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HHS Touts Study Aimed at Slashing Opioid Deaths

WASHINGTON — Health and Human Services Secretary Alex Azar announced a new study that aims to dramatically cut opioid overdose deaths in four states within 3 years.

The HEALing Communities study aims to lower the overdose death rate by 40% within 3 years in select communities in four states: Kentucky, Ohio, New York, and Massachusetts.

The program is part of a broader trans-agency program known as the Helping to End Addiction Long-Term (HEAL) initiative.

Azar spoke Thursday alongside leaders from the NIH and the Substance Abuse and Mental Health Services Administration (SAMHSA), as well as Kentucky Gov. Matt Bevin (R), all of whom stressed the study’s science-based, holistic approach.

“It takes a whole community to beat this crisis. It takes doctors, nurses, cops, courts, teachers, mayors, employers, parents, coaches, young people, faith leaders. It takes everybody,” Azar said.

HEAL awarded grants to academic institutions in the four states, an NIH press release noted, each of which will partner with at least 15 communities to assess “the impact of integrating evidence-based prevention, treatment and recovery interventions across primary care, behavioral health, justice and other settings in highly affected parts of the country.”

“We’ve been doing it in isolation, but we’ve never done something as ambitious as this” with an integrated effort, said Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA).

“The communities themselves are going to be the laboratory that is going to allow us to learn how to address the crisis,” she added.

While there’s strong consensus that medication-assisted treatment (MAT) should be the standard of care, it often doesn’t reach the people most in need of evidence-based therapy.

Speaking at the press briefing, Alex Elswick, 28, founder of Voices of Hope in Lexington, Kentucky, and a person in long-term recovery, said he was initially prescribed painkillers following the removal of his wisdom teeth. He then became addicted to opioids, then heroin.

Elswick spent time in jail and on the streets while cycling through periods of recovery and relapse.

“The entire time that I was addicted I never initiated on medication for opioid use disorder, because none of the health professionals I interacted with ever presented it to me as a legitimate option, despite the fact the research tells me that it’s the gold standard for treating my condition.”

Elswick said he sought help for his addiction.

“[E]very time I left the treatment center, they called it a graduation, and they handed me a pamphlet with a list of ’12 step’ meetings … and every time I relapsed and I devastated my family, because there was never a meaningful linkage to long-term recovery support services.”

Elswick said he’s been to more funerals than weddings due to the epidemic and is heading to another funeral — that of a young man from his college who overdosed — on Friday.

“I’m sorry to say that HEAL came too late for him, but HEAL is just in time for the tens of thousands of lives it’s going to save going forward,” he said.

Elements of the study include increasing distribution of naloxone and connecting those within the criminal justice system to treatment for opioid use disorders, noted the NIH press release.

Asked about stigma as a barrier to treatment and the oft-repeated line that MAT is just “replacing one drug with another,” NIH Director Francis Collins, MD, PhD, called them “destructive.”

“If you’re setting up a treatment for opioid addiction, it has to include medication,” Collins told MedPage Today, citing a March report from the National Academies of Sciences, Engineering, and Medicine. “Without medication the failure rates are dramatically high.”

While psychosocial supports are important in combination with medication, Collins added, “what we really need less of, and I know this is hard for people to hear … are 28-day ‘detox’ programs that send people out, after 28 days, without medication treatment and without a plan. That is often the area of greatest risk for somebody to fall back into the same pattern and end up with an overdose and even a death.”

The HEALing Communities study will cost more than $350 million.

The NIH will oversee the research study in combination with SAMHSA, which already funds many of prevention, treatment, and recovery support services that will be involved in the study, and in partnership with state and local government officials, said Adm. Brett Giroir, MD, HHS’s assistant secretary for health and its top opioid policy advisor.

The four academic institutions partnering in the study include the University of Kentucky in Lexington; Boston Medical Center; Columbia University in New York City; and Ohio State University in Columbus.

RTI International, based in North Carolina, will be responsible for coordinating the study as well as managing “data analysis, health economics research, and widespread dissemination of research findings over the course of the study.”

A SAMHSA spokesperson reminded the press and clinicians that digital tools for identifying treatment centers can be found through SAMHSA’s treatment locator.