>> HELLO EVERYBODY. I WANT TO
WELCOME YOU TO THE THE HEAL
MULTI-DISCIPLINARY WORKING
GROUP MEETING. THE HEAL 2.0
MULTIDISCIPLINARY WORKING
GROUP. I AM SUSAN WEISS,
FILLING IN TODAY FOR AMY ADAMS
AT THE DESIGNATED FEDERAL
OFFICIAL FOR THIS.
IN MY OTHER JOB I AM THE
DIRECTOR OF THE DIVISION OF
EXTRAMURAL RESEARCH AT NIDA.
FIRST OF ALL I WANT TO THANK
WENDY WOULD AND -- FOR DOING
THE PREPARATORY WORK TO GET US
TO THIS POINT. WENT IN
PARTICULAR FOR PREPPING ME AND
TALK ME THROUGH EVERYTHING THAT
IS GOING TO HAPPEN TODAY. I
THINK WE HAVE MOST OF THE
COUNCILMEMBERS HERE, MOST OF
THE WORKING WORK MEMBERS HERE.
IS THAT CORRECT MINDY?
>> YES.
>> DR. WEISS:I THINK WE CAN
BEGIN. I WILL TURN IT OVER TO
THAT DR. VOLKOW.
>> DR. VOLKOW: HELLO EVERYONE'S
HOPEFULLY WE CAN GET AN ISSUES
TO WHERE WE ARE PERTINENT TO
THE CRISIS. ONE THAT IS
CHANGING CONSTANTLY. IN VERY
MANY TIMES AND PREDICTABLE
WAYS.
IN MY PRESENTATION TODAY I'M
GOING TO HIGHLIGHT SOME OF THE
AREAS WHERE THERE HAVE BEEN
MAJOR CHANGES, BUT ALSO UPDATE
YOU IN SPECIFIC PROGRAMS WHERE
WE HAVE STARTED TO SEE RESULTS.
HAVING SAID THAT, I AM NOT
GOING TO SHARE MY SCREEN. I
NEED TO KNOW IF YOU CAN SEE IT.
CAN YOU SEE IT?
>> YES.
>> YEP.
>> DR. VOLKOW:NICE. SO I WILL
START WITH THE NUMBERS AND
THESE ARE THE LATEST NUMBERS
THAT WE HAVE FROM CDC.
ACTUALLY REPORT UNTIL OCTOBER
23, THE DATA FOR THE 12 MONTHS
THAT PRECEDE THAT. 110,640
PEOPLE DIED FROM OVERDOSE IN
THE 12 MONTH AND THAT
CORRESPONDED TO A 1.10%
INCREASE FROM WHAT IT WAS A
YEAR BEFORE. IF YOU LOOK AT IT
IT IS SIGNIFICANTLY SMALLER
CHANGE THAT WE WERE SEEING
DURING THE COVID PANDEMIC. THE
FIRST YEAR WAS 30% INCREASE,
SECOND-YEAR 15% INCREASES IN,
THEY HAVE BEEN SLOWLY TRENDING
DOWNWARD. BUT UNFORTUNATELY WE
ARE STILL SEEING UPTICS IN
OVERDOSE DEATHS.
IF YOU LOOK AT GRANULARITY
WITHIN GROUPS, SOME OF THE
GROUPS WHERE WE ARE STARTING TO
DETECT INCREASES IN OVERDOSE
MORTALITY. AND OTHERS WHERE WE
SEE STEEP INCREASES;
UNDERSTANDING THE PARAMETERS
THAT ALWAYS HIGHLIGHT, WE NEED
TO LOOK ALL THE DATA AND THIS
COLUMN HERE SHOWS A VERY
DRAMATIC REDUCTION, GOING ON
FOR MANY YEARS IN THE OVERDOSES
THAT RESULT FROM HEROIN. 31%
FROM ONE YEAR TO THE OTHER.
ALSO THIS IS THE CATEGORY WHERE
YOU HAVE OPIOID PAIN
MEDICATIONS, AND THEY HAVE ALSO
BEEN GOING DOWN, NOT AS
DRAMATICALLY AS HEROIN, BUT
SIGNIFICANTLY SO.
THIS IS METHADONE FOR PRACTICAL
PURPOSES, NO CHANGES. THE ONES
THAT WE DO SEE INCREASES OUR
FENTANYL, COCAINE AND
METHAMPHETAMINES. AND IF YOU
JUST LOOK AT THE NUMBERS, IT IS
70% WE KNOW OF ALL OF THE
OVERDOSES ARE FROM FENTANYL.
AND THESE OVERDOSES, COCAINE IN
MED AND METHAMPHETAMINES,
67,000 MANY OF THEM CORRESPOND
TO CO-ADMINISTRATION ON BOTH
THE STIMULANT DRUG WITH
FENTANYL. THESE NUMBERS
CONTINUE TO RISE IN SOME YEARS
THERE HIGHER THAN OTHERS, BUT
THERE SIGNIFICANTLY TRENDING
UPWARD.
WHAT WE KNOW RIGHT NOW, FOR
WHICH WE DON'T REALLY NEED TO
DO NORMAL RESEARCH, IS THAT THE
MEDICATIONS FOR OPIOID USE
DISORDER, WHETHER METHADONE OR
NALTREXONE -- SIGNIFICANTLY
REDUCE THE LIKELIHOOD OF
RELAPSE AND OVERDOSING.
OBVIOUSLY THAT IS A KNOWN FACT
THAT WAS BASICALLY REPORTED BY
THE NATIONAL ACADEMY OF
SCIENCES IN MEDICINE,
DOCUMENTING THAT THIS IS THE
MOST POWERFUL TOOL THAT WE
HAVE. ALONGSIDE OF COURSE
NALOXONE, THE OVERDOSE REVERSAL
AGENT AND NOT SURPRISING IT IS
BEEN TO EXPAND ACCESS TO
NALOXONE, AS WELL AS EXPANDING
TREATMENT WITH MEDICATIONS FOR
THOSE WITH A OPIOID USE
DISORDER AND HOW WE ARE DOING
IN BOTH OF THESE ENDEAVORS DATA
SHOWS THAT DEFINITELY I DON'T
HAVE THE GRAPH, BUT FROM
ACTIVIA WE HAVE SEEN A
SIGNIFICANT RISE IN
PRESCRIPTIONS NALOXONE. ONE
THINGS TO DISTRIBUTE NALOXONE;
AND THE OTHER IS GETTING IT
INTO THE RIGHT HANDS, AND THAT
IS WHY WE ARE CORRECTLY
RESEARCHING AND TRYING TO
DETERMINE IF IT IS OPTIMALLY
BEING DISTRIBUTED.
WHEN IT COMES TO MEDICATIONS,
ACTUALLY WE KNOW THAT
UNFORTUNATELY WE ARE DOING
VERY, VERY POORLY IN PROVIDING
THESE MEDICATIONS FOR PEOPLE
WITH AN OPIOID USE DISORDER WHO
WOULD SIGNIFICANT BENEFIT FROM
THEM.
LATEST ANALYSIS BUT WAS
RECENTLY ACTUALLY DOCUMENTED
THAT ONLY 22% OF PEOPLE WITH AN
OPIOID USE DISORDER RECEIVED
THESE MEDICATIONS EVEN THOUGH
RIGHT NOW WE KNOW THAT THE USE
OF OPIOIDS IS EXTREME THE
DANGEROUS. AND THAT MORTALITY
RISKS ARE VERY HIGH.
AND SO IT IS UNCLEAR-- I MEAN I
DON'T WANT TO SAY UNCLEAR, BUT
OBVIOUSLY THERE ARE MULTIPLE
FACTORS THAT DRIVE THE VERY LOW
PENETRATION OF MEDICATIONS FOR
OPIOID USE DISORDER. THAT
COULD PROBABLY BE THE MOST
POWERFUL TOOL THAT WE HAVE FOR
PREVENTING OVERDOSES, ALONGSIDE
NALOXONE.
THAT IS WHY ONE OF THE TOP, TOP
PRIORITIES HAS BEEN TO ACTUALLY
TAKE OF THE HELPER SYSTEM,
BECAUSE IT REPRESENTS THE MOST
IMPACTFUL INFRA STRUCTURE THAT
WE HAVE IN OUR COUNTRY TO
PREVENT SUBSTANCE USE
DISORDERS. IT GOES WITHOUT
SAYING WE CANNOT CONTINUE TO BE
RELYING ON SPECIALIZED
TREATMENT PROGRAMS FOR
ADDRESSING THE OVERDOSE CRISIS
THEY ARE INSUFFICIENT AND IT
DOESN'T MEAN THAT THOSE
PROGRAMS IMPROPERLY PREPARED TO
DO THE ACTUAL EVIDENCE-BASED
INTERVENTIONS IN SOME OF THOSE
PROGRAMS. THEY DON'T
NECESSARILY ADMINISTER ADVANCED
RATIONS.
TO THE CLINICAL TRIAL NETWORK,
WE WANT TO ACCELERATE WITH
FUNDING FROM HEAL. IT HAS
ENABLED US TO EXPAND THE
PROJECT THAT ACTUALLY CREATE
EVIDENCE THAT SHOWS THAT
INVOLVEMENT OF DIFFERENT
MEDICAL SPECIALTIES HAS ENABLED
US TO EXPAND THAT CAPABILITIES,
TO BE ABLE TO SCREEN AND
PROVIDE MEDICATIONS FOR OPIOID
USE DISORDER AND ACTUALLY
SUPPORT THEM AND THOSE
INTERVENTIONS, IN THE HELPER
SYSTEM, RESULTED IN GOOD
OUTCOMES AS THOSE SPECIALIZING
IN TREATMENT THAT OFFER
MEDICATIONS FOR OPIOID USE
DISORDER.
FOR NETWORK PROJECTS, THE MOST
IMPACTFUL HAS BEEN THE
DOCUMENTATION INITIATED
MEDICATIONS FOR OPIOID USE
DISORDER IN THE EMERGENCY
DEPARTMENT, AND THESE MODELS
ARE NOW BEING IMPLEMENTED IN
MULTIPLE SITES ACROSS THE
UNITED STATES.
SECOND ONE, VERY IMPACTFUL WAS
INVOLVED IN THE PRIMARY CARE,
AND SCREENING. WHY? BECAUSE
THAT IS THE MOST EXTENSIVE
NETWORK AVAILABLE AND IT DOES
SHOW THAT PRIMARY CARE
PHYSICIANS ARE ABLE TO PROVIDE
SUCCESSFUL FOLLOW-UP AND
MANAGEMENT OF THESE PATIENTS.
A THIRD MODEL HAS BEEN THE
INTEGRATION OF INFECTIOUS
DISEASE DOCTORS WITH CARE FOR
MEDICATIONS FOR OPIOID USE
DISORDERS, AND THESE INTEGRATED
PROGRAMS HAVE SHOWN THAT
SIGNIFICANT BENEFICIAL EFFECTS
FOR ENSURING THAT PATIENTS ARE
STAYING ON MEDICATIONS FOR
OPIOID USE DISORDERS ALSO HAVE
SHOWN THAT THEY HAVE IMPROVE
THE OUTCOMES FOR INFECTIOUS
DISEASE-- IN THIS CASE HIV.
THERE ARE OTHER MODELS THAT
RELY ON ALTERNATIVES. SPOKE
AND HUB MODELS PERMIT NETWORKS
THAT ARE CENTRALIZING IN THE
AREA OF SPECIALTY, WHERE A
DOCTOR MAY HAVE A SPECIALTY FOR
TREATMENT OF SUBSTANCE USE
DISORDER THAT THEN PROVIDES
THAT SUPPORT FOR FARAWAY SITES
THAT ARE ABLE TO PRESCRIBE
THOSE MEDICATIONS.
ALTERNATIVE METHODS LIKE
PHARMACY DELIVERY OF MOUD
LARGELY POTENTIALLY, THEY WERE
IMPLEMENTED AT THE LEVEL THEY
SHOULD. THEY WOULD LARGELY
EXPAND ACCESS TO MEDICATIONS TO
MANY PEOPLE, AND FACILITATE THE
RETENTION. BECAUSE PHARMACIES
TEND TO BE CLOSER TO WHERE
PEOPLE LIVE.
MOBILE DELIVERY FOR OPIOID USE
DISORDER DISORDER HAS BEEN
ANOTHER INNOVATION THAT IS
BROUGHT TREATMENT TO DIFFICULT
TO REACH COMMUNITIES, RURAL
AREAS WERE EVEN A PHARMACY MAY
NOT BE SO CLOSE BY.
AND FINALLY LIKE MANY AREAS OF
MEDICINE, ACCESS TO TELEHEALTH
HAS EXPANDED OUR CAPABILITY FOR
PROVIDING TREATMENT AND SUPPORT
FOR PEOPLE WITH OPIOID USE
DISORDERS.
AND THE CHANGES THAT ARE DONE
COINCIDENT WITH THE COVID
PANDEMIC MADE IT EASIER TO
PRESCRIBE MEDICATIONS FOR
OPIOID USE DISORDERS VIA
TELEHEALTH.
A SECOND PRIORITY FOR US HAS
BEEN THE JUSTICE SETTING, I
WOULD SAY IT IS THE HIGHEST
IMPACT INFRASTRUCTURE WE HAVE
IN OUR COUNTRY TO BE ABLE TO
SCREEN AND PROVIDE FOR
TREATMENT OF INDIVIDUALS WITH
AN OPIOID USE DISORDER. HOW
CONSEQUENTIAL IS THE JUSTICE
SYSTEM?
WELL IF YOU TAKE THESE NUMBERS
HERE, THE STATISTICS, ONE IN 4,
25%, OF PEOPLE THAT HAVE DIED
FROM AN OVERDOSE HAD A PRIOR
YEAR JUSTICE INVOLVEMENT. 25%.
THIS WAS AN OPPORTUNITY SUCH
THAT IF THERE HAD BEEN THE
ABILITY TO PROVIDE THEM WITH
TREATMENT, THOSE INDIVIDUALS
MAY HAVE NOT DIED. IN THIS
PAPER THAT ACTUALLY WAS DONE IN
RHODE ISLAND, WHERE THE
IMPLEMENTED TREATMENT, ALL OF
THEM, THREE MEDICATIONS, IN
JAIL, SYSTEMATICALLY SHOWED
THAT THEY REDUCED MORTALITY BY
70% WHEN PEOPLE WERE RELEASED
AFTER ONE YEAR AFTER THEY WERE
RELEASED INTO THE COMMUNITIES.
AND THE EFFECT OF THAT IN THE
STATE WAS 31% DECREASE IN
MORTALITY IN RHODE ISLAND FROM
THAT INTERVENTION.
SO THIS IS WHY ONE OF OUR TOP,
TOP PRIORITIES IS BEEN THE
JUSTICE COMMUNITY OPIOID
INNOVATION NETWORK INITIATED IN
2019. AND HAS BEEN GOING ON
NOW FOR SIX YEARS. AND WE ARE
GOING TO BE HEARING DETAILS
FROM THAT FROM TISHA WILEY
LATER ON. BUT I DO WANT TO NOTE
SOMETHING THAT CAPTURED MY
ATTENTION.
WHEN YOU LOOK AT THE SURVEYS OF
JAILS THAT WERE ABLE TO PROVIDE
MEDICATIONS AVAILABLE, THIS IS
A SURVEY THAT WAS DONE ON 2019.
THIS IS THE SURVEY DONE THREE
YEARS LATER. YOU CAN SEE-- NOT
THE SAME SURVEY, SO YOU CANNOT
DO A DIRECT COMPARISON-- BUT IT
IS NOTABLE THAT THERE APPEARS
TO BE A MUCH LARGER NUMBER OR
SYSTEMS THAT ARE ACTUALLY JAILS
PROVIDING MEDICATION. AND THAT
HAS BEEN CORROBORATED BY OTHER
PUBLICATIONS BOTH IN JAILS AND
PRISONS.
THESE NUMBERS BASICALLY DOES
NOT LOOK LIKE IT HAS CHANGED
VERY MUCH. I DON'T KNOW THAT
WE CAN SAY NOTHING ABOUT IT.
BUT IT DOES PUSH US TO THE FACT
THAT PEOPLE THAT COME IN
ALREADY WITH MEDICATIONS FOR
OPIOID USE DISORDER, A
SIGNIFICANT PORTION AS OF 2022,
WERE NOT CONTINUING TO RECEIVE
THEM ONCE THEY GET INTO THE
JAIL. THIS IS IN JAILS.
NOW, LET ME GO TO THE NEXT
THERAPY AND POLITICIAN PROBLEM.
HEALTHCARE JUSTICE AND HEALING
COMMUNITY STORIES. I WOULD SAY
WE DECIDED WE WOULD SAY, LET'S
BE AMBITIOUS. LET'S CREATE A
PROJECT THAT BRINGS TOGETHER
ALL OF THE EVIDENCE-BASED, AND
DOCUMENT AND DEMONSTRATE HOW
TAKING ADVANTAGE OF THE
EVIDENCE-BASED INTERVENTIONS IN
SITES, AND COMMUNITIES THAT
HAVE SOME OF THE HIGHEST RATES
OF OVERDOSES IN THE COUNTRY CAN
ACTUALLY SIGNIFICANTLY REDUCE
OVERDOSE MORTALITY. AND THAT IS
HOW THE HEALING COMMUNITY
STARTED.
IT STARTED WITH FUNDING IN 2019
TO THE 4 DIFFERENT STATES,
KENTUCKY, OHIO, MASSACHUSETTS
AND NEW YORK. 66 COMMUNITIES,
67, MAY INVOLVE RURAL AND URBAN
AREAS.
AGAIN SELECTED FOR THEIR HIGH
RATE OF OVERDOSE MORTALITY.
AND THE INTERVENTION WAS TO
ACTUALLY IN EACH COMMUNITY, TO
QUANTIFY THE CHALLENGES AND THE
INFRASTRUCTURE THAT EXISTED IN
THAT COMMUNITY. AND TO USE THAT
DATA TO ACTUALLY MONITOR
INTERVENTIONS. AND TO BRING
TOGETHER JUSTICE, HEALTH CARE
AND THE STATES AND THE
COMMUNITIES IN ORDER TO DEPLOY
THE INTERVENTIONS. IT IS AN
INTEGRATED MODEL OF CARE OF
DEPLOYING THE EVIDENCE-BASED
INTERVENTIONS.
THE MAIN INTERVENTIONS FROM THE
MEDICAL PERSPECTIVE WAS
INCREASED NALOXONE IS DIVISION
AND ACCESS UTILIZATION OF MOUD
AND DECREASE HIGH-RISK OPIOID
PRESCRIBING. THE RESULTS HAVE
NOT YET BEEN PUBLISHED SO
PLEASE KEEP IT CONFIDENTIAL.
THIS CANNOT BE DISTRIBUTED. THE
PAPER HOPEFULLY WILL BE COMING
SOON.
SO WHAT DID WE OBSERVE? THESE
ARE THE RESULTS. THE MAIN
OUTCOME WAS REDUCTION IN
OVERDOSE MORTALITY. AND THIS IS
THE DATA. IT IS COMPARING WAVE
1 AND WAVE 2. IMPLEMENTATION
OF THE HEALING COMMUNITY
INTERVENTION AND DURING THE 12
MONTH PERIOD, AND COMPARING TO
THE WAVE 2 WHO DID NOT GET THE
INTERVENTION JUST TREATMENT IN
THOSE COMMUNITIES.
THIS IS THE RATE OF MORTALITY
PER 100,000 FOUR WAVE 1 THAT
RECEIVE THE INTERVENTION AND
WAVE 2 THAT DID NOT. YOU CAN
SEE A REDUCTION IS NOT
SIGNIFICANT. 9% REDUCTION. WE
BASICALLY HAD WANTED THE IDEA
THEORETICALLY TO EXPECT A 40%
REDUCTION IN OVERDOSE
MORTALITY. AND WE OBSERVED A
9%.
AND WHAT IS INTERESTING IS
THAT, THESE ARE THE THINGS THAT
ARE INTERESTING ABOUT IT. THE
DIFFERENCE IN SUCCESS OF THE
INTERVENTIONS BETWEEN THE
STATES. AND IT IS NOTABLE THAT
KENTUCKY DID NOT SEE A
DIFFERENCE BETWEEN WAVE 1 AND
2. WE CAN DISCUSS IF YOU HAVE
QUESTIONS WHY THAT MIGHT BE SO.
WHEREAS IN THE OTHER ONES YOU
CAN CONSISTENTLY SEE IT.
WHAT IS ALSO NOTABLE, NOT THE
MAIN OUTCOME BUT INTRIGUING, IS
THAT WHAT WE DID SEE A
SIGNIFICANT REDUCTION IN ONE
YEAR WAS IN TERMS OF TOTALITY
ASSOCIATE WITH
PSYCHOSTIMULANTS, WITH
FENTANYL. THIS IS WAVE 1 AND
WAVE 2.
