NIH HEAL Initiative: The Healing Communities Study

About the Healing Communities Study

The National Institutes of Health (NIH) and Mental Health Services Administration implemented the Helping to End Addiction Long-term (HEAL) Initiative, or the Healing Communities Study (HCA) in 2019 in an effort to quickly discover science-based strategies for ending the opioid crisis. Funds in the form of grant awards were issued to the University of Kentucky, Lexington; Boston Medical Center, Boston; Columbia University, New York City; and Ohio State University, Columbus with each site partnering with communities in 4 states: Kentucky, Massachusetts, New York, and Ohio -67 in total. The communities in the study have had high rates of fatalities due to opioid overdose in the U.S. (Hedegaard et al., 2020). The study consists of measuring the impact of integrating evidence-based prevention, treatment, and recovery interventions across a variety of setting, including primary care, behavioral health, and justice. The coordinating center is RTI International, a nonprofit research organization located in North Carolina. RTI International maintains responsibility for the aspects of data analysis, health economics research, and dissemination of research findings over the course of the study. The goal is to reduce opioid related deaths by 40 percent over the course of three years, with the findings to serve as a blueprint for communities nationwide. Additional details about the communities and settings of the study are available on the NIH HEALing Communities Study website. People can even sign up for email updates about this exciting NIH study.

Aiming At a Moving Target

In a recent Journal of the American Medical Association (JAMA) commentary, authors Dr. Nora Volkow and Dr. Carlos Blanco described the HCS as a “multiprong approach,” using comprehensive, science-based interventions such as increasing the use of medication for opioid use disorder (MOUD), increasing treatment retention, and broadening the use of naloxone. Data from each community are used for targeted interventions specific to each community across settings (Volkow & Blanco, 2021). This combination of science-based strategies and goals adapted to specific communities is based on results of a study that supported the use of adaptations based on community-specific data and results showing that no single strategy was effective enough by itself to achieve the hoped for 40% reduction in opioid overdose deaths (Linus et al., 2021). Drs. Volkow and Blanco powerfully stated: “No strategy would suffice if applied alone” (Volkow & Blanco, 2021). The authors also stressed the importance of the use of comprehensive strategies and the “dire consequences of inaction” due to the changing dynamic of the opioid crisis that the Linus and colleagues study had not included as a variable. In describing the continuous changes and stages of the opioid crisis, the authors cited “at least 3 overlapping phases: an initial phase with predominant misuse of prescription opioid analgesics, a second phase with increased use of heroin, and a third phase characterized by deliberate and unintentional use of fentanyl and its analogs”(Volkow & Blanco, 2021). While the current HCS study was based data from each included community as of 2018, the COVID-19 pandemic has radically changed the landscape of every community since that time. Some of the resulting changes -both positive and negative-that have created challenges for the researchers include reallocation of both public and private resources in the wake of the pandemic, regulatory changes for MOUD, increased access to telehealth, increased isolation, job losses, and evictions. Although hard data are not available, provisional data from the Centers for Disease Control and Prevention (CDC) as of June 2020 reflect 83,335 overdose deaths during the previous 12-month period with the likelihood of increased rates of overdose since then (Volkow & Blanco, 2021).

Watch the Research Evolve

The journal Drug and Alcohol Dependence has published an entire issue devoted to the HCS study. The goal of the special issue is “to describe the vision, rationale, and scientific approach to the HCS. The collection of papers includes the main study protocol and detailed descriptions of the scientific approaches used for key components of the study, including community engagement, selected evidence-based practices, communications campaign, implementation science framework, data collection, and health economics” (Drug and alcohol dependence, 2021). In the introductory article to the issue, El-Bassel and colleagues invite readers to “learn about the scientific process of the design and implementation of a community-engaged intervention, its methodologies, guiding conceptual models, and research implementation strategies that can be applied to address other health issues” (El-Bassel et al., 2021). The authors cite the overwhelming impact of the coronavirus pandemic as creating unprecedented urgency to discover evidence-based practices that will address the opioid crisis that has undoubtedly been impacted by the pandemic due to high numbers of structural and social determinants related to COVID-19. The special issue contains papers from a variety of diverse disciplines and fields so that the HCS, its design, implementation, and eventual study results can be viewed from an assortment of perspectives, such as addiction treatment, health economics, systems science, policy analysis, behavioral health, and biostatistics.

