WELCOME TO THE NATIONAL
INSTITUTES OF HEALTH, NIH HEAL
INITIATIVES AUGUST MEETING OF
THE MULTI-DISCIPLINARY WORKING
GROUP SO HAPPY TO SEE THE FACES
OF THE MULTI-DISCIPLINARY
WORKING GROUP NUMBERS AND HEAL
LEADERSHIP ALREADY ON. I THINK
WE WILL GIVE EVERYONE ANOTHER
MOMENT TO JOIN. CAROL MAY I YOU
TO RUN THROUGH THE ROLL OF THE
MULTI-DISCIPLINARY WORKING GROUP
MEMBERS AND TURN VIDEO AND AUDIO
ON AND FEW WORDS OF WELCOME TO
MAKE SURE WE CAN HEAR YOU LOUD
AND CLEAR. I SEE DR. TABAK IS
NOW ON SO WE CAN GET STARTED.
>>GOOD MORNING, EVERYBODY.
>>DO YOU WANT ME TOE CALL ROLL
NOW?
>>I'M SORRY, REBECCA DO YOU
WANT ME TO BEGIN OR ROLL CALL?
>>I WANTED TO WAIT UNTIL WE
HAVE YOU TO BEGIN BUT WE SHOULD
START WITH ROLL CALL.
SPEAKER5: ABSOLUTELY. THANK YOU.
>>OKAY. SO DR. GARLAN GARLAND.
>>GOOD TO SEE EVERYONE.
>>DR. HARRIS.
>>GOOD MORNING.
>>DR. HENRY.
>>GOOD MORNING, EVERYONE.
>>DR. DONFRIO.
>>GOOD MORNING.
>>DR. JONES.
>>GOOD MORNING.
>>DR. DEBARR.
>>NICE TO SEE EVERYBODY.
>>BEASLEY.
>>GOOD MORNING, EVEN.
>>DR. HENRY.
>>GOOD MORNING, AGAIN.
>>SORRY. DR. SMITH.
>>YES, I SEE YOU TOO.
>>GOOD MORNING. DR. JERNIGAN.
>>HI. HI, EVERYBODY.
>>EVERYONE WHOSE VIDEO IS ON, I
THINK WE CAN GET STARTED.
>>I SEE THE PROBLEM I WAS
MISLABELED.
>>BUT YOU CORRECTED YOURSELF.
>>ARE THERE MEMBERS OF THE HEAL
MULTI-DISALLYNARY WORKING GROUP
WHO HAVE NOT SAID GOOD MORNING
-- DISCIPLINARY WORKING GROUP
WHO HAVE NOT SAID GOOD MORNING
YET?
>>REBECCA NOT SURE ABOUT IC
DIRECTOR, I JOINED A MINUTE
LATE. NICE TO BE HERE.
>>WE CAN WELCOME MEMBERS OF THE
HEAL EXECUTIVE COMMITTEE. DR.
KOROSHETZ.
>>GOOD MORNING, FOLKS.
>>DR. VOLKOW.
>>GOOD MORNING, EVERYONE.
>>DR. (INAUDIBLE).
>>GOOD MORNING, I'M BACK. SEEM
TO HAVE DROPPED OFF.
>>DID I MISS ANYONE? I SAW ALAN
APPEAR WHILE SAYING GOOD
MORNING. GOOD MORNING, ALAN. I
WILL NOW TURN IT TO DR. TABAK,
THE ACTING NIH DIRECTOR TO START
OFF OUR MEETING.
>>THANKS VERY MUCH, REBECCA. I
JUST WANTED TO BEGIN BY ONCE
AGAIN THANKING YOU PERSONALLY
AND THE ENTIRE HEAL TEAM FOR ALL
THE THINGS YOU HAVE BEEN DOING
WITH THE PROGRAM. I KNOW THERE
ARE MANY COMMUNITIES THEY CROSS
THE NATION COUNTING ON THIS
EFFORT. YOU ARE PROVIDING THEM
SOME HOPE. AS THIS GROUP KNOWS
TOO WELL, THE OPIOID CRISIS IS
DYNAMIC, IT CONTINUES TO CHANGE
WITH DRUG SUPPLIES EVER
MORPHING, OVERDOSES FROM
FENTANYL AND XYLOZENE AND
STIMULANTS UNFORTUNATELY
CONTINUE THE RISE. IN TERMS OF
FEDERAL RESPONSE HAS BEEN, HEAL
OF COURSE IS AN INITIATIVE THAT
SPANS ACROSS THE AGENCY AND WE
ARE NOW AT A POINT WHERE IT
BENEFITS FROM MOST OF THE INPUT,
MOST NIH INSTITUTES AND CENTERS
WE ALSO WORK CLOSELY WITH
FEDERAL PARTNERS, CDC CMS FDA,
SAMHSA AND DEA. WE MEET MONTHLY
WITH THE FEDERAL AGENCIES
THROUGH THE DEPARTMENTS
BEHAVIORAL HEALTH COORDINATING
COUNCIL. LAST TIME WE MET I TOLD
YOU ABOUT A FEW NEW FDA
APPROVALS THAT HOLD GREAT
PROMISE TO SAVE LIVES, MARCH OF
23 THE FIRST OVER THE COUNTER
OPIOID REVERSAL AGENT, MARCH OF
-- MAY OF 23 NASAL SPRAY, A NEW
PRESCRIPTION OPIOID REVERSAL
OPTION, THEN ALSO IN MAY OF 23
AN EXTENDED RELEASE
BUPRENORPHINE INJECTION. OTHER
AGENCIES ARE ACTIVELY ENGAGED
AND THINKS SINCE OUR LAST
MEETING FOR EXAMPLE, DEA IS
WORKING MULTIPLE WAYS TO TRACK
FENTANYL, THEY ARE USING AI,
USING SOCIAL MEDIA, THEY ARE
MONITORING CRYPTO CURRENCY WHICH
APPARENTLY IS IN USE BY THE
CARTELS. THE WHITE HOUSE
RELEASED AN ACTION PLAN TO
ATTEMPT TO LIMIT THE SPREAD AND
IMPACT OF ZYLOZENE STREET NAME
TRANK DOPE, THERE IS A GOAL TO
REDUCE THE DEATHS BY 15% OVER
THE NEXT TWO YEARS AND SIX POINT
PLAN ISSUED BY THE WHITE HOUSE
DRUG CONTROL OFFICE TO SCALE UP
TESTING TREATMENT AND EFFORTS TO
INTERCEPT ILLEGAL SHIPMENTS OF
ZYLOZENE BEING MIXED INTO
FENTANYL AS WELL AS OTHER
ILLICIT OPIOIDS. TELEHEALTH
RULES THAT WERE EXPANDED DURING
THE PANDEMIC ARE STILL IN PLACE.
THE PUBLIC COMMENT PERIOD ON RFI
WHETHER OR NOT TO CONTINUE TO
ALLOW PRESCRIBING OF CONTROLLED
MEDICATIONS THROUGH TELEMEDICINE
IS EXTENDED UNTIL NOVEMBER. WE
HAVE GOTTEN OVER 38,000 COMMENTS
INTO THE DEA ABOUT THIS ISSUE.
THAT IS A RECORD NUMBER OF
COMMENTS. THE WORK WE DO HERE AT
NIH AND OTHER AGENCIES HAVE BEEN
INFORMING THIS POLICY, I THINK
BY MOST ACCOUNTS RESEARCH
SUPPORT IT IS SAFETY AND
EFFECTIVENESS OFFER TELEHEALTH
PRESCRIBING BUPRENORPHINE AND
METHADONE. PLEASE STAY TUNE.
THIS IS A VERY FLUID STATE
OBVIOUSLY. FDA ISSUED DRAFT
GUIDANCE FOR RESEARCHERS
INVESTIGATING PSYCHODELLIC DRUG
AS POTENTIAL TREATMENT FOR
MEDICAL CONDITIONS SUCH AS
PSYCHIATRIC OR SUBSTANCE USE
DISORDERS. I WANT TO BRIEFLY
MENTION ADMINISTRATIVE CHANGES
FOR HEAL BY MANY MEASURES, HOPE
YOU AGREE HEAL IS A VERY SUCC
SUCCESSFUL PROGRAM IT HAS
ACHIEVED CUTTING EDGE SCIENTIFIC
GOALS AND ADMINISTRATIVELY THIS
PROGRAM IS QUITE WELL ORGANIZED
AND WE ACHIEVED AS A MENTIONED A
FEW MOMENTS AGO ENGAGEMENT OF
MULTIPLE INSTITUTES CENTERS AND
OFFICES ACROSS NIH. PROGRAM HAS
SUFFICIENTLY MATURED TO ALLOW US
TO MOVE THE DAY TO DAY
ADMINISTRATION OF HEAL ACTIVITY
THE OFFICE OF THE DIRECTOR. TO
THE RELEVANT INSTITUTES AND
CENTERS WHERE APPROPRIATIONS
HAVE ALWAYS BEEN AS DECIDED BY
THE CONGRESS. HEAL STAFF WILL BE
MOVING TO EITHER NINDS OR NIDA
AS A RESULT OF DAY TO DAY HEAL
ADMINISTRATIVE FUNCTIONS WILL BE
CARRIED OUT AT THE IC LEVEL. OUR
INTENTION IS TO MAINTAIN THE
HEAL BRAND AND STRATEGY. AND
THIS SHOULD BE NOTICEABLE TO
PARTNERS AND OTHERS INTERESTED
IN OUR WORK. THIS IS CRITICAL
BECAUSE I SAID MANY TIMES THE
WORK THAT WE ARE ALL DOING IS
URGENT AND WE DON'T WANT TO SLOW
DOWN AND THINK THE
ADMINISTRATIVE SHIFTS MAY ENABLE
A SPEEDING OF WORK WITH PERHAPS
SOME ENHANCED EFFICIENCIES. WE
CONTINUE TO LOOK FOR YOUR GROUP
AND OTHERS FOR GUIDANCE AND
STEWARDSHIP ON THE HEAL
INVESTMENT WHICH IS SUBSTANTIAL
OVER THE NEXT COUPLE OF DAYS YOU
WILL HEAR PROJECTS AND PROGRAMS,
AS ALWAYS WE WANT YOUR
UNVARNISHED VIEW ABOUT THEIR
VALUE. THE NEW APPROACHES
PROPOSED ARE INTENDED TO ADDRESS
KEY GAPS PAIN MANAGEMENT
SOLUTIONS FOR UNDERSERVED
POPULATIONS FOR EXAMPLE, MEETING
THE NEEDS OF PATIENTS ON LONG
TERM OPIOIDS. INDIVIDUALS IN
RURAL AREAS AND WITH SICKLE CELL
DISEASE. EACH BRINGING THEIR OWN
UNIQUE COMPLICATED ISSUES. WE
WANT TO ENSURE QUALITY AND
RELIABILITY OF ADDICTION CARE.