NOTE ALSO THAT THE RATE OF
MORTALITY AS EXPECTED IS MUCH
LOWER FOR PSYCHOSTIMULANTS
OVERALL THEN WITH THESE FOUR
OPIOIDS. THAT REPRESENT THE
REALLY PREDOMINANCE OF
OVERDOSES LINKED WITH OPIOIDS
DIRECTLY.
SO WHAT ARE THE CONCLUSIONS
FROM THE HEALING COMMUNITY
STUDY? YES THERE WAS A
REDUCTION IN OPIOID OVERDOSE
DEATHS, BUT NOT STATISTICALLY
SIGNIFICANT. THERE WAS A 37%
REDUCTION ON OVERDOSE DEATHS
FROM OPIOIDS AND
PSYCHOSTIMULANTS, OTHER THAN
COCAINE. THIS WAS SIGNIFICANT.
IN TOTAL THERE WERE 525
OVERDOSE DEATHS THAT WERE
OBVIATED, AVERTED IN WAVE 1
WHEN COMPARED TO WAVE 2.
YES WE WANTED 40% REDUCTION IN
OVERDOSES. HOPING THAT WE HAD
TENTATIVELY ESTABLISHED WITH NO
PRECEDENCE ABOUT WHY THAT
NUMBER, BUT TO HAVE A BOLD
STATEMENT. AT THAT TIME, ONE OF
THE REASONS WHY WE DID NOT WANT
STOP 40% OR ANY OTHER NUMBER,
WAS THAT WE WERE STARTING TO
SEE THERE WAS A RISE IN
METHAMPHETAMINE USE THE
COMMUNITY. AND THOSE
INTERVENTIONS THEY WERE
TARGETED SPECIFICALLY FOR
OPIOID USE DISORDER MAY BE MUCH
LESS EFFECTIVE.
WE DO NOT KNOW OR ANYBODY KNOWS
WAS THAT WE IMPLEMENTED THE
HEALING COMMUNITY STUDIES,
COVID EMERGE IN OUR COUNTRY AND
THAT LED TO ABSOLUTE CLOSURES
OF THE HEALTHCARE SYSTEMS,
SUPPORT SYSTEMS FOR PEOPLE WHO
WERE RECEIVING TREATMENT
PARTICULARLY IN THE SUBSTANCE
USE DISORDER.
ALSO RESULTED BECAUSE OF THAT
IN CHANGES IN THE PROVISION OF
METHADONE, TAKE-HOME METHADONE,
AND FACILITATION AND
IMPLEMENTATION OF PENOPHRIN.
ALSO DURING THAT PERIOD THERE
WAS A MASSIVE INCREASE OF
FENTANYL IN OUR COUNTRY. AND
THE ILLICIT MARKET BECAME
INCREASINGLY MORE UNPREDICTABLE
VIS-à-VIS THE COMBINATIONS.
SO, WE DELAYED THAT. ONE OF
THE REASONS WHY THESE RESULTS
MAY NOT HAVE BEEN SIGNIFICANT
WAS CERTAINLY ALL OF THE
DISTURBANCE REDUCED BY EITHER
THE COVID PANDEMIC AND VERY
IMPORTANTLY THE EXPANSION OF
FENTANYL.
A QUESTION TO ASK IS, DURING
THE PERIOD OF IMPLEMENTATION OF
EVERYTHING DONE, ONE YEAR AND A
HALF, WAS IT SUFFICIENT? DO WE
NEED A LONGER PERIOD OF TIME?
THAT IS POSSIBLE. IT IS A
HYPOTHESIS THAT MAY HAVE
ACTUALLY CONTRIBUTED.
FROM MY PERSPECTIVE OF WHAT THE
ANALYSIS OF WHAT I'VE SEEN IN
OTHER PARTS OF THE COUNTRY,
CERTAINLY THE EXPANDED USE OF
FENTANYL IN COMBINATION WITH
BASICALLY ALMOST ANY OTHER
ILLICIT DRUG, HAS MADE THE
PROBLEM VERY, VERY COMPLEX. AND
IT IS NOT JUST EVEN DRUGS.NOW
WE ARE SEEING ALSO ALL SORTS OF
OTHER TOXIC SUBSTANCES THAT MAY
BE MIXED.
THIS IS AN EXAMPLE. CERTAINLY
WE HAVE SEEN INCREASES STARTING
REALLY IN 2020 WITH THE COVID
PANDEMIC ARISE IN A NUMBER OF
OVERDOSE DEATHS THAT CONTAIN
ACTUALLY -- AND IN THE UNITED
STATES IF YOU LOOK RIGHT NOW,
IS APPROXIMATELY 12% OF THE
OVERDOSE DEATHS IN OUR COUNTRY
FROM FENTANYL CONTAINING
XYLAZINE.
XYLAZINE WHEN COMBINED WITH
FENTANYL, LO AND BEHOLD AND
THIS IS A STUDY NOT ONLY DOSES
OF XYLAZINE, 100-FOD INCREASE
FOR ILLICIT DOSE OF FENTANYL.
XYLAZINE DECREASES BLOOD
PRESSURE AND PRODUCES
HYPOGLYCEMIA. WE SEE THE RISE.
NOT THAT WE ARE TO UNDERSTAND
THE RESEARCH, BUT WHY HAVE
THEY BEEN MIXING XYLAZINE WITH
FENTANYL?
WE KNOW FROM ANIMAL STUDIES AND
FROM WHAT PEOPLE ARE SAYING,
NUMBER ONE IN ANIMAL STUDIES IT
BASICALLY PROLONGS THE DURATION
OF THE EFFECTS OF FENTANYL.
WHICH PATIENTS TEND TO
CORROBORATE.
THE OTHER THING THAT PATIENTS
ARE TELLING US IS THAT
BASICALLY THE CULMINATION
REDUCES THE EMERGENCE OF
WITHDRAWAL SYMPTOMS. NOT
SURPRISING SINCE IT IS A ...
SO THE CLINICAL TRIAL NETWORK
HAS BEEN AT WORK TRYING TO
IDENTIFY PRACTICES. AND ALSO
RESEARCH GAP AREAS THAT NEED
TO BE TO HELP CLINICIANS ALL
OVER THE UNITED STATES TO
ADDRESS HOW DO YOU TREAT
SOMEONE THAT COMES WITH AN
OVERDOSE FROM FENTANYL,
XYLAZINE? AND MORE RETURNEES TO
BE DONE.
XYLAZINE BY ITSELF CAN PRODUCE
PHYSICAL DEPENDENCE. WHICH CAN
RESULT IN WITHDRAWALS. AND THAT
CAN EXACERBATE THE ABILITY TO
KEEP PEOPLE TREATED. ALSO IF
ASSOCIATED WITH MANIFESTATIONS
PRESENTED IN THE PAST.
WE NEED TO EXPAND THE
SURVEILLANCE OF XYLAZINE AND
ITS DETECTION IN CLINICAL
STUDIES.
THE EMERGENCE OF THESE PATTERNS
OF COMBINED DRUG USE AND
OVERDOSE, IN OUR PIPELINE FOR
THE DEVELOPMENT FOR NOVEL
THERAPEUTICS, WE HAVE TO EXPAND
THE SCOPE OF WHAT WE WERE
AIMING TO DO. INITIALLY IT WAS
OF COURSE TO ADDRESS THE ISSUE
OF OVERDOSES FROM OPIOIDS IN
INDIVIDUALS WITH OPIOID USE
DISORDERS. THAT IS NOT
SUFFICIENT. YOU HAVE HEARD ME
SAY THAT MANY TIMES.
WE ALSO NEED TO ADDRESS
WHATEVER DIFFICULTIES IN NOT
JUST ADDRESSING AN OVERDOSE
THAT CONTAINS FENTANYL AND
COCAINE OR METHAMPHETAMINE? BUT
ALSO HOW DO YOU ADDRESS THE
DIFFICULTY ON KEEPING SOMEONE
ON TREATMENT, FOR MEDICATIONS
FOR OPIOID USE DISORDER WHO MAY
ALSO HAVE A COCAINE OR A
META-FENTANYL USE DISORDER? AND
SO THE CHALLENGES OF WORKING
WITH HAVING TO DEAL WITH PEOPLE
THAT ARE TAKING ... WHEN THEY
THINK YOU'RE TAKING HEROIN THEY
ARE TAKEN FENTANYL, WHICH MAKE
DEPENDENCE MUCH WORSE.
HOW DO WE ENSURE THAT THEIR
PROPERLY MANAGED? AND IN OUR
MEDICATIONS, IT IS VERY CLEAR
IN OUR BRAINS, THAT WE NEED TO
MOVE MORE AND MORE TO TARGET
SUBSTANCES, AS OPPOSED TO JUST
TARGETING OPIOID USE DISORDERS
BY THEMSELVES. RIGHT NOW, IF
YOU LOOK AT IT IN TERMS OF
PATTERNS, THE FREQUENCY OF
CO-ABUSE IS SEEN IN MORE THAN
60% OF URINE THAT COMES IN FROM
PATIENTS ARE GOING TO TREATMENT
INDICATED THAT MORE THAN 60%
ARE COMBINING DRUGS.
AND FOR THE FINAL ADVOCATE, I
WANTED TO SAY AND HIGHLIGHT. WE
SPOKE ABOUT THAT 1.5% INCREASE,
BUT I TOLD YOU THAT IS NOT THE
CASE FOR SOME GROUPS. AND YOU
HAVE SEEN ME PRESENT THESE.
THIS IS AN UPDATE, AMERICAN
INDIAN ALASKA NATIVES, 64.4%
PER HUNDRED PERCENT POPULATION
DEATH RATE. DOUBLE THAT OF THE
REST OF THE UNITED STATES. ALSO
IN BLACK COMMUNITIES, THE
OVERDOSE RATES ARE VERY HIGH.
AND THAT IS WHY WE ACTUALLY CAN
SEE THAT OF THE NATIVE COLLECT
RESEARCH EFFORT TO ENHANCE
WELLNESS LED BY DR. -- AND
OVERDOSE OF SUBSTANCE USE FOR
PAIN, AND THE MAIN GOAL IS TO
BUILD THE INFRASTRUCTURE TO
ALLOW TRIBAL COMMUNITIES,
NATIVE AMERICAN RESEARCHERS, TO
BE INVOLVED IN THE PURSUIT OF
SOLUTIONS THAT THEY CAN TAKE
ADVANTAGE OF THE TRADITION OF
MEDICINE AS WELL AS A STRONG
SOCIAL SUPPORT SYSTEMS.
THE N CREW REQUEST REPLICATION
REPORTED IN JUNE 2023, RECEIVED
THE APPLICATIONS IN NOVEMBER
2024. AND ON FEBRUARY 24. WE
EXPECT FUNDING OF THE AWARD IN
JUNE 2024. AND DOCTOR -- WILL
BE GIVING YOU AN UPDATE WHEN
THAT IS DONE.
WHERE ARE WE? CERTAINLY WHERE
WE'RE, I WOULD SORT OF SAFER
RESEARCH, FOR THE PERSPECTIVE,
THERE IS A LOT OF GAP AREAS.
WHAT ARE THE CONSEQUENCES OF
FENTANYL AND SUBSTANCE ABUSE?
WE DO UNDERSTAND AND PROPERLY.
INCLUDING THE INITIATION AND
RETENTION. WHAT ARE THE
CONSEQUENCES OF OVERDOSES?
SEVERELY HYPOGLYCEMIC. HOW DOES
THAT AFFECT THE BRAIN?
ULTIMATELY THESE OVERDOSES ARE
REPEATED. SO HOW DOES THAT
IMPAIR THE ABILITY OF AN
INDIVIDUAL TO RECOVER? AND THAT
PERTAINS EXACTLY TO WHAT ARE
THE LONG-TERM OUTCOMES OF
SOMEONE THAT SUFFERS WITH
DIFFERENT TRAJECTORIES FOR
OPIOID USE DISORDER? WITH OR
WITHOUT OVERDOSES. WITH OR
WITHOUT ACTUALLY MIXTURE WITH
STIMULANTS. WE HAVE LIMITED
INFORMATION.
WE NEED TO CONTINUE TO EXPAND
RESEARCH ON HARD-TO-REACH,
UNDERSERVED POPULATIONS. I
SPOKE ABOUT THE AMERICAN
INDIANS, AND ALASKA NATIVES. I
ALSO MENTIONED MORTALITY RATES
IN BLACK AMERICA CONTINUE TO
INCREASE AT A MUCH HIGHER RATE
THAN WHITE AMERICA IN RURAL
AREAS. AMONG THE HOMELESS. THE
HOMELESS HAVE THE HIGHEST RATES
OF MORTALITY AMONG ANY OTHER
GROUP.
CERTAINLY PREGNANT WOMEN WERE
THE OVERDOSE MORTALITY HAS
CONTINUED TO INCREASE
SIGNIFICANTLY. IT IS OBVIOUS--
AND I ACTUALLY AM LOOKING AT
THIS, THESE CONDITIONS DO NOT
OCCUR IN ISOLATION. SUBSTANCE
USE DISORDER IN GENERAL WITH
OPIOID USE DISORDER HAS A HIGH
COMORBIDITY WITH PAIN AND WITH
PSYCHIATRIC OTHER DISORDERS.
IN TERMS OF SUICIDE, OPIOID USE
DISORDER AND SUBSTANCE USE
DISORDER ACCOUNTS FOR 25% OF
PEOPLE WHO DIED FROM SUICIDE.
WE NEED NOVEL HARM REDUCTION
APPROACHES. WHAT WE WANT
EVERYBODY TO GO TO TREATMENT,
ENERGY RECOVERY, MANY PEOPLE
ARE DYING AND ARE NOT READY TO
GO TO TREATMENT. WE NEED TO
KEEP THEM ALIVE.
WE NEED TO CONTINUE TO MONITOR
THE CHANGING LANDSCAPE. IT IS
SURPRISING TO HEAR WHAT STATES
ARE STARTING TO REPORT
VIS-à-VIS WHAT TYPE OF DRUGS
ARE BEING COMBINED WITH
FENTANYL.
AND IT IS ACTUALLY THE
RECOGNITION TOO THAT PREVENTION
IS A KEY COMPONENT OF WHAT WE
ARE DOING. AND WHY WE HAVE
CERTAINLY ALWAYS PRIORITIZED
PREVENTION AMONG ADOLESCENTS
AND YOUNG ADULTS, WHO HAVE THE
HIGHEST RISK FOR DRUG USE, IN
THIS CASE PREVENTION HAS TO BE
EXPANDED ACROSS THE WHOLE
LIFESPAN. WHAT WE ARE SEEING IS
RISES OF OVERDOSE MORTALITY
AMONG PEOPLE OVER 65 YEARS, AND
YOU HAVE SEEN THE PRESENT DATA
ON RISING MORTALITY AMONG
TEENAGERS.
AND HEALTH DISPARITIES AND THE
INCREASED RISK OF BOTH AMERICAN
INDIANS, ALASKA NATIVES, BLACK
AMERICANS, AND THE HOMELESS ARE
THE SOCIAL DETERMINANTS OF
HEALTH. AND THE UNDERSTANDING
AND DEVELOPING MODELS BASED ON
RESEARCH AND EVIDENCE THAT
DOCUMENTS THE BENEFITS IS THE
WAY THAT WE HAVE A CHANCE TO
ACTUALLY INFORM POLICIES, AND
HOPEFULLY PUSH FOR POLICIES
THAT WILL BE ABLE TO BENEFIT
EVERYONE IN A MORE ACCREDITED
FASHION.
WITHOUT I WANT TO THANK YOU FOR
YOUR ATTENTION. I AM GOING TO
STOP SHARING.
>> DR. WEISS: OKAY. WALTER YOU
ARE UP NEXT.
>> DR. KOROSHETZ: THANK YOU
VERY MUCH. I AM GOING TO TALK A
LITTLE BIT ABOUT THE WORK THAT
HEAL HAS BEEN DOING IN PAIN.
TRYING TO REDUCE THE SUFFERING
DUE TO PAIN. AND PREVENT
ADDICTION. AND JUST TO STRESS
AS I ALWAYS DO THAT THE "L" IN
HEAL STANDS FOR LONG-TERM,
HELPING TO END ADDITION OF THE
LONG-TERM. THE IDEA IS THAT
ONLY BY DEVELOPING EFFECTIVE,
NONADDICTIVE THERAPIES FOR PAIN
THAT WE ARE GOING TO BE
SUCCESSFUL OVER THE LONG TERM.
LET'S TALK A LOT OF THE PROCESS
BECAUSE WE ARE GOING TO BE
SEEING SOMEBODY DELIBERATIONS
FROM THIS PROCESS.
AS MENTIONED PREVIOUSLY, THE
HEAL GOVERNANCE IS NOW A LITTLE
BIT DIFFERENT. ACTUALLY -- AND
MYSELF OVERSEE THE HEAL PROGRAM
AND KEEP IT FOCUSED ON THE
CRISIS THAT NORA JUST TALKED TO
US ABOUT. THE PAIN PROGRAM
SIDE OF IT IS A LITTLE BIT
DIFFERENT. BECAUSE THERE IS NO
INSTITUTE FOR PAIN, LIKE THERE
IS FOR DRUG ABUSE. AND SO, WE
ARE KIND OF INTERESTED IN DOING
THINGS ON THE PAIN SIDE THAT
NIDA IS BEEN DOING FOR DECADES
ON THE OPIOID OVERUSE DISORDER
SIDE. AND WE WORK TOGETHER VERY
WELL ON THESE CROSSCUTTING
PROGRAMS LOOKING AT PAIN IN
PEOPLE WITH OPIOID USE DISORDER
OR PEOPLE BEING TREATED FOR
PAIN. TRAINING PROGRAMS AND SO
FORTH AND WE WILL TALK ABOUT
SOME OF THOSE.
WE HAVE ABOUT 14 DIFFERENT
INSTITUTE NOW INVOLVED IN THE
PAIN SECTION OF THE HELPING TO
END ADDICTION LONG-TERM.
WE HAVE THREE IC DIRECTORS
MYSELF, -- -- AND YOU HEAR
ABOUT THEM FROM HELEN IN A BABY
WE ARE BASICALLY OVERSEEING THE
WEEK TO WEEK, MONTH-TO-MONTH
ACTIVITIES OF THE HEAL PAIN
SIDE.
WILL BRING ALL DECISIONAL
ACTIONS TO THE IC DIRECTORS,
THE 14 IC DIRECTOR THAT HAVE
COME TOGETHER ONCE A MONTH TO
DISCUSS THE PAIN PROGRAM. NEXT
SLIDE.
AND THEN EVERY THREE MONTHS OR
SO WE MEET TOGETHER WITH NIADR
AND THE OTHER ENTITIES INVOLVED
IN THE OPIOID OVERUSE MEETING.
THIS GOVERNS WHAT WE DO. WE
WILL TALK A LITTLE ABOUT THE
STRATEGIC PLAN GOING FORWARD.
AND THIS ALSO IS KIND OF THE
GOVERNING PRINCIPLE FOR THAT.
SO BASICALLY IT STATES THAT
HEAL PAIN RESEARCH AIMS TO
REDUCE PAIN AND THE RISK OF
OPIOID USE DISORDER BY
DEVELOPING SAFE AND EFFECTIVE
PAIN TREATMENT AND PREVENTION
STRATEGIES TO IMPROVE QUALITY
OF LIFE FOR ALL PEOPLE. NEXT
SLIDE.
THE WORK THE WAY IT IS
DIVIDED-- THERE ARE SO MANY
PEOPLE LIKE HUNDRED PEOPLE
ACROSS THE INSTITUTE WORKING ON
THE HEAL PAIN SIDE NOW, ALL OF
THE INSTITUTE HAVE EQUITIES AND
PAIN. THEY MAY HAVE PAIN
PHYSICIANS IN THE PORTFOLIO.
AND SO THEIR VALUED INPUT IN
HEAL IS NOT TO BE UNDERSTATED.
WE HAVE WORKING GROUPS, WHICH
ARE PROGRAM DIRECTORS, WHO WORK
ON THE VARIOUS PROGRAMS IN
HEAL. NOT ONLY IN MANAGING THE
ONES THAT HAVE BEEN FUNDING BUT
IN DEVELOPING PLANS FOR NEW
PROGRAMS TO COME INTO HEAL.
AND THE WORKGROUPS FOCUS ON
COLLABORATION ACROSS THE
INSTITUTE, DO INITIATIVE
DEVELOPMENT, FUNDING PLAN
DEVELOPMENT, IN-DEPTH
SCIENTIFIC DISRUPTIONS, PROGRAM
UPDATES AND FEEDBACK, AND
DISSEMINATION OF INFORMATION.
THERE ARE FOUR OF THEM. WE USED
TO HAVE TWO, JUST CLINICAL AND
PRECLINICAL.
