder into rural settings
• Developing/validating new measurement-based instruments focused on addiction
• Implementing buprenorphine initiation for individuals with opioid-use disorders seen in hospital emergency departments
• Identifying barriers to, and facilitators of, medication-assisted treatment for opioid-use disorder in two Washington tribal communities
• Facilitating culturally appropriate medication for primary-care and addiction-treatment programs that serve American Indians and Alaska Natives
• Integrating collaborative care management of opioid-use disorders in primary care
• Translating research findings (from the Clinical Trials Network) on treatment of opioid addiction into clinical practice
• Evaluating different forms of medication treatment for opioid-dependent expectant mothers
• Preventing and identifying opioid-use disorder using the “Six Building Blocks” strategy for improving opioid prescription management

Department of Psychiatry and Behavioral Sciences: $123,000

Jason Ramirez, acting assistant professor of psychiatry and behavioral sciences, will evaluate cognitive and developmental risk factors for opioid misuse among adolescent cannabis users. 

Division of Nephrology: $2.8 million

Researchers will compare interventions to reduce prescription opioid use for patients with kidney failure. The University of Washington will be a clinical center where patients undergoing long-term dialysis with chronic pain needing opioids will be enrolled in a clinical trial to test multiple strategies to see if they help patients get off prescription opioids.

Some patients will receive cognitive behavioral therapy(CBT) or CBT augmented by safer medical therapy such as buprenorphine patches. CBT is a type of psychotherapy in which negative thought patterns about the self and the world are challenged to alter unwanted behavior patterns and to treat mood disorders such as depression. The principal investigator is Rajnish Mehrotra, a UW professor of nephrology and medicine.

Researchers said the rate of opioid prescriptions for patients undergoing long-term hemodialysis is more than twice that of the general population. Short-term and low-dose prescription opioids both are associated with significant health risk to hemodialysis patients, the researchers said.

The trial will be led by three co-principal investigators that have partnered with five nonprofit dialysis providers for access to a diverse group of hemodialysis patients in Albuquerque, New York and Seattle with a census over three years of more than 7,000 patients.

Department of Anesthesiology and Pain Medicine: $2 million

Investigators hope to better understand the brain processes and sleep disturbances that occur during opioid withdrawal. In collaboration with scientists at SRI International in Menlo Park, Calif., they will also evaluate the nociceptin peptide system as a possible sleep aid.

“Chronic pain is a major factor contributing to insomnia, and sleep disruption due to chronic pain causes patients to seek relief, exacerbating the drive for prescription opioids,” researchers wrote in their grant proposal.

“This grant is getting at how the brain works to regulate sleep, as well as developing a target to promote sleep,” said professor Michael Bruchas, one of the lead investigators. He also is a principal faculty member at UW’s new Center for the Neurobiology of Addiction, Pain and Emotion, and his team will partner with the sleep neurobiology lab led by Thomas Kilduff in the biosciences division at SRI International.

“This grant will enable a multidisciplinary, multi-institutional collaboration to address opiate-use disorder by combining the expertise in sleep and circadian neurobiology at SRI with the neurobiology and pharmacology of addiction expertise in professor Bruchas’ laboratory,” said Kilduff.

When people with opioid-use disorder or opioid addiction become abstinent, they experience hyper arousal and cannot sleep, which contributes to them returning to drug use, noted researchers.

Bruchas said there is a natural sytem in the body that regulates sleep, which  includes nociceptin peptide receptors in the brain. He said researchers will investigate ways to activate the receptors to help people sleep naturally.

Department of Anesthesiology and Pain Medicine: $4.7 million

Jennifer Rabbitts, associate professor, and Tonya Palermo, professor, both in anesthesiology and pain medicine, will study the effectiveness of a mobile phone-based psychosocial intervention to prevent acute postsurgical pain in adolescents.

Department of Anesthesiology and Pain Medicine: $933,000

Miroslav Backonja, clinical professor, and professors Michele Curatolo and Brett Stacey, all in anesthesiology and pain medicine, will lead the UW hub as specialized clinical center to conduct clinical trials, phenotyping and biomarker studies within the EPPIC-Net (Early Phase Pain Investigation Clinical Network). 

Department of Pediatrics and School of Social Work: $4 million

Dr. Kym Ahrens, associate professor of pediatrics, and Kevin Haggerty, professor of social work, will research how to prevent young people in Washington’s juvenile justice system from misusing opioid substances. Their team will evaluate behavioral strategies to prevent opioid use and escalation among youth released from residential confinement facilities and group homes. 

School of Nursing and Department of Medicine: $3.3 million

Dr. Cynthia Price, research professor in the School of Nursing, and Dr. Joseph Merrill, professor in the Department of Medicine, have two projects to discern the value of mindful body-awareness training as an adjunct medication-assisted treatment for patients with opioid-use disorder. 

Department of Rehabilitation Medicine: $2.75 million

Mark Jensen, professor of rehabilitation medicine, and Melissa Day, senior lecturer at the University of Queensland in Australia, will study the effects and mechanisms of psychosocial treatments for chronic low back pain, including their effects on opioid medication use. 

[10/16/2019 editor's note: We have appended the original release to include additional grant awards involved in the HEAL initiative, and updated the total funding amount.]

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