WE WANT TO CONTINUE TO DEVELOP
PRECISE OUTCOME MEASURES FOR
HUMAN PAIN. PREPONDERANCE OF THE
EVIDENCE WE CONTINUE TO
ACCELERATE THE PATH TO
COMMERCIALIZATION FORM BASIC AND
TRANSLATIONAL WORK FUNDED BY THE
HEAL INITIATIVE. SO JUST TO SUM
UP THE CRISIS OF UNDERTREATED
PAIN OF SUBSTANCE USE AND
OVERDOSE CONTINUES OUR FULL
ATTENTION, DEDICATION,
CREATIVITY. RESEARCH DOES GIVE
PEOPLE HOPE. I HOPE Y'ALL AGREE
THROUGH SCIENCE AND EMPOWERING
COMMUNITIES HEAL IS REALLY
MAKING A DIFFERENCE IN THE LIVES
OF MANY PEOPLE ACROSS THE
COUNTRY. I WANT TO THANK YOU
AGAIN FOR YOUR TIME AND YOUR
TALENT AND OF COURSE YOUR
CANDOR. WE DO LISTEN TO YOUR
CONCERNS AND YOUR ADVICE. WE
CERTAINLY RELY ON YOU HELP
ENSURE WE ARE ON THE BEST PATH
FORWARD TO ACHIEVE OUR MISSION
OF ENDING ADDICTION LONG TERM.
SO WITH THAT, I WILL TURN THE
PODIUM BACK TO YOU, REBECCA.
THANK YOU.
>>THANK YOU, DR. TABAK. I SEE
DR. NUNEZ HAS JOINED US WHILE WE
WERE GETTING STARTED. WOULD YOU
LIKE TO SAY HELLO, GOOD MORNING,
DR. NUNEZ? UH-OH. I PUT YOU ON
THE SPOT. I'M SORRY. I WILL
JUST WAVE AT YOU AND SAY GOOD
MORNING. ALSO WE HAVE DR. JOENY
(INAUDIBLE) HEAL EXECUTIVE
COMMITTEE REPRESENTING NCATS,
JUST A MOMENT, JONI. I THINK WE
CAN AT THIS TIME TURN IT OVER TO
DR.S KOROSHETZ AND VOLKOW WHO
WILL BE SHARING THEIR PLANS FOR
THE NEXT PHASE OF HEAL AND
ASKING FOR YOUR INPUT AND
DISCUSSION. NORA, I BELIEVE YOU
ARE GOING FIRST.
>>THANKS REBECCA VERY MUCH AND
I ALSO WANT TO THANK JUST LIKE
LARRY DID EVERYONE AT THE
MULTI-DISCIPLINARY WORKING GROUP
BECAUSE THIS HAS BEEN YOUR INPUT
HAS BEEN VERY USEFUL HELPING
IDENTIFY WHAT MAYBE PRIORITIES
AND HOW TO ACCELERATE THE
SCIENCE. FROM THE BEGINNING NIDA
HAS BEEN ADDRESSING MAJOR
CHALLENGES WITH OVERDOSE CRISIS
AND THROUGH THE HEAL WE HAVE
BEEN ABLE TO EXPAND THE SPEED
AND DEPTH TO DEAL WITH EM.
THIS THE EFFORTS HAVE BEEN
FOCUSED FROM INCEPTION ON
HELPING TO DEVELOP MEDICATIONS
AND THERAPEUTICS THAT ARE MORE
EFFECTIVE PROVIDE ALTERNATIVES
FOR PEOPLE THAT DON'T JUST
RESPOND TO ONE. WE FOCUS VERY
MUCH THROUGHOUT ALL THE EFFORTS
ENSURING MEDICATIONS AND
TREATMENT THAT HAVE SHOWN
EVIDENCE OF EVE DA SID DO SHOW
EVIDENCE OF EFFECTIVENESS WHEN
TAKING ADVANTAGE OF THE CLINICAL
TRIAL NETWORK TO DO SO. WE PRY I
DON'T HAVE ADVERTISE THROUGH THE
FUNDING COMING THROUGH THE HEAL
TO ENSURE IMPLEMENTATION
RESEARCH AND ENGAGING WITH
COMMUNITIES NORMALLY NOT THE
TARGET OF THE NIH. LIKE THE
NETWORK RESEARCH THAT ENABLED US
TO PERMEATE AND DEVELOP
STRATEGIES TO TREAT PEOPLE THAT
ARE IN JAIL OR RELEASED FROM
JAIL AND SIGNIFICANTLY CHANGE
THE CULTURE OF THOSE PRACTICES.
WE PRIORITIZED ALL ALONG AND
STRENGTHENING THAT WITH
RESOURCES FROM HEAL. VERY MUCH
THE WHOLE AREA OF PREVENTION
BECAUSE AT THE END OF THE DAY
THIS IS LIKELY TO BE
INTERVENTION THAT WILL HAVE THE
LARGEST INSIGHT. -- IMPACT. WE
HAVE COME TO RECOGNIZE ISSU ISSF
COMORBIDITY. PAIN IS A KEY
PLAYER IN THE OVERDOSE CRISIS.
BUT IT IS ALSO COMPOUNDED BY
OTHER ASSOCIATED CONDITIONS
NOTABLY MENTAL HEALTH CONDITIONS
AND FREQUENCY CO-MORBID
SUBSTANCE USE ACTUALLY OCCURS.
IN THIS PROCESS THROUGHOUT THESE
FIVE YEARS OF HEAL, WE ENGAGE
PARTNERSHIPS WITH MULTIPLE
INSTITUTES THAT HAVE REALLY
ENRICHED THE ABILITY TO DEVELOP
AND ACCELERATE THE SCIENCE.
WHEN WE PLAN TO MOVE THE NEW
PHASE OF HEAL CALLING IT 2.0. TO
GENERATE HEAL IN NIDA, THE
DIRECTORS OF IT TO TAKE
ADVANTAGE OF THE STRUCTURE THAT
EXCEEDS EXPERTISE THE INSTITUTE
WHICH ACTUALLY WAS THE ONE THAT
WAS LEADING BASICALLY THE
PROJECTS THAT RELATE TO OPIOID
USE DISORDER TREATMENT AND
OVERDOSE REVERSAL IMPLEMENTATION
SCIENCES. WE WILL ENGAGE AUTISM
WHO HAVE BEEN PARTICIPATING AND
THERE WILL BE MONTHLY MEETINGS,
UPDATES WILL BE MADE TO ENSURE
THERE SHAH PARTICIPATION AND
DIALOGUE. ALL THESE WILL BE DONE
IN PARTNERSHIP WITH EQUIVALENT
OF IT AT NINDS WILL BE LIKE
WALTER. AT THE END OF THE DAY WE
WILL BE NIDA WILL TAKE THE
RESPONSIBILITY TO ENSURE AND YOU
HAVE OUR COMMITMENT THAT THE
PROJECTS WILL CONTINUE, WE WILL
CONTINUE TO ACCELERATE THE
SCIENCE, MAXIMIZE RESOURCES, AND
HAVE THE FLEXIBILITY TO ACTUALLY
CHANGE THE LANDSCAPE OF THE
OVERDOSE CRISIS WHILE ENSURING
OF COURSE WE ARE WORKING WITH
THE RELEVANT AGENCIES. SO THE
MULTI-DISCIPLINARY WORKING GROUP
WILL BE PART OF ALL THESE
ENDEAVOR AND I LOOK FORWARD TO
MULTIPLE INTERACTIONS. SO NOW I
PASS IT BY TO YOU WALTER.
>>THANKS, NORA AND REBECCA. THE
MAIN POINT I WANT TO MAKE IS
THAT I THINK THE TRANSITION OF
THE OPERATIONS FROM DR. TABAK'S
SOURCE OF INSTITUTES SHOULD BE
COMPLETELY UNIMPORTANT TO THE
OUTSIDE WORLD, IT IS BASICALLY
JUST ANOTHER WAY OF OPERATING
AND NORA AND I CERTAINLY WORKED
IN THIS SPACE WITH OTHER
PROGRAMS VERY SIMILAR WITH BRAIN
INITIATIVE CERTAINLY THE
BIGGEST. SO I THINK IN TERMS OF
PAIN SIDE OF THINGS, I JUST SAY
WE ARE COMMITTED TO MAKING HEAL
HEALTHY WHOLE AND ACTUALLY
BECAUSE THERE IS NO INSTITUTE
FOR PAIN THE HEAL INITIATIVE IS
JUST A FANTASTIC OPPORTUNITY TO
MOVE PAIN SCIENCE FORWARD. FOR
PAIN RESEARCH IT IS JUST AMAZING
WHAT WE HAVE BEEN ABLE TO DO. WE
COULDN'T HAVE DONE IT WITHOUT
HEAL AND LEADERSHIP WE GOT FROM
DR. COLLINS TABAK AND BAKER. SO
GOING FORWARD THE PLAN ON THE
PAIN SIDE IS TO BASICALLY WORK
AS WE DO SAY IN BRAIN OR
BLUEPRINT NEUROSCIENCE, SO IT IS
AN IC LED GOVERNANCE MODEL, THE
IDEA THERE IS THAT YOU REALLY
CAN LEVERAGE THE SCIENTIFIC
MULTIPLE INSTITUTES AND THEN USE
ADMINISTRATIVE INFRASTRUCTURE
THAT NIDA AND NINDS HAVE SLOTTED
IN THE OPERATIONAL PIECES. BUT
THE SCIENCE WAS THE MOST
IMPORTANT PIECE SO WE CONTINUE
TO HAVE THE SCIENCE TEAMS,
CONTINUE TO WORK ON NEW
INITIATIVES, MANAGING PROGRAMS,
THE PROGRAMS ARE MANAGED BY THE
INSTITUTES. THEN THE IC
DIRECTORS AS NORA MENTIONED WITH
EQUITIES IN HEAL OUD AND PAIN
WILL CONTINUE TO HAVE A KEY ROLE
IN THE HEAL GOVERNANCE. SO THE
IC DIRECTORS WILL BE MEETING ON
A FREQUENT BASIS AND THE PAIN
SIDE WE HAVE BEEN ABLE TO EXPAND
NUMBER OF ICs THAT WILL BE
COMING INTO THE EXECUTIVE
COMMITTEE THAT WILL THEN HAVE
VOTING POWER WHAT WE ACTUALLY DO
AND ALSO BE LOOKING ON AN ALMOST
CONTINUOUS BASIS LIKE REBECCA'S
TEAM DID ON WHAT IS GOING ON AT
HEAL. SOD WE HAVE NIAMS, LINDS
SHY, NCCIH ARENA, NLM IS ALSO
JOINING, PATTY BRENNAN IS GREAT
AT BIOINFORMATICS AND NIDDK WILL
JOIN, ABDOMINAL PAIN AND
DIABETIC NEUROPATHY PAIN, DR.
