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Notice of Special Interest (NOSI): HEAL Initiative: Opioid Use Disorder Care Pathways for Individuals with Histories of Exposure to Violence

National Institutes of Health

The NIH HEAL initiative aims to speed the development and implementation of scientific solutions to the national opioid public health crisis by bolstering research across NIH to (1) improve treatment for opioid misuse and addiction and (2) enhance pain management. More information and periodic updates about the HEAL Initiative are available at: https ://heal.nih.gov/ .

Prior research demonstrates a substantial association between exposure to violence and opioid use. The majority of people diagnosed with substance use disorders have been exposed to violence; and among those with injection drug use, over a quarter have experienced a new episode of violence in the past month. Victimization can be linked to opioid use through a variety of pathways. It can result in physical pain and mental distress leading to substance use initiation and escalation. Victimization can also occur as a consequence of drug seeking behavior. Social and structural determinants of health, such as housing insecurity and justice-system involvement, also increase individual risk for opioid use and exposure to violence.

Despite the strength of the association between exposure to violence and substance misuse and disorders, research about the extent to which and the ways in which victimization history affects initiation of opioid misuse, escalation to opioid use disorder (OUD), engagement in OUD prevention or treatment services, retention in services, and OUD recovery is limited. Victimization experiences may result in PTSD, characterized by intrusive memories, avoidance behaviors, negative cognitions and mood, and changes in physical and emotional reactions. Over a third of people diagnosed with OUD are estimated to have symptomss consistent with post-traumatic stress disorder (PTSD). Although a PTSD diagnosis does not seem to predict poorer treatment retention on medications for opioid use disorder (MOUDs), concurrent treatment of PTSD and OUD has been shown to dramatically improve retention on MOUDs. Likewise, research with patients in OUD treatment has shown that exposure to traumatic events and a worsening of PTSD symptoms during the course of OUD treatment are associated with increased risk of treatment interruption.

The proposed initiative seeks to test innovative models of service delivery to improve substance use and mental health outcomes for individuals who have actionable needs following exposure to violence. Specifically, this initiative would support awards to test care pathways that either: 1) provide opioid misuse and OUD screening, prevention and treatment referral or services to victims of violence in victim service settings; or 2) provide PTSD screening and treatment or intimate partner violence (IPV) screening and services for individuals receiving treatment or prevention services for opioid misuse or OUD. Studies must include OUD relevant outcomes, but may propose interventions to treat or prevent stimulant use disorder in combination with OUD. Intervention studies supported through this initiative can be targeted at the individual, provider, and/or organizational level. Interventions can be proposed for adolescent, emerging adult and/or adult populations. Hybrid implementation-effectiveness trials are preferred and should be proposed as appropriate to the intervention and research questions posed. Validated screening measures for exposure to violence , substance use and PTSD from the PhenX Toolkit should be used when appropriate to the study design.

This notice applies to due dates on or after October 12, 2022 and subsequent receipt dates through July 13, 2025.

NOT-DA-23-007