WE HAVE ONE THAT IS DEVOTED TO
TRAINING. ONE THAT IS DEVOTED
TO CLINICAL CARE. AND CLINICAL
TRIALS. THINGS LIKE ADVANCING
HEALTH EQUITY IN PAIN. WE HAVE
A GROUP THAT IS LOOKING AT
TRANSLATIONAL DEVELOPMENT AND
NONADDICTIVE THERAPEUTICS FOR
PAIN.
AND THEN WE HAVE A GROUP THAT
WORKS ON WHAT WE CALL
"INTEGRATED PAIN MECHANISMS."
THESE ARE PROJECTS THAT THEY
INVOLVE THE PAIN SYSTEM. BUT
THEY CUT ACROSS MULTIPLE
INSTITUTE. AND THEY ARE
PROJECTS THAT NO ONE INSTITUTE
COULD DO ON THEIR OWN.
WE HAVE A NUMBER OF THESE NOW.
FOR INSTANCE, REJOIN, LOOKING
AT THE INNOVATION OF THE WHOLE
JOINT AND NOT JUST -- BUT ALSO
MUSCLE AND LIGAMENTS. THESE
KINDS OF PROGRAMS WILL FALL
INTO THIS GROUP.
AND THEY ARE DIFFERENTIATED
FROM THE WORK THAT WILL BE DONE
IN AN INSTITUTE BECAUSE THE
PROBLEM IS TOO BIG FOR ONE
INSTITUTE. IT CUTS ACROSS
MULTIPLE INSTITUTE. NEXT SLIDE.
YOU CAN SEE HOW THE PAIN PLANS
PROCESS OCCURS AND YOU WILL
HEAR THE PAIN PLANS IN THE
CLOSED SESSION. AS I MENTIONED
IN THE SCIENTIFIC WORKGROUPS,
THE OTHER FOLKS WHO HAVE
GENERATED THE IDEAS. THEY ARE
ON THE NOTICE OF FUNDING
ANNOUNCEMENTS, AND THEY LOOK
AND PARTICIPATE AND LISTEN TO
THE REVIEWS. AND MAKE
DECISIONS ON WHAT THEY THINK
SHOULD BE FUNDED.
THEN THAT GROUP BRINGS THEIR
PLANS TO WHAT WE CALL THE HEAL
PAIN STEERING COMMITTEE. A
GROUP OF ABOUT 14 PROGRAM
DIRECTORS FROM ACROSS THE
INSTITUTES. AND THEY HAVE BEEN
REALLY FANTASTIC. THEY
EVALUATE THE FUNDING PLANS, OR
THE INITIATIVES. AND THEY GIVE
THEIR INPUT THEN TO THE HEAL
PAIN IC DIRECTORS THAT DO THE
ACTUAL VOTING.
IN THIS CASE, WE DID BECAUSE OF
THE TIMING, WE HAD OUR IC
DIRECTORS MEETING LAST WEEK.
THE HOPE WOULD BE THAT WE COULD
BRING THEM TO MDWG TO GET
FURTHER INPUT AND THEN GO BACK
TO THE IC DIRECTOR HERE AND THE
MDWG IS COMING AFTER THE IC
DIRECTORS BUT WE WILL BE TAKING
THEIR INPUT AND RUNNING IT
THROUGH THE IC DIRECTORS FOR
ANY DIFFERENCES THAT COME UP IN
TODAY'S DISCUSSION.
AND THEN, FOR ALL OF NIH'S
PROCESSES, FUNDING PLANS HAD TO
BE APPROVED BY A COUNCIL. AND
SO DEPENDING ON THE CONTENT OF
THE SCIENCE, AND THE DIFFERENT
GRANT FUNDING PLANS, IT WILL GO
TO ONE OF THE COUNCILS THAT ARE
INVOLVED IN HEAL.
THAT IS KIND OF HOW IT WORKS.
IT IS DEFINITELY A VERY
DELIBERATE PROCESS. MULTIPLE
DIFFERENT STEPS. WE FEEL IT
GIVES US A REALLY GOOD PRODUCT.
AT THE END. PARTICULARLY WHEN
WE ARE ABLE TO GET YOUR INPUT.
SO THANKS IN ADVANCE FOR THAT.
NEXT SLIDE.
THIS IS A PICTURE OF THE BUDGET
AVAILABLE FOR THE HEAL
INITIATIVE ON THE PAIN SIDE.
AS YOU PROBABLY KNOW, THE
FUNDING FROM CONGRESS ON HEAL,
IT COMES TO NINDS AND TO NIDA.
NIDS YOU SEE NICAEA ABOUT 285
LINEAR. I THINK NIDA IS UPWARDS
OF 355, I MIGHT HAVE TO BE
CORRECT ABOUT. THIS SLIDE
BASICALLY SHOWS WHERE THE FUNDS
HAVE ALREADY BEEN COMMITTED TO
PRECLINICAL IN THE DARK BLUE,
TO CLINICAL PROJECTS IN THE
LIGHT BLUE. TO THE FY24
PROPOSED BUDGETS HERE IN THIS
CORRUGATED BLUE. FY25 PROPOSED
CONCEPTS IN THE RED. AND THEN,
THE PURPLE ARE CROSSCUTTING
PROJECTS THAT ARE FUNDED BY
BOTH THE NIDA FUNDS AND THE
NIDS FUNDS. AND THERE ARE
CAMPS, IN WHAT WE CALL RMS TO
RUN THE PROGRAM.
AND IN THE BUBBLE YOU SEE THE
AMOUNT OF FUNDS THAT ARE
AVAILABLE, THAT HAVE NOT BEEN
ASSIGNED AS OF YET.
AND SO THE KEY POINT INVOLVED
HERE, IS THAT WE ARE THINKING
WE ARE GOING TO DROP DOWN TO
ABOUT 3 MILLION DOLLARS IN
2026. BASED OFF THE ASSUMPTION
THAT WE WILL GET FIVE BUDGETS
GOING FORWARD. WHICH IS PRETTY
CLOSE TO TWO, BUT THIS YEAR
AGAIN WE DID GET A $5 MILLION
INCREASE.
AND SO WITH THAT, NEXT SLIDE,
WHAT WE DECIDED TO DO IS TO NOT
PUT OUT INITIATIVES, NEW
INITIATIVES FOR FY26, BECAUSE
WE DON'T HAVE $3 MILLION IN
FY26. AND ACTUALLY HOLD A NEW
INITIATIVE DEVELOPMENT FOR
FY27, WHEN WE HAVE MORE MONEY
FOR THE PAIN PROGRAM. AND ALSO
AS YOU WERE HERE, WE WILL HAVE
A STRATEGIC PLAN WHICH WILL BE
REALLY GREAT IN TERMS OF A
ROADMAP OF WHAT WE SHOULD BE
DOING.
WHAT WE HAVE WORKED ON IN THE
LAST YEAR IS A PLAN TO DEVELOP
A PROGRAM WITH AN INTRAMURAL
NIH, AGAIN MULTIPLE INSTITUTES
INVOLVED. WITH THE IDEA THAT
THERE ARE SOME THINGS THAT CAN
BE DONE IN THE INTRAMURAL
PROGRAM UNIQUELY ADVANTAGEOUS
TO DO IT THERE. WE WILL BE
LOOKING FOR PROJECTS COMING OUT
OF THE INTRAMURAL PROGRAM THAT
WILL BE REVIEWED BY THE
STEERING COMMITTEE. AND
PREPARED FOR THE PROGRESS
COMING IN FROM THE EXTRAMURAL
SPACE. BUT WE HAVE NOT UP UNTIL
NOW DEVOTED ANY FUNDS IN THE
EXTRAMURAL PROGRAM, AND WE
THINK THE HEAL CAN REALLY
ADVANCE THAT BY DOING SO.
AND I MENTIONED THE NEW
SCIENTIFIC WORKGROUPS THAT WE
PUT TOGETHER ALREADY. WE'RE
GOING TO HEAR A LAYER ABOUT
THIS FANTASTIC PROGRAM THAT
KATHY -- THE NATIVE AMERICAN
PROGRAM TO ENHANCE WELLNESS BY
REDUCING OPIOID OVERUSE
DISORDER, AND REDUCE THOSE
DEATHS. AND ALSO TO IMPROVE
THE MANAGEMENT OF PAIN.
BECAUSE I THINK THEY ARE VERY
INTEGRALLY TIED. IT IS GOING
TO BE CHALLENGING. BUT KATHY
HAS DONE A FANTASTIC JOB. AND
YOU WILL HEAR MORE ABOUT IT
LATER.
SO WE ARE REALLY VERY
ENTHUSIASTIC ABOUT WORKING WITH
NIDA TO BUILD IN PROGRAMS FOR
BETTER PAIN MANAGEMENT IN
TRIBAL NATIONS. NEXT SLIDE.
THIS IS A SLIDE TO TALK ABOUT
WHAT HEAL HAS BEEN DOING. WE
HAVE A LOT OF CLINICAL TRIALS.
AND MANY OF THEM ARE GOING TO
BE COMING TO A CLOSURE PRETTY
SOON. SO WE WILL START GETTING
SOME REALLY INTERESTING RESULTS
OUT OF THEM. AND YOU CAN SEE
THE CONDITIONS TARGETED IN THE
CLINICAL TRIALS. THE DIFFERENT
TYPES OF TRIALS. AND, SO WE
ARE LOOKING AT -- HEALTH NEW
PROGRAM FOR TREATING CHILDREN
WITH BOTH ACUTE AND CHRONIC
PAIN. WE HAVE THE PRISON
NETWORK THAT YOU WILL HEAR
ABOUT FROM HELEN SHORTLY ABOUT
THE PRAGMATIC TRIAL THEY ARE
DOING WITH APPROVED PAIN CARE.
NEXT SLIDE.
AND THE INTRAMURAL PROGRAM I
MENTIONED ALREADY. THE GOAL IS
TO ENTERTAIN AND SOLICIT
PROPOSALS THAT COULD THEN GET
REVIEWED, FURTHERING THOSE THAT
ARE FURTHERING THE MISSION OF
THE HELPING TO END ADDICTION
LONG-TERM INITITIVE AND WE HAVE
SIGNIFICANT PROGRAM THROUGH THE
NATIONAL CENTER FOR ADVANCING
THE TRANSITIONAL SCIENCES OR
NCATS FOR DEVELOPING DRUGS AND
HUMAN CELL BASED TESTING
PLATFORMS. NEXT SLIDE.
TO TALK A LITTLE ABOUT THE HEAL
PAIN THERAPEUTIC SIDE OF THINGS
WE TALKED ABOUT CLINICAL
TRIALS, AND WE HAVE DEFINITELY
SOME SUCCESSES HERE. WE HAVE
FIVE INVESTIGATIONAL DEVICE
EXEMPTIONS FROM THE FDA TO GO
INTO PEOPLE WITH DEVICES FOR
PAIN, COMING OUT OF THE DEVICE
PROGRAM. WE HAVE TWO INPS THAT
HAVE COME OUT OF THE 12
MOLECULE GROUPS, AND WE HAVE
APPLIED THEM TO TEST ASSET FOR
MANY COMPANIES AND ACADEMICS
FOR THEIR EFFECTIVENESS IN
MULTIPLE DIFFERENT ... FOR
PAIN. LOOKING SO FAR AT 40
ASSETS. AND AS I MENTIONED
NCATS, VERY ACTIVE IN 14 DRUG
DISCOVERY PROJECTS AND THEY
HAVE A COMPOUND LIBRARY THAT
CAN BE SCREENED AGAINST THE
RELEVANT ASSAY TO UNDERSTAND
WHICH OF THOSE MIGHT BE
VALUABLE IN DEVELOPING A NEW,
NONADDICTIVE PAIN TREATMENT.
NEXT SLIDE.
AND, WE WE TALKED IN THE PAST
ABOUT HOW THE INDUSTRY IS KIND
OF LEFT PAIN BECAUSE OF ALL THE
FAILURES AND THERE IS ONE
RECENT REPORT COMING UP WITH
COMPANY, NOT A PUBLISHED PAPER
YET THE COMPANY REPORTED THAT
THEY ARE NOW 1.8 INHIBITOR,
BASICALLY IN THE POSTOPERATIVE
SCENARIOS, WAS ABLE TO MATCH
THE EFFECTIVENESS OF
COMBINATION OF I THINK IT WAS
VICODIN AND TYLENOL-- OXYCODONE
AND TYLENOL.
SO, I GUESS THE MESSAGE HERE IS
THAT, THERE IS A TARGET HERE
THAT DOES NOT INVOLVE THE
OPIOID SYSTEM. IT IS NOT
ADDICTIVE. IT PERFORMS AS WELL
IS ONE OF THE MOST MORE COMMON
OPIOIDS GIVEN FOR POST
OPERATIVE PAIN.
THIS COMPANY ALSO I THINK
LICENSED ONE OF THE NAV 1.7S
THAT WE FUNDED EARLIER. BUT
THIS IS A NAV 1.8. WE WILL SEE
WHAT HAPPENS THERE. BUT SOME
PROGRESS IN THE FIELD WHICH I
THINK WILL HOPEFULLY OPEN UP
MORE AND MORE. NEXT SLIDE.
AND, I'M GOING TO HAND OFF TO
JACKIE WARD, TO TALK ABOUT THE
STRATEGIC PLAN. THANK YOU ALL
FOR YOUR PARTICIPATION IN THIS.
YOU ARE GOING TO BE HEARING
FROM US. REALLY IMPORTANT THAT
WE DO A REALLY GOOD JOB HERE.
WE ARE REALLY LUCKY TO HAVE
JACKIE.
JACKIE IS A SENIOR ADVISOR HERE
AT NINDS IN THE OFFICE OF PAIN
POLICY AND PLANNING. PRIOR TO
THAT JACKIE WAS MY CHIEF OF
STAFF, AND THEN SHE LEFT FOR A
DEMOTION AT THE WHITE HOUSE.
SHE WENT TO THE WHITE HOUSE.
RECENTLY CAME BACK. WE ARE
REALLY HAPPY, THAT SHE IS GOING
TO DO A GREAT JOB OF LEADING
THIS GROUP. AND I WANT TO TURN
THAT OVER TO JACKIE.
>> DR. WARD: THANKS WALTER. SO
I SEE MYSELF ON THE SCREEN. I
HOPE EVERYONE CAN HEAR ME OKAY.
SO I WANT TO SAY THAT WE ARE
BASICALLY GOING TO TALK RIGHT
NOW ABOUT THE DEEP DIVE INTO
THE PAIN SIDE TWO DIGIT
PLANNING FOR THE PAIN SIDE AND
THEY WILL COME BACK TO TALK
ABOUT THE CROSSCUTTING
STRATEGIC PLAN. BUT AS WALTERS
SAID IN HIS TALK, WE ARE IN THE
SIX YEAR OF FUNDING FOR HEAL.
A LOT OF THE EARLY AWARDS THAT
WERE GIVEN OUT IN THE FIRST
YEAR, STARTING TO REPORT
RESULTS OF LOOKING TO THE
FUTURE TO FIGURE OUT WHAT THE
BEST OPPORTUNITIES ARE TO
SUPPORT THE MISSION OF HEAL
PAIN THAT WALTER TALKED ABOUT,
BY DEVELOPING RESEARCH
PRIORITIES THAT WILL GUIDE THIS
NEXT PHASE OF THE HEAL PAIN
PROGRAMS AND FUNDING
OPPORTUNITIES.
I DO WANT TO SAY THAT SINCE
PAIN RESEARCH AT NIH EXTENDS
WHAT IS SUPPORTED BY HEAL, WE
ARE HOPING THAT THE STRATEGIC
PLANNING PROCESS WILL BE
INFORMED BY THE BROADER
LANDSCAPE OF IC-SUPPORTED
RESEARCH. THAT IS AN IMPORTANT
COMPONENT WE ARE THINKING ABOUT
AS WELL.
AND THESE NIH-WIDE STRATEGIC
RESEARCH PRIORITIES FOR HEAL
PAIN, WILL BE ULTIMATELY PAIRED
WITH NIDA STRATEGIC PLAN THAT
ADDRESSES PRIORITIES FOR OPIOID
USE DISORDER AND OVERDOSE, THAT
WILL SUBSEQUENTLY GUIDE THE
DEVELOPMENT OF THE CROSSCUTTING
HEAL STRATEGIC PLAN THAT WILL
BE DEVELOPING IN PARALLEL. TO
DIVE INTO THE PAIN SIDE LITTLE
BIT.
WE WANT TO MAKE SURE THAT THESE
PRIORITIES REFLECT THE THOUGHTS
OF THE EXTERNAL SIGNS COMMITTEE
AND THE COMMUNITY OF PEOPLE
WITH LIVED EXPERIENCE OF THE
GENERAL PUBLIC. SO WE ARE
ACTUALLY STANDING UP AN
EXTERNAL COMMITTEE TO GUIDE AND
OVERSEE THIS PROCESS. AND I AM
HAPPY TO ANNOUNCE THAT YOUR
FELLOW MDWG MEMBER ROB GERAU
HAS AGREED TO CHAIR THIS
COMMITTEE WITH KATHLEEN SLUKA.
ROB IS A DIRECTOR OF THE
WASHINGTON UNIVERSITY PAIN
CENTER AND SERVES AS A DOCTOR
SEYMOUR AND ROSE T. BROWN BY
CAREFUL RESEARCH IN
ANESTHESIOLOGY AT THE
WASHINGTON UNIVERSITY ST.
LOUIS, WORKING TO DETERMINE
CELLULAR AND MOLECULAR
MECHANISMS INVOLVED IN THE
DEVELOPMENT OF CHRONIC PAIN
CONDITIONS WITH AN EYE TO THE
DEVELOPMENT OF NEW APPROACHES
FOR THE PREVENTION AND
MANAGEMENT OF CHRONIC PAIN AND
ITS COMORBIDITIES. AND
RECEIVED AN AWARD FOR
OUTSTANDING MENTORSHIP IN 2020.
KATHLEEN SLUKA IS A PROFESSOR
OF PHYSICAL THERAPY AND
REHABILITATION AT THE
UNIVERSITY OF IOWA CARVER
COLLEGE OF MEDICINE. HER WORK
FOCUSES ON THE PERIPHERAL AND
CENTRAL MECHANISMS OF CHRONIC
MUSCULOSKELETAL PAIN AND
NONPHARMACOLOGICAL TREATMENT
FOR CHRONIC PAIN. SHE IS THE PI
OF A NUMBER OF NIH AND HEAL
AWARDS INCLUDING AS PI OF THE
CLINICAL COORDINATOR ENCOUNTER
FOR THE ACUTE TO CHRONIC PAIN
SIGNATURE PROGRAM AND ALSO AS A
CO-PI OF THE IOWA T-32 PROGRAM
ON PAIN RESEARCH AND RECIPIENT
OF THE HEAL 2020 AWARD.
LOOKING FORWARD TO WORKING WITH
THEM AND ALSO WANT TO POINT OUT
THE PRIMARY CHARGE OF THIS
GROUP THAT THEY WILL BE
COCHAIRING IS TO PROPOSE AND
PRIORITIZE FUTURE STRATEGIC
RESEARCH PRIORITIES FOR THE
NEXT PHASE OF PAIN RESEARCH TO
ADVANCE THE HEAL MISSION.
AND WE WILL BE ALSO BE ASKING
THEM TO ASSESS THE PROGRESS
HEAL HAS MADE TO DATE, AND
IDENTIFY GAPS IN THE CURRENT OR
PAST HEAL PAIN RESEARCH
PORTFOLIO AND RECOMMENDING
BETTER WAYS TO ACHIEVE THE
GOALS OF HEAL. AS WELL AS
SUGGESTING NEW OPPORTUNITIES
WHETHER THROUGH NEW
PARTNERSHIPS OR TECHNOLOGIES OR
BREAKING DEVELOPMENTS IN THE
SCIENCE. NEXT SLIDE.
AS FAR AS THE TIMELINE GOES,
THIS IS WHAT WE ARE THINKING
RIGHT NOW. AS I SAID, WE ARE
REALLY INTERESTED IN ENGAGING
THE SCIENTIFIC COMMUNITY, BUT
ALSO PEOPLE WOULD LIVED
EXPERIENCE AND THE GENERAL
PUBLIC AND SO WE ARE WORKING
WITH NIDA TO GET PUBLIC INPUT.
WE ARE IN THIS TIME PERIOD OF
APRIL AND MAY FOR WE APPOINTED
THE COCHAIRS FOR THE HEAL PAIN
STRATEGIC PLANNING AND
EXECUTIVE COMMITTEE AND WORKING
ON IDENTIFYING ADDITIONAL
COMMITTEE MEMBERS. AND THEIR
FIRST TASK IS TO THINK ABOUT
THE WAY WE WANT TO ORGANIZE THE
SCRIPT AROUND DIFFERENT
SCIENTIFIC FOCUS AREAS. THAT IS
HAPPENING NOW THROUGH JUNE.