HODES FROM THE AGING INSTITUTE,
PAIN AND AGE IS CERTAINLY A BIG
PROBLEM. WE WOULD LIKE TO LIKE
WITH ANY PROGRAMS TAKE ADVANTAGE
OF SOME OF THE WORK THAT CAN BE
DONE IN THE CLINICAL CENTER SO
THAT CAN -- KIM GILLMAN RUNS THE
CLINICAL CENTER, BRUCE TROMBURG
FROM NIDID, THE NEW DIRECTOR OF
OBSSR AND DR. CLAYTON FROM
OFFICE OF WOMEN'S HEALTH. SO WE
PLAN TO MEET ON A REGULAR BASIS
ONCE EVERY MONTH TO GET
OPERATIONALIZE THIS, WE USUALLY
HAVE A COUPLE OF IC DIRECTORS
WORKING DAY TO DAY, WEEK TO WEEK
AT LEAST PREPARING FOR THE
MONTHLY MEETINGS. SO I WILL
CHAIR THAT WITH ONE OR TWO OTHER
IC MEMBERS AND EVERYONE WILL GET
A CHANCE TO PITCH IN. AS NORA
MENTIONED THERE WILL BE JOINT
MEETING OF PAIN GROUP AND THE
HEAL GROUP TO ADVISE ON THE
CROSS CUTTING PROGRAMS AND
KEEPING THE HEAL BRAND OUT THERE
AND SACRED, PLANNING THE SCIENCE
THAT CROSS CUTS BETWEEN PAIN AND
OPIOID OVERUSE DISORDER, THINGS
LIKE THE DATA ECOSYSTEM, THE
COMMUNICATION DISSEMINATION PART
OF HEAL, CROSS CUTTING PROGRAM
THAT THE BIGGER JOINT GROUPS
WILL OVERSEE NWG AND THE HEAL
PARTNERSHIP COMMITTEE AND THE
HEAL PI MEETINGS. SO THE PLAN IS
TO DO EXACTLY WHAT HAS BEEN DONE
BEFORE, AND OVER TIME WORKING AS
ALWAYS TO TRY TO IMPROVE THINGS
SO INPUT IS REALLY IMPORTANT AS
IT HAS BEEN IN THE PAST. BUT
MAYBE MORE IMPORTANT IN THE
FUTURE AS IT GETS TO MORE
DISSEMINATED MULTI-IC OPERATION.
THE OTHER THING TO MENTION IS
THAT WE ARE TRYING TO RUN THE
PAIN SIDE IS TO INTEGRATE MORE
WITH WHAT WE CALL NIH PAIN
CONSORTIUM. I DON'T KNOW PEOPLE
KNOW ABOUT THIS, BUT THIS WAS
ESTABLISHED A LONG TIME AGO AND
ALL MEMBERS OF THE LEADERSHIP
COMMITTEE ARE ON THE PAIN
EXECUTIVE COMMITTEE AS WELL.
-REPRESENTS 19 NIH INSTITUTES
AND CENTERS. WE ARE HOPING TO
MAYBE HIT THE BUTTON AGAIN,
SOMETHING IS NOT SHOWING. GO
BACK. THE HEAL PAIN CONSORTIUM
IS THE OPPORTUNITY TO GET INPUT
FROM ALL THE INSTITUTES EVEN
THOSE WHOSE IC DIRECTORS REALLY
CAN'T TAKE PART OF THE EXECUTIVE
COMMITTEE BECAUSE OF THE FINE
CONSTRAINTS, LIKE DR. GIBBONS,
NHLBI, SICKLE CELL PAIN, DR.
BERGNOLI NCI CANCER PAIN BUT ALL
THE INSTITUTES CAN MEET AND HAVE
THEIR REPRESENTATIVES UNDERSTAND
WHAT IS GOING ON AT HEAL AND
GIVE HEAL THEIR THOUGHTS ABOUT
WHAT WE CAN DO THAT IMPACT THEIR
MISSION. OF COURSE THE PROGRAMS
THEMSELVES ARE RUN OUT OF
MULTIPLE INSTITUTES WITH THE
PROGRAM DIRECTORS GRANT HERE AND
THERE, SO WE -- AND ALSO TO
BRING IN PROGRAM PEOPLE FROM THE
INSTITUTES TO WORK IN HEAL, THIS
WILL BE A WAY FOR THOSE WHO
CAN'T MAKE AN EXECUTIVE
COMMITTEE TO BE REALLY
INTEGRATED INTO WHAT HEAL IS
DOING. NEXT SLIDE. SO THE
THOUGHT IS THE REPRESENTATIVES
OF THE PAIN CONSORTIUM WILL
SERVE BETWEEN THE LINK BETWEEN
HEAL AND INSTITUTE, THE BANK
CONSORTIUM REPRESENTATIVES WILL
MANAGE YOUR PROJECTS OR ADVISE
HEAL TEAMS, THE PROGRAMS HAVE
FOLLOWING THE INSTITUTE AND THE
HEAL PAIN CONSORTIUM WILL SERVE
AS A VOICE BETWEEN THE HEAL AND
THE EXECUTIVE COMMITTEE
PROPOSING AND DESIGNING NEW
INITIATIVES.
SO WE ARE TAKING THE LESSONED
LEARNED AT HEAL AND JUST TRYING
TO STRENGTHEN THE SCIENTIFIC AND
MANAGEMENT EXPERTISE WE HAVE
ACROSS MULTIPLE INSTITUTES
INVOLVED IN PAIN. SO LOOKING
FORWARD TO THIS, I THINK IT IS
EXCITING OPPORTUNITY, THE
STRENGTH AND THE PAIN SIDE OF
THE HEAL AND THE WORK, CONTINUE
TO WORK WITH NIDA AND THE OUD
TEAM ON THE OVERALL AIM OF HEAL
WHICH IS TO REDUCE OPIOID USE
DISORDER AND DEATH FROM THE PAIN
SIDE THE L IN HEAL STANDS FOR
LONG TERM. I THINK PEOPLE AGREE
THE LESS WE CAN GET OPIOIDS USE
FOR PAIN DIMINISHED AND MEDICAL
CARE WE ARE NEVER GOING TO GET.
AND NEVER GOING TO SOLVE THIS
PROBLEM IN THE LODGE RUN. THAT'S
WHAT -- LONG RUN. THAT IS WHAT I
WANTED THE SHARE WITH PEOPLE AT
THIS POINT. LOTS OF THINGS IN
THE AIR BECAUSE THIS IS A
DEMOCRATIC PROCESS AND WE GET
INPUT FROM ALL THE DIFFERENT
ICs NOW.
>>THANK YOU, WALTER. THANK YOU,
NORA. ARE THERE QUESTIONS FROM
THE EXECUTIVE COMMITTEE
SPECIFICALLY ABOUT WHAT YOU
HEARD. QUESTIONS FROM THE
EXECUTIVE COMMITTEE, QUESTIONS
FROM THE MULTI-DISCIPLINARY
WORKING GROUP ABOUT WHAT YOU
JUST HEARD IN TERMS OF THE
ORGANIZATIONAL PLAN GOING
FORWARD?
>>HOPEFULLY YOU WON'T NOTICE
ANYTHING. ALAN IS BITING HIS
FINGERNAILS.
>>I'M SCRATCHING MY TEETH.
THAT'S WHAT I TOLD MY FATHER.
>>-- YOU HAVE YOUR HAND RAISE.
>>SORRY GUYS, FUN TO BE TRIPLE
BOOKED. BUT I HAD BROUGHT THIS
UP BEFORE, I THINK IT IS A
FABULOUS TIME IN OUR HISTORY AND
TO LAUNCH FROM THE PROGRAM TO BE
ENGAGED IN A REFRESH MODE OF A
STRATEGIC PLAN FOR BOTH ENTITIES
THAT ALLOW US TO THINK
DIFFERENTLY AND MOVE AHEAD IN A
DIFFERENT WAY OR REPEAT BEST
PRACTICES. I THINK -- I'M HOPING
THAT IS ACTUALLY POSSIBLE.