Watch this space for updates on the HCS study and for additional resources that are sure to follow. For more information and resources on the opioid crisis and issues surrounding it, check out the CASAT OnDemand Resources & Downloads page and the following blog posts from the Catalyst blog:

• International Opioid Overdose Awareness Day August 31, 2019: “Time to Remember, Time to Act”
• Integrated Opioid Treatment and Recovery Centers (IOTRCs) – No Wrong Door
• Advances in the Field and Treatment Implications for Opioid Use Disorders in Sexual and Gender Minority Populations
• Overcoming Barriers to MAT: Bridging the Gap Between Research and Treatment in Nevada
• Medication Assisted Treatment: The Basics in Nevada
• 7 things you should know about Naloxone in Nevada

For professional development for this important issue, check out the following online trainings from CASAT Training:

• Gambling and Opioid Use Disorder: Intersections and Integration – Online Video
• Opioid Management, Medication Assisted Treatment – Online Video
• The Science and Practice of Treating Pregnant Women with Opioid Use Disorder – Online Video

Whether your field is Prevention, Treatment, or Mental Health, many valuable resources are available through SAMHSA’s Technology Transfer Centers (TTC) Program:

Addiction Technology Transfer Centers (ATTC): The ATTCs support national and regional activities focused on preparing tools needed by practitioners to improve the quality of service delivery and to providing intensive technical assistance to provider organizations to improve their processes and practices in the delivery of effective SUD treatment and recovery services.

Mental Health Technology Transfer Centers (MHTTC): The MHTTCs work with organizations and treatment practitioners involved in the delivery of mental health services to strengthen their capacity to deliver effective evidence-based practices to individuals, including the full continuum of services spanning mental illness prevention, treatment, and recovery support.

Prevention Technology Transfer Centers (PTTC): The PTTCs develop and disseminate tools and strategies needed to improve the quality of substance abuse prevention efforts; provide intensive technical assistance and learning resources to prevention professionals in order to improve their understanding of prevention science, how to use epidemiological data to guide prevention planning, and selection and implementation of evidence-based and promising prevention practices; and develop tools and resources to engage the next generation of prevention professionals.

References

Centers for Disease Control and Prevention. Increase in fatal drug overdoses across the United States driven by synthetic opioids before and during the COVID-19 pandemic. CDC Health Alert Network. December 17, 2020. Accessed January 20, 2021. https://emergency.cdc.gov/han/2020/han00438.asp

Drug and alcohol dependence. (n.d.). Retrieved February 17, 2021, from https://www.sciencedirect.com/journal/drug-and-alcohol-dependence/special-issue/10B0L1KKVKK

El-Bassel N, Jackson RD, Samet J, Walsh SL. Introduction to the special issue on the HEALing Communities Study. Drug Alcohol Depend. 2020 Dec 1;217:108327. doi: 10.1016/j.drugalcdep.2020.108327. Epub 2020 Oct 1. PMID: 33091843; PMCID: PMC7528891.

Hedegaard H, Miniño AM,Warner M. Drug Overdose Deaths in the United States, 1999-2018. NCHS Data Brief, No. 356. National Center for Health Statistics; 2020.

Linas BP, Savinkina A, Madushani RWMA, et al. Projected estimates of opioid mortality after community-level interventions. JAMA Netw Open. 2021;4(2):e2037259. doi:10.1001/jamanetworkopen.2020.37259

Redonna K. Chandler, Jennifer Villani, Thomas Clarke, Elinore F. McCance-Katz, Nora D. Volkow, Addressing opioid overdose deaths: The vision for the HEALing communities study, Drug and Alcohol Dependence, Volume 217, 2020, 108329, ISSN 0376-8716, https://doi.org/10.1016/j.drugalcdep.2020.108329.

Volkow ND, Blanco C. Interventions to Address the Opioid Crisis—Modeling Predictions and Consequences of Inaction. JAMA Netw Open. 2021;4(2):e2037385. doi:10.1001/jamanetworkopen.2020.37385

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