AND SUBCOMMITTEES WILL BE
FORMED AROUND THOSE DIFFERENT
FOCUS AREAS. AND THAT IS
REALLY WHERE A LOT OF THE WORK
WILL BE DONE, THE DOSE OF
COMMIT WILL BE TASKED WITH
FURTHER ENGAGEMENT THROUGH
LISTENING SESSIONS, MAY BE
ADDITIONAL RFIS AND SOME OTHER
SORT OF MORE IN-DEPTH MEETINGS
TO GET AT RESEARCH PRIORITIES.
AND LATER THIS YEAR BEGINNING
NEXT YEAR WE WILL GO THROUGH
THE PROCESS OF PRIORITIZING
WHAT THOSE RESEARCH TOPICS WILL
BE FOR THE NEXT PHASE OF HEAL
PAIN. AND THOSE WILL BE
FORMALLY PRESENTED TO THE NINDS
ADVISORY COUNCIL FOR APPROVAL
AND I DID WANT TO MENTION THAT
THE SCOPE OF THIS GROUP AND THE
STRATEGIC PLAN CROSS ACROSS ALL
THE ICS, BUT WE'RE INTERESTED
IN ENSURING THAT THIS
COLLABORATIVE AS POSSIBLE
ACROSS ALL OF THE OTHER
INSTITUTES AND CENTERS AND
WITHIN HEAL PAIN.
ALONG THE WAY WE WILL WORK WITH
OUR COLLEAGUES AT NIDA TO
DEVELOP A CROSSCUTTING
STRATEGIC PLAN. AND DEVELOPING
A TIMELINE AND I WILL CLOSE BY
SAYING THAT WE ARE REALLY AS
WALTERS SAID, WITH THESE BUDGET
WE ARE LOOKING AHEAD TO FY 27
WHEN THE BUDGET LOOSENS UP A
LITTLE BIT FOR THE PROJECT TO
COME TO A CLOSE, AIMING TO
ENSURE THE PROJECT PLANNING
INFORMS WHAT DOES FY 27 FUNDING
OPPORTUNITIES WILL LOOK LIKE. I
WILL STOP THERE. THAT MIGHT BE
THE END OF THE DISCUSSION. I
DON'T KNOW IF WALTER HAS ANY
ADDITIONAL SLIDES.
>> DR. WEISS: THANKS VERY MUCH.
I THINK WE ARE OPEN NOW FOR
THE DISCUSSION ABOUT LAURA AND
WALTER AND JACKIE'S
PRESENTATION. WE HAVE ABOUT 20
MINUTES. I WILL UNMUTE YOU.
>> DR. VOLKOW: THERE DOES NOT
SEEM TO BE ANY QUESTIONS.
WALTER?
>> DR. KOROSHETZ: NORA, HERE IS
A HARD ONE. IF YOU HAD TO DO IT
ALL OVER AGAIN, WHAT WOULD YOU
DO DIFFERENTLY?
>> DR. VOLKOW: I CERTAINLY
WOULD'VE LIKED TO TAKE
ADVANTAGE FROM MORE OBJECTIVE
WAYS OF MONITORING THE DRUGS IN
THE COMMUNITIES. I THINK THAT
IT TOOK US A WHILE TO REALLY
UNDERSTAND THAT. AND IF WE
HAVE THE TOOLS IN PARTICULAR,
WASTEWATER, DEPLOYING THAT. ONE
OF THE THINGS THAT I ALWAYS
FELT VERY FRUSTRATED WITH THE
INABILITY TO DEPLOY THE
WASTEWATER WITH THE HEALING
COMMUNITIES STUDIES. THAT
WOULD HAVE GIVEN US A BROADER
PERSPECTIVE ON THE ONE HAND OF
WHAT DRUGS WERE THERE. BUT
ALSO HOW EFFECTIVE IS OUR
IMPLEMENTATION FOR TREATMENT.
SO IS THERE NALOXONE IN THE
WASTEWATER? OR ARE WE
DISTRIBUTE IN IT, AND NEVER BE
USED?
SO A SECOND ONE WALTER, THIS IS
SOMETHING THAT WOULD BECOME
MORE CENTRALIZED, WE SHOULD
HAVE FROM THE BEGINNING ENGAGED
WITH MORE ACTIVE PARTICIPANTS.
PEOPLE THAT HAVE LIVED
EXPERIENCE IN TREATMENT. BUT
PEOPLE THAT WERE STRUGGLING IN
THEIR-- EITHER THE USE OF
SUBSTANCES, THAT ARE NOT
INTERESTED ONGOING TO
TREATMENT. LISTENING TO THEM.
THAT WAS NOT SOMETHING WITH IT
UNTIL VERY RECENTLY.
I ALSO THINK IF WE HAD A
RETROSPECTIVE ON UNDERSTANDING
TEENAGERS EXPOSED TO
PSYCHOTHERAPEUTIC, WOULD HAVE
ENABLED US TO DEPLOY PREVENTION
INTERVENTION, THAT WERE
TAILORED TOWARDS THIS RISK.
AND CERTAINLY ALL OF THE WORK
ON THE UNDERREPRESENTED GROUPS
HAS EMERGED MORE RECENTLY. FOR
EXAMPLE THE SORT OF RECOGNITION
ON NATIVE AMERICANS, AND BLACK
AMERICANS, THAT WE NEED TO HAVE
TAILORED INTERVENTIONS FOR
THEM. WE HAVE VERY LITTLE FOR
ADOLESCENTS, IN TERMS OF
TREATMENT. THERE IS A HUGE GAP
AREA WE TO ADVANCE IT.
SO THESE ARE OVERALL LESSONS
LEARNED FROM HAVING SEEN THE
EPIDEMIC EMERGE. I WISH I HAD
IT AT THE BEGINNING, WHEN WE
WERE MAKING THE DECISIONS.
I STAND BY THE WHOLE DECISION
STRUCTURE TO INVEST
IMPLEMENTATION IN HEALTH CARE,
IN JUSTICE SETTINGS, AND IN
COMMUNITIES. AND AT THE SAME
TIME, INVEST IN THERAPEUTICS.
OTHERWISE WE WILL ALWAYS BE
FINDING THOSE INDIVIDUALS THEY
DON'T RESPOND TO THE
MEDICATIONS, OR STOP TAKING
THEM.
IN MY LAST SLIDE, I DID
IDENTIFY THE AREAS WHERE WE
HAVE THE KNOWLEDGE RIGHT NOW.
WE NEED TO STRENGTHEN THAT. SO
I HOPE WALTER THAT ANSWER YOUR
QUESTION.
>> THANKS LAURA.
>> DR. VOLKOW: I'M GOING TO ASK
YOUR QUESTION BECAUSE I DON'T
SEE ANY OTHER QUESTIONS.
IN TERMS OF-- YOU HAVE BEEN SO
INVOLVED. YOU'VE ACTUALLY
SPOKEN SO VERY MUCH IN TERMS OF
THE NEUROBIOLOGICAL-- I'M GOING
TO SHUT UP. I SEE OTHER PEOPLE
RAISING THEIR HANDS. I WOULD
RATHER LISTEN TO THEM. ELISEO
PLEASE.
>> I JOINED A BIT LATE. AND
MISSED THE FIRST PART NORA.
REFLECTING ON WHAT HAS BEEN
GOING ON IN THE SPACE OF
TRANSFORMATIVE ANALYSIS, I AM A
UCSF PRIMARY CARE DOCTOR, HOW
THINGS HAVE SHIFTED, AND THE
LATEST ONE. AND WHETHER HEAL
IN ALL ITS ASPECTS NEEDS TO
SORT OF ADAPTER THAT AND HOW
NIMBLE CAN WE BE? THAT WAS ONE
THOUGHT.
PRESCRIBING OF OPIOIDS IN THE
CLINICAL SETTING HAS DEFINITELY
BEEN IMPACTED BY THIS AWARENESS
BEFORE HEAL. NOT TO THE POINT
WHERE WE WANT PEOPLE HURT
BECAUSE THEY ARE NOT GETTING
SUFFICIENT PAIN MEDICINE, WHEN
THEY HAVE CONDITIONS THAT ARE
NOT MANAGEABLE. AND WE STILL
HAVE NOT -- I'VE NEVER SEEN
THAT CHRONIC OPIOIDS ARE GOOD
FOR CHRONIC PAIN, IN TERMS OF
COMPARISON TO OTHER THERAPIES.
BUT IN A TRIAL BASIS.
BUT THEN, N CREW IS EXCITING.
EVERYTHING I'VE SEEN. WHAT
ABOUT AN N CREW FOR AFRICAN
AMERICAN COMMUNITIES? THEY
COULD BE IN A PILOT PROSPECT.
PERHAPS AREAS THAT COULD BE
HIGHEST AFFECTED. COULD BE THE
DISTRICT OF COLUMBIA. WE HAVE
A PROGRAM AT MHMD, 13" PCUS ARE
PART OF IT, INCLUDING HOWARD.
IT IS A THOUGHT OUT THERE WITH
LIMITED FUNDS. IN THE NEXT
COUPLE OF YEARS TO THINK ABOUT
THAT.
>> DR. VOLKOW: YOU CANNOT
IGNORE WHAT IS HAPPENING IN
BLACK COMMUNITIES. I DO LIKE
VERY MUCH THE ISSUE OF A PILOT
PROGRAM. AND WE HAVE BEEN
DISCUSSING THIS IN THE INTERNAL
PROGRAM IN ULTIMO BECAUSE THERE
IS A BLACK COMMUNITY
PREDOMINANTLY. IT IS
DEVASTATING OVER THERE. IT
COULD ENABLE US TO DO A
DEPLOYMENT THAT FOCUSES
SPECIFICALLY IN OUR BACKYARD.
SO, THERE IS THE
INFRASTRUCTURE TO DO IT.
IN THE DISTRICT OF COLUMBIA,
THE TREATMENT IS NOT AS
EXPENSIVE AS BALTIMORE. BUT WE
CAN DISCUSS THIS AS A SEPARATE
IDEA.
>> I WAS AT A MEETING MONDAY
MORNING, WE DEFINITELY SHOULD
TALK FURTHER BECAUSE I THINK
THERE'S OPPORTUNITY THERE.
>> DR. VOLKOW: GREAT
SUGGESTIONS.
>> THANKS FOR THE PRESENTATION.
WERE INTERESTING AND
ILLUMINATING. MY QUESTION IS
ABOUT THE ISSUE OF
ENVIRONMENTAL JUSTICE. SO, AT
LEAST THE IC DIRECTORS KNOW
THAT ENVIRONMENTAL JUSTICE IS A
MAJOR AREA OF FOCUS FOR
SECRETARY BECERRA AND OTHER
PARTS OF THE US GOVERNMENT. BUT
A LOT OF US IN ENVIRONMENTAL
JUSTICE HAVE TRADITIONALLY
FOCUSED AND POPULATIONS EXPOSED
TO AIR POLLUTION AND TOXIC
CHEMICALS IN VARIOUS THINGS.
BUT THE SAME COMMUNITIES--
THOSE ENVIRONMENTAL JUSTICE
COMMUNITIES-- ARE EXACTLY THE
ONES THAT YOU WERE HIGHLIGHTING
IN YOUR PRESENTATION. IS THAT
CORRECT? IS ENVIRONMENTAL
JUSTICE, IS THE DEFINITION
FUNDAMENTALLY INCLUDE OPIOID
USE DISORDERS? IF NOT WE SHOULD
BE EXPANDING THE DEFINITION OF
ENVIRONMENTAL JUSTICE.
>> DR. VOLKOW: THAT IS A GOOD
POINT. I WOULD NOT FEEL
COMFORTABLE DETERMINING-- NOT
TO MY KNOWLEDGE. I DON'T THINK
IT IS INCLUDED THERE. BUT IT
DOES REFLECT. NOT SURPRISING.
PEOPLE THAT ARE VULNERABLE THEY
DON'T HAVE A WAY OUT, THERE ARE
IN DESPAIR, ALL COME TOGETHER.
NOT SURPRISING. PEOPLE FEEL
COMPLETELY ABANDONED BY THE
SYSTEM ARE THE ONES THAT ARE
VULNERABLE. AND THAT IS WHERE
THEY ALSO GET-- THEY DON'T HAVE
THE MEANS TO ENSURE THAT THEY
HAVE AN ENVIRONMENT THAT IS
HEALTHY. I WOULD WELCOME THE
OPPORTUNITY, BECAUSE AGAIN
THESE ARE ISSUES THAT PEOPLE IN
NATIVE LANDS HAVE TO DEAL WITH.
THAT LEADS THEM TO DISTRESS,
AND HOPELESSNESS. THIS ASPECT
OF ENVIRONMENTAL TOXIC
EXPOSURES ARE DRIVING FURTHER
THE DISPARITIES. I WOULD BE
VERY INTERESTED IN ALSO
LISTENING TO OTHERS. BECAUSE
SOMETIMES IF YOU ADD MORE
THINGS INTO CONCEPTS, IT CAN
GET DILUTED.LET'S DISCUSS IT.
IT IS A GOOD POINT, RELATED
OBVIOUSLY. WE WILL FOLLOW UP
ON THAT.
>> WE CAN FOLLOW UP. AND I WILL
HAVE TREVOR ARCHER LEADING THE
NIH-WIDE INITIATIVE. I SEE
THESE THINGS SO INTERCONNECTED.
SOME OF THE ENVIRONMENTAL
JUSTICE COMMUNITIES WERE LIVING
IN TOXIC ENVIRONMENTS. THE
HELPLESSNESS MAY LEAD THEM TO
OPIOID USE DISORDERS. AND IT
EXACERBATES THE PROBLEM.
>> DR. VOLKOW: ABSOLUTELY, YES.
>> GREAT PRESENTATION, VERY
WELL DONE.
>> I KEEP SAYING THIS -- WE DO
THE SIGNS AND SOMEHOW WE CAN'T
GET THE SIGNS TO LOOK FORWARD.
I THINK ACTUALLY, THE NEW
SURVEY, NATIONAL SURVEY ON
HEALTH, IS ONLY 18% OF PEOPLE
THAT ARE GETTING -- -- ALWAYS
TRYING TO LOOK FOR OTHER WAYS
THAT WE CAN ENFORCE IT THROUGH
SOME QUALITY MEASURE STUFF. I
KNOW WE DO THAT IN STL
ELEVATION-- THAT IS REALLY DONE
THROUGH MEDICARE. HOW WE DO
THAT THROUGH MEDICAID, OR HOW
WE DO THAT SOME OTHER WAYS,
IT'S JUST WORTH NOTING. LIKE
THE JAILS AND PRISONS. THERE
MUST BE A WAY TO MAKE PRISONS--
I MEAN AT LEAST IN THE FEDERAL
SYSTEM, HOW DO WE MAKE THEM
GIVE OUT MEDICATION? I DON'T
KNOW THAT. I AM PUTTING IT OUT
THERE. AND WHAT ADVOCACY
GROUPS, OR WHAT OTHER THINGS WE
COULD BE DOING TO MAKE THOSE
THINGS HAPPEN.
BECAUSE I AM AT A LOSS. I GIVE
A LOT OF TALKS. WE GET A LOT OF
MONEY FROM YOU THANK YOU BUT MY
DOING THE TALKING DOES NOT DO
ANYTHING. IS REALLY MORE ABOUT
PUTTING THINGS IN PRACTICE,
WHICH WE HAVE TRIED A LOT TO
DO. WE HAVE OUR EHRS NOW
ADOPTING CERTAIN CLINICAL
PATHWAYS FOR DOING THAT IN EDS.
I THINK WE ARE GETTING CLOSER.
BUT, I'M JUST KIND OF
WONDERING, HOW WE COULD-- THAT
IS MY FIRST QUESTION-- HOW WE
CAN DO THESE QUALITY MEASURES
OR THESE ADVOCACY THINGS THAT
WE COULD DO TO MAKE IT BETTER.
THE ONLY OTHER THING I WANTED
TO COMMENT, HEALING
COMMUNITIES, NOT BE DISTRAUGHT
ABOUT THAT. BECAUSE LOOKING AT
THE OVERWHELMING AMOUNT OF
OVERDOSE, LUCKILY OVERDOSES ARE
NOT ESCALATING, NOT GETTING
BETTER, BUT NOT HORRIBLY
ESCALATING. AND THERE IS ONLY
SO WE CAN DO ABOUT NALOXONE
THAT IS AVAILABLE BUT WHEN WE
TALK ABOUT PATIENTS IN OUR
STUDIES ABOUT NONFATAL
OVERDOSES, WE REALLY ARE
PREVENTING MANY NONFATAL
OVERDOSES. I JUST WANTED TO
KNOW, DON'T TAKE THAT TO HEART
THAT IT IS NOT BEING DONE.
BECAUSE THE AMOUNT OF NONFATAL
OVERDOSES THAT WE KNOW ARE
OCCURRING ARE ESCALATING. IT IS
HARD TO FIND THE DATA SINCE
THEY DON'T COME TO THE ED OR
WHATEVER. IT IS REALLY BY
TALKING TO PEOPLE, AND ASKING
ABOUT IT. ANYWAY THOSE ARE MY
TWO COMMENTS.
>> DR. VOLKOW: THOSE ARE VERY
GOOD COMMENTS INTO THE LAST
ONE, ONE OF THE THINGS WE
STARTED IS A PILOT PROJECT TWO
DIFFERENT PIS, AND OBTAIN
WASTEWATER AND LOOK AT NALOXONE
TO SEE IF WE SEE CHANGES. AND
SEE THAT CORRELATE TO THE
PRESCRIPTION OF NALOXONE.
AS I SAID, THE DIVISION OF
NALOXONE HAS INCREASED
SIGNIFICANTLY. BUT WE KNOW HOW
MUCH WAS DEPLOYED. THE OTHER
ONE THAT RELATES ULTIMATELY IS
HOW DO WE ENSURE THAT
EVIDENCE-BASED IS IMPLEMENTED?
WHY ARE WE STILL STRUGGLING
WITH SUCH A TERRIBLE GAP? AND
AGAIN THERE IS NOT JUST ONE
ANSWER TO THAT. BUT ONE HAS TO
LOOK AT WHICH ARE THE TRACTABLE
ONES WHERE WE CAN INTERVENE.
AND CERTAINLY ONE OF THE
ASPECTS THAT MAKES CLINICIANS
NOT BE WILLING TO PRESCRIBE OR
EVEN SCREAM PEOPLE FOR OPIOID
USE DISORDER IS A LEVEL OF
REIMBURSEMENT THEY GET IS
INADEQUATE FOR THEM. THEY WOULD
MAKE MUCH MORE MONEY TREATING
OTHER CONDITIONS.
THE OTHER ASPECT OF IT IS NOT
STRAIGHTFORWARD. EVEN THOUGH
THERE IS A LAW THAT THAT SHOULD
NOT DISCRIMINATE IN
REIMBURSEMENT FOR MEDICATION OR
TREATMENT, THAT IS NOT
NECESSARILY AT ALL DEPLOYED. SO
THE AMOUNT OF-- YOU CAN GET THE
INSURANCE TO PAY FOR
BUPRENORPHINE. BUT IF YOU WANT
TO DO AN EXTENDED RELEASE, GOOD
LUCK WITH IT. THERE ALWAYS
ECONOMIC BARRIERS THAT DO NOT
INCENTIVIZE CLINICIANS TO DO
THE PROPER THING.
HOW DO WE TACKLE THAT?
CERTAINLY I DO-- WE HAVE TO
SPEAK WITH PEOPLE THAT ARE
ACTUALLY AT HIGHER GOVERNMENT
LEVELS THAT ARE RESPONSIBLE FOR
DEFINING WHAT THOSE
REIMBURSEMENTS ARE. BUT WE
ALSO NEED TO ACTUALLY SHOW DATA
THAT YOU CAN IN THE HELPER
SYSTEM SIGNIFICANTLY IMPROVE
OUTCOMES AND SAVE MONEY IF YOU
IMPLEMENT THEM IN A SYSTEMATIC
WAY. AND ARPA-H TO THE HEROES
PROGRAM, IS LAUNCHING THIS-- WE
ARE DISCUSSING IT-- THEY ARE
GOING TO GIVE THE PRIZE FOR A
HEALTHCARE SYSTEM ABLE TO SHOW
INTERVENTIONS AND REDUCE THE
COSTS AND IN MY BRAIN IF YOU
SYSTEMATICALLY PROVIDE
MEDICATIONS TO EMERGENCY
DEPARTMENTS FOR TREATMENT YOU
WILL REDUCE THE NUMBER OF
HOSPITALIZATIONS AND EMERGENCY
DEPARTMENT USE. YOU CAN
DOCUMENT IT.
THERE ARE MULTIPLE THINGS IN
TERMS OF CREATING DATA, THAT
HOPEFULLY CAN INFORM POLICY AND
INCENTIVIZE THE HELPER SYSTEM
TO DO THE RIGHT THING AND THAT
IS WHERE WE STAND RIGHT NOW.