>>I AGREE COMPLETELY. MY
PERSPECTIVE IS IN GENERAL WHICH
IS LOOKING AND BE SELF-CRITICAL
DETERMINING WHETHER THE SHAH
OPTIMAL AND THIS OPPORTUNITY OF
MOVING. INDEED, IT IS GOING TO
-- TO ME ONE OF THE KEY ASPECTS
ABOUT ALL OF THIS IS THE
OVERDOSE CRISIS IS MOVING SO
FAST, WE HAVE NOT BEEN ABLE TO
CONTAIN IT. BECAUSE OF THIS
MOVING PART IT IS CRUCIAL WE
BASICALLY EVALUATING WHERE WE --
WHERE THERE MAY BE GAPS AND
WHERE WE CAN ACTUALLY STRENGTHEN
AND FORM PARTNERSHIPS. SO I
THINK THIS IS A KEY COMPONENT TO
ENSURE THAT WE WILL BE
SUCCESSFUL IN ADDRESSING THE
CRISIS.
>>THANK YOU.
>>OTHER QUESTIONS?
>>CHRIS HAND HER HAND UP.
>>HI, CHRIS, GOOD MORNING. I
UNDERSTAND THE SHIFT AND THERE'S
DISCUSSION AND PLANNING AMONG
AND BETWEEN THE INSTITUTES AND
OFFICE OF THE DIRECTOR. ONE OF
THE MAJOR SUCCESSES OF HEAL, IN
MY OPINION IS I CAN SPEAK
OBVIOUSLY BETTER ON THE PAIN
SIDES BECAUSE THAT IS WHAT I
HAVE BEEN INVOLVED FOR THE LAST
25 YEARS BUT THE FACT FOR THE
FIRST TIME IN HISTORY HAVE ALL
OF THE INSTITUTES AND OFFICES AT
THE NIH WORKING TOGETHER
COLLABORATIVELY ON PAIN THAT IS
ONE THING. THE SECOND IS THIS
ALSO COMING TOGETHER OF THE SUD
AND PAIN COMMUNITIES WHICH
HISTORICALLY IN THE PAST HAVE
BEEN DISPARATE AND ALMOST PINNED
US AGAINST ONE ANOTHER. SO I
JUST WANT TO EMPHASIZE, AND SURE
THIS IS AT THE TOP OF EVERYONE'S
MIND AS YOU MOVE TO THE NEW
STRUCTURE Z THAT IT IS REALLY
IMPORTANT TO CONTINUE TO
COLLABORATE IN THOSE WAYS. AND
ALSO TO COMMUNICATE TO THE
SCIENTIFIC CLINICAL PATIENT
COMMUNITIES THAT IT IS NOT GOING
BACK TO BUSINESS AS USUAL BEFORE
WHERE THIS INSTITUTE DOES THIS
AND THAT INSTITUTE DOES THIS AND
THERE IS NO COLLABORATION
BETWEEN THE SUD AND THE PAIN
COMMUNITIES. FROM THE VANTAGE
POINT OF NIH MIGHT SAY I DON'T
SEE HOW THAT IS POSSIBLE BUT
BEING IN THESE COMMUNITIES FOR A
LONG TIME AND THE WAY THE NIH IS
STRUCTURE FOR BETTER OR FOR
WORSE, IT IS A VERY REAL
PERCEPTION. HASN'T BEEN THAT
LONG THESE COMMUNITYINGS HAVE
BEEN WORKING TOGETHER. AND IT
TAKES TIME TO BUILD
COLLABORATION AN TRUST AMONG
THOSE COMMUNITIES AND WE WANT TO
MAKE SURE WE ARE CAREFUL ABOUT
COMMUNICATING THAT THIS IS STILL
THE WAY HEAL IS GOING TO
FUNCTION MOVING FORWARD
IRRESPECTIVE WHERE THIS
COMMITTEE LIES OR THAT COMMITTEE
LIES OR WHATEVER, THE NEW
STRUCTURE WILL BE WITHIN HEAL.
AND FINALLY I WANT TO THANK
REBECCA FOR YOUR LEADERSHIP,
THIS HAS BEEN AN AMAZING PROCESS
AND COMMITTEE TO BE INVOLVED
WITH. MANY OF US HAVE SERVED ON
A NUMBER OF FEDERAL COMMITTEES
AND SOMETIMES WE FEEL LIKE WE
ARE JUST KIND OF THERE. AND HEAL
HAS BEEN SO DIFFERENT IN THAT
RESPECT WHERE REALLY FEEL THAT
YOU AND THE ENTIRE TEAM HAVE
REALLY BEEN VERY CAREFUL TO
SOLICIT OUR OPINIONS AND NOT
JUST HEAR US BUT ACT ON THEM.
THERE'S SO MANY THINGS INCLUDING
THE PATIENT AND COMMUNITY
ENGAGEMENT SIDE OF HEAL THAT I
HAVE SEEN COME TO FRUITION OVER
THE LAST FEW YEARS. SO I JUST
WANT TO REALLY THANK YOU FOR
YOUR TERRIFIC LEADERSHIP AND
BRINGING HEAL TO WHERE IT IS
TODATODAY. THIS HAS BEEN AN AMAG
PROCESS AND INITIATIVE TO BE
INVOLVED WITH. THANK YOU.
>>I ALMOST LOWERED MY HAND
BECAUSE CHRIS SAID IT
ARTICULATELY, I THINK THAT
COLLABORATIVE WHAT I OBSERVED AS
WELL AND WORKING IN THESE
INTERFACES THAT REALLY MATTER
BETWEEN -- AND I WOULD ADD
MENTAL HEALTH TO THAT TOO, WE
HAVE COME FULL CIRCUMSTANCE
MILLION THAT WAY. AS WELL AS
REBECCA, I THINK YOUR ROLE. I
WAS JUST CURIOUS WHAT THIS
MOVING INTO THE ICs AND THAT
MAKES SENSE THE LEADERSHIP
APPRECIATES THAT DESCRIPTION.
REBECCA, IF YOU CONTINUE MANY
THE ROLE THAT YOU HAVE OR HOW
THAT WILL BE STRUCTURED?
>>I WILL NOT, DR. VOLKOW AND
KOROSHETZ AND SEEN YOUR STAFF
WILL BE COORDINATING
MULTI-DISCIPLINARY WORKING
GROUP. SOME OF THE HEAL TEAM
WILL BE MOVING TO THOSE ICs TO
ASSIST THEM. I HAVE LOVED
WORKING WITH ALL OF YOU. I LOVED
HEARING YOUR IDEAS. I WOULD
SUGGEST NORA AND WALTER KIND OF
SPEAK TO HOW THE INTEGRATION AND
THE WAYS THAT WE WERE ABLE TO
BUILD CONNECTEDNESS BETWEEN
PAIN, ADDICTION, MENTAL HEALTH
AND THE DIFFERENT SCIENTIFIC
ASPECTS THAT FEED INTO THOSE
WILL BE SUSTAINED INTO THE NEXT
PHASE. FOR ME IT WAS JUST SUCH A
TREAT WORKING WITH ALL OF YOU
FROM THE BEGINNING OF HEAL WHEN
WE HAD A SKELETON, WHAT WE
WANTED TO DO, FLESHING THAT OUT
INTO THE AS SAID, MORE MATURE
FRAMEWORK WE HAVE NOW. IT IS UP
TO ALL OF YOU TO CARRY IT
FORWARD. SO I WILL DEFER TO
WALTER AND NORA. IN ADDRESSING
THAT.
>>REBECCA, THANKS. I THINK
STAFF COMMENDS WERE BEING MADE.
I THINK CERTAINLY IT HAS BECOME
CLEAR AND EVIDENT THAT THERE HAS
BEEN BASICALLY ALMOST NO
COMMUNICATION IN TERMS OF
PATIENT GROUPS AND INDIVIDUALS
AFFECTED BY PAIN OR SUBSTANCE
USE DISORDER. AS A RESULT OF
THAT, THAT HAS LED TO A MISSING
OPPORTUNITY OF ACTUALLY
EXPANDING TREATMENT AND
PREVENTION OF PAIN AND SUBSTANCE
USE DISORDER. I THINK THAT THE
EXTENT TO WHICH ACTUALLY NIDA
FROM MANY DECADES HAS BEEN
INVOLVED WITH PAIN, WITH
BASICALLY THE INSTITUTE IN TERMS
OF DOLLAR AMOUNT, IN ABSOLUTE
TERMS WE ARE AT THE TOP. BECAUSE
IT IS CRUCIAL AND WE BELIEVE IT
I THINK WHAT HEAL HAVE ENABLED
US TO DO AND MANY OTHER
INSTITUTES THAT HAVE BEEN
ENGAGED WITH PAIN. BUT BECAUSE
THERE WASN'T AN INSTITUTE AT NIH
THAT DEAL WITH PAIN, THERE WAS
THE OPPORTUNITY OF STRUCTURE AS
COMMON STRATEGIC GOAL THAT COULD
STRENGTHEN WHAT WE WERE DOING ON
THE ONE HAND. IMPORTANTLY THE
RESOURCES THAT WERE GIVEN FOR
PAIN WERE RELATIVELY
CONSTRAINED. THAT LIMITED OUR
ABILITY TO REALLY MAKE A LARGE
MARK ON HEAL HAVE CHANGED THAT
DRAMATICALLY. NOT JUST BECAUSE
HE HAS BROUGHT DOLLARS BUT WHAT
WE HAS DONE IS CREATE THAT
PATIENT FORWARD THAT VOICE THAT
RECOGNITION THAT COMMUNICATION
IS FUNDAMENTAL. THE STRUCTURES
THAT CURRENTLY EXIST DURING HEAL
WILL BE CONTINUED IN THESE NEW
HEAL 2.0. WE ARE ALSO GOING TO
SORT OF ANOTHER ASPECT THAT HAS
BEEN TOO VERY KNOWLEDGEABLE ON
HEAL AND HASN'T BEEN BROUGHT UP
BUT WILL CONTINUE TO
INCREASINGLY PLAY A KEY IMPACT
IS THAT DATA SCIENCE AND
ACTUALLY THE NETWORKING THAT
CURRENTLY EXISTS THROUGH THE
DATA ECOSYSTEM THAT WILL ALLOW
US TO MAXIMIZE INFORMATION. SO
THAT IN TURN IS A WAY THAT WE
CAN USE FOR COMMUNICATION AND
DISSEMINATION AND STICKING FOR
OPPORTUNITIES THAT CAN BRING
OTHER PLAYERS INTO THE GAME SO I
COMPLETELY AGREE THIS ELEMENT IS
FUNDAMENTAL AND I ALSO
COMPLETELY AGREE THAT WE ARE
GOING TO HAVE TO GO AND TACKLE
UP FRONT COMPLEX CONDITIONS OF
EVERY DAY LIFE WHICH ENGAGE
PATIENTS WITH MULTIPLE
COMORBIDITIES AND CONDITIONS.
