>>WELCOME.
THIS IS A FIRST IN A SERIES OF
MDWG OR HEAL MULTI-DISCIPLINARY
MEETING DISCUSSIONS THIS MONTH.
TODAY WE'RE GOING TO FOCUS ON
HEAL PROGRAMS THAT WERE LAUNCHED
IN 2018 AND 2019 WHEN WE ALL
FIRST MET AND LEARNED ABOUT THE
PROGRESS THEY'VE MADE IN THEIR
PLANS FOR GOING FORWARD.
NEXT WEEK WE'LL TALK ABOUT NEW
PROPOSED RESEARCH, AS WE HAVE IN
THE PAST.
CONSIDERING HOW THIS RESEARCH
ALLIANCE WITH THE PUBLIC-HEALTH
AND RESEARCH GOALS OF THE
HELPING TO END ADDICTION
LONG-TERM INITIATIVE AND GAIN
YOUR INPUT AND I AM SIGHT ON
IN SIGHT ON THOS
PROPOSED PROJECTS.
THANK YOU FOR JOINING US.
THANK YOU TO THE HEAL TEAM AND
THE SCIENTISTS WE'RE GOING TO
HEAR FROM IN THE NEXT COUPLE
MEETINGS.
WE'VE WORKED REALLY HARD TO PUT
TOGETHER THIS SET OF
PRESENTATIONS FOR YOU, AND WE
HOPE IT CAN BE REALLY
DISCUSSIONAL SO, WE'RE GOING TO
RESERVE SOME TIME.
ASK YOU TO WEIGH IF WITH YOUR
THOUGHTS AND INPUT.
PLEASE DON'T HESITATE TO DO THIS
OR PUT A NOTE INTO THE CHAT WE
CAN GO BACK TO, IF YOU DON'T
WANT TO JUST JUMP IN AT THAT
MOMENT.
WE APPRECIATE THE TIME THAT YOU
GIVE TO US AND THE EFFORT YOU
MAKE IN REVIEWING ALL THESE
MATERIALS AND ALSO, FOR YOUR
INSIGHTS AND EXPERTISE AS WE
ADDRESS THIS URGENT
PUBLIC-HEALTH CRISIS, AS YOU
KNOW, SINCE WE LAST MET, THE
CRISIS OF PAIN, THE MISUSE,
ADDICTION AND OVERDOSE HAS NOT
IMPROVED IN FACT THE DATA SHOW
IT'S IN FACT WORSENING.
WE'RE GOING TO HEAR A LITTLE BIT
MORE THIS MORNING ABOUT THE
SPECIFICS OF THAT EVOLUTION
ALTHOUGH WHAT WE'RE SEEING IS
THAT SINCE 2020, THE MOST RECENT
DATA IN 2021 SHOWS SIGNIFICANT
INCREASE AND THAT THIS INCREASE
IN OVERDOSE DEATH IS REALLY
DRIVEN BY FENTANYL, THE DEADLY
SYNTHETIC OPIOID THAT IS
EVERYWHERE AND
DISPROPORTIONATELY EFFECTING
CERTAIN COMMUNITIES INCLUDING
PEOPLE OF COLOR AND YOUNG PEOPLE
EVEN AS YOUNG AS MIDDLE SCHOOL.
AND AT THE SAME TIME, WE'RE
SEEING NEW THREATS, NEW
SUBSTANCES LIKE SIGH LOW SEEN
LAYING ON EXISTING PROBLEMS THAT
ARE DIFFICULT TO SOLVE WITH OUR
CURRENT RESEARCH TOOLS.
THE IMPORTANCE OF LOOKING AT THE
TOOLS WE HAVE FOR TREATMENTS, AS
WELL AS OUR TOOLS WE HAVE
THROUGH OUR COLLABORATIONS WITH
OUR SISTER AGENCIES WILL BE
REALLY IMPORTANT TO CONSIDER HOW
WE CAN WORK TOGETHER, IDENTIFY
GAP AREAS, AND INTERVENTIONS FOR
THESE CHALLENGES AND REALLY
TROUBLING DEVELOPMENTS IN THE
OVERDOSE CRISIS.
AND AT THE SAME TIME, WE
CONTINUE TO STRUGGLE WITH THE
NEEDS OF INDIVIDUALS WITH
UNTREATED PHYSICAL AND EMOTIONAL
PAIN.
WE'VE BEEN DEALING WITH THESE
FOR A LONG TIME BUT THE OPIOID
CRISIS HAS NOT MADE THEM GO AWAY
AND IN FACT OUR COUNTRY IS
FACING AN UNPRECEDENTED MENTAL
HEALTH CRISIS AND PEOPLE OF ALL
AGES, BLACK AND BROWN
COMMUNITIES DIS PURCHASE OR THED
UNDER TREATED.
THE UNIQUE COMBINATION OF
LONELINESS, SOCIALIZATION AND
BRIEF BROUGHT UPON BY THE
PANDEMIC IS CALLING US TO
DEVELOP NEW SCIENTIFIC SOLUTIONS
TO ADDRESS ALL OF THE ELEMENTS
OF THE NEEDS OF OUR POPULATIONS
WE SERVE.
AND SO THIS, I BRING UP, IN PART
BECAUSE THERE'S A REAL
LEGISLATIVE AND ADMINISTRATIVE
CONTEXT FOR THE HELPING TO END
ADDICTION LONG-TERM OR HEAL
RESEARCH THAT WE'RE GOING TO
TALK ABOUT.
FORTUNATELY, WE HAVE A LOT OF
COMMITTED PEOPLE THAT ARE
WORKING ON THIS PROBABLE WITH
INCLUDING OUR LEADERSHIP IN THE
JOE BIDEN ADMINISTRATION WHO
HAVE BEEN VOCAL ABOUT ADDRESSING
THE DRIVERS AND CONSEQUENCES OF
THE OPIOID CRISIS, INCLUDING
SUBSTANCE ABUSE, YOUTH MEMBER
HEMENTALHEALTH AND SUICIDE.
IN 2022, AT THE VERY, VERY END
OF THE YEAR, CONGRESS PASSED TWO
MAJOR PIECES OF LEGISLATION THAT
ARE IMPORTANT FOR EVERYONE TO
KNOW ABOUT AND I ALSO KNOW THAT
WE WILL EXPANDS ON THESE AND
TALK ABOUT THEM IN MORE DETAIL.