>> JUST BE CAREFUL ABOUT THE
REPEAT VISITING WHICH I FIGHT
WITH ALL THE TIME. AS YOU
MENTIONED IN ONE OF YOUR SLIDES
ABOUT THE SOCIAL DETERMINANTS
OF HEALTH, OUR PATIENTS ARE ALL
UNHOUSED OR HAVE UNSTABLE
HOUSING. THE ENTIRE SYSTEM IS
BROKEN SO INDIVIDUAL WILL ONLY
USE THE ED IS THE ONLY SOURCE
OF CARE. SO THE REPEAT,
ELIMINATE THE AROUND OF
SUBSTANCE USE DISORDER, FOR
WHATEVER ELSE THEY NEED TO DO.
IT IS JUST A CAUTION TO BE
CAREFUL ABOUT IT.
AND ONE POSITIVE NOTE WITH THE
SEVEN DAY EJECTABLE, WE HAVE
MANY PEOPLE IN OUR STUDY, MANY
SITE IN OUR STUDY INCLUDING NEW
HAVEN, GRADY, UNIVERSITY OF
PENNSYLVANIA, ALL HAVE AGREED
TO PUT THE 7-DAY EJECTABLE IN
THEIR ED FORMULA. WE ARE MOVING
TOWARDS THAT. WE NEED A POINT
TO REDUCE. WE HAVE BEEN ABLE TO
GET THAT FAR.
>> DR. VOLKOW: THAT IS GREAT
NEWS. ERIC?
>> THANK YOU NORA FOR THE
EXCELLENT TALKING THANK YOU
WALTER AS WELL. JUST REFLECTING
ON THE HEALING COMMUNITIES
STUDY RESULTS, I CANNOT HELP
BUT FEEL A LITTLE SAD TO SEE
THAT. AND ALSO I REALLY
APPRECIATED YOUR ANALYSIS OF
WHY THE RESULTS WERE THE WAY
THEY WERE.
I WONDER IF THIS IS ALSO A
FUNCTION OF HISTORY IN THE
SENSE THAT THE STUDY WAS
LAUNCHED AT THE BEGINNING OF
THE NIH HEAL INITIATIVE. BUT
NOW WE HAVE HAD MANY YEARS OF
INNOVATIONS AND DISCOVERIES
FROM THE NIH HEAL INITIATIVE
NOVEL THERAPEUTICS, NOVEL
MEDICATIONS, NOVEL
PSYCHOTHERAPEUTIC
INTERVENTIONS. I'M HOPING THAT
THERE WILL BE A HEALING
COMMUNITIES TOO AT SOME POINT
TO TAKE THE MOST EFFICACIOUS
MEDICATIONS DEVELOPED OVER THE
COURSE OF THE NIH HEAL
INITIATIVE AND TESTAMENT AGAIN
IN THIS LARGE-SCALE
IMPLEMENTATION KIND OF WAY IN
THE COMMUNITY. BECAUSE WHAT WE
DID IN THE HEALING COMMUNITIES
STUDY IS TO TEST TO THE BEST OF
OUR KNOWLEDGE IN TERMS OF HOW
TO HELP THIS PROBLEM AT THAT
POINT. HOPEFULLY WE HAVE
EVOLVED THAT NOW, OVER THE
COURSE OF THE PAST FIVE YEARS
OR SO.
>> DR. VOLKOW: WELL ERIC, A LOT
OF THE KNOWLEDGE WAS THERE. I
FEEL WE HAVE COME A LONG WAY
WITH INFORMATIVE INFORMATION ON
HOW TO ACTUALLY TREAT PEOPLE
WITH AN OPIOID USE DISORDERS,
OR HOW TO DISTRIBUTE NALOXONE,
AND THE FACT WE NEED TO HAVE
BETTER PRACTICES FOR PAIN. I
THINK THAT THE CHALLENGE
OBVIOUSLY IS HOW TO WORK IN A
COHESIVE INTEGRATED FASHION.
AND HOW TO FORM COALITIONS A
COMMENT TO THE COMMUNITY AND BE
MORE EFFECTIVE. LESSONS LEARNED.
THE LESSONS LEARNED IS NOW
BEING IMPLEMENTED ON WAVE 2.
WE ARE NOW PROVIDING ALL OF THE
INTERVENTIONS TO WAVE 2. WE
WILL SEE HOW THE OVERDOSE
MORTALITY COMPARED TO THE YEAR
BEFORE WITH THIS IMPLEMENTATION
THAT IS ACTUALLY GOING TO BE
EXPEDITED. BECAUSE WE ARE
OBVIATING SOME OF THE INITIAL,
SLOW STEPS THAT WERE TAKEN. I
THINK THAT WE WILL NOT HAVE THE
COVID PANDEMIC WHICH WAS
BASICALLY A TREMENDOUS
CHALLENGE. AND WHAT IS
SURPRISING IS THAT DESPITE THE
COVID PANDEMIC-- AND REMEMBER
THE FIRST 18 MONTHS, EVERYTHING
SHUT DOWN. PEOPLE COULDN'T GO
INTO THE JAIL SYSTEMS. WE DON'T
HAVE THAT. BUT WE LEARNED A LOT
ABOUT HOW TO ADJUST, AND DO
RESEARCH.
SO WE WANT TO TAKE ABSOLUTELY
THE ESSENCE OF WHAT HAS COME,
THAT WE HAVE LEARNED FROM THE
HEALING COMMUNITY STUDIES AND
TRANSLATE IT IN A WAY THAT CAN
BE TRANSLATED TO OTHER
COMMUNITIES. AND THAT IS A WAY
WHERE WE CAN SEE THE HEALING
STUDY GO TO 2.0. HOW DO WE
EXPAND AND TRANSLATE WHAT IS
USEFUL? AND WHAT WE LEARN FROM?
AS WELL AS OTHER THINGS THAT
MAY HAPPEN IN BETWEEN.
>> THANK YOU. I THINK THERE HAS
TO BE NOVELTY AND INNOVATION
THAT IS BEEN GENERATED FOR THE
REST OF THE HEAL INITIATIVE
THAT CAN REALLY BE INTEGRATED
INTO HEALING COMMUNITIES 2.0 TO
INCREASE THE EFFICACY OF THE
INITIATIVE. THANK YOU.
>> DR. VOLKOW: I THINK ED HAD
HIS HAND UP?
>> THANK YOU NORA. FOLLOWING
UP ON GAIL'S POINTS ABOUT
EMERGENCY INTERVENTIONS, AND
YOUR RESPONSE ANTICIPATED MY
QUESTION. BUT I REALLY LIKED
THE ANALOGY BETWEEN THE ST
ELEVATION AND THE RESPONSE IN
THE EMERGENCY ROOM AND HOW THAT
HAS BEEN INCENTIVIZED. AND THE
RESPONSE TO PATIENTS WITH AN
OVERDOSE OR OPIOID USE DISORDER
THAT COMES TO THE EMERGENCY
ROOM. HOSPITALS GET PAID A LOT
OF MONEY TO INTERVENE WITH THE
PATIENT UP TO THE CATH LAB PUT
IN STINTS, ETC., THAT IS REALLY
REIMBURSED VERY WELL.
I WONDER IF IT IS WORTH NEEDING
ABOUT STUDIES THAT LOOK AT THE
VARIED REIMBURSEMENT. TO SEE
WHETHER VARYING REIMBURSEMENT
FOR THESE ACUTE INTERVENTIONS
THAT WE KNOW CAN MAKE A BIG
DIFFERENCE ENSURE EFFECTIVENESS
AND CROSS EFFECTIVENESS DOWN
THE LINE.
ONE OTHER THING THAT STRUCK ME
ABOUT THE HEALING COMMUNITY
STUDIES, A LOT OF THE MONEY
WENT INTO RESEARCH OF ONE KIND
OR ANOTHER. SOME MONEY WENT
INTO THE COMMUNITIES. BUT THE
FUNNY THAT WENT INTO THE
COMMUNITIES TO AUGMENT
TREATMENT SERVICES AND SO FORTH
WAS LIMITED. I WONDER ABOUT THE
IDEA OF STARTING REIMBURSEMENT
AS AN INTERVENTION IN THE
COMMUNITY. OR HEALTH CENTER
LEVEL. WOULD MORE PEOPLE GET
INVOLVED IN THIS? AND WOULD
MOUD, MEDICATION AND
EVIDENCE-BASED PRACTICES
DISSEMINATE FASTER IF YOU GOT
PAID MORE TO DO IT?
>> DR. VOLKOW: I THINK IT IS A
GREAT IDEA. I AM THINKING HOW
TO DEPLOY SUCH A STUDY. IT IS A
GOOD IDEA.
>> I THINK WE SHOULD MOVE ON.
WE ARE JUST ABOUT ON-TIME.
THANK YOU ALL. AND WALTER, DO
YOU WANT TO INTRODUCE ELAINE?
SHE IS HAVING SOME INTERNET
ISSUES AND WE HAVE TO WORK IT
OUT WITH HER.
>> DR. KOROSHETZ: LOOKS GREAT
RIGHT NOW.ELAINE IS THE
DIRECTOR OF NATIONAL CENTER FOR
INTEGRATED CENTER FOR COMMUNITY
HEALTH. SHE SPENT HER CAREER
STUDYING PAIN AND NONADDICTIVE
THERAPEUTICS FOR PAIN. SHE HAS
BEEN AS I MENTIONED ONE OF THE
CO-DIRECTORS OF THE ICD GROUP
FOR HEAL PAIN. AND SHE WILL
TALK TO US TODAY ABOUT THE
PRAGMATIC TRIAL PROGRAM AT
HEAL.
HELEN?
>> DR. LANGEVIN: THANK YOU
AGAIN WALTER AND MY INTERNET
HAS BEEN A LITTLE BIT SLIPPERY.
IF I HAVE A PROBLEM I WILL
SWITCH TO A DIFFERENT MODE. CAN
I HAVE MY SLIDES UP PLEASE?
I APPRECIATE THE OPPORTUNITY TO
TALK ABOUT TWO PROGRAMS THAT
ARE NOT ACTUALLY HEAL PROGRAMS
BUT THAT DO INTERFACE WITH HEAL
IN A MUTUALLY BENEFICIAL WAY.
ONE IS THE PRAGMATIC TRIAL
COLLABORATORY OR PCPC AND THE
OTHER IS THE NIH PAIN
MANAGEMENT COLLABORATORY OR
PMC, THE ACRONYMS ARE SIMILAR
AND SOMETIMES THE PROGRAMS GET
CONFUSED. I HOPE YOU WILL SEE
HOW IMPORTANT THEY ARE FOR THE
HEALING INITIATIVE. NEXT SLIDE.
I WILL START WITH THE
MOTIVATION FOR WHY DO WE NEED
COLLABORATORY TYPE OF RESEARCH
PROGRAMS? THAT HELP US ADDRESS
VERY, VERY IMPORTANT PROBLEM
WHICH HAS COME UP MANY TIMES IN
THE DISCUSSIONS THAT WE HAVE
HAD HERE AT THE MDWG. AND WERE
RAISED A SECOND AGO GY GAIL,
AND ALSO MENTIONED BY NORA IN
HER PRESENTATION.
THERE IS A HUGE PROBLEM IN HOW
RESEARCH THAT IS HAPPENING,
THAT IS SUCCESSFUL, ETC., HOW
THE IMPLEMENTATION AND THE
UPTAKE OF THE RESEARCH
FINDINGS INTO ACTUAL PATIENT
CARE?
IT IS A DISCONCERTING NUMBER.
IT TAKES 17 YEARS FOR RESEARCH
TO BE APPLIED TO CLINICAL
THERAPY. NOT ONLY DOES IT TAKE
TIME BUT 14% OF RESEARCH, BY
SOME ESTIMATES, HAS ACTUALLY
APPLIED TO PATIENT CARE AND
ONLY 18% OF PRACTITIONERS
REPORT REGULARLY USE
EVIDENCE-BASED PRACTICE. THIS
IS A PROBLEM.
HOW DO WE CLOSE THIS GAP? HOW
DO WE ADDRESS THIS? THIS IS
WHAT THE TWO COLLABORATORY
PROGRAMS GO TALK ABOUT ARE IN
RESPONSE TO THIS. HOW DO WE
PUT TOGETHER A STRUCTURE THAT
WILL STRENGTHEN CAPACITY TO
REALLY TRANSLATE RESEARCH INTO
CARE? NEXT SLIDE.
SO, STARTING WITH BOTH OF THESE
PROGRAMS INVOLVE PREGNANT
TRIALS. IN ONE QUICK WORD ABOUT
WHAT A PRAGMATIC TRIAL IS. AN
EXPLANATORY TRIAL, THE ONES WE
ARE MOSTLY USED TO, ARE TO
DETERMINE THE EFFECT OF AN
INTERVENTION COMPARED WITH THE
PLACEBO CONTROL FOR EXAMPLE.
THESE ARE USUALLY TESTED UNDER
IDEAL CIRCUMSTANCES. USUALLY IN
THE RESEARCH SETTING. AND THE
PATIENT POPULATIONS CAREFULLY
SELECTED TO MINIMIZE
CONFOUNDERS, ETC. A TYPE OF
CONTROL.
IN CONTRAST, A PRAGMATIC TRIAL
IS A TRIAL THAT ADDRESSES A
DIFFERENT KIND OF QUESTION. NOT
SO MUCH DOES THE INTERVENTION
WORK. BUT WHAT HAPPENS WHEN
THIS INTERVENTION IS
IMPLEMENTED FOR EXAMPLE IN
HEALTHCARE? WHAT ARE ITS
EFFECTS? WHAT ARE THE VARIOUS
FACTORS THAT WILL INFLUENCE THE
EFFECTIVENESS OF THIS
INTERVENTION? NEXT SLIDE.
SO, THERE ARE DIFFERENT
CHARACTERISTICS. WE CALL HIM
THE FIVE RS OF THE CLINICAL
TRIALS. FIRST OF ALL THEY HAVE
TO ASK A QUESTION THAT IS
RELEVANT TO PATIENT CARE, IN A
VERY PRACTICAL WAY. THE TRIAL
ITSELF NEED TO BE PRACTICED IN
WHAT WE CALL A REAL-WORLD
SETTING. NOT A RESEARCH
ENVIRONMENT, BUT AN ACTUAL
PLACE LIKE A CLINIC OR
HOSPITAL, ETC., WHERE
HEALTHCARE IS BEING PRACTICED.
THE POPULATION THAT IS TESTED
NEED TO BE REPRESENTATIVE OF
THE RELEVANT POPULATION,
INCLUDING REPRESENTATION OF
VARIOUS DIFFERENT CIRCLES.
RACIAL, ETHNIC GROUPS,
SEX/GENDER, ETC.
IMPORTANTLY THE DATA COLLECTION
NEEDS TO BE REALLY KIND OF PART
AND PARCEL OF CARE. ONE
EXAMPLE OF THAT IS TO DIRECTLY
USE HEALTH RECORDS FOR EXAMPLE
TO USE AS COLLECTIVELY ARE
GENERATED BY THE PRACTITIONERS
THEMSELVES. AND FINALLY IT HAS
TO BE RIGOROUS. THIS IS REALLY
IMPORTANT.
SOMETIMES PRAGMATIC TRIALS GET
REPETITION OF BEING RESEARCH
DONE IN AN UNCONTROLLED WAY.
THE COULD NOT BE FURTHEST FROM
THE TRUTH. THE WAY OF
PERFORMING PRAGMATIC TRIAL IN A
GROUP IS TO RANDOMIZE.
SECONDLY, REALLY LOOK AT
CONFOUNDERS. LOOK AT ALL THE
FACTORS THAT COULD BE AFFECTING
THE RESULTS BESIDES CLINICAL
QUESTIONS BEING ASKED.
SO THE ART OF DOING THESE
TRIALS IS TO DO THEM IN A
RIGOROUS WAY. WHERE WE ENTER
THE PRAGMATIC TRIALS. NEXT
SLIDE.
SO, WHY ARE IS A PRAGMATIC
TRIAL COLLABORATIV? WHAT IS
MEANT TO DO. REALLY TO CREATE
AND PARTICIPATE IN WHAT WE CALL
LEARNING HEALTHCARE SYSTEM.
WHAT IS THAT?
THIS IS REALLY A HEALTHCARE
SYSTEM THAT UTILIZES, IS
ACTIVELY ENGAGED IN PERFORMING
AND USHERING AND INTERPRETING
RESULTS OF EMBEDDED,
LARGE-SCALE STUDIES THAT
ACTUALLY ENGAGE WITH THE
HEALTHCARE SYSTEM AND
HEALTHCARE DELIVERY
ORGANIZATIONS THEMSELVES. SUCH
THAT THERE ARE PARTNERS. THE
HEALTHCARE SYSTEM IS IN
PARTNERSHIP WITH THE DESIGN OF
THE STUDY, IN CONDUCTING THE
STUDY, AND GATHERING AND
INTERPRETING THE RESULTS. AND
FINALLY, (AUDIO LOST)
>> YEAH, SHE SAID SHE WAS GOING
TO CALL IN, IF SHE HAD TROUBLE.
>> (NO AUDIO)
>> MY BE IN BUILDING 31, WHERE
I AM HAVING TROUBLE TOO.
>> ... WITH NO RELEVANCE TO
CONTINUE THE CYCLE. HOW TO USE
SOMETHING LIKE THIS SUCH AS
HEALTHCARE CAN IMPROVE AS A
RESULT?
>> HELEN? MAYBE YOU SHOULD SHUT
OFF YOUR VIDEO NOW. WE JUST
LOST YOU A SECOND AGO.
>> IS IT BETTER?
>> YEAH.
>> GO BACK A SLIDE? WHERE DID
YOU LOSE ME?
>> YOU CAN START WITH THIS ONE.
>> WITH THIS ONE? THE LEARNING
HEALTHCARE SYSTEM. I WILL SAY
THAT AGAIN QUICKLY. SO THE
IDEA OF A LEARNING HEALTHCARE
SYSTEM IS WHERE PRAGMATIC
TRIALS ACTUALLY PERFORM IN THE
CONTEXT OF THE HEALTHCARE SUCH
THAT THE RESULTS OF THE STUDY
ARE IMPLEMENTED BY THE
HEALTHCARE SYSTEM FORMING SORT
OF THE LEARNING CYCLE OF
LEARNING AND FINALLY GENERATING
MORE CLINICAL QUESTIONS.
THE IMPORTANT THING TO ACHIEVE
THAT IS THAT THE HEALTHCARE
SYSTEM NEEDS TO BE A PARTNER IN
THE RESEARCH. SUCH THAT THE
RESEARCH QUESTIONS THAT ARE
ASKED ARE QUESTIONS THAT
ACTUALLY MATTER TO THE PEOPLE
WHO ARE PERFORMING THE CARE.
SUCH THAT THEY ARE INVESTED IN
THE RESULTS. AND, (AUDIO LOST)
>> IT MIGHT BE BETTER TO SWITCH
TO THE PHONE.
>> LET ME SENS HER A CHAT.
>> I'M SWITCHING TO A DIFFERENT
SYSTEM. HOW ABOUT NOW? ANY
BETTER?
>> SO FAR.
>> SO, DID YOU HEAR WHAT I SAID
ABOUT THE LEARNING HEALTHCARE
SYSTEM?
>> I THINK SO.
>> GETTING A CYCLE WHERE WE ASK
RESEARCH QUESTIONS ARE RELEVANT
TO THE HEALTHCARE SYSTEM, AND
THE HEALTHCARE SYSTEM IS
INVESTED IN THE RESULTS OF THE
STUDY, AND IN IMPLEMENTING
THESE RESULTS IN THE CONTEXT OF
THEIR CARE. WHICH CREATES A
LEARNING CYCLE.
STILL OKAY? STILL HEARING ME?
>> YES.
>> NEXT SLIDE.
ESSENTIALLY, THE PRAGMATIC
TRIAL COLLABORATIVE, I'VE BEEN
AT NIH SINCE 2012, THIS WAS A
STUDY, A PROGRAM THAT WAS
INITIALLY STARTED BY THE NIH
COMMON FUND. IT HAS BEEN GOING
ON EVER SINCE.
INITIALLY, THE FUNDING FOR THE
COMMON FUND, PROGRAM OUT OF THE
NIH'S DIRECTORS OFFICE WAS VERY
ACCESSIBLE IN THE TRANSITION
FROM A COMMON FUND TO SUPPORT
FROM THE NIH INSTITUTES AND
CENTERS. RECENTLY INTEGRATED
WITH THE NIH HEAL INITIATIVE
WHICH I WILL TELL YOU ABOUT.
AND ALSO HAS SPAWNED DIFFERENT
OTHER INITIATIVES AROUND THE
SAME KIND OF THEME. ONE OF THEM
BEING THE PAIN MANAGEMENT
COLLABORATORY, AND ALSO THE
IMPACT OF COLLABORATORY --
ISSUES AROUND AGING. NEXT SLIDE.