LIKE PAIN AND ALL THE PATIENTS
THAT SUFFER BUT IT GOES BEYOND
THAT, AND THAT REQUIRES
ABSOLUTELY THAT WE COLLABORATE
BUT AS WALTER SAID WE HAVE DONE
THAT IN MULTIPLE PROJECTS, IT IS
NOT THAT WE -- THE SENSE THAT
THE INSTITUTES ARE WORKING IN
SILOS, IT DOES REFLECT THE
REALITY OF WHAT HAPPENS.
OBVIOUSLY WHEN YOU HAVE
RESOURCES THAT MAXIMIZE WHAT YOU
CAN DO IN THIS COLLABORATIVE
ENTERPRISES, I WOULD ALSO
WELCOME TO HEAR WHAT WILL WALTER
HAS TO SAY TOO.
>>I JUST WANT TO SAY AS YOU
HEARD REBECCA IS NOT GOING TO
STAY ON. THAT IS GOING TO BE A
REAL PROBLEM FOR ME AND NORA.
SHE IS REALLY BEEN THE GLUE THAT
COULDS EVERYTHING TOGETHER AND
CAN IMAGINE CAN ALL THE ICs
INVOLVED, HOLDING IT TOGETHER IS
REALLY HARD. BUT SHE DID IT.
LARRY, FRANCIS, EVERYTHING WENT
REALLY SMOOTHLY. SO (INAUDIBLE)
COULDN'T JOIN THE PAIN TEAM BUT
SURE SHE WILL DO EVEN GREATER
THINGS, HATS OFF TO REBECCA AND
HER TEAM WE GOT SOME OF THE
MEMBERS OF HER TEAM TO COME
OVER. SO WE HAVE SOME -- WE HAVE
CONTINUITY THERE A LOT OF THE
ISSUES. REALLY GRATEFUL TO THEM
WE JUST HAVE TO WORK HARD TO
MAKE HER PROUD. THIS IS A GREAT,
AS I SAID FOR PAIN. THERE IS
NOTHING LIKE IT, IT IS THE
GREATEST THING TO HAPPEN TO PAIN
RESEARCH. WE CALL IT REALLY
CLOSE TO OUR HEARTS AND WE WILL
-- CERTAINLY NINDS AND OTHER
INSTITUTES ON THE PAIN SIDE WILL
BE REALLY ROLLING UP THEIR
SLEEVES AND REALLY MOVING THINGS
FORWARD IN THE NEW RENDITION.
THANKS SO MUCH TO REBECCA FOR
SURE.
>>THANK YOU, WALTER. PATRICE,
YOU ARE NEXT.
>>THANK YOU, AND FIRST OF ALL
LET ME ADD TO THOSE KUDOS TO
REBECCA. I ALSO ALMOST LOWERED
MY HAND BECAUSE CHRIS AND LYNN
MADE THE POINTS SO I WILL JUST
SAY AGAIN IT SEEMS TO ME THIS IS
PERFECTLY REASONABLE EVOLUTION
BECAUSE REALLY WHAT YOU WANT TO
DO IS STAND UP SOMETHING AND IN
THE NEXT PHASE IS MAKING SURE IT
IS INTEGRATED INTO MY WORDS, DNA
OF THE WORK AND THE DNA OF THE
ORGANIZATION AND AT LEAST THAT
IS WHAT I'M HEARING IS THE GOAL.
BUT TO WALTER AND NORA. SO WHEN
WE FIVE YEARS FROM NOW H I'M
SURE YOU PROBABLY HAVE NOT DUG
DEEP ON THIS YET AND YOU WILL
AND MAYBE THIS SOMETHING YOU CAN
SHARE AT A LATER MEETING BUT
FIVE YEARS FROM NOW HOW WILL YOU
KNOW THAT THE GOALS YOU ARE
SETTING FORTH FOR 2.0 HAVE BEEN
MET. SO AGAIN, IF THAT IS
SOMETHING I KNOW THAT THAT IS
SOMETHING THAT YOU ARE THINKING
ABOUT. BECAUSE THAT IS WHAT
Y'ALL DO IN YOUR EVERY DAY, YOU
ARE VERY ACCOMPLISHED. BUT MAYBE
IN ANOTHER MEETING WE CAN THINK
ABOUT WHEN WE AGAIN GET TOGETHER
IN FIVE YEARS, MAY NOT BE THIS
PARTICULAR GROUP BUT WHEN YOU
LOOK BACK ON THIS IN FIVE YEARS
AND SAY YES 2.0 IS GOING EXACTLY
OR MAYBE NOT EXACTLY BUT AS WE
EXPECTED, HOW WE THINKING ABOUT
THAT?
>>BASICALLY ABSOLUTELY, I THINK
THAT WE WILL ADDRESS THAT IN
ANOTHER ONE BUT HANKS SO MUCH
FOR BRINGING IT UP. WE HAVE TO
KEEP OUR EYE ON THE WORK.
ABSOLUTELY.
>>NORA, WALTER, CAN I --
(OVERLAPPING SPEAKERS)
>>PATRICE, JUST SIMPLE, I'M A
VERY SIMPLE PERSON. THE JOB IS
TO GET MORE EFFICIENT WITH PAIN
MEDS TO THE PEOPLE WHO ARE
SUFFERING THE PAIN SO THEY DON'T
GO TO OPIOIDS NEEDLESSLY. THAT'S
NUMBER ONE. NUMBER TWO IS
UNDERSTANDING HOW WE USE A TOOL
WE HAVE NOW TO GET BETTER
MANAGEMENT OF PAIN AND REDUCE
THE RISK OF 'DICTION. THOSE ARE
THE TWO THINGS THAT IF WE DON'T
-- IT IS NOT HOE WE MAKE IT
COMPLICATED, I THINK WE CAN
REALLY LOSE SIGHT BUT THAT HAS
GOT TO BE WHAT WE DO. WE DON'T
DO THAT, IT IS A HARD PROBLEM.
THESE ARE NOT EASY PROBLEMS.
THERE IS A REASON WHY NONE OF
THE DRUG COMPANIES ARE DOING
THIS IN TERMS OF DEVELOPING NEW
THERAPIES ANY MORE. IT IS REALLY
UP TO US NOW TO DO THAT. IN
TERMS OF HELPING -- PROVIDING
THE INFORMATION FOR PHYSICIANS
HOW TO MANAGE PATIENTS WITH
CHRONIC PAIN, HOW WE MANAGE
ACUTE PAIN SO THEY DON'T BECOME
NEEDLESSLY EXPOSED TO OPIOIDS IS
SOMETHING THERE SYSTEM ALL
DOABLE NOW BUT IT IS NOT EASY
BECAUSE DIFFERENT SEGMENTS OF
THE POPULATION IS DIFFERENT
CONDITIONS, DIFFERENT TYPES OF
PATIENTS, AND ALL THE SOCIAL
FACTORS THAT COME IN BUT THOSE
ARE THE KIND OF THINGS THAT I
THINK WE CAN NEGOTIATE AND GET
TO THE GOAL WE ARE AFTER. BUT TO
ME THE GOAL NEVER CHANGES, IT IS
ALWAYS THAT ULTIMATE SINGULAR
FOCUS ON IMPROVING PAIN
MANAGEMENT SO PEOPLE ARE NOT
SUFFERING, THAT THEIR FUNCTION
IS OPTIMIZED. AND THAT MEANS
RISK OF ADDICTION INVOLVED.
ANYWAY, I'M HAPPY IF THERE IS
MORE NUANCES THAT I SHOULD
CONSIDER.
>>SO JUST A POINT ON THE -- I
WANT US TO PUT US ON THE SPOT
WALTER AND MYSELF, PATRICE
COMMENT IS RELEVANT, WE HAVE
MORE RELEVANCE IN TERMS OF WHAT
WE EXPECT FOR THE DIFFERENT
LEVELS SO REDUCING PAIN WHAT
DOES THAT MEAN IN TERMS OF
ACTUALLY HOW DO WE REDUCE
ADDICTION. HOW DO WE TREAT, HOW
DO WE CHANGE, HOW WE DO
PREVENTION, BEING ABLE FOR ALL.
I THINK OF THE
MULTI-DISCIPLINARY WORKING
GROUP, WE ARE IN THISSING TO AND
GET YOUR PERSPECTIVE ALSO. SO I
APOLOGIZE, RENA.
>>I'M AS COMPLEX AS WALTER IS
SIMPLE AND PROBABLY AS COMPLEX
AS CONDITIONS WE ARE CONCERNED
ABOUT. SO I WANT US TO BE
THINKING INSITUATION WITH OTHER
VERY RELATED HEALTH CONDITIONS.
AND I HENCE WOULD ENVISION
SOMETHING LIKE REBECCA IN A ROLE
THAT WOULD ALLOW FOR SUCH
INTEGRATION TO WITH MENTAL
HEALTH ITSELF. THAT FIELD AS YOU
KNOW IS SO BADLY NEEDS ATTENTION
AND IS A PRIORITY FOR THIS
PRESENCE AN THIS TIME WE LIVE
ENOUGH. IT IS RELATED TO SO MANY
OTHER ASPECTS OF HUMAN
CONDITIONS TODAY. I WOULD LIKE
US TO BE THINKING OR ADVOCATING
PROPOSITIONING, WHATEVER YOU
WANT TO CALL IT WITH SUCH A ROLE
THAT WOULD ALLOW US TO KEEP THE
HISTORY AND CREATE NEW FUTURES
FOR US THAT WE HADN'T ENVISIONED
IN THE PAST. AND USING SOMEONE
-- NOT USING BUT TAKING
ADVANTAGE OR LEVERAGING FROM
SOMEONE LIKE REBECCA. TO BE
CREATING THAT INTEGRATED ROLE
BECAUSE I SEE THAT IS THE FUTURE
OF OUR WORK. THAT IS MY SPIEL
AND I WILL GET OUT OF HERE.