THOSE PROVIDE HISTORIC FUNDING
FOR MENTAL AND BEHAVIORAL HEALTH
PROGRAMS, INCLUDING PUTTING
DOLLARS INTO THE IMPORTANT
BEHAVIORAL WORKFORCE THAT OUR
COLLEAGUES AND PARTNERS CARRYING
FOR PEOPLE WITH PAIN SUBSTANCE
USE DISORDER AND ALSO
LEGISLATIVE ACTION THAT'S WILL
STRENGTHEN THE CONTEXT IN WHICH
HEAL IMPLEMENTATION RESEARCH IS
CONDUCTED.
WE'LL SPEED THE PROCESS OF
PUTTING RESULTS INTO PRACTICE
AND COMMUNITIES ACROSS THE
COUNTRY.
SO, AS YOU KNOW, WE'RE WORKING
REALLY DILIGENTLY TO WITH OUR
PARTNERS ACROSS GOVERNMENT TO
PUT INTO PLACE SOME OF THE
ELEMENTS OF THE MOST RECENT
OMNIBUS AND THAT INCLUDES
MAINSTREAMING ADDICTION
TREATMENT ACT AND THE MEDICATION
ACCESS AND TRAINING EXPANSION
ACT AND I REFERRED TO THESE
BEFORE THESE ARE BOTH TARGETED
TOWARDS INCREASING ACCESS TO
TREATMENT FOR SUBSTANCE USE
DISORDER AND AIM TO MAKE IT IT
EASIER FOR PHARMACY TO STOCK AND
DISPENSE MEDICATION AND FOR
PROVIDERS TO PRESCRIBE
MEDICATIONS FOR THE TREATMENT OF
OPIOID USE DISORDER AND THEN IN
ADDITION TO THOSE LEGISLATIVE
EFFORTS THERE ARE EFFORTS TO
MODERNIZE HOW WE DISTRIBUTE
NALOXONE AND OVER THE COUNTER IF
EVIDENCE SHOWS ITS SAFE AND
EFFECTIVE.
SURELY, ALL OF THESE EFFORTS
ACROSS GOVERNMENT ARE REALLY
TIGHTLY CONNECTED AND WE'RE
GOING TO TAKE THIS INTO
CONSIDERATION TODAY WHEN WE TALK
ABOUT SOME OF THE RESEARCH
PROJECTS THAT ARE ON GOING THAT
WE LAUNCHED AT THE BEGINNING OF
HEAL AND HOW THE INSIGHTS COMING
FROM THOSE COULD BE PUT INTO
PRACTICE NOW IN THIS NEW KIND OF
LEGISLATIVE AND PRACTICE
FRAMEWORK.
SO, I THINK WHAT WE'LL DO NOW,
IS TO KIND OF SWITCH -- SO NOW
I'LL END BEING DR. TABAK.
THANKING YOU AGAIN FOR JOINING
US TODAY.
FOR YOUR CONTRIBUTIONS TO HEAL.
FOR YOUR THOUGHTS ON THE CURRENT
AND FUTURE OF PLANNED HEAL
RESEARCH EFFORTS.
OUR MISSION ENABLES US TO
ADVANCE SCIENTIFIC SOLUTION
ACROSS DISCIPLINES AND SECTORS
AND SO I THANK YOU FOR ALL THE
CONTRIBUTIONS THAT YOU ARE GOING
TO MAKE OVER THE NEXT COUPLE OF
DAYS AND THANK YOU FOR YOUR
TIME, TALENT AND DEDICATION.
WE RELY ON YOU TO ENSURE WE'RE
ON THE BEST PATH FORWARD FOR THE
HEAL MISSION OF ENDING ADDICTION
LONG-TERM SO I'M GOING TO STOP
THERE AND THEN WE CAN SWITCH
GEARS TO KIND OF A MORE
PROGRAMMATIC UPDATE ON HEAL
RESEARCH AND I THINK WE HAVE
SLIDES FOR THAT.
>>THANK YOU.
>>SO, NEXT SLIDE, PLEASE.
SO, AS YOU ALL KNOW WHILE HEAL
LAUNCHED IN 2018 AND 2019 AND
HAVE SPENT WOULD AND A HALF
BILLION DOLLARS ON RESEARCH,
CONTRACTS, GRANTS AND
CO-OPERATIVE AGREEMENTS OVER
1,000 DIFFERENT PROJECTS AND
OVER 40 DIFFERENT PROGRAMS IN
ALL 50 STATES ARE NOW UNDER WAY
SEEKING TO BRING TOGETHER THE
POWER OF SCIENCE AND COMMUNITY
AND HERE ON THE LEFT, I HAVE A
FEW EXAMPLES OF HOW WE ARE
TAKING OR SEEKING INTO
CONSIDERATION COMMENTS AND INPUT
YOU'VE GIVEN US IN THE PAST TO
DRIVE HEAL RESEARCH FORWARD.
IN THE PAST YEAR, WE'VE LAUNCHED
THE HEAL CONNECTIONS PROGRAM
WHICH PARTNERS A DIVERSE SET OF
COMMUNITIES, STAKEHOLDERS,
TOGETHER WITH EXPERTS IN PAIN
AND OPIOID USE DISORDER SO THAT
AS RESULTS FROM THESE OVER A
THOUSAND PROJECTS COME FORWARD,
WE CAN BE AS PREPARED AS
POSSIBLE TO SHARE THESE RESULT
AND BROADEN THE IMPACT OF HEAL
FINDINGS.
WE HAVE KIND OF DIVERSIFIED OUR
OVER ALL REAL RESEARCH PORTFOLIO
AIMED AT ADAPTING TO THE CRISIS
AS EVOLVES SO THERE'S BEEN A LOT
OF CHANGES IN POPULATION AND
SUBSTANCES THAT ARE DRIVING THE
OVERDOSE CRISIS AS WELL AS
INCREASING APPRECIATION OF THE
ROLE OF HEALTH EQUITY AND CO
OCCURRING CONDITIONS AND
PATTERNS OF DRUG USE.