AN IMPORTANT PART OF THE
PRAGMATIC TRIAL'S
COLLABORATORY, IS IT PROVIDES A
WEALTH AND EXPERTISE IN VERY
IMPORTANT AREAS INCLUDING
BIOSTATISTICS AND STUDY DESIGN,
ETHICS, ELECTRONIC HEALTH
RECORDS, HEALTHCARE SYSTEMS
INTERACTIONS, AS WELL AS HEALTH
EQUITY. AND ALSO IMPLEMENTATION
OF SCIENCE. AND SO THERE ARE
IN ADDITION TO THIS, THERE ARE
WORKING GROUPS THAT HAVE HELPED
THE INVESTIGATORS TO DESIGN THE
STUDIES AND TO RUN THEM, ETC.,
AND TO MAKE SURE THAT THE STUDY
HAS THE OUTCOME THAT IS MOST
POSITIVELY USEFUL. NEXT SLIDE.
SO JUST TO GIVE YOU A SENSE OF
THE VAST NUMBER OF PARTNERS
THAT THE COLLABORATORY HAS NOW
BEEN WORKING WITH OVERALL THESE
YEARS. THERE'S BEEN 32
PRAGMATIC TRIALS INVOLVING 13
DIFFERENT NIH INSTITUTES AND
CENTERS YOU CAN SEE OVER 1000
CLINICAL SITES, ALMOST A
MILLION PARTICIPANTS. AND VERY
IMPRESSIVE SUCCESS IN TERMS OF
PUBLICATIONS, DISSEMINATIONS,
ETC., IN A VERY SUCCESSFUL
GRAND ROUNDS SERIES THAT IS
WELL ATTENDED. AS WELL AS A
WEBSITE THAT HAS WHAT IS CALLED
A LIVING TEXTBOOK FOR PEOPLE
CONSTANTLY ARE UPDATED ON BEST
PRACTICES, AND THEIR USEFUL
INFORMATION ALL CONDUCTING
PRAGMATIC TRIALS. NEXT SLIDE.
THIS SHOWS YOU WHAT KIND OF
MOSAIC OF ALL THE TRIALS THAT
HAVE BEEN FUNDED SO FAR BY THE
COLLABORATORY. IN YELLOW IS A
SHOW OF THE STUDIES ARE NOW
PART OF HEAL. ALSO AS IN
GREEN. THOSE ARE OUTLINED IN
YELLOW ARE PART OF A HEAL
PROGRAM CALLED PRISM, PRAGMATIC
AND IMPLICATIONS STUDIES THE
MANAGEMENT OF PAIN TO REDUCE
OPIOID PRESCRIBING. ALL
PRAGMATIC STUDIES, THE
PRAGMATIC MODEL OF SELLING
ABOUT. AND THEY UTILIZE THE
PRAGMATIC TRIALS COLLABORATORY
COORDINATING CENTER. AND THAT
IS HOW THEY ARE CONNECTED TO
THE PRAGMATIC TRIALS
COLLABORATORY.
AND THE STUDIES GREENER STUDIES
THERE ARE ABOUT RURAL PAIN
MANAGEMENT. AND THESE ARE AGAIN
PRAGMATIC STUDIES THAT ARE
CONNECTED TO THE PRAGMATIC
TRIALS COLLABORATORY. NEXT
SLIDE.
THIS SLIDE SHOWS YOU WHAT TYPES
OF STUDIES THESE ARE. YOU CAN
SEE THE ONE AT THE TOP. THERE
ARE SEVEN STUDIES THAT ARE PART
OF THE PRISM PROGRAM AND THREE
IN PAIN MANAGEMENT. DISCOVER A
RANGE OF NONPHARMACOLOGICAL
STUDIES, RANGING FROM
ACUPUNCTURE TO TRANSCUTANEOUS
NERVE STIMULATION, GUIDED
RELAXATION; THERE IS
MINDFULNESS. AS WELL AS A
VARIETY OF MANAGEMENT MODELS
IN THE RURAL CARE STUDIES. I
WANT TO HIGHLIGHT THE ONE AT TO
1 OF THE TOP. THE PRAGMATIC
TRIAL OF ACUPUNCTURE. THE STUDY
WAS DONE IN COLLABORATION WITH
CMS. THE STUDY IS TIED TO
COVERAGE DETERMINATION. SO WHAT
I WAS DISCUSSING EARLIER ABOUT
STUDYING HEALTHCARE
REIMBURSEMENT PATTERNS IS VERY
RELEVANT HERE. SO YOU CAN SEE
THAT THE CMS HAS COMMITTED TO
UTILIZING THE RESOURCES OF THE
STUDY IN ORDER TO MAKE
DECISIONS ABOUT COVERAGE. NEXT
SLIDE.
THIS IS TO SHOW YOU HOW THE
STUDIES ARE PROGRESSING. YOU
CAN SEE THAT DESPITE SOME
CHALLENGES DURING THE PANDEMIC,
MANY OF THE STUDIES ARE NOW--
YOU SEE THE TOP SEVEN-- THREE
OF THE SEVEN HAVE MET THEIR
ENROLLMENT TARGETS. AND THE
OTHER ONES ARE ON TRACK, THEY
ARE CATCHING UP PRETTY QUICKLY
AFTER A SLOWDOWN IN ENROLLMENT
DURING THE PANDEMIC. BUT NOW,
THEY ARE DOING QUITE WELL.
THE BOTTOM THREE ARE STILL IN
THE PILOT PHASE, THE ONE IN THE
RURAL PAIN PROGRAM. NEXT SLIDE.
I PRESUME YOU'RE STILL HEARING
ME. RIGHT? THIS SHOWS YOU A
TIMELINE, JUST TO SHOW YOU HOW
THIS IS GOING ON SINCE 2019,
WHEN THE HEAL INITIATIVE
STARTED TO FUND STUDIES THAT
UTILIZED THE PRAGMATIC TRIALS
COLLABORATORY. FOUR FUNDED IN
2019. TWO IN 2020. AND THE RULE
PAIN MANAGEMENT STUDIES WERE
ADDED IN 23 AND 24. WE
ANTICIPATE THE COORDINATED PAIN
CARE PROGRAM WILL ADD 3-4
TRIALS ANTICIPATED FOR 2025.
AND THEN, AS WE KEEP GOING,
ADDITIONAL TRIALS CAN BE ADDED
TO ADDRESS HEAL PRIORITIES AND
GAP.
NOTHING ABOUT THE MODELS WE
ESTABLISHED A STRUCTURE THAT IS
QUITE EASY. ALMOST
PLUG-AND-PLAY. EACH TRIAL THAT
WAS TO UTILIZE THE PRAGMATIC
TRIALS COLLABORATORY
COORDINATING CENTER CAN PAY
RELATIVELY MODEST ANNUAL SUM OF
MONEY TO UTILIZE THE
COORDINATING CENTER. THAT IS
EASY TO DO, AND IT GOES QUITE
WELL. NEXT SLIDE.
SO, I WANT TO NOW SHIFT GEARS A
LITTLE BIT TO TALK ABOUT THE
PAIN MANAGEMENT COOPERATIVE.
THIS IS A DIFFERENT
COLLABORATORY THAT IS IN THE
MILITARY. IT IS A COLLABORATION
BETWEEN NIH, DEPARTMENT OF
DEFENSE, IN THE VETERANS
ADMINISTRATION, TO TEST THE
IMPLEMENTATION AND EVALUATION
OF NONPHARMACOLOGICAL
APPROACHES TO THE MANAGEMENT OF
PAIN FUNDED IN 2017. IT NOW HAS
INCLUDED PRIMARY TRIALS, SOME
FUNDED BY NIH, OTHERS BY DOD
AND OTHERS BY THE VA. THIS IS
BEEN VERY SUCCESSFUL. IN FACT
FOR FY 23, AND OMNIBUS
APPROPRIATIONS BILL INCLUDED A
CONGRESSIONAL RECOGNITION TO
EXPAND ON THIS PROGRAM. NEXT
SLIDE.
SO, WHY THIS COLLABORATION?
WELL IT HAS BEEN CLEAR THAT
SERVICE MEMBERS OR VETERANS AND
ACTIVE DUTY MEMBERS,
DISPROPORTIONATELY SUFFER FROM
PAIN. WE KNOW THAT 29% OF
ACTIVE-DUTY SERVICE MEMBERS AND
32% OF VETERANS HAVE CHRONIC
PAIN. MANY OF THEM ARE AT HIGH
RISK. MANY OF THEM OVERLAPPING
WITH PTSD, TRAUMATIC BRAIN
INJURY, AND DEPRESSION AND EVEN
SUICIDE RISK. THIS IS A VERY
VULNERABLE POPULATION THAT --
AND IT'S ALSO VERY UNIQUE
SETTING. IT IS VERY INTERESTING
FROM THE POINT OF VIEW OF
RESEARCH. BECAUSE THIS IS AN
INTEGRATED STUDY OF THE
MILITARY THAT USES A SINGLE
ELECTRONIC HEALTH RECORD SYSTEM.
SO THE OPPORTUNITIES FOR DOING
RESEARCH WHERE DATA CAN BE
SHARED IS VERY, VERY GOOD. VERY
HIGH. WE HAVE BEEN TAKING FULL
ADVANTAGE OF THIS.
YOU CAN SEE THE EXTENT OF THIS.
9 MILLION ENROLLED VETERANS
EACH YEAR AS WELL AS OVER 9
MILLION SERVICE MEMBERS WHO ARE
BENEFICIARIES. NEXT SLIDE.
AND, SO ... THE ACCOMPLISHMENTS
SO FAR IS THAT WE HAVE
DEMONSTRATED THAT WE CAN DO
RESEARCH THAT IS COORDINATED,
THAT IS PRAGMATIC, THAT
FULFILLS ALL OF THE GOALS OF
PRAGMATIC TRIALS IN THIS
SETTING. THAT WE CAN DO
HARMONIZATION OF KEY OUTCOMES
ACROSS STUDIES TO SUPPORT
FUTURE, LARGE-SCALE
META-ANALYSIS. AND ALSO THAT WE
WERE ABLE TO WORK THROUGH THE
CVOID-19 CHALLENGES, AND THE
PUBLICATION RECORD HAS BEEN
WITNESSING A LOT OF SUCCESS.
NEXT SLIDE.
JUST A QUICK TIMELINE TO SHOW
YOU HOW THIS HAS EVOLVED. 2017
WAS THE BEGINNING. HEAL
ACTUALLY SUPPLEMENTED TO START
THIS. SINCE THEN THE PMC TRIAL
HAS CONTINUED ON ITS OWN
FUNDING, VARIETY OF TRIALS. AND
JUST RECENTLY, WE CAN SEE IN FY
24 HEAL HAS NOW CO-FUNDED A
PORTION OF THE COORDINATING
CENTER, AND WE ANTICIPATE THAT
THERE WILL BE TRIALS FROM HEAL
THAT WILL NOT GRAFT ON TO THE
STRUCTURE.
ONE QUESTION THAT SOMETIMES
GETS ASKED. WHY IS THERE A
SEPARATE COORDINATING CENTER
FOR THE PRIMARY TRIALS
COLLABORATORY AND FOR THE PAIN
MANAGEMENT COLLABORATORY?
THE REASON FOR THAT IS THE
ENVIRONMENT IS DIFFERENT. THE
EXPERTISE NEEDED TO MANAGE
THOSE STUDIES IS-- THE MILITARY
ENVIRONMENT IS A WHOLE
DIFFERENT ANIMAL FROM THE
CIVILIAN HEALTHCARE SYSTEMS.
AND SO THIS IS WHY WE NEED A
SEPARATE COLLABORATORY, NOT
THAT THE GOALS ARE ALL THAT IS
SIMILAR. IT IS JUST THAT THE
ENVIRONMENT IS VERY DIFFERENT.
AND REALLY WANTS A SEPARATE
INFRASTRUCTURE. NEXT SLIDE.
SO WHAT ABOUT FUTURE DIRECTIONS?
WE THINK THAT BOTH PROGRAMS
CAN BE SUCCESSFULLY USED IN
TRIALS FOR HEAL PRIORITIES LIKE
PREVENTION OF PAIN. AND WHOLE
PERSON PAIN MANAGEMENT, WHICH
IS A BIG FOCUS, ESPECIALLY AT
THE VA. AS WELL AS THE OVERLAP
OF ADDICTION AND PAIN. SO WE
ARE VERY EXCITED TO REALLY
LEVERAGE THESE TWO VERY
SUCCESSFUL PROGRAMS FOR THE
HEAL INITIATIVE. AND WE REALLY
LOOK FORWARD TO CONTINUING THIS
REALLY FRUITFUL COLLABORATION.
SO THANK YOU VERY MUCH FOR YOUR
ATTENTION. HAPPY TO ANSWER ANY
QUESTIONS.
NOT HEARING ANYTHING.
>> DR. WEISS: THERE IS A HAND
RAISED. LYNN?
>> THANK YOU FOR GREAT
PRESENTATION. I HAVE A VERY IN
THE WEEDS QUESTION FOR YOU. YOU
MENTIONED THAT THERE IS A
COORDINATED PAIN CARE
INITIATIVE THAT IS FUNDED BY
HEAL EMBEDDED WITHIN PRISM. I
WONDER IF YOU CAN SAY MORE
ABOUT THAT. SOME OF THE
ANTICIPATED TRIALS THAT WILL BE
FUNDED IN THE NEAR RUN. MAYBE
I MISSED THAT. I WAS INTERESTED
IN HEARING MORE.
>> THE COORDINATED PAIN CARE IS
NOT PART OF PRISM> IT IS A
SEPARATE INITIATIVE. THAT
FOCUSES ON THESE INTEGRATED
PAIN MANAGEMENT VERY
SPECIFICALLY. WHEREAS PRISM IS
NOT 100% -- LET'S PUT IT THIS
WAY, THESE ARE
MULTIDISCIPLINARY TEAMS. IT CAN
BE. BUT THE COORDINATING PAIN
CARE IS REALLY SPECIFICALLY
TARGETING THIS. THERE'S A LOT
OF, YOU KNOW, SIMILARITIES. BUT
THERE SOMETHING VERY SPECIFIC
ABOUT THAT INITIATIVE ABOUT
COORDINATED PAIN CARE.
>> THANKS FOR CLARIFYING.
>> YEAH, THE -- GOAL IS WITH
THAT ONE ALSO IS TO HAVE IT
PILOTED IN HEALTHCARE SYSTEMS
THAT COULD ADOPT IT, SHOULD IT
SHOW BENEFIT.
>> AND THIS IS WHAT WE THINK
THE COLLABORATIVE WOULD BE SO
HELPFUL IN HELPING IT TO BE
SUCCESSFUL.
>> ERIC?
>> THANK YOU HELEN FOR
REPRESENTATION. I WAS CURIOUS
ABOUT THE COLLABORATORY AND
WHETHER THE LARGER SIZE
COMMUNITY IS AWARE OF THIS
RESOURCE. HOW THEY ACCESS IT? A
RESOURCE POTENTIALLY AVAILABLE
FOR TRIALS THEY ARE PROPOSING?
IS THAT WIDELY KNOWN? IF NOT
HOW CAN WE GET THE WORD OUT TO
OTHER PAIN RESEARCHERS AND
INTEGRATED HEALTH RESEARCHERS
CAN ACCESS THIS RESOURCE?
>> DR. LANGEVIN: THIS IS SUCH A
GREAT QUESTION.
HOW CAN PEOPLE GET MORE AWARE
OF THIS? IT USED TO BE THE
BEST-KEPT SECRET AT NIH. IT IS
REALLY A RESOURCE. WE HAVE BEEN
TRYING EVERYTHING INCLUDING
THIS PRESENTATION TODAY TO
REALLY SPREAD THE WORD TO
PEOPLE UNDERSTAND THEY CAN USE
IT.
NOW, HOW DO YOU ACCESS IT? FOR
EXAMPLE, ONE WAY WE CAN ACCESS
IT USED TO BE THAT WE WOULD
ISSUE RFAS. THAT WOULD
SPECIFICALLY FOR STUDIES THAT
WOULD THEN UTILIZE THE
COORDINATING CENTER.
NOW WHAT WE ARE DOING THAT IS
EVEN EASIER, YOU DON'T EVEN
HAVE TO RESPOND TO AN RFA.
ANYBODY THAT HAS PROPOSED A
STUDY WHERE THEY THINK IT MIGHT
BE A GOOD FIT FOR UTILIZING THE
COORDINATING CENTER, DISCUSS IT
WITH THE PROGRAM STAFF AND WHAT
THEY WILL DO IS THEY WILL MAKE
THE LEAP TO THE COLLABORATORY.
VICE VERSA. PROGRAM STAFF AND
NIH STAFF CAN IDENTIFY STUDIES
EVEN AFTER THEY ARE FUNDED. OH,
THIS MIGHT BE A GOOD FIT FOR
THE COLLABORATORY. AND THEY CAN
INITIATE THE LINK.
IT IS ACTUALLY VERY EASY. WE
CALL IT PLUG-AND-PLAY. IT IS
QUITE EASY. SOME PEOPLE
SOMETIMES GET CONFUSED. THEY
THINK THAT THE COLLABORATORY IS
ITS HAS ITS OWN CLINICAL TRIAL
NETWORK. IT DOESN'T. IT IS ONLY
A RESOURCE. ONE WAY TO
UNDERSTAND IT IS TO VISIT THE
WEBSITE. THE BEST WAY TO
REMEMBER WHAT THE WEBSITE IS,
IF YOU TYPE "REINVENTING
CLINICAL TRIALS." YOU WILL GET
THERE.
AND, THE WEBSITE HAS ALL THE
DETAILS, ABOUT ALL THE
RESOURCES THAT ARE AVAILABLE TO
ANYBODY WHO WANTS TO VISIT THE
WEBSITE. FIRST OF ALL. AND ALSO
SPECIFICALLY TO INVESTIGATORS
WHOSE STUDIES ARE CONNECTED TO
THE COLLABORATORY. IT IS TRULY
EXCELLENT. CANNOT RECOMMEND IT
ENOUGH.
>> THANK YOU SO MUCH.
>> AND DR. LANGEVIN, I HAVE A
QUESTION. GREAT RESOURCE. MY
UNDERSTANDING IS IN VA
HOSPITALS, DOCTORS CANNOT
PRESCRIBE MARIJUANA. BUT AT THE
SAME TIME, WE KNOW THAT ONE OF
THE MAIN USES OF MARIJUANA, AND
PARTICULARLY IN VETERANS, IS
OBVIOUS. FOR PAIN. IS IT BEING
RECORDED? IS A VIABLE? IS IT
BEING FOLLOWED UP?
>> DR. LANGEVIN: WELL I DON'T
KNOW THE ANSWER TO THIS. I
WOULD BE INTERESTED TO KNOW THE
ANSWER MYSELF. I DON'T KNOW.
GOOD QUESTION. DAVID-- I DON'T
KNOW IF DAVID IS ARTICLE. HE
MIGHT KNOW.
>> IT IS A GREAT QUESTION. IT
IS SOMETHING WE SHOULD EXPLORE.
IN THEORY THE EHR SHOULD HAVE
SOME RECOMMENDATION. BUT YOU
ARE RIGHT. UNDER FEDERAL LAW,
PHYSICIANS CANNOT PRESCRIBE IT,
BUT THEY MAY BE CAPTURING IT.
AND I KNOW NCR IS DOING A LARGE
MULTISTATE STUDY LOOKING AT
CANCER PATIENTS'USE OF
CANNABIS, FOR REASONS OF DRUG
INTERACTIONS AMONG CANCER
PATIENTS. GREAT QUESTION FOR
THE VA. WE COULD FOLLOW-UP AND
GET YOU AN ANSWER.
>> THANK YOU DAVID.
>> NORA? SORRY. >> NOW IT IS MY
TURN TO INTRODUCE ACTUALLY THE
NEXT SPEAKER. ONE SECOND. I
HAVE ALL OF MY SCREENS.
I'M INTRODUCING TISHA WILEY,
THE PLEASURE TO INTRODUCE HER.
SHE IS THE LEAD PERSON ON J
COINT, WITH HER TEAM SHE HAS
MADE IT POSSIBLE TO SERVE AS
THE BRANCH CHIEF OF NATIONAL
INSTITUTES -- OF NATIONAL
INSTITUTES (CORRECTION) NIDA
DIVISION OF EPIDEMIOLOGY. AND
THIS INCLUDES NIDA JUSTICE
COMMUNITY AND THE OPIOID
INNOVATION NETWORK, THE JCOIN.