>>WALLY YOUR HAND IS RAISED.
>>YES. TO THAT END PERHAPS IN
THE NEXT SIX MONTHS WALTER AND
NORA CAN BRING BACK A DRAFT OF A
STRATEGIC PLAN WITH PROCESSES
AND OUTCOME GOALS FOR US TO
COMMENT ON AND CRITIQUE. AND WE
CAN PUBLISH THAT SO THAT THE
PUBLIC WILL KNOW HOW WE WILL
KNOW WHETHER WE SUCCEEDED.
>>THAT IS A CHALLENGE, NORA,
WALTER?
>>I LIKE IT IT. I LIKE IT. I TK
THIS IS -- WE HAVE A TREMENDOUS
RESPONSIBILRESPONSIBILITY. AND P
SUMMARIZING THE GOAL OF WHAT IT
IS WE ARE DOING. IT IS VERY
COMPLEX, AS WALTER WAS SAYING,
EVEN THOUGH SIMPLE GOAL TO END
ADDICTION LONG TERM, OF COURSE
IT SOUNDS BEAUTIFUL BUT HOW DO
YOU IMPLEMENT THAT INTO REALITY
THAT IS NOT FANTASY. AND TO ME
WANTING TO BE VERY CONCRETE,
WHAT ARE THE STEPS THAT LEADS US
TO APPROACH THAT AND WHAT
ACTUALLY ARE THE METRICS. AND
THE IDEAL AND THEN WHAT ARE SORT
OF OTHER INTERMEDIATE STEPS. I
LIKE IT. WE WILL -- IT DOES HELP
US BECAUSE OBVIOUSLY WE WORK
WITH ADDICTION, WE WORK WITH
TREATMENT, WITH EVERYTHING THAT
WE DO WITH HEAL. IT IS
INTEGRATED. BUT ULTIMATELY,
DECISIONS IN TERMS OF FUNDS
ALLOCATED THROUGH THE CLUSTER OF
HEAL FUNDS VERSUS OTHERS THAT
ARE O THE INSTITUTE
STRATEGICALLY HOW WE ENSURE THAT
WE ARE MAXIMIZING THE GOAL
REVERSING THIS OVERDOSE, THAT
REPORTS INTERVENTIONS ACTUALLY A
YEAR MORE TOWARDS
IMPLEMENTATION, CLINICAL
SOLUTIONS AS OPPOSED TO
FUNDAMENTAL SCIENCE. SO IT WILL
ALSO BE VALUABLE FOR US TO HAVE
IT SO I LIKE IT. I WANT US TO
GET ON THE RADAR. SIX MONTHS TO
ME SEEMS REASONABLE. BUT I DON'T
KNOW WALTER, IS THIS TOO -- ARE
YOU ON BOARD ON THIS?
>>WELL, WE HAVE TALKED ABOUT
PAIN OF DEVELOPING THE STRATEGIC
PLAN FOR HEAL. WE DO HAVE -- WE
HAVE YOU ADD STRATEGIC PLAN TO
YOUR INSTITUTE WE HAVE NATIONAL
PAIN STRATEGY PUT TOGETHER YEARS
AGO. WHICH IS WHAT I DO, THAT'S
BEEN THE BIBLE FOR ME. BUT
ACTUALLY WE ARE PLANNING TO DO
ON THE PAIN SIDE.
>>I THINK ALAN HAD HIS HAND
RAISED.
>>JUST TO SAY THANK YOU TO
REBECCA TO BEGIN WITH. AND WE
WILL MISS YOU. THAT'S THE
SIMPLEST ANSWER. WE SHOULD
FIGURE OUT HOW REBECCA KICKED
THE HABIT AND MAYBE WE WILL
LEARN SOMETHING. IF YOU ARE ABLE
TO GIVE THIS UP. ON A MORE
SERIOUS NOTE FROM THE
DISCUSSION, DIFFERENT THINGS
COME TO MIND WITH THE HEAL
MOVING INTO THE INSTITUTES, I
KNOW WE HAVE TO SEPARATE
TRADITIONAL FUNDING, ENTERPRISE,
WITH HEAL FUNDING BUT IT IS HARD
TO IMAGINE WE HAVE TO SEPARATE
THE SCIENCE AND IDEAS. IT IS
GOING TO BE SO MUCH CLOSER TO
WHAT THE INSTITUTE IS FUNDING
THROUGH TRADITIONAL STUDY
SECTIONS. THE ISSUE, IS THERE
OVERLAP, IS THERE MUCH IN SOME
OPINION BETTER WORK COMING FROM
SOME INDIVIDUAL PROPOSALS
THROUGH THE NIH, TRADITIONAL
SYSTEM OR VICE VERSA? AND HOW TO
INTEGRATE THOSE TWO TO MAKE --
TO IMPROVE THE SCIENCE COMING
OUT OF THE INDIVIDUAL LABS? THEY
ARE SEPARATED. I KNOW THEY ARE
SEPARATED ON A FUNDING BASIS. IN
A STRATEGIC FUND MAYBE THERE IS
SOME WAY TO TRY TO GET SOME
BENEFIT FROM THE FACT THAT IT IS
MUCH CLOSER TO HOME NOW. THE
OTHER ISSUE, THIS IS REALLY OFF
THE WALL. IT IS OUT OF IGNORANCE
THAT I ASK THIS QUESTION, COMING
FROM SAN FRANCISCO IT IS A HUGE
QUESTION. EVERYONE THINK IT IS
CITY IS FALLING APART. IT IS
NOT. BUT DO WE HAVE A HOMELESS
CRISIS? YOU BET WE WE DO. THERE
ARE FRIENDS OF MINE WORKING WITH
THE IS CITY ON THE HOMELESS
THING. WHAT I LEARNED IS MANY
HOMELESS PEOPLE ACTUALLY BEGAN
PEOPLE WHO ARE QUITE WELL OFF.
AT HOMES, FAMILIES, AND BECAUSE
OF THE PANDEMIC OR WHATEVER THEY
LOST THEIR JOBS AND WITHIN SIX
MONTHS TO A YEAR THEY ARE ON THE
STREET. THEN THEY END UPTURNING
TO OPIOIDS. TO WHAT EXTENT IF
AT ALL DOES HEAL LOOK AT
HOMELESSNESS AS A DRIVER OR IS
THAT HANDLED BY SOME INSTITUTE
OR SOME OTHER ENTITY AT THE NIH
OR IS IT SOMETHING THAT WE
SHOULD REALLY CONSIDER AS PART
OF THIS CHICKEN AND EGG, WHAT IS
THE INITIATORS? WE KNOW FENTANYL
CROSSING THE BORDER IS IMPORTANT
BUT WE CAN'T STOP FENTANYL
CROSSING THE BORDER BUT TO GET
TO THE ACTUAL LOCAL DRIVERS,
PSYCHOLOGY OF THIS, MAYBE WE ARE
DOING IT ALREADY, I DON'T KNOW.
MY LAST QUESTION IS ONE BECAUSE
I STILL I'M A SCIENTIST, I DON'T
THINK IT HAS EVER COME UP AND I
DON'T UNDERSTAND THIS. WE HEAR
ABOUT CRANK AND XYLOZE IN,E. I
HOPE THE TWO ANTAGONISTS BLOCK
THE EFFECTS. WHY DO WE HEAR
NARCAN AND EVERY OPIOID
ANTAGONIST BUT NOT ABOUT THE TWO
ANTAGONIST?
>>ALAN, THANKS FOR BRINGING
THAT -- THE HOMELESSNESS PROBLEM
AND THANKS FOR TESTIMONY LAST
QUESTION, LET ME JUMP AT THE
LAST QUESTION BECAUSE IT IS
EASIER. ZEAL SCENE IS
(INAUDIBLE) IT MAKESES SENSE
ALPHA 2 ANTAGONIST REVERSES THE
EFFECTS. WHEN YOU GET BOTH
FENTANYL AND XYLOSENE YOU CAN
REVERSE IT LIKE THAT. THE ISSUE
IS WHY WE DO IT IS -- WHAT
HAPPENS WHEN YOU GIVE NALOXONE
TO A PERSON THAT IS PHYSICALLY
DEPENDENT THEY ARE GOING TO GO
THROUGH ACUTE OPIOID WITHDRAWAL
WITH STIMULATION OF HYDRO GENEIC
SYSTEM. SO AMPLIFYING THAT, THAT
IS THE REASON WHY IT IS NOT
AUTOMATIC. IF YOU ARE IN A
CIRCUMSTANCE WHERE YOU KNOW A
PERSON DOES NOT HAVE OPIOID
PHYSICAL DEPENDENCE, ABSOLUTELY
GIVEN ALPHA 2 ANTAGONIST BECAUSE
YOU WILL ACCELERATE THE
RECOVERY. THE PROBLEM IS MOST
OVERDOSES ARE GOING TO BE ON
PHYSICALLY DEPENDENT PEOPLE. SO
CURRENTLY WE ARE PRIORITIZING
THIS AND WE HAVE (INAUDIBLE) TO
TRY TO ADDRESS WHAT IS IT WE
KNOW ABOUT THE COMBINATION OF
FENTANYL AND EX,YLOSENE NOT JUST
TO THE OVER DOSE BUT THE
CLINICAL PRESENTATION. AND THERE
ARE MANY CHALLENGES BUT FIRST IT
IS NOT CLEAR CUT EVIDENCE THAT
THE COMBINATION IS MORE
DELETERIOUS. IN FACT TWO PAPERS
HAVE COME UP IN THE PAST THREE
OR FOUR MONTHS THAT HAVE SHOWN
PEOPLE WITH FENTANYL AND
XYLOSENE WERE LESS LIKELY TO END
UP WITH FATAL OVERDOSES. SO IT
IS NOT SORT OF DYNAMICS ABOUT
WHAT MAYBE DRIVING THIS, ARE
THEY CONSUMING LESS FENTANYL AND
THIS OTHERWISE OR
PHARMACOLOGICAL PROPERTIES WE
DON'T UNDERSTAND OR IS THIS IS A
(INAUDIBLE). SO BOTTOM LINE, WE
NEED TO CHARACTERIZE BETTER THIS
PRESENTATION. SO IT IS AN AREA
OF HIGH PRIORITY, NOT JUST IN
TERMS OF NIDA ITSELF BUT ACROSS
AGENCIES AND WE ARE, WHOING WITH
THEM TO HELP DEVELOP GUIDELINES
AMONG THE BIG CHALLENGES WHICH
RELATES TO YOUR FIRST QUESTION,
SO YOU DON'T FEEL THAT I HAVE
FORGOTTEN IT, IS THIS
(INAUDIBLE) GROW RAPIDLY THAT,
ARE NOT JUST OBSERVED IN THE
PLACE WHERE PEOPLE ARE INJECTED.