YOU ARE HEAL OVER THE NEXT TWO
WEEKS, MORE INFORMATION ABOUT
HOW OUR RESEARCH IS ADAPTING TO
THESE CHANGES.
WE ALSO HAVE LAUNCHED RESEARCH
TO -- WE LIKE A DATA-DRIVEN
APPROACH TO RESPONDING TO THE
CRISIS.
WORKING WITH PARTNERS WHO GATHER
REAL-TIME DATA AND INFORMING
TARGETED TREATMENTS AND THEN
LASTLY, ENSURING OUR RESULTS ARE
IMPACTFUL.
MEANING THAT WE ARE PARTNERING
INCLUDING WITH THOSE IN THE
JUSTICE SYSTEM WITH FOLKS IN
COMMUNITIES AND HEALTHCARE
SETTINGS TO BRING FORWARD OUR
RESEARCH FINDING AND IN THE NEXT
SLIDE, I THINK THIS ARE A FEW
EXAMPLES THAT I ALLUDED TO
ALREADY.
AS PATTERNS OF DRUG USE ARE
SHIFTING, WE CONSIDER WAYS OUR
EXISTING RESEARCH CAN BE USED TO
UNDERSTAND AND ADDRESS NEW
THREATS SUCH AS XYLAZINE AND
TARGETING TREATMENT AND SERVICES
AND STIMULANTS HAVE FENTANYL AND
ADDRESS THE NEEDS WITH THOSE AT
RISK OF OVERDOSING AS WELL AS
PULLING IN THE DATA NEEDS TO
COMMUNITIES HAVE DASHBOARDS AND
INFORMATION AT THEIR FINGER TIPS
TO SEE WHAT I'M ARE USING AND
HOW THEY RESPOND.
HOW MENTAL HEALTH AND MENTAL
ILLNESS ARE ACCESSING TREATMENT
AND SERVICES HOW THEY HAD ACCESS
HIGH-QUALITY PAY MANAGEMENT ARE
COR DCOORDINATE.
AND PRO FIGHTING HEALTH AND WE
ARE ADDRESSING THROUGH RESEARCH
ON SOCIAL DETERMINANTS OF
HEALTH.
A FEW AREAS OF RESEARCH -- I
THINK THAT YOU WILL HEAR MORE
ABOUT THIS NEXT WEEK, BUT THIS
IS JUST A SHORT PREVIEW ON THE
PAIN MANAGEMENT SIDE,
UNDERSTANDING VARIATIONS IN
INDIVIDUALS AND HOW THEY
EXPERIENCE PAIN EX WHAT PAIN ANT
CONTRIBUTES TO THEIR PAIN.
PAIN IS COMMON IN PEDIATRIC
POPULATION AND WE DON'T HAVE A
TON OF RESEARCH WITHIN HEAL TO
ADJUST THIS.
ALSO CONSIDERING THE END POINTS
WE MEASURE PAIN AND HOW WE CAN
IMPROVE ON THAT THROUGH OUR
COLLECTIVE RESEARCH.
ON THE OPIOID USE DISORDER
FRONT, WE HAVE RESEARCH IN NEW
FINDINGS AND NEW POPULATIONS FOR
DISTRIBUTING BOTH TREATMENT AND
HARM REDUCTION STRATEGIES.
COMBINATIONS OF MEDICATIONS FOR
THE TREATMENT OF OPIOID USE
DISORDER AND A FOCUS ON SPECIFIC
POPULATIONS INCLUDING POSTPARTUM
WOMEN WHO REPRESENT
OPPORTUNITIES TO INTERVENE.
AND THEN WE ALSO HAVE SOME MORE
DATA-FOCUSED RESEARCH AS OUR
ECOSYSTEM IS BUILT OUT.
WE CAN BRING IN MORE RESEARCH ON
CLINICAL OUTCOMES AND DATA
REANALYSIS TO INFORM FUTURE
RESEARCH AND TREATMENT
STRATEGIES.
SO, NEXT SLIDE, PLEASE.
OVER THE NEXT COUPLE
PRESENTATIONS, YOU ARE GOING TO
HEAR FROM A LOT OF THE FOLKS AND
THE VICTIMS WHOSE NAMES ARE
LISTED ON THIS SLIDE.
I'LL JUST REMIND YOU THAT HEAL
HAS TWO OVERARCHING AND
INTERCONNECTED GOALS IN
ENHANCING PAIN MANAGEMENT AND
IMPROVING TREATMENTS FOR OPIOID
MISUSE AND PREVENTING TREATMENT
STRATEGIES FOR A BIG USE IN
ADDICTION.
THE CO-CHAIRS OF THE TEAMS
REPRESENTING THE SIX AREAS OF
RESEARCH FOCUS THAT YOU SEE
SHOWN ON THIS SLIDE, ARE GOING
TO SHARE WITH YOU THE PROGRESS,
MADE ALREADY IN THEIR DIFFERENT
RESEARCH PROGRAMS THAT HAVE BEEN
LAUNCHED AND SCIENTISTS HAVE
BEEN HARD AT WORK TO BRING ABOUT
THESE SCIENTIFIC SOLUTIONS AND
NEXT WEEK THEY WILL TELL YOU
WHAT THEY THINK CAN VAST ADDANCE
OUR GOALS, BASED ON WHAT WE'RE
ALREADY DOING, SOME OF THE GAPS
AND OPPORTUNITIES THAT THEY SEE
FOR FUTURE RESEARCH.
SO, THIS IS KIND OF OUR MAP OF
THE DIFFERENT GROUPS AND
INDIVIDUALS THAT WE'RE GOING TO
HEAR FROM.
AND THEN I'LL REMIND YOU THAT
SPECIFICALLY FOR TODAY, WE HAVE
A SERIES OF PRESENTATIONS FROM
PROGRPROGRAMS LAUNCHED AT THE
BEGINNING IN HEAL.
WHEN WE ALL FIRST MET IN 2019,
THESE PROGRAMS WERE LAUNCHED
BASED ON A SET OF CUTTING-EDGE
MEETINGS AND WHERE WE BROUGHT
TOGETHER STAKEHOLDERS FROM
DIFFERENT SECTORS AND
DISCIPLINES TRYING TO UNDERSTAND
WHAT NIH AND THE BIOMEDICAL
RESEARCH COMMUNITY COULD DO WITH
OUR COLLECTED EQUITIES TO
ADDRESS THIS VERY INTER
DISCIPLINARY CROSS-CUTTING AND
LARGE IN MAGNITUDE CRISIS OF
PAIN AND ADDICTION.