AND BEFORE THAT SHE SERVICES
SCIENCE OFFICER IN JUSTICE
INITIATIVES INCLUDING THE
JUVENILE JUSTICE TRANSLATIONAL
INTERVENTION FOR ADOLESCENTS IN
THE LEGAL SYSTEMS, IN THE
CRIMINAL JUSTICE PROGRAM
TREATMENT STUDIES COOPERATIVE
RESEARCH PROGRAMS. DURING HER
TIME AT NATIONAL INSTITUTES OF
HEALTH AND NIDA, SHE HAS
DEVELOPED IMPLEMENTATION
STUDIES AMONG MULTIMEDIA
MEASUREMENTS AMONG OTHERS. IT
IS A PLEASURE TO INTRODUCE HER.
DR. WILEY?
>> DR. WILEY: CAN I SHARE MY
SCREEN SO I CAN GO THROUGH...
ARE USING THE RIGHT VERSION?
GOOD NOW?
>> NO.
>> TISHA: HOLD ON. STOP
SHARING. LET ME TRY AGAIN. I AM
ALREADY IN PRESENTATION MODE,
THAT WAS PROBABLY THE PROBLEM.
AND SHARE ...
NOW?
>> YES.
>> TISHA: THANK YOU AND SORRY
FOR THAT. THANK YOU FOR THE
KIND INTRODUCTION, AND FOR THE
OPPORTUNITY TO TALK TO Y'ALL
AGAIN ABOUT JCOIN AND THE WORK
WE ARE DOING SO NORA A LATE A
LOT OF THE LOGIC OF THIS AND
WANT TO START WITH WHY THE
JUSTICE SYSTEM. AND YOU ALL
KNOW THE NUMBERS, WHILE WE ARE
IN THE VIRTUAL ROOM TODAY. TO
ME PEOPLE ARE LOSING THEIR
LIVES TO OVERDOSES. WE HAVE TO
FIGURE OUT THE WAYS TO
INTERVENE AND THE BEST WAYS TO
INTERVENE IN REALLY THE JUSTICE
SYSTEM REPRESENT SUCH AN
IMPORTANT OPPORTUNITY WE CAN
MAKE A DIFFERENCE.
WE KNOW PEOPLE WHO WERE
TOUCHING THE JUSTICE SYSTEM ARE
DISPROPORTIONATELY REPRESENTED
AMONG THE PEOPLE LOSING THEIR
LIVES AND CAN BE OFTEN THEIR
USE OF SUBSTANCES BRINGING THEM
INTO THE SYSTEM FOR MANY YEARS
WHEN PEOPLE DO GO INTO JAILS
AND PRISONS AND THEY GO BACK
INTO THE COMMUNITY THAT IS A
PERIOD WHERE THEY ARE REALLY AT
RISK FOR RELAPSE AND FOUR FATAL
OVERDOSES. PARTICULARLY AS THE
DRUG SUPPLY HAS GOTTEN MORE AND
MORE TALKING OVER TIME AND THE
STUDY IN RHODE ISLAND, REALLY
AMONG THE LEADERS IN THE
COUNTRY TRYING TO EMBRACE
MEDICATIONS BEING DELIVERED IN
JAILS AND PRISONS. AND THEY
WERE ABLE TO SEE GREAT SUCCESS
WITH THAT APPROACH AND
PROJECTED THAT HE COULD REALLY
MAKE A SUBSTANTIAL REDUCTION IN
OVERDOSE DEATHS. THIS POINT TO
THE JUSTICE SYSTEM AND IN
PARTICULAR JAILS IS AN
IMPORTANT PLACE TO INTERVENE
BUT IS REALLY NOT ENOUGH TO
JUST THINK ABOUT JAIL OR THE
CRIMINAL JUSTICE SYSTEM IN
ISOLATION.
IS REALLY WHAT HAPPENS IS
PEOPLE RETURNED BACK, TO THE
COMMUNITIES AND THE WAY THE
ACCESS CARE AND ROAD POINTS,
AND THE IMPORTANCE OF CROSS
SECTOR PARTNERSHIPS, THAT
INTERVENE IN MULTIPLE SYSTEMS.
THIS PICTURE HERE IS ACTUALLY
FROM ONE OF OUR STUDIES THAT WE
FUNDED THROUGH JCOIN OUT OF THE
CHESTNUT RESEARCH HUB,
NAVIGATORS IN THE COMMUNITY
DOING THE OUTREACH THEY DO
EVERY DAY.
EVEN AS PEOPLE GO INTO
TREATMENT SYSTEMS, LOTS OF
CHALLENGES WITHIN THE TREATMENT
SYSTEMS GENERALLY. THOSE WHO
HAVE TOUCHED THE JUSTICE SYSTEM
OR EVEN AT A DISADVANTAGE IN
THAT RESPECT. THIS IS A STUDY
FROM JUST BEFORE WE WERE
LAUNCHING JCOIN SHOWING THAT
ONLY 5% OF PEOPLE REFERRED INTO
THE TREATMENT SYSTEM HAD BEEN
GIVEN ACCESS TO METHADONE AND
BUPRENORPHINE. AND GETTING
ACCESS TO THOSE MEDICATIONS.
AND HOUSECLEANING INTERVENTIONS
TO BE LAUNCHED JCOIN 1.0 IN
2018, ONE OF THE FIRST PROGRAMS
WE WERE ABLE TO GET FUNDING OUT
AND WERE ABLE TO DO SOUTHERLY
SUPPLEMENTS TO GET EARLY
SUPPLEMENTS AND LAUNCH PROJECT
QUICKLY AND IN 2019. AND LIKE
MANY PROGRAMS WE WERE AFFECTED
BY COVID SO A LOT OF CLINICAL
TRIALS ARE GOING TO STAY IN THE
FIELD A LITTLE BIT LONGER. BUT
BY 2025 WE SHOULD HAVE ALL OF
THE JCOIN 1.0 PROJECT LAUNCHED.
CONCURRENTLY WITH INPUT AND
SUPPORT FROM HEAL AND NIDA,
LEADERSHIP-- WE HAVE BEEN GIVEN
PERMISSION TO LAUNCH A SECOND
ITERATION OF JCOIN TO BUILD ON
OUR SUCCESSES ALL GIVE YOU
LITTLE BIT MORE DETAIL LATER
ON. ABOUT WHERE WE ARE AT IN
TERMS OF THAT LUNCH. THAT WILL
CARRY US INTO 2030.
AN END IS VENN DIAGRAM CAPTURES
THE ESSENCE OF ONE OF HER CORE
PHILOSOPHIES, DATA SECTION WHAT
HAPPENS WITH JUSTICE PARTNERS--
JAILS, PRISONS ARE COMMITTED TO
CORRECTIONS-- AND THE COMMITTED
PARTNERS WHICH CAN INCLUDE THE
HIPAA HEALTH PROVIDER, CCBHCS,
AND WHAT RESEARCHERS CAN BRING
AND HOW WE CAN BUILD THOSE
PARTNERSHIPS AT THE
INTERSECTION OF THAT VENN
DIAGRAM.
ONE OF THE THINGS THAT REALLY
IS THE FOUNDATION OF HOW WE
APPROACH JCOIN WAS STUDYING A
VISION -- WE MOVE THROUGH THIS
AND ON THE SURFACE IT IS A
SIMPLE VISION. THE IDEA THAT
EVERY PERSON WHO IS INVOLVED IN
THE JUSTICE VISION THAT HAS A
SUBSTANCE ABUSE DISORDER SHOULD
HAVE ACCESS TO EFFECTIVE
TREATMENT, IN JAIL PRISON OR IN
THE COMMUNITY.
AND THERE ARE FIVE PILLARS HOW
TO APPROACH THIS VISION. THIS
IS NOT A FIVE-YEAR VISION. THIS
IS A 20+ YEAR VISION OF WHERE
WE ARE TRYING TO GO. BUT THIS
WILL GIVE YOU A SENSE OF HOW WE
ARE APPROACHING THIS, AND
EVERYTHING TRACKS BACK TO ONE
OF THESE FIVE PILLARS BECAUSE
WE ARE NIH FIRST AND FOREMOST
WE ARE FOCUSED ON RESEARCHING
HOW TO ENERVATE EVIDENCE ABOUT
WHAT WORKS IN THE STUDY BUT
ALSO HOW DO WE TAKE WHAT WE
KNOW TO WORK AND BUILD EVIDENCE
OF HOW TO GET IT INTO PRACTICE.
EXACTLY THE POINT THAT GAIL
WAS MAKING EARLIER.
AND SPEAKING TO THE VENN
DIAGRAM I SHOWED YOU ON THE
LAST SLIDE, WITH EITHER THE
HEART OF THIS IS BUILDING
COLLABORATIONS AT THE
INTERSECTION OF THAT VENN
DIAGRAM, BUILDING THIS NATIONAL
COLLABORATIVE NETWORK OF
PRACTITIONERS WORKING TOGETHER
WITH RESEARCHERS AT THE
INTERSECTION OF JUSTICE AND
COMMUNITY SERVICE STUDIES.
ALSO FOCUSING HERE ON BECOMING
A GO TO RESOURCE FOR THE FIELD,
MAKING SURE THAT OUR
DISSEMINATION PATHWAYS ARE NOT
JUST GENERAL ARTICLES, REALLY
THINKING ABOUT HOW WE ARE
BUILDING THAT TRANSLATIONAL
PIPELINE IN REAL TIME,AND
PUSHING THINGS OUT AS QUICKLY
AS WE CAN.
WE ALSO HAVE A LOT OF EMPHASIS
ON CAPACITY BUILDING IN TWO
RESPECTS. IN THE FIRST RESPECT
IT'S ABOUT CAPACITY, BUILDING
CAPACITY FOR RESEARCHERS TO
KNOW HOW TO DO THIS RESEARCH,
HOW TO NAVIGATE THE
COMPLEXITIES. BUT ALSO FOR THE
PRACTITIONERS, UNDERSTAND WHERE
TO FIND THE RESEARCH AND HOW TO
INTERPRET IT AND HOW TO
PARTICIPATE IN IT AS WELL. SO
WE HAVE BEEN TRYING TO BUILD
BOTH ASPECTS OF CAPACITY. AND
THE IDEA IS THAT IF WE CAN PULL
THIS TOGETHER WE CAN ADDRESS
THAT CHASM THAT HELEN WAS
TALKING ABOUT AND SPEEDING
SOLUTIONS TO SCIENCE AROUND
THIS PARTICULAR AREA.
THERE WERE 13 RESEARCH HUBS,
BUILDING LARGE-SCALE
MULTI-CLINICAL TRIALS. SEVEN
ARE SPECIFICALLY FOCUSING ON
LINKAGE INTERVENTIONS. WHAT
HAPPENS IS PEOPLE TRANSITION
FROM JAILS AND PRISONS BACK
INTO THE COMMUNITY? TO FOCUSING
ON STATEWIDE POLICY ROLLOUT IN
MASSACHUSETTS. THIS WAS PRIOR
TO JCOIN, REQUIRING ALL THREE
FORMS OF MEDICATION FOR OPIOID
USE DISORDER, TO BE PROVIDED BY
JOE'S IN THAT STATE. AND WE HAD
A TIME PERIOD TO ROLL THAT OUT,
AND WE WERE ABLE TO PARTNER
WITH THEM. AND IN NEW YORK
THERE WAS A SIMILAR THING,
CALLED THE OPIOID COURT MODEL.
AND WE WERE DOING STUDIES OF
HIGH COMPARATIVES TRIALS
ESPECIALLY LONG-ACTING
NALOXONE, AND IN ONE TRIAL
WOULD LONG-ACTING FROM
RELATIONS OF -- STUDY AND ALSO
FOR SUPPLICATE, AND ALSO
COMPARISONS WITH
NON-EXPONENTIAL METHODS. WE
ARE EXCITED ABOUT WHAT WE'RE
FINDING FROM THOSE.
AND TWO OF HER STUDIES WE ARE
LOOKING AT ORGANIZATIONAL
IMPLEMENTATION STRATEGIES. HOW
DO YOU GET THIS INTO PRACTICE?
ONE OF OUR GOALS WITH JCOIN,
WHEN YOU LOOK AT THE LITERATURE
THAT HAS BEEN PUBLISHED UP TO
2018, A LOT OF THE STUDIES WERE
REALLY HAPPENING IN NORTHEAST,
IF YOU WENT OUT AND TALK TO
PEOPLE IN THE COMMUNITY WOULD
HEAR LOTS OF RUMBLINGS ABOUT
HOW THAT WASN'T APPLICABLE. AND
HOW THOSE COMMUNITIES WERE
DIFFERENT. ONE THING WOULD MADE
A CONCERTED EFFORT IN 140
COUNTRIES, 38 STATES AND
HOPEFULLY IN 2.0 WE WILL BUILD
THAT NATIONAL FOOTPRINT AND
ENROLLED NEARLY 23,000
PARTICIPANTS IN CLINICAL
TRIALS, LITTLE BIT OF AN OLD
NUMBER. WE PROBABLY CLEARED
23,000 PARTICIPANTS AT THIS
POINT.
AND WE SUPPORTED THE WORK OF
THESE RESEARCH HUBS TO SUPPORT
CENTERS. ON METHODOLOGY AND
ADVANCING RESOURCE CENTER WHICH
IS BEEN BUILDING THE RESOURCES
TO SUPPORT COMMON DATA
INFRASTRUCTURE. SUPPORTING
COLLABORATIONS ACROSS THE
STUDIES; COORDINATION AND
TRANSLATION CENTER FOCUS MORE
ON THE DAY-TO-DAY COORDINATION,
AND THE TRANSLATION AND
DISSEMINATION PEAS AND BUILDING
A DATA AND TRANSLATIONAL
PRODUCTS. DOES NOT ENCOMPASS
THE WHOLE OF JCOIN. THIS IS A
NETWORK REGION RESEARCH,
EMBEDDED IN MANY PLACES AND WE
HAVE 55 ADDITIONAL RESEARCH
PROTOCOLS INCLUDE NATIONAL
SURVEYS AND PILOTS AND
MODELING, AND MAPPING STUDIES,
DIVERSITY SUPPLEMENTS, SMALL
GRANT PROGRAMS, LOTS OF
RESEARCH BUILT INTO THE NETWORK
IN LOTS OF DIFFERENT WAYS IN
THE IDEA THAT ALL OF THESE
PIECES ARE COMPLEMENTARY TO
EACH OTHER.
JUST GIVING YOU KIND OF A QUICK
VISUAL. THIS REPEATS A LITTLE
BIT OF WHAT I WAS SHOWING YOU
IN TERMS OF THE 88 RESEARCH
PROTOCOLS IN THE 13 LARGE-SCALE
CLINICAL TRIALS. WHAT I WANT TO
HIGHLIGHT HERE IS THE COLOR
CODING. WHAT YOU SEE IN ORANGE,
THESE ARE ALL JAIL STUDIES. WE
ARE PRIMARILY A JAIL FOCUSED
NETWORK AT LEAST IN 1.0 WE
WERE. BECAUSE PEOPLE GO PRETTY
THREE JAIL THE AVERAGE STAY IS
LESS THAN A WEEK. SO THESE ARE
PEOPLE COMING IN AND OUT, VERY
VULNERABLE BUT ALSO MORE
FOCUSED ON PROBATION AND
PAROLE. AND JUVENILE JUSTICE.
THAT GIVES YOU A SENSE OF WHAT
KINDS, WHAT PARTS OF THE SYSTEM
WE HAVE BEEN FOCUSED IN, IN
THIS FIRST PHASE OF JCOIN.
I WILL TURN NOW TO SORT OF TALK
ABOUT HOW THE RESEARCH AND
CAPACITY BUILDING THAT WE DO
REALLY SYNERGIZES US AND WORKS
TOGETHER TO TRY TO PUSH US
TOWARDS BUILDING THIS RESEARCH
PRACTICE. THE RESEARCH
PROTOCOLS.
CLINICAL TRIALS, NONE OF THEM
ARE COMPLETE. MANY OF THEM ARE
COMPLETE BUT NONE OF THEM HAVE
PUBLISHED THEIR MAIN FINDINGS
YET. AND EVEN WITHOUT THOSE
STUDIES BEING COMPLETE, WE HAVE
165 PUBLICATIONS AND THE NUMBER
GROWS ALMOST EVERY DAY AT THIS
POINT. A FEW MONTHS AGO I
PLUGGED ALL APPLICATIONS IN AND
CALCULATING WHAT THE NIH OFFICE
OF RESEARCH BECAUSE THE
CITATION RELEVANT ISSUE AND GOT
A 2.41. AND SO THE PAPER IS
CITED AS OFTEN AS IN THE FIELD
AND I SHOW YOU THAT THESE ARE
PAPERS THAT ARE ALREADY
INFLUENTIAL, EVEN THOUGH WE ARE
ALREADY AT THE EARLY STAGES OF
PUBLICATIONS COMING OUT OF THE
NETWORK.
THE OTHER THING THAT IS REALLY
INTERESTING AND IMPORTANT ABOUT
OUR PUBLICATIONS IS THAT THE
NETWORK STRUCTURE HAS ALLOWED
COLLABORATIONS ACROSS DIFFERENT
TEAMS, ACROSS DIFFERENT PEOPLE
THAT WORK TOGETHER AND WE BEEN
ABLE TO ANALYZE AND DEMONSTRATE
THAT USING THIS NET STRATEGY
HAS REALLY INCREASED AND BUILT
RELATIONSHIPS WHICH I THINK
IMPROVES THE QUALITY OF THE
SCIENCE.
ONE THING THAT IS A LITTLE BIT
DIFFERENT ABOUT WHAT WE DID,
THAT I THINK HAS BEEN REALLY
INTERESTING AND HAS HAD A GREAT
PAYOFF, IS REBUILT THE IDEA OF
RAPID INNOVATION GRANTS. GRANTS
ADMINISTRATIVE BY THE
COORDINATION AND TRANSLATION
CENTER, BUILT ALONG THE SAME
STRUCTURE AS TRADITIONAL NIH
GRANTS BUT THEY GET REVIEWED
FASTER DECISIONS ARE MADE
WITHIN THREE MONTHS OF THEIR
RELATIVELY SMALL AWARDS.
AND WE NEEDED A VERSION OF
APPLICATION ACCESSIBLE EVEN FOR
PRACTITIONERS THAT DID NOT HAVE
ALL THE NECESSARY
INFRASTRUCTURE TO APPLY TO A
TYPICAL NIH GRANT. WE HAVE SEEN
JUST REALLY-- WE HAVE GOTTEN
DIRECT AWARDS TO PARTNERS, TO
EARLY STAGE INVESTIGATORS. WE
HAVE SEEN PUBLICATIONS COME OUT
OF THESE. I THINK THIS HAS BEEN
AN IMPORTANT TOOL FOR SEEDING
THE FIELDS AND LEARNING NEW
THINGS AND LEARNING FASTER,
TAKING SMALL RISKS THAT ARE
PAID OFF IN A LOT OF WAYS THAT
WE COULD NOT HAVE ANTICIPATED.
THIS IS BEEN A REALLY VALUABLE
TOOL FOR US.
I ALSO TALKED ABOUT OUR
CAPACITY BUILDING AND OUR
TRAINING PROGRAM. WE FOUND 71
PEOPLE TO GO THROUGH THE EARLY
PROGRAM, FOCUSING ON MENTORING.
TWO TRACKS. ONE FOCUSING ON
ACADEMICS, PEOPLE WHO ARE
GETTING READY TO LAUNCH AND NIH
GROUP AND THE OTHER TRACTORS
EARLY-STAGE FOLKS AS WELL AS
PRACTITIONERS ANYTHING IT IS
BEEN REALLY INTERESTING TO SEE
HOW THIS IS WORK BY BRINGING
THEM TOGETHER IN A PROGRAM
TOGETHER BECAUSE THEIR BUILDING
RELATIONSHIPS THAT I THINK WILL
PAY OFF IN THE FUTURE.
AND THEN WE GOT A DIVERSE SET
OF OTHER THINGS. MORE THAN 50
COURSES AND PODCASTS THAT HAD
ALMOST 15,000 DOWNLOADS,
NEWSLETTERS AND WEBINAR AND ONE
OTHER UNIQUE PIECE I WANT TO
HIGHLIGHT -- IF EVERYONE COULD
MUTE THEMSELVES -- ONE OTHER
UNIQUE PIECE, WE WERE ABLE TO
ESTABLISH A MEMORANDUM OF
UNDERSTANDING WITH OUR PARTNERS
AND COLLEAGUES OVER AT THE
BUREAU OF JUSTICE TO PAIR UP
WHAT WE DO WITH THEIR WORK. BJA
LIKE CENSUS SINCE A LOT OF
MONEY OUT TO THE FIELD. AND
WERE ABLE TO BRIDGE THE KIND OF
WORK WE DO WITH WHAT THEY DO
BY CREATING A PIPELINE FOR
PEOPLE OUT IN THE FIELD WHO
WANTED TO UNDERSTAND WHAT
MEASURE TO DO. OR I AM TRAINED
IN A PROGRAM AND I DON'T KNOW
WHERE TO START IN TERMS OF
DESIGNING AN EVALUATION. HOW
CAN I DO THAT? WHO CAN HELP ME?