AND NOT NECESSARILY JUST
OBSERVING PEOPLE THAT TAKE
XYLOSENE BY INJECTION. SO THEY
ARE DIFFERENT FROM REGULAR
DETERMINE TO LOGICAL ISSUES THAT
WE SEE WITH PEOPLE INJECTING
DRUGS, THEY ARE NOT TYPICALLY
INFECTED BUT OF COURSE THEY CAN
GET INFECTED. AND GUESS WHAT, IN
TERMS OF THERAPEUTIC
INTERVENTIONS WHAT CONDITIONS WE
ARE OBSERVING IS IT IS VERY
DIFFICULT TO MANAGE THEM. AND IF
YOU HAVE A HOMELESS PERSON YOU
MAY IMAGINE HOW IMPOSSIBLE IT IS
TO TRY FOR THEM TO FOLLOW-UP
PROCEDURES. SO NOT SURPRISING,
WE ARE SEEING THE WORST OUTCOMES
AMONG HOMELESS PEOPLE WITH
RESPECT TO CLINICAL OUTCOMES BUT
ALSO OVERDOSE MORTALITY. SO IF
YOU LOOK IN THE UNITED STATES
WHERE IS THE GROUP WITH HIGHEST
MORTALITY OVERALL, THOSE ARE
PEOPLE THAT ARE HOMELESS. AND
LOOK AT THE RESEARCH INVOLVEMENT
OVERALL HOMELESS POPULATION, YOU
CAN IDENTIFY GIGANTIC GAP AREA.
THAT NIDA IS THE MAIN INSTITUTE
DOING WORK WITH HOMELESSNESS AND
HAS BEEN DOING THAT, THAT DOES
NOT NECESSARILY MEAN THAT THAT
IS SUFFICIENT, FAR FROM IT. IN
FACT AN AREA WE HAVE BEEN AIMING
RESEARCHERS TO LOOK INTO AND
PRIORITIZE EXPLICITLY STATING IS
THE NEED TO DEVELOP RESEARCH
PROGRAMMING HOMELESS POPULATION
BECAUSE AMONG OTHER THINGS FOR
EXAMPLE, ONE OF THE MOST
VULNERABLE HOMELESS POPULATIONS
THAT WE HAVE IS WOMEN. WOMEN
WITH CHILDREN CAN END UP
HOMELESS SO THEY HAVE THE REALLY
EXTREMELY DIFFICULT CHALLENGE TO
MOVE FORWARD. HOMELESSNESS IS
EVERYWHERE, IT IS AFFECTING ALL
RACE AND ETHNIC GROUPS. I JUST
CAME FROM TRIBAL RESERVATIONS
AND I WAS BASICALLY MIND BLOWN
BY HOW MANY AMERICAN INDIANS AND
ALASKA NATIVES ARE NOW ACTUALLY
HOMELESS. GLAD YOU BROUGHT IT UP
BECAUSE IT BRINGS IT TO THE
FOREFRONT OF THE
MULTI-DISCIPLINARY WORKING GROUP
THAT WE NEED TO TACKLE IT.
500,000 PEOPLE ARE HOMELESS IN
THE UNITED STATES. THEY ARE
EXTREMELY HIGH RATES OF OVERDOSE
DEATH, DRUGS AND ALSO DEATH FROM
VIOLENCE. THE HOMELESSNESS
POPULATION CAN FACILITATED THE
FUSION OF METHAMPHETAMINE
BECAUSE MANY TIMES USE
METHAMPHETAMINE TO STAY AWAKE
BECAUSE THEY DON'T HAVE A
PROTECTED SPACE. SO IT IS A VERY
CHALLENGING AND SERIOUS AND I
THINK IT WOULD -- IT'S -- I
IMAGINE IT IS OUR RESPONSIBILITY
TO DEVELOP SCIENCE TO HELP
ADDRESS THE CHALLENGES OF TAKING
CARE OF PEOPLE THAT ARE
EXTRAORDINARY VULNERABLE.
>>NORA, IN HEARING AN AREA OF
FOCUS FOR THE STRATEGIC PLAN
THAT WE ARE GOING TO DELIVER TO
TO THE MULTI-DISCIPLINARY
WORKING GROUP IN SIX MONTHS, I
ALSO WONDER IF YOU -- AND WALTER
PERHAPS OTHER MEMBERS OF THE
EXECUTIVE COMMITTEE WHO ARE
PRESENT COULD SPEAK TO ALAN'S
VERY ASTUTE POINT ABOUT THE TYPE
OF SCIENTIFIC THAT GETS FUNDED
THROUGH THE BASIS OF THE ICs.
THE TYPES OF SCIENCE THAT WE
HAVE SOUGHT TO FUND THROUGH
HEAL. WHAT MAKES THEM DIFFERENT
AND HOW THAT DIFFERENCE WILL BE
SUSTAINED BUT ALSO EVOLVE WITH
THE EVOLVING CRISIS.
>>I THINK THAT THAT WOULD BE
ONE OF THE ASPECTS AS I MENTION
BEFORE. BUT IN TERMS OF THE
STRATEGIC PLAN OVERALL WE HAVE A
STRATEGIC SCIENCE TIME, THE
ISSUE IS HOW THIS IS DEFINED FOR
PAIN WHERE THERE IS NO PAIN
INSTITUTE MAYBE DIFFERENT FOR
ALL THERE IS. SO ONE OF THE
ELEMENTS HAS BEEN EASIER FOR US
THE DIFFERENCE IS BASIC
FUNDAMENTAL SCIENCE THAT WE DO
AT THE INSTITUTE TO HELP US
ANSATE EFFECT OF DRUGS IN THE
BRAIN AND ADDICTION BUT HELP
IDENTIFY TARGETS FOR TREATMENT
WHETHER MEDICATIONS OR NEURAL
MODERATION. -- MODULATION. THAT
BASIC SCIENCE FUNDING OVERALL
SIMPLER TO PUT ON THE PATH. BUT
ALAN WAS ALSO COMMENTING WE
DON'T WANT TO CREATE ARTIFICIAL
AREAS WHERE THEY DON'T EXIST.
AND THAT IS WHY THE CLINICAL
TRIAL NETWORK BASICALLY IS NOT
DIFFERENTIATING THIS IS HEAL AND
THIS IS NOT HEAL BECAUSE THE
STRUCTURES AREN'T THERE AND
WHICH WANT TO MAXIMIZE AND
TREATING ADDICTION OVERALL IS
VERY, VERY RELEVANT. SO THERE
WILL BE AREAS WHERE THIS IS MUCH
SIMPLER THAN OTHERS AND NOT
SIMPLE BECAUSE THAT STRUCTURE
ITSELF DOES NOT ALLOW TO THIS
COMPARTMENTALIZATION THAT WILL
BE ARTIFICIAL AND WILL MAKE US
MUCH LESS EFFICIENT. SO IT IS AN
ISSUE OF THINKING
PROGRAMATICALLY TO MAXIMIZE
RESOURCES AND AT THE END OF THE
DAY ACCELERATING THE SCIENCE IN
WAYS THAT MAKE A DIFFERENCE TO
ADDRESSING THE OVERDOSE CRISIS.
>>THE PAIN SIDE, WE HAVE TO DO
THIS STRATEGIC PLAN JUST FOR
THAT PURPOSE ALAN, TO REALLY
IDENTIFY WHAT IS HEAL, WHAT
BELONGS TO THE INSTITUTES. WE
DON'T WANT TO HAPPEN IS HAVE
INSTITUTES DOWNLOADING THE PAIN
RESEARCH TO HEAL. WE WANT THE
INSTITUTES TO DO RESEARCH ON
CONDITIONS PAINFUL CONDITIONS
THAT ARE IN THEIR INSTITUTE BUT
TO DO THE MULTI-DISCIPLINARY
STUFF THAT CAN ONLY BE DONE IN
HEAL IS WHAT I THINK IS THE KEY
CHARACTERISTIC OF THAT. SO ONE
BIG EXAMPLE IS THE WORK THAT
LINDSEY AND ALAN AND RENA HAVE
BEEN DOING ON THE WHOLE JOINT
AND MULTIPLE DIFFERENT
INSTITUTES WE ARE INTERESTED IN
THE NERVES AND MUSCULOSKELETAL
SYSTEM, THE CARTILAGE, THAT
PROGRAM COULD NEVER BE DONE
WITHOUT HEAL SO IT IS A GREAT
EXAMPLE OF A PROGRAM THAT IS
INHERENTLY MULTI-DISCIPLINARY AS
RELIANT ON SOMETHING LIKE HEAL
TO GET ACCOMPLISHED. THOSE ARE
THE KIND OF THINGS THAT WE
SHOULD BE DOING IN ADDITION TO
THOSE THINGS LIKE THERAPY
DEVELOPMENT WHICH IS WHAT HEAL
WAS STARTED FOR, AND FOR DOING
RESEARCH TO INFORM PHYSICIANS
AND PATIENTS ON BEST MANAGEMENT
AND PAN CONDITIONS. SO NIDA IS
A WHOLE INSTITUTE FOR DRUG ABUSE
AND OPIOID OVERUSE DISORDER. WE
HAVE PAIN DISTRIBUTED ACROSS 20
INSTITUTES. WE HAVE A LITTLE BIT
OF A DIFFERENT ROADMAP TO PUT
OUT THERE FOR ALL THE OTHER
INSTITUTES THAT FALL INTO AND
ADVANCING HEAL.