THAT BECAME ALL OF THE RESEARCH
YOU HEARD ABOUT OVER THE PAST
SEVERAL YEARS AND NEXT SLIDE,
PLEASE.
AND WHAT WE SAW TO DO IN THIS
WAS REALLY MAP HOW PROGRAMS WERE
LAUNCHED IN 2019.
IN SOME CASES RIGHT BEFORE THE
END OF 2018 BUT FOR THE MOST
PART 2019 AND THEN AS TIME
PROGRESSED WE ADDED ADDITIONAL
PROGRAMS AND SO ALL THE WAY ON
THE LEFT, THESE ARE KIND OF OUR
INAUGURAL HEAL RESEARCH EFFORTS
AND WHAT I SHOWS HERE WITH THESE
LITTLE RED SLIDES ARE AREAS
WHERE WE'RE COMING TO YOU FOR
PROGRAMS THAT WERE LAUNCHED AT
THE BEGINNING OF HEAL SHARING
WITH YOU UPDATES ON THE PROGRESS
THESE PROGRAMS HAVE MADE AND
ALSO ASKING FOR YOUR INPUT IN
GUIDANCE ON THE BEST WAY TO
CONTINUE THE GOALS OF THESE
PROGRAMS AND MAKE SURE THAT AS
FINDINGS EX FORWARD AND AS WE
LEARN, WE'RE BEST DECIDING WHAT
SHOULD HAPPEN AND THE PROGRAM
SHOULD BE CONTINUED, SHOULD IT
BE SCALED DOWN, RECOGNIZING IT'S
ACHIEVED A LOT OF ITS GOALS.
SHOULD IT BE STRATEGICALLY SPUN
INTO SOMETHING ELSE BASED ON
EMERGING NEEDS SO YOU WILL HEAR
FROM THE EXPERTS WHO ARE LEADING
THESE PROGRAMS AND THE CO-CHAIRS
OF THE SCIENTIFIC TEAMS WHO
OVERSEE THEM AND FOR THE
SCIENTIFIC TEAM, THE NEW
STRATEGIES TO PREVENT AND TREAT
OPIOID ADDICTION.
WE'LL HEAR ABOUT RESEARCH
FOCUSED ON PREVENTING OPIOID USE
DISORDER AS WE RESEARCH THROUGH
THE CHILD NETWORK FOCUSING ON
OPIOID USING HEAL FUNDING.
IN THE RESEARCH FOCUS AREA OF
TRANSLATION TO FOCUS PRACTICE
FOR THE TREATMENT OF ADDICTION
WE'LL HAVE PRESENTATIONS FROM
THE LEADS OF THE JUSTICE
COMMUNITY OPIOID NETWORK AND THE
HEALING COMMUNITIES STUDY AND
THEN SOME RELATED RESEARCH ALSO
GOING THROUGH THE NIDA CLINICAL
TRIALS NETWORK.
SWITCHING GEARS TO THE RESEARCH
THAT'S FOCUSED ON PAIN AND
PRECLINICAL SETTINGS AND WAYS TO
TRANSLATE THAT RESEARCH INTO
TREATMENTS FOR PEOPLE WITH
DIFFERENT PAIN CONDITIONS, WE'LL
HEAR ABOUT RESEARCH UNDERWAY
THROUGH THE PRECLINICAL
SCREENING PLATFORM FOR PAIN AS
WELL AS RESEARCH THAT HEAL HAS
SUPPORTED THROUGH NCATS THAT
FOCUSED ON TRANSLATING SOME OF
THE INSIGHTS FROM OUR DIFFERENT
COLLABORATORS AND EXTRAMURAL
COMMUNITY FROM THE COMMUNITY OF
PAIN.
NEXT SLIDE, PLEASE.
THIS IS A LITTLE BIT CUT OFF ON
MY SCREEN.
THIS IS JUST THE OVER ALL BUDGET
OUTLOOK FOR THE HEAL INITIATIVE
AND AT BEGINNING BECAUSE SUCH AN
IMPORTANT FOCUS ON TREATING
OPIOID USE DISORDER AND
PREVENTING OVER ALL DOSES THE
BALANCE OF INVESTMENTS WAS MORE
FOCUSED ON THE OPIOID USE
DISORDER AND OVERDOSE SIDE BUT
WITH TIME WE'VE BEEN INCREASING
THE RESEARCH IN OUR PAIN
PORTFOLIO SHOWN IN BLUE AND
ORANGE WITH THE CROSS CUTTING
RESEARCH ALSO BEING IMPORTED AND
NOT ALL IT RESEARCH FALLS NEATLY
INTO ONE SIDE OR THE OTHER.
THIS IS KIND OF QUITE A REDUCK
DIFFERENT EXERCISE TO PUT IT IT
INTO ONE CATEGORY OR THE OTHER
BUT WE WANT YOU TO SEE THERE'S
BEEN AN INCREASE IN THE
INVESTMENTS AND YOU WILL HEAR
MORE NEXT WEEK ABOUT WHAT THE
SCIENTIFIC TEAM FOCUSED ON PAIN
HAS IDENTIFIED AS PRIORITIES
GOING FORWARDS.
SO, NEXT SLIDE, PLEASE.
THIS IS A REMINDER OF THE
PROGRAMS THAT WILL BE DISCUSSED
TODAY.