AND THE RAPID INNOVATION GRANTS
AND THE ON-DEMAND TECHNICAL
ASSISTANCE ALL WORK TOGETHER
VERY SYNERGISTICALLY, AND THIS
IS BEEN A LITTLE BIT OF THE
THINGS THAT HAVE WORKED BETTER
THAN EVEN WE HOPED WOULD WORK.
I WANT TO SHOW YOU THE FACE OF
THE LEAD INVESTIGATORS. THE
FACES OF THE FUTURE OF THE
FIELD. THIS HAS ALSO HELPED US
DIVERSIFY THE NETWORK AND IS
GOING TO LEAD TO BETTER
RESEARCH IS REMOVE, BECAUSE WE
HAVE A DIVERSITY OF BACKGROUNDS
AND PERSPECTIVES. AND THESE
ARE PEOPLE WHO HAVE PERFORMED
IN THE NETWORK. THIS HAS BEEN
A REALLY NICE FEATURE OF THE
NETWORK.
ONLY TAKE A FEW MINUTES AND
WALK YOU THROUGH AN EXAMPLE OF
HOW WE TAKE A PARTICULAR
FINDING AND WORKING TRANSLATE
IN THAT BACK OUT INTO THE FIELD
AS QUICKLY AS POSSIBLE. THIS
IS A PAPER THAT WAS PUBLISHED
OUT OF THE MASSACHUSETTS JCOIN
HARM. THE ISSUE THAT IT TACKLES
IS A VERY COMMON CONCERN THAT
WE HEAR FROM OUR JAIL PARTNERS
ABOUT OFFERING BUPRENOFRIN IN
THEIR STUDIES AND ANYTHING THAT
GETS DIVERTED IN THE JAIL STUDY
CREATE SAFETY AND SECURITY
ISSUES. SO AS PART OF THIS
EFFORT TO ALSO FUND MEDICATION
IN THE JAILS, THE RESEARCHERS
WENT IN AND EQUALITY WORK TO
UNDERSTAND WHAT THE CONDITIONS
WERE FROM THE STAFF PERSPECTIVE
AND HOW THEY OFTEN HAPPENED.
THEIR CONCLUSION WAS THAT IT
WAS BOTH UNCOMMON AND
PREVENTABLE.
IN THE PAPER THEY LAYOUT SOME
OF THE STRATEGIES THAT THE
JAILS IN MASSACHUSETTS HAVE
USED TO REALLY ADDRESS THE
CONCERNS AROUND DIVERSION. WE
PUT A SUMMARY OF THE NEWSLETTER
AND HAD WERE NOT WITH GOING
OVER THE RESULTS OF THE FUNDING
AND A LITTLE BIT MORE UNUSUAL,
THE PODCAST THAT HAS QUITE A
FEW SUBSCRIBERS SO THERE IS A
PODCAST TO TALK WITH
INVESTIGATORS, A SHORT SNIPPET.
WE ALSO CREATED INFOGRAPHICS,
LAYING OUT WHAT THE KEY
STRATEGIES WERE FOR PREVENTING
AND ADDRESSING DIVERSION, AS
WELL AS SOCIAL MEDIA PUSHES
WITH DIFFERENT ELEMENTS OF
THAT.
THIS HAS BEEN QUITE SUCCESSFUL.
I ACTUALLY HAD A CONVERSATION
WITH ED HANES (PHONETIC) WHO IS
THE SUPERINTENDENT IN ONE OF
THESE JAILS. ONE OF THE THINGS
HE SHARED WITH ME IS THAT HE
FOUND AS A PARTNER FOR THIS
RESEARCHERS, HE FOUND IT SUPER
VALUABLE. AS OTHERS IN THE
COUNTRY HAVE LOOKED TO HIM AND
HIS TEAM AND WHAT THEY HAVE
BEEN DOING HAVING ALL THESE
RESOURCES IS SOMETHING HE CAN
REFER HIS PEERS TO. SOMETHING
HE HAS FOUND VERY VALUABLE IN
TERMS OF BEING ABLE TO MANAGE
THE INTEREST AND HELP
COLLEAGUES WHO ARE INTERESTED
IN LEARNING FROM WHAT THEY HAVE
DONE.
I WANT TO GIVE YOU ONE MORE
EXAMPLE ABOUT THIS TRANSLATION
PIPELINE. STILL USING
MASSACHUSETTS AS AN EXAMPLE.
THIS ONE IS A PARTNERSHIP THAT
EVOLVED FROM THE ECONOMICS TEAM
WORKING ACROSS THESE DIFFERENT
STUDIES, AND THE STAFF AT
DIFFERENT JAILS. THIS IS A
PAPER TALKING ABOUT DESCRIBING
WHAT THEY CALLED "BUDGET IMPACT
TOOL." HERE ONE OF THE KEY
QUESTIONS FOR THE JAILS AS THEY
WERE PUSHING TO INCORPORATE
METHADONE, WAS SHOULD WE SET UP
AN OTP WITHIN OUR OWN JAIL?
SHOULD WE CONTRACT OUT WITH
ANOTHER SERVICE? SHOULD WE WORK
OUT SOME SORT OF GUEST DOSING,
COMMUNITY OTP? THOSE ARE
DECISIONS THAT DEPEND AROUND
THE CONFIGURATION OF THE
PREPARATION BEING SERVED IN THE
FACILITY, AS WELL AS THE
COMMUNITY FACTORS. AND SO THIS
PAPER REPORTED ON THAT BUDGET
IMPACT WILL THAT REFLECTED ON
THE LESSONS LEARNED IN
MASSACHUSETTS.
BUT I'M HIDING HERE IN THE RED
SQUARE FOR YOU, IS THAT AN
UNUSUAL FEATURE IS THAT THE
CO-AUTHORS OF THE PAPER
INCLUDED SHERIFF-- THE SHERIFF
OF MIDDLESEX COUNTY--
(INDISCERNIBLE) WHO WAS BUDGET
DIRECTOR OF THE MIDDLESEX
COUNTY JAIL, AND THE -- HOUSE
OF CORRECTIONS AND ED HANES THE
SUPERINTENDENT IN THE FRANKLIN
COUNTY JAIL. THESE PARTNERS
CO-AUTHORING ON THE PAPER WHICH
WAS BOTH THE FOUNDATION THAT WE
FOCUS FROM THE BEGINNING OF
JCOIN, CLOSE COLLABORATIVE
RELATIONSHIPS TO TURN THE TOOL
INTO A DOWNLOADABLE, EXCEL
SPREADSHEET THAT OTHERS COULD
USE.
DID A WEBINAR AGAIN. BUT IN
TERMS OF RAPID TRANSLATION TO
PRACTICE, WE WERE ABLE TO SHARE
THIS CLOSELY WITH OUR
COLLEAGUES, OUR FEDERAL
COLLEAGUES. AND JUST A FEW
MONTHS AFTER THE PAPER WAS
PUBLISHED, THAT TEAM CAME IN
AND DID A WHOLE SESSION FOR
TEAMS THAT HAD COME IN FROM
AROUND THE COUNTRY TO HELP THEM
UNDERSTAND WHAT THIS TOOL WAS,
HOW TO USE IT, AND SUPPORT THE
USE OF TEAMS BEING BROUGHT UP
BY SAMSAH AS PART OF THE
ACADEMY STRATEGY. AND WE USED
TO TECHNICAL ASSISTANCE
COMPONENT TO PROVIDE SUPPORT.
I KNOW I'M RUNNING OUT OF TIME.
I WANTED TO GIVE YOU A LITTLE
BIT OF A PREVIEW OF HOW WE ARE
GOING TO TRANSLATE THESE
LESSONS LEARNED INTO A SECOND
PHASE OF JCOIN. AND WE WANT TO
KEEP OUR MOMENTUM.
SO BACK LAST FALL, WE
ADVERTISED TO CONTINUE THE
INFRASTRUCTURE THAT HAS BEEN
PROVIDED BY OUR COORDINATION
AND TRANSLATION CENTER AND THE
ADVANCED METHODOLOGY AND
RESEARCH CENTER. WE SHOULD BE
MAKING AN ANNOUNCEMENT ABOUT
THOSE AWARDS VERY SOON, NOT
QUITE YET BUT VERY SOON.
MEANWHILE WE ALSO PUBLISHED OUR
INTENT TO CONTINUE JCOIN, THAT
WE WILL BE REALLY SEEING THIS
VERY SOON, AND OUR NEXT PHASE
OF RESEARCH HUBS. WE BEEN
SHARING THAT IN SOME PEOPLE CAN
ANTICIPATE THAT IS COMING.
AND AMONG THE THINGS THAT ARE
COVERED IN THAT, IS THE IDEA OF
WANTING TO MOVE EARLY ON THE
CONTINUUM. SHOW YOU SOMETHING
THAT IS OFTEN REFERENCES THE
INTERCEPT MODEL. AND TO ADJUST
THE WAY OF THINKING HOW PEOPLE
MOVED TO THE SYSTEM FROM
INITIAL LAW ENFORCEMENT
CONTACT, TO WHAT HAPPENS AFTER
THEY GET ARRESTED, TO COURTS,
JAILS AND PRISONS AND TO RETURN
TO THE COMMUNITY. WHEN YOU LOOK
AT WHAT WE HAVE DONE WE HAVE
FOCUSED ON THE 4-5 INTERCEPT
TRAJECTORY AND WE SEE A LOT OF
OPPORTUNITIES FOR ADDITIONAL
RESEARCH BUT WE ARE AT THE
EARLY STAGES, BUT KEEPING
PEOPLE OUT OF THE SYSTEM AS
MUCH AS WE CAN.
ONE OF THE OTHER BIG CHANGES WE
HOPE TO MAKE, THAT WE WILL BE
MAKING IN THE SECOND PHASE, IS
CONVERTING THE "O" FROM OPIOID
TO OVERDOSE. NOT JUST OPIOIDS,
PEOPLE ARE DYING FROM OTHER
THINGS, DOUBLING DOWN ON THE
IDEA OF BRINGING IN THE
PERSPECTIVE OF PEOPLE WE LIVED
EXPERIENCE. AND CONTINUE TO
RAMP UP THE SCALE OF THINGS
THAT WORKED. LOTS AND LOTS OF
REALLY, REALLY IMPORTANT POLICY
CHANGES HAPPENING RIGHT NOW. I
THINK THAT NORA SHARED EARLIER
DATA ABOUT THE SURVEY WERE
COMPARED TO 2018 WITH NOT KNOW
WHAT IMPLEMENTATION OF MOUDS IN
JAILS LOOK LIKE. WE THOUGHT IT
WAS RARE. THERE HAVE BEEN A LOT
OF CHANGES. THE JCOIN CHANGES
HAVE BEEN INCORPORATED INTO WAS
COMING OUT OF THE BUREAU OF
JUSTICE STATISTICS, STARTING TO
MAKE CHANGES IN LOTS OF POLICY
CHANGES. THEY ARE PUSHING THAT
DIRECTION.
YOU ASKED THE QUESTION EARLIER.
LOTS AND LOTS OF STUFF IS
HAPPENING. A LOT OF MOVEMENT
IS IN THE SPACE AND WE ARE
SEEING EXAMPLES WHERE CMS IS
NOW OFFERING STATES TO APPLY TO
BE ABLE TO PAY FOR SERVICES
BEFORE PEOPLE RETURN TO THE
COMMUNITY. HOPEFULLY WILL BE
ABLE TO UNDERSTAND. AND
SIGNIFICANT CHANGES WITH SOME
OF THE ROLES THAT SAMSAH HAS
ABOUT METHADONE AND HOW IT IS
BEING DELIVERED LOTS OF POLICY
CHANGES THAT I THINK ARE ON THE
HORIZON. WHERE WE SEE IMPACTS
ON THE SYSTEM MOVING FORWARD.
WILL ALSO THINK WE NEED MORE
WORK ON DISORDERS, AND LOTS OF
ISSUES AROUND TECHNOLOGY AND
SPECIAL POPULATIONS LIKE WOMEN,
ADOLESCENTS AND TRIBAL. I WANT
TO LEAVE TIME FOR QUESTIONS. WE
ARE RUNNING A LITTLE BIT LATE.
I WANT TO STOP THERE. I THANK
MY TEAM AND THE RESEARCHERS, IN
THE PARTICIPANTS IN THE TRIAL.
AND I WELCOME ANY QUESTIONS YOU
HAVE. AND IF YOU WANT TO SEE
ANY OF THOSE RESOURCES, THE
JCOIN CTC WEBSITE IS EVERYTHING
I REFERENCED. THE COURSES IN
THE PODCASTS, AND EVERYTHING
ALSO THANK YOU FOR THE
OPPORTUNITY TO SHARE.
>> DR. VOLKOW: THANK YOU FOR
THE EXCELLENT PRESENTATION. I
KNOW WE ARE RUNNING A LITTLE
BIT LATE BUT CAN WE ASK
QUESTIONS?
>> DR. WEISS: YEAH WHY DON'T WE
TAKE FIVE MINUTES FOR QUESTIONS.
I ALSO HATE TO CUT THESE
THINGS OFF ALSO.
>> HI. THANK YOU SO MUCH FOR
YOUR REPRESENTATION. I AM
WONDERING, IN YOUR DISCUSSIONS
AND LOOKING AT THE FUTURE WHERE
YOU ARE WITH PARTNERING WITH
HOUSING AUTHORITIES? A LOT OF
THIS POPULATION IS UNHOUSED, OR
HOUSING IS UNSTABLE, DIFFICULT
TO GET TREATMENT.
>> I AGREE WITH YOU ENTIRELY.
THIS IS SUCH AN IMPORTANT
PIECE. I HAVE NOT REACHED OUT
TO HUD. BUT I WOULD SAY THAT
DOOR IS WIDE OPEN. HALFWAY
HOUSING IS PART OF WHAT IS
OFTEN ON THE CONTINUUM OF CARE,
PEOPLE RETURNING TO THEIR
COMMUNITY. YEAH, THAT IS KIND
OF EXAMPLE SOMETHING THAT THE
DOOR IS WIDE OPEN, PART OF THE
SOCIAL DETERMINANTS OF HEALTH.
SO SUPER IMPORTANT. ABSOLUTELY
WOULD WELCOME WITH OPEN ARMS
ANYONE WHO WANTED TO EXPLORE
THE POSSIBILITY.
>> AND I THINK THE OTHER PIECE
IS, VOCATIONAL RETRAINING.
BECAUSE IF YOU DON'T HAVE A
JOB, OBVIOUSLY YOU CAN'T AFFORD
HOUSING. RIGHT? SO THOSE THINGS
GO HAND-IN-HAND. AND SO THOSE
ARE THE TWO MAJOR ASSET YOU CAN
ADD TO THE FUTURE PLANNING
PERHAPS.
>> TISHA: I WILL SAY TO YOU I
THINK THAT IS SOMETHING WE HOPE
IN THE COMPONENTS THAT WE ARE
PLANNING AROUND ... REALLY
INCREASING OUR EFFORTS FOR
LISTENING TO THE PERSPECTIVES
OF PEOPLE WE LIVED EXPERIENCE,
THAT IS WHAT WOULD HELP THEM.
WHAT DO THEY NEED? HOW DO YOU
SUPPORT THAT? BECAUSE I DO
THINK THAT IF YOU GO BACK TO
MASLOW HIERARCHY OF NEED, IF
SOMEONE RETURNS TO THEIR HOME
AND ALL THEY HAVE -- THEY GO
HOME TO ALMOST NOTHING. RIGHT?
THEY MAY BE DISCONNECTED. THEY
MAY NOT BE FOCUSED ON THE
CARDIOVASCULAR HEALTH. OR EVEN
THEIR SUBSTANCE USE DISORDER IF
THEY DON'T HAVE A PLACE TO
LIVE, OR WAYS TO SUPPORT
THEMSELVES. ABSOLUTELY.
>> THANK YOU.
>> DR. VOLKOW: TISHA, ONE
QUESTION. DO WE HAVE GOOD DATA
IN TERMS OF LONG-TERM OUTCOMES?
WE KNOW THAT THERE AT HIGHER
RISK OF DYING. HAVE THERE BEEN
RECENT ESTIMATES ABOUT WHAT
HAPPENS THAT IS IN JAIL OR
PRISON WITH A SUBSTANCE USE
DISORDER? WHAT IS YOUR LIFE
EXPECTANCY?
>> TISHA: LIFE EXPECTANCY,
DON'T KNOW THE ANSWER. BUT I AM
CERTAIN IT IS DRAMATICALLY
DECREASED RELATIVE TO OTHER
POPULATIONS, FOR A WHOLE
VARIETY OF REASONS. INCLUDING
NOT JUST SUBSTANCE USE, BUT IN
GENERAL PEOPLE WHO ARE -- AND
OFTEN PEOPLE THINK OF THIS AS
AN INVITED THING. BUT PEOPLE
WHO ARE INCARCERATED HAVE WORSE
OUTCOMES IN ALMOST EVERY
DIMENSION, CARDIOVASCULAR
HEALTH, THERE IS INFECTIONS
DISEASES, LOT OF CHRONIC
DISEASES. A POPULATION THAT IN
TURN STRUGGLES WITH HOUSING AND
ALL KINDS OF THINGS SO LIFE
EXPECTANCY RELATIVE TO OTHER
POPULATIONS-- I WILL SEE IF I
CAN FIND ANY THAT THIS IS ABOUT
THE IMPACT OF INCARCERATION ON
LIFE EXPECTANCY. BUT I CAN
GUARANTEE YOU, IT IS NOT GOOD.
>> DR. VOLKOW: YOU HAVE YOUR
HAND RAISED RICK.
>> TISHA DON'T FORGET ABOUT
THOSE CLASSIC EXPOSURES. THAT
ARE COINCIDENT WITH THESE
ENVIRONMENTS. IT IS A VERY
CHALLENGING LIFESTYLE.
>> TISHA: I WILL ACTUALLY
MENTION, JUST TWO WEEKS AGO I
WAS AT THE ACADEMIC AND
CORRECTIONAL HEALTHCARE
CONSORTIUM, ONE OF THE BIG
MEETINGS IN THE SPACE THAT
TRIES TO LEARN WHAT THE
ACADEMIC AND COMMUNITY PARTNER
PERSPECTIVES, AND THE WHOLE
THEME OF THE CONFERENCE WAS
ENVIRONMENTAL JUSTICE. THAT WAS
ONE OF THE KEY THEMES. THE
MEETING WAS HOSTED IN ARIZONA,
FOCUSING ON HEAT, AND CROSSROAD
FACILITIES OFTEN HAVE POOR
INFRASTRUCTURE. THEY WERE AMONG
THE HARDEST HIT FACILITIES
DURING COVID BECAUSE OF THE
LACK OF INFRASTRUCTURE.
ABSOLUTELY.
>> SO, THIS PROCESS GOES
HAND-IN-HAND WITH SOME MANY OF
THESE THINGS. NORA, I DON'T
KNOW THE REST OF YOU, WE HAD A
MEETING WITH SECRETARY BECERRA.
HE WAS TALKING ABOUT THE
COMPLICATIONS OF MANY
FARMWORKERS IN CENTRAL
CALIFORNIA. THE IMPACTS OF
CLIMATE CHANGE, AND INCREASED
HEAT, IN THE CONTEXT OF THESE,
PEOPLE ARE EASING SOME OF THEIR
PAIN WITH ILLICIT DRUG USE. IT
IS REALLY A COMPLICATED
FORMULA. NOT SURPRISED IF THE
LIFESPANS ARE MARKEDLY REDUCED
IN THESE INDIVIDUALS.
>> DR. VOLKOW: ABSOLUTELY,
TISHA IS CORRECT. IT WILL BE
INTERESTING TO SEE HOW MUCH
LOWER. IT IS AN ISSUE THAT BY
SPEAKING ABOUT IT PEOPLE CAN
START TO REACT. WE ARE SPENDING
MINUTES OF DOLLARS IN THE
CRIMINAL SYSTEM, AND THE
OUTCOMES ARE CLEARLY NEGATIVE
FOR PEOPLE WHO END UP THERE AND
THEIR FAMILIES. BECAUSE
OBVIOUSLY THE CHILDREN HAVE
MUCH WORSE OUTCOMES. SOCIAL
DISPARITIES AT THE EXTREME.
BUT THANKS FOR A FANTASTIC
PRESENTATION TISHA. AND I WILL
TURN IT BACK TO YOU SUSAN, TO
GUIDE US TO THE NEXT PART OF
THE MEETING.
>> DR. WEISS: SO WE HAVE A
BREAK RIGHT NOW WHICH GOES
UNTIL 2:25. WHY DON'T WE MAKE
IT UNTIL 2:30 PM, SO WE HAVE 15
MINUTES AND THEN WILL START THE
CLOSE SESSION THEN. SEE YOU
BACK YOUR 2:30 PM. IS THERE A
SEPARATE SIGN IN FOR THIS?
>> [BREAK]