>>WALTER, I SEE BOTH LINDSEY
AND ALAN HAVE THEIR HANDS RAISED
AND I KNOW THEY WILL HAVE A LOT
OF CONTRIBUTIONS TO MAKE BOTH IN
THE STRATEGIC PLAN AND IN THIS
DISCUSSION BUT I WOULD RECALL
WHAT YOU HEARD FROM LYNN AND
PATRICE AND CHRIS ABOUT THE
INTEGRATION SO STRATEGIC PLAN
FOR HEAL CAN'T JUST BE ONE PAIN
PLAN AND ONE ADDICTION PLAN BUT
IT DOES HAVE TO INCORPORATE THE
CROSS CUTTING AND OVERALL
ELEMENTS OF HEAL THAT WE BUILT
OVER THE PAST FIVE YEARS. SO I
WILL JUST ADD THAT IN AS MY
PERSONAL REMINDER AND THEN HAND
IT TO YOU, LINDSEY.
>>THANK YOU FOR YOUR HELP IN
THIS MORNING'S SESSION AND
EVERYTHING FROM THE CALL OUT TO
THE VALUE OF THE STRATEGIC PLAN,
THANK YOU TO RENA AND WALLY AND
OTHERS FOR RAISING THAT AGAIN AT
THIS JUNCTURE. ALSO APPRECIATE
ALAN'S POINTING TO AN OBVIOUS
HUGE OBSTACLE OR CONTRIBUTOR TO
OPIOID USE AND PAIN WHICH IS THE
HOMELESSNESS PROBLEM. WE CAN'T
SOLVE IT EXCLUSIVELY WITH NIH
RESEARCH WE SHOULDN'T IGNORE IT
EITHER. ALAN, THANK YOU FOR
CALLING THAT OUT AS SOMETHING
THAT I HOPE WE WILL TRY TO
TACKLE. THIS IS NOT TO SUGGEST
THERE AREN'T ALREADY REALLY
IMPORTANT EFFORTS UNDERWAY AT
NIDA AND NIMH BUT I HOPE WE CAN
EXTEND THOSE. IN TERMS OF THE
RELATIONSHIP BETWEEN THE
INSTITUTES AND HEAL AS A
RELATIVE NEW COMER TO THE NIH, I
APPRECIATE SO MUCH HAVING
STRUCTURE AND PROGRAMS LIKE HEAL
THAT HELP US RECOGNIZE
OPPORTUNITIES ACROSS THE
INSTITUTES AND CENTERS AND
OFFICES. BECAUSE OF ALL OF OUR
SHARED INTEREST. SO THIS
STRUCTURE HAS BEEN ENORMOUS
HELP. BUT I HOPE WE CAN MOVING
FORWARD ALSO MAKE SURE WE ARE
ENGAGING INVESTIGATORS THAT
CURRENTLY LIVE WITHIN OUR
INSTITUTES, WHETHER THAT IS IN
THE EXTRAMURAL ENVIRONMENT OR
THE INTRAMURAL RESEARCH
ENVIRONMENT. THIS STRUCTURE
THERE IS BROADER ENGAGEMENT FOR
EXAMPLE ON THE PAIN SIDE OF SO
MANY INSTITUTES COMMITTING VERY
SIGNIFICANT EFFORT TO WORK
TOGETHER THAT WILL HELP IDENTIFY
MEMBERS OF OUR COMMUNITIES THAT
CAN CONTRIBUTE TO THIS PROBLEM
THAT MIGHT NOT BE AWARE OF THIS
EFFORT, MIGHT NOT COME TO OUR
ATTENTION SO I'M HOPING MOVING
FORWARD WE CAN BETTER LEVERAGE
EFFORTS WITHIN THE INSTITUTES,
IDENTIFY PARTNERSHIPS ACROSS THE
INSTITUTES, AND FUNCTION IN THIS
COLLABORATIVE WAY THAT WILL BE
SO INCREDIBLY IMPORTANT. THANKS
TO EVERYBODY WHO MADE
APPROPRIATE AN INSPIRING
COMMENTS THIS MORNING.
>>THANKS, LINDSEY.
>>THANKS, LINDSEY. ALAN.
>>JUST WANT TO FIRST -- HELENE.
>>THANKS TO EVERYBODY FOR WHAT
THEY SAID AND I THINK WHAT IS
ALSO DESCRIBING ABOUT THE
SITUATING PAIN SIDE OF HEAL IN
THE CONTEXT OF PAIN CONSORTIUM.
THAT IS GOING TO BE REALLY
HELPFUL BECAUSE WE ARE ABLE TO
GET INPUT FROM SO MANY DIFFERENT
INSTITUTES AND CENTERS AT NIH,
NOT NECESSARILY PART OF HERE AND
MOW BUT CONTRIBUTE A LOT OF
USEFUL IDEAS AND DEVELOP NEW
CONCEPTS SO THIS IS GOING TO
MOVE INTEGRATIVE DIRECTION WHICH
IS A GOOD THING. VERY EXCITED
ABOUT THIS.
>>PUN INTENDED, RIGHT?
INTEGRATIVE.
>>WE LIKE TO INTEGRATE.
GENERALLY. IT IS A GOOD
DIRECTION TO GO.
>>ALAN, AGAIN, GO RIGHT AHEAD.
>>QUICK LAST QUESTION. I PEOPLE
JUST STARTING TO FILL OUT AN
RPPR ON AN R 35 COMING TO AN
END, VERY SAD AND IT IS RATHER
EXTENSIVE FORTUNATELY, WE HAVE
BEEN BUSY. BUT ANY RO1 WE HAVE
TO WRITE AN RPPR WE HAVE TO SAY
WHAT HAVE WE DONE, WHAT IS
SUCCESS? WE DO IT ON AN ANNUAL
BASIS. I DON'T KNOW ABOUT THE
HEAL GRANTS. THEY CERTAINLY
DON'T COME BACK TO US OR ME OR
THE NDWG. I THINK IT WOULD BE
REALLY HELPFUL TO FIND OUT WHAT
THE PROBLEM HAS BEEN. BUT WE GET
NO FEEDBACK ON THAT, NO IDEA.
WOULD BE MICE TO KNOW WHAT
WORKED AND WHAT DIDN'T.
>>WE CAN DO THAT. WE SHOULD BE
USING PART OF OUR MEETINGS TO
GIVE YOU A SUMMARY OF THINGS
THAT HAVE HAPPENED. BECAUSE WE
DO MONITOR CERTAINLY. THAT WOULD
BE A BIG ROLE FOR THE
HARDWORKING YOU ARE DOING FROM
RESPECT TO THE SCIENCE.
ABSOLUTELY.
>>I WILL TAKE THAT AS AN
OPPORTUNITY TO TRANSITION. THANK
YOU, EVERYONE FOR THE KIND
WORDS. ESPECIALLY IN OUR OPEN
SESSION FIRST THING IN THE
HORNING. I LOVED HEARING IT I
LOVED WORKING WITH YOU. WHAT YOU
WILL SEE IN THIS PRESENTATION
WHICH I WILL TRY TO GO THROUGH
BRIEFLY BECAUSE WE ARE QUITE
BEHIND IS A BRIEF OVERVIEW OF
WHAT HEAL HAS SOUGHT OUT TO DO
AND A FRAMEWORK FOR THE QUESTION
YOU JUST POSED, A ALAN. MOST
RESEARCH FIND US RIGHT NOW ARE
STILL UNDERWAY. WE HAVE SOME
STUDIES READY TO GO WITH THE
FIRST YEAR OF HEAL 2019 GOT OFF
TO A STRONG START AND WE ARE
ABLE TO DELIVER RESULTS BUT WE
HAVE A LOT OF STUDIES STILL
ONGOING. PARTICIPANTS STILL
RECRUITED. DATA STILL BEEN
ANALYZED. THAT MEANS WE ARE NOT
QUITE READY TO DELIVER WHERE WE
ARE IN OUR SUCCESS. FOR THE
FUTURE AND THE STRATEGIC PLAN,
THAT THE TEAM ALSO COME UP WITH,
THEY WILL USE AS A STARTING
POINT THE RESEARCH PLAN THAT WE
DEVELOPED FOR HEAL IN ITS FIRST
YEAR. AND THAT HAVE CONCRETE
GOALS IN TERMS OF CLINICAL
GUIDANCE, INDs, AND SPECIFIC
DELIVERABLES WE SOUGHT TO BRING
ABOUT THROUGH THIS RESEARCH. AS
Y'ALL KNOW WELL, IT GOES DEEPER
THAN THAT. NOT JUST TANGIBLES
BUT ALSO THE KNOWLEDGE BEING
DELIVERED TO THE COMMUNITY AND
TO THE NEW SOURCES OF INNOVATION
AND SCIENTIFIC SOLUTIONS TO THE
OPIOID CRISIS. SO I SECOND THAT
SUGGEST. -- SUGGESTION AND
ENCOURAGE THE TEAM GOING FORWARD
TO FIND WAYS EVEN WHEN RESEARCH
IS ONGOING TO DELIVER UPDATES TO
YOU AND THE MULTI-DISALLYNARY
WORKING GROUP, FEEDBACK AND
FUTURE DIRECTIONS. --
MULTI-DISCIPLINARY WORKING GROUP
FEEDBACK AND FUTURE DIRECTIONSS
T I WANT TO SET THE STAGE FOR
THE REST OF THE TWO DAY MEETING.
I WILL DO IT QUICKLY. FIRST
SLIDE PLEASE. WHAT IS OUR
VISION? HELPING TO END ADDICTION
LONG TERM. AS NORA SAID IT IS
VERY AMBITIOUS. IT NECESSARILY
INCLUDES COMBINING THE POWER OF
SCIENCE AND THE STRENGTH OF OUR
COMMUNITY TO PROVIDE THE