WE'RE REALLY LOOKING FOR YOU TO
THINK EXPANSIVELY AND HELP US
RECOGNIZING THAT THERE HASN'T
BEEN ENOUGH TIME FOR THESE
PROGRAMS TO ACTUALLY COMPLETE
THEIR RESEARCH AND TO SHARE ALL
OF THEIR FINDINGS AND YET THEY
HAVE MADE PROGRESS AND THEY'LL
COME AROUND THE PROGRESS THEY'VE
MADE AND ABOUT WHERE THEY
PROPOSE TO GO MOVING FORWARD SO
WE'RE ASKING YOU TO THINK ABOUT
THE PUBLIC NEEDS THESE RESEARCH
PROGRAMS ARE ADDRESSING AND THE
DEGREE TO WHICH THEY'VE BEEN
SUCCESSFUL AND THE GOALS THAT
THEY'VE SET OUT FOR THEMSELVES
FROM A SCIENTIFIC PERSPECTIVE
AND THE PUBLIC-HEALTH
PERSPECTIVE AND THEN LOOKING
OVER ALL ACROSS ALL OF THE
DIFFERENT THINGS THAT HEAL IS
TRYING DO BECAUSE WE HAVE SUCH A
LARGE CRISIS AND SUCH A LARGE
POPULATION IMPACT IN FRONT OF US
AND SUCH A BREADTH OF RESEARCH
TO ADDRESS IT, HOW CAN WE BEST
PROGRAM THAT RESEARCH
INVESTMENTS FOR THE NEEDS AND
OPPORTUNITIES SO THANK YOU FOR
THINKING ABOUT THIS WITH US AND
NOW I WILL PAUSE FOR QUESTIONS
OR COMMENTS BEFORE WE MOVE
FORWARD.
>>CAN I CAN APP OUT OF THE --
IT'S NOT RELATED BUT YOU
MENTIONED IT IN THE INTRODUCTION
AND I THOUGHT I WOULD THROW IT
OUT.
IT'S BEEN BOTHERING ME A LOT
RECENTLY.
WHEN I READ ABOUT THE XYLAZINE.
IT'S A ALPHA 2A AGO GA NIST AND
THERE'S ANTAGONIST TO THAT
RECEPTORS.
JUST AS PEOPLE WALK AROUND WITH
NARCAN, IS THERE ANY EXPLAIN WHY
IT CAN'T BE ADDRESSED.
IT IT DOESN'T MAKE ANY SENSE TO
ME?
>>NORAH, WOULD YOU LIKE TO
RESPOND TO ALAN'S QUESTION.
IT'S NOT AN EASY ONE.
>>NO, NO, NO.
ACTUALLY THERE'S NOT MUCH
RESEARCH ON THIS WHOLE FIELD.
WITH RESPECT TO XYLAZINE BUT
THINK ABOUT THE FOLLOWING THING,
ALAN, WHEN SOMEONE GOES ON
OPIOID WITHDRAWAL INCLUDING ALSO
NALOXONE PARTICIPATED WITHDRAWAL
WHICH IS MUCH WORSE.
YOU GIVE AN ALPHA SILO SEEN
COMPOUND SO HERE YOU ARE
OBSERVING PEOPLE OVERDOSING.
98% OF XYLAZINE DEATHS HAVE
ANOTHER DRUG AND THAT OTHER DRUG
IS FREQUENTLY FENTANYL.
SO, WHAT YOU ARE GOING TO BE
DOING BY ANTAGONIZING THAT
RESPONSE COULD BE EXACERBATED.
IT'S NOT BLACK AND WHITE, ALAN.
I THINK TO ME IT HAS BEEN A VERY
CHALLENGED PHARMACOLOGICALLY
BECAUSE THE PRINCIPLE NET
REDDICKLY, RIGHT, YOU WOULD
EXPECT THE XYLAZINE WILL HAVE
THE WITHDRAWAL AND IT'S NOT THE
REASON WHY PEOPLE SAY THEY
COMBINED XYLAZINE WITH OPIOIDS.
THEY COMBINE THEM, THEY STAY
BECAUSE IF THE INCREASES THE
DURATION THE EFFECTS OF THE
DRUG, WHICH AGAIN, IS NOT
PHARMACOLOGICALLY STUDIED
SPECIFICALLY, BUT WE COULD
HYPOTHESIZE IT MAY REFLECT THIS
TYPE OF AGENTS THAT THEN
ACTUALLY KEEPS THAT DRUG IN
PLACE, IT IT DOES NOT CLEAR IT.
BUT THIS IS AN AREA THAT
REQUIRES RESEARCH FOR US TO
UNDERSTAND, WHY IS IT THAT
PEOPLE ARE COMBINING THAT?
WHAT ARE THE MECHANISMS AND
IMPORTANTLY TO YOUR QUESTIONS,
HOW TO OPTIMALLY TREAT IT
BECAUSE IT'S NOT DONE
NECESSARILY STRAIGHT FORWARD.
>>THANK YOU.
>>ALAN, THE OTHER THING IS, I
HAVE TO CHECK IN THIS, BUT ONE
OF THE PROBLEMS IS NA CRISIS OF
THE SKIN AND EXTREMITIES DUE TO
THE FACT YOU ARE INJECTING
LOCALLY GETTING A BIG HIGH DOSE
RIGHT WHERE YOU INJECT.
I'M NOT SURE -- BUT I HAVE TO
LOOK INTO IT MORE TO KNOW THE
SYSTEMIC BLOCKADE WOULD BE
HELPFUL OR NOT.
>>IT SAYS SYSTEMIC EFFECTS
BECAUSE YOU OBSERVE I AND MAY
REFLECT VAAS OWE CONSTRICTION
BUT AGAIN IF IT'S NOT -- THERE
MAY BE -- I MEAN I'M TRYING TO
LOOK AT PHARMACOLOGY TO SEE
MOLECULAR TARGETS APART FROM THE
ALPHA AND IT'S NOT STRAIGHT
FORWARD AND I CANNOT FIND
ANYTHING THAT I CAN PUT MY HANDS
ON THAT WOULD CLARIFY IT
FURTHER.
>>I HAVE A FEW HANDS RAISED.
NED, IF YOUR QUESTION OR COMMEN-
>>JUST THAT ANECDOTALLY I'VE
HEARD THAT THE DEALERS ARE
PUTTING XYLAZINE WITH THE
FENTANYL BECAUSE IT DOESN'T
SUPPRESS RESPIRATION SO THEY'RE
LESS LIKELY TO KILL THEIR
CLIENTS AND IT'S INTERESTING TO
THINK ABOUT A AN AN TAG AN ANTA.
>>YOU GET SEVERE WITHDRAWALS.
>>YEAH, YEAH.
>>AND HYPERTENSION AND WHO
KNOWS WHAT ELSE.
I AGREE IT'S APP AREA TO STUDY.
THANK YOU.
CHRIS, YOU HAVE YOUR HAND
RAISED.
