Teleconferencing and regulatory adjustments are allowing a major four-state study on opioid-use disorder (OUD) treatments to continue despite the challenges posed by the stubborn SARS-CoV-2 (COVID-19) pandemic and its resulting restrictions on group activities.
The HEALing Communities Study was unveiled in 2019 to test a one-stop strategy for treating patients who are trying to kick a crippling opioid habit by offering a comprehensive and coordinated regime of evidence-based practices (EBP) tailored to the profiles of the enrolled communities. The goal is to see if using a full range of EBP methods, including medications and counseling, can reduce the number of opioid deaths in the overall study area by 40 percent over a three-year period.
The timing of the HEALing Study is propitious thanks to the COVID-19 black swan, which sent the booming U.S. economy off the rails and unceremoniously shut down the offices of physicians and other healthcare providers that many OUD patients had relied on to stay clean. “COVID-19 continues to be an uncertain, ever-evolving reality, and its impacts are particularly being felt among those with addiction and those in recovery from substance use disorders,” Dr. Nora Volkow, director of NIDA, wrote Sept. 14 in her official blog.
The HEALing Study is a $350 million project administered by the National Institutes of Health’s National Institute on Drug Abuse (NIDA) in a partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA). It will center on 67 communities scattered across New York, Ohio, Kentucky and Massachusetts and will be run out of Columbia University, Ohio State University, University of Kentucky, and Boston Medical Center.
The HEALing Study is the largest implementation study ever funded in the field of addiction research, and it covers a lot of ground involving determining the delivery and effectiveness of multiple EBP strategies in unique communities. Lead researchers in each state have their own priorities:
- Kentucky: Highest number of annual opioid deaths in the nation. Increasing access to treatment services and uptake. Expanding distribution of naloxone.
- Ohio: Ranked second in opioid deaths in 2017. Increase engagement with community leaders and state-level officials to improve treatment infrastructure.
- New York: Opioid deaths nearly tripled between 2010 and 2017. Increase naloxone distribution and expand services linking OUD patients in emergency rooms and other “hot spot” communities to treatment services.
- Massachusetts: Ranked among the top 10 states for opioid deaths. Increase access to medication among high-risk individual while in detox, jail, or a hospital.
“The study will track communities as they work to increase the number of individuals receiving medication-based treatment for OUD, increase treatment retention beyond six months, provide recovery support services, expand the distribution of naloxone, a medication to reverse opioid overdose, and reduce high-risk opioid prescribing,” NIDA said in a recent statement.
Around 1.6 million people in the United States were considered to be grappling with OUD in 2019, down from 2.1 million the previous year. However, only 18.1 percent of those were receiving medication treatment last year.
This year, the situation has reversed as job losses, school closures and difficulty accessing in-person treatment appeared to be leading to an increase in drug use.
The Addiction Policy Forum surveyed 1,027 people with OUD nationwide in late April and early May and found that around 20 percent reported that their substance abuse, or abuse by a family member, had increased since the pandemic took hold in March. Volkow wrote that “an analysis of a nationwide sample of 500,000 urine drug test results conducted by Millennium Health also showed steep increases following mid-March for cocaine (up 10 percent), heroin (up 13 percent), methamphetamine (up 20 percent) and non-prescribed fentanyl (up 32 percent).”
Volkow went on to note that timely changes to Medicaid and Medicare along with other government regulations were making it easier for substance-abuse patients to access treatment through teleconferencing and for prescribers to distribute methadone and buprenorphine in larger supplies or without an initial doctor visit.
The adjustments will help the HEALing Study not only generate data that is less influenced by the outlier COVID-19 and also help clinicians manage the real-life patients who are trying to kick their habits by trying multiple EBP ideas on individuals rather than relying on a single strategy. “Implementation research in addiction science has typically focused on designing strategies to implement a single evidence-based prevention or treatment practice into one or more settings,” Volkow and four of her NIDA colleagues said in a paper published in the October issue of “Drug and Alcohol Dependence.” “However, it was clear that isolated interventions would not yield a large-scale, EBP implementation approach capable of substantially reducing opioid overdose deaths in highly impacted communities, nor would they create a model for other large-scale substance abuse implementation studies.”
Volkow said in her blog last month that while hard data on the effect that COVID-19 was having on OUD susceptibility and outcomes, “we need to imagine and implement new ways of facilitating treatment delivery and needed recovery supports under these new circumstances.”