>>YEAH, I HAVE A DIFFERENT
TOPIC SO I DON'T KNOW IF -- WELL
RELATED BUT NOT SPECIFIC TO WHAT
WE'RE DISCUSSING SO IF OTHERS
HAVE QUESTIONS OR COMMENTS I'M
HAPPY FOR THEM TO GO BEFORE ME.
>>WE'RE GOING TO TALK A LITTLE
BIT MORE ABOUT SIGH LOW SEEN --
>>CONGRESS ASKED HEAL TO START
ADDRESS STIMULANT ABUSE AS WELL
AND IF SO, WHAT LED PERFORMING R
AMOUNT OF BUDGET IS BEING
DEDICATE TODAY THAT.
MY QUESTION RELATE TODAY WHAT
WE'RE TALKING ABOUT NOW IS -- IS
XYLAZINE PART OF THE PORTFOLIO
OR ADDRESSED BY NIDA OR
ADDRESSED UNDER THE HEADING OF
MULTI SUBSTANCE USE, I GUESS,
I'M A LITTLE BIT CONFUSED IN
TERMS OF WHAT THE ACTUAL PURVIEW
OF HEAL IS IS, IF IT'S EXPANDING
AND THEN HOW THE BUDGET IS BEING
DIFFERENTIATED VERSUS WHAT IS
BEING FUNDED DIRECTLY OUT OF
NIDA'S BUDGET.
NON-HEAL RELATED, IF THAT MAKES
SENSE.
>>I CAN START TO TALK ABOUT
HEAL AND NORAH, WEIGH IN IF YOU
WOULD LIKE TO ADD ABOUT THE
RESEARCH THAT'S UNDERWAY AND
PLANNED OUTSIDE OF THE HEAL
INITIATIVES.
SO, WHEN WE LAUNCHED IN 2018,
THE MISSION WAS TO FOCUS ON
PAIN, THE MISUSE ADDICTION AND
OVERDOSE.
AND WE LAUNCHED A SET OF
RESEARCH TO ADDRESS THIS REALLY
FOCUSING ON A FEW CORE AREAS.
SO HOW DO WE ACCELERATE THE
DEVELOPMENT OF NEW PAIN
TREATMENTS, HOW DO WE GIVE
CLINICIANS THE INFORMATION THEY
NEED TO FAST TREAT PAIN AND
REDUCE ALLIANCE ON OPIOID WHEN
THEY MAY NOT BE EFFECTIVE AND
THEY MAY HAVE RISKS INCLUDING
THE RISK OF ADDICTION.
A BIG FOCUS ON NOVEL MEDICATIONS
FOR THE TREATMENT OF OPIOID DIS
DISORDERS, PREVENTION AND
REVERSAL OF OVERDOSE INCLUDING
DIFFERENT ASPECTS OF THE
ADDICTION PROCESS, CRAVING
WITHDRAWAL AND THEN AS YOU HEARD
A LOT ABOUT, QUITE A FEW
CLINICAL RESEARCH STUDIES AND
TRANSLATIONS RESEARCH TO
PRACTICE IMPLEMENTATION-STYLE
STUDIES THAT SEEK TO TAKE THE
REALLY LIFE SAVING MEDICATIONS
AND INTERVENTIONS FOR OPIOID USE
DISORDERS AND FOR OPIOID
OVERDOSE AND TO GET THEM INTO
THE COMMUNITY HEALTHCARE JUSTICE
AND OTHER SETTINGS WHERE PEOPLE
WERE COMING AND SEEKING HELP EX
AT RISK FOR OVERDOSE AND
OVERDOSE DEATH.
SO THAT WAS THE STARTING POINT
FOR OUR COLLECTIVE RESEARCH
INVESTMENTS.
AS CONGRESS IDENTIFIED THE
CHALLENGES RELATED TO STIMULANTS
WITH A SPECIFIC INTEREST IN HOW
SUBSTANCE USE AND THE WAS MAKING
OUR RESPONSE TRAGEDY MORE
COMPLICATED.
WE EXPANDED THE SUBSTANCE USE
DISORDER SIDE OF THE HEAL
RESEARCH INITIATIVE TO INCLUDE
MEDICATION DEVELOPMENT EFFORTS
FOCUSED ON STIMULANT USE
DISORDERS AS WELL AS QUITE A
SIGNIFICANT SET OF NEW PROGRAMS
FOR THIS PALLIA SIV SUBSTANCE
USE INTERVENE NORTH PRIMARY CARE
SETTINGS FROM A PREVENTION
APPROACH AND A SYSTEMS APPROACH
RECOGNIZING MOST PEOPLE WHO USE
SUBSTANCES USE MORE THAN ONE
SUBSTANCE, HOW CAN OUR RESEARCH
REFLECT THAT AND HOW CAN WE BE
SMART IN OUR INVESTMENTS SO WE
ARE ABLE TO COME UP WITH
SOLUTIONS THAT ARE GOING TO BE
MEANINGFUL IN THE CONTEXT OF
SUBSTANCE USE.
SO THAT'S KIND OF WHAT I SEE AS
THE EVOLUTION OF HEAL RESEARCH.
WE HAVE DONE VERY LITTLE
PIVOTING OR ADDITION OF ANY KIND
RELATE TODAY XYLAZINE WHERE MORE
JUST HAVING A DISCUSSION AROUND
IT IT AND PROBABLY CONSIDERING
HOW IT IT AFFECTS OUR
TRANSLATIONAL RESEARCH PORTFOLIO
THAT IS FOCUSED ON PRIMARILY
OPIOIDS.
NORAH MAY HAVE MORE TO ADD IN
TERMS OF HOW NIDA IS THINKING
ABOUT THIS AND HOW THERE COULD
BE OPPORTUNITIES TO EXPAND AND
BE THOUGHTFUL WHERE HEAL HAS
ALREADY MADE INVESTMENTS.
>>I THINK IT'S A VERY GOOD
RESPONSE.
REBECA, I THINK TO ALSO MEAN
HEAL'S MISSION IS TO ADDRESS THE
OVERDOSE CRISIS AND SO THE
OVERDOSE CRISIS HAS CHANGES AND
IT CHANGES DRAMATICALLY AND
QUITE RAPIDLY SO IF WE WANT TO
SUCCEED, WE NEED TO HAVE THE
FLEXIBILITY TO I AM CORPORATE
THE RESEARCH OBJECT AGAIN DA AND
WHAT WE'RE SERVING IN THE REA
LOT OFTHALITY OFTHIS CRISIS ANDN
THAT MULTIPLE SUBSTANCES WERE
FOUND IN PEOPLE DYING FROM
OPIOID OVERDOSES HAS BEEN THERE
AT LEAST FOR FIVE YEARS IF NOT
MORE AND IT'S NOT JUST XYLAZINE.
IT'S RECENT IN THE PAST I WOULD
SAY THROW OR FOUR YEARS BUT ALL
ALONG, WE SEE THAT COMBINATIONS
WITH A WIDE VARIETY OF DRUGS
INCLUDING SOME OF THE ANTI-EP EP
LET TICK DRUGS.
WE CANNOT DIVERSE OUR PORTFOLIO
OF WHAT ATTRACTS THE ATTENTION
OF THE MEDIA BUT WE DO HAVE TO
BE ALERT ABOUT UNDERSTANDING
WHAT IS EMERGING SO WE HAVE BOTH
FROM THE PERSPECTIVE OF HOW WE
MANAGE THE NIDA PORTFOLIO AND
HOW BASICALLY WE PROPOSE THAT WE
SEARCH FOR THE HEAL COMPONENT
OPIOID CRISIS TO ACTUALLY
MAXIMIZE OUR ABILITY TO PROVIDE
WITH KNOWLEDGE THAT CAN BE USED
FOR TREATMENT.
AND IN THIS CASE, IT DOES RELATE
TO UNDERSTANDING BETTER THE
PHARMACOLOGY OF XYLAZINE AND THE
DISCUSSION THAT'S WE'RE JUST
HAVING.
AS OF YOUR QUESTION FOR THE
STIMULANTS, I MEAN,
UNFORTUNATELY, WE KNOW NOW THAT
PROBABLY SOMETHING LIKE 65,000
PEOPLE DIE FROM STIMULANT
OVERDOSES.
MOST OF THEM ARE ASSOCIATED WITH
FENTANYL.
BUT SINCE OUR MISSION IS TO
ADDRESS THE OVERDOSE CRISIS
THROUGH THE HEAL, OR TO ADDRESS
THE PROBLEMS OF DRUG USE THROUGH
NIDA, ADDITIONALLY, WE HAVE TO
MAXIMIZE AND BE CLEVER ON HOW WE
USE THE RESOURCES TO BASIC
EXTRACT INFORMATION THAT IS
PERTAINING TO BOTH OPIOIDS BUT
ALSO POLY SUBSTANCE USE AND WHAT
YOU WILL BE HEARING, NOT SO MUCH
TODAY BUT ONE OF THE STRATEGIES
THAT HAS BEEN TO MOVE MORE
TOWARDS MEDICATIONS THAT CAN BE
USED FOR DRUGS, DRUG ADDICTION
IN GENERAL, NOT JUST FOR OPIOIDS
OF COCAINE THAT TACKLE
MECHANISMS THAT ARE PERTINENT TO
ADDICTIONS IN AND OF ITSELF AND
BECAUSE THIS IN PRINCIPLE HAVE
THE POTENTIAL OF ADDRESSING MORE
THAN ONE SUBSTANCE.
THAT'S WHERE WE ARE.
WE RELY ON AWFUL TO YOU GIVE US
INPUT AND GIVE US YOUR
PERSPECTIVE ON HOW TO MAXIMIZE
THE LIKELIHOOD THAT WE WILL BE
SUCCESSFUL AND WE'RE NOT USING
THE OPPORTUNITY FOR THE MOST
IMPACTFUL RESEARCH.
>>THAT MAKES SENSE, THANK YOU
FOR THE THOROUGH EXPLANATION.
I KNOW WE LIKE TO NEATLY AND
NICELY SEPARATE EVERYTHING INTO
YOU CAN BETS AND CATEGORIES BUT
DEALING WITH SUBSTANCE USE
DISORDER AND OPIOID SUBSTANCE
USE AND ALSO WITH PAIN WE KNOW
THESE ARE COMPLEX THINGS AND YOU
CAN'T JUST SEPARATE ONE LITTLE
PIECE OUT FROM THE OTHER.
I JUST WANT TO MAKE SURE I WAS
CLEAR ON WHERE THINGS CURRENTLY
STAND IN TERMS OF CONGRESS'
MANDATE FOR HEAL.
>>THANK YOU, CHRIS AND THEN
ROB, YOU HAVE YOUR HAPPENED
RAISED.
>>YEAH, I WAS FOLLOWING ON TO
THAT.
JUST SOMETHING TO KEEP OUR EYE
ON THE BALL, I MEAN, WE HAVE TO
KEEP EVOLVING AS Dr. VOLKOF
WAS SAYING ON THE THREATS OF THE
GROUPED AND IT'S A MOVING
TARGET.
I THINK THAT YOU KNOW, THE
BUDGET SLIDE WAS CUT OFF A
LITTLE BIT BUT TRYING FOR US TO
THINK ABOUT HOW WE DO THAT AND
RESPOND TO THOSE THINGS WITHOUT
ERODING THE OTHER PARTS OF THE
MISSION AND THEY'RE GOING TO
CONTINUE TO BE NEW DRUGS ON THE
STREET AND THINGS MIXED IN WITH
THE SUPPLY BUT PAIN REMAINS AND
I JUST WANT TO BE CONTINUING TO
HAVE THE SAME FOCUSED ON THAT
MISSION.
PAIN DOESN'T -- WE DON'T GET NEW
PAINS NECESSARILY POPPING UP BUT
WE STILL HAVE THE SCOPE THE
IMPACT WE HAVE SOMETHING TO
ADDRESS OVERDOSE ISSUES.
HOW DO WE DO THAT AND STILL
MAINTAIN THAT BALANCE MISSION
THAT WE'RE SUPPOSED TO BE.
>>THE SUBSTANCE USE DISORDER
OVERDOSE PREVENTION AND REVERSAL
GOALS ARE VERY INTERTWINED AND
ARE GOING TO BE EFFECTED BY THE
SUBSTANCE OF PEOPLE ARE USING
AND THE PAIN AND SIDE OF THE
PORTFOLIO IS ALWAYS GOING TO BE
CONNECTED TO THAT AND SOME
REGARD AND IN TERMS OF THE
POPULATIONS OF PEOPLE AND
WHETHER THEY EXPERIENCE PAIN AND
WHETHER THE TREATMENTS WE'RE
USING ARE PUTTING THEM AT RISK
FOR OWNERSHIP MISUSE BUT THE
FLIP SIDE WE HAVE QUITE A
DIVERSE PORTFOLIO ON BOTH SIDES
AS YOU'VE SEEN AND WE WILL SEE
SO WE HAVE A LOT OF RESEARCH ON
THE PAIN SIDE FOCUSED ON
DIFFERENT PAIN CONDITIONS AND ON
NOT QUITE BASIC SCIENCE BUT
PRETTY PRECLINICAL AND BROAD
RANGING EXPLORATORY AND
THERAPEUTIC DEVELOPMENT ORIENTED
RESEARCH AND THEN WE ALSO HAVE
QUITE A DIVERSE RESEARCH ON
CLINICAL MANAGEMENT OF PAIN AND
THE NEEDS OF DIFFERENT
POPULATIONS AND THE BARRIERS TO
ACCESS TO HIGH-QUALITY PAIN AND
ALL OF THAT CONTINUES TO GROW
AND CONTINUES TO EVOLVE BASED ON
THE SCIENTIFIC NEED AND BASED ON
THE INPUT THAT WE HEAR FROM YOU
FRANKLY AS WELL AS FROM
STAKEHOLDERS OUTSIDE OF THIS
GROUP.
SO I THINK THERE'S A LOT TO
COVER BUT THE -- THE STRENGTH OF
OUR PORTFOLIO IS HOW BROAD IT IS
AND HOW IT IT SEEKS TO BRING
THESE DIFFERENT PERSPECTIVES
TOWARDS THIS REALLY
INTERCONNECTED SET OF GOALS.
I KNOW WE HAVE A BREAK THAT IS
SET ASIDE SO WE CAN TURN THE
VIDEO CAST AND SWITCH GEARS INTO
THE CLOSED SECTION BUT BUT WE
CAN GO A FEW MINUTES PASSED.
WALTER, I INVITE YOU TO REACT TO
THE PAIN FORT FOAL AND HOW YOU
SEE THAT CONTINUING TO ADDRESS
PUBLIC-HEALTH NEEDS AND
SCIENTIFIC AND OPIOID CRISIS AND
OVERDOSE CRISIS CONTINUES TO
EVOLVE.
>>WELL, I THINK WE HAVE LOTS OF
CHALLENGES ON THE PAIN SIDE AND
WE'LL TALK LATER ABOUT THE DATA
THE PAIN PROBLEMS ARE GETTING
WORSE, NOT GETTING BETTER.
WE WENT THROUGH THIS PERIOD OF
TIME WHERE THERE WAS A SHIFT OF
PEOPLE WHO NEEDED OPIOIDS,
COULDN'T GET THEM.
WE'RE WORKING HARD TO DEVELOP
GUIDELINES THAT ALLOW PATIENTS
TO BEST UTILIZE THE CURRENT
TREATMENTS AVAILABLE IN A WAY
THAT GIVES BALANCE THAT IMPROVES
FUNCTION AS THE TOP GOAL AND SO
BALANCING IN THAT RISK OF
ADDICTION AND THAT RISK OF PAIN
INHIBITING ONES DAILY DIFFERENT
TACTIVITIESIS IMPORTANT THE MAIE
NEED TO INVIGORATE THE THERAPY
DEVELOPMENTS SPACE TO GET BETTER
MEDICINAL TREATMENTS THAT WILL
BE ALTERNATIVES FOR OPIOIDS AND
THAT IS WHAT WE HAVE TO PRESS
FORWARD.
IT'S NOT EASY.
THAT'S WHY THE COMPANIES AREN'T
DOING IT ANYMORE.
SO ALMOST THE ONLY GAME IF TOWN
BUT THEY FEEL WE REALLY HAVE TO
PRESS AHEAD THERE TO MAKE A
LASTING DIFFERENCE AND THAT'S
WHAT HEAL IS TO HELP END
ADDICTION LONG-TERM.
TO DO THAT, WE REALLY NEED TO
HAVE ALTERNATIVES FOR OPIOIDS
AND WE HAVE TAP TAS TICK GROUP P
WORKING HERE TO MAKE THAT
HAPPEN.
HAPPY TO GET INTO MORE LATER.
>>THANK YOU, WALTER.
I HEAR EVERYONE'S INTEREST IN
THE BUDGET BREAKDOWN AND HOW THE
INVESTMENTS ARE ORGANIZED INTO
THESE DIFFERENT SECTIONS.
SO, GOING INTO THE MEETING
SCHEDULED FOR NEXT WEEK, WE'LL
PUT INTO THE AGENDA A LITTLE BIT
MORE TIME TO BREAK THAT DOWN AND
TALK THROUGH IT SO EVERYONE
UNDERSTANDS AND NOT JUST FLASH A
HIGH-LEVEL IMAGE IN FRONT OF
YOU.
NOW SINCE WE HAVE JUST ANOTHER
MINUTE OR SO, ARE THERE ANY
OTHER MEMBERS OF THE EXECUTIVE
COMMITTEE OR THE
MULTI-DISCIPLINARY WORKING GROUP
WHO WOULD LIKE TO ADD A COMMENT
OR RESPONSE AT THIS TIME?
OK.
AND THAT CASE, THANK YOU VERY
MUCH FOR TUNING IN, EVERYONE.
THIS CONCLUDES THE OPEN SESSION
OF TODAY'S MULTI-DISCIPLINARY
WORKING GROUP OF THE NIH HELPING
TO END ADDICTION LAUNCH OR HEAL
INITIATIVE.
FOR NIH STAFF, AND MEMBERS OF
THE MULTI-DISCIPLINARY WORKING,
WE'LL RECONVENE IN FIVE MINUTES
AT 11:50 A.M. FOR OUR CLOSED
SESSION DISCUSSION.
THANK YOU, VERY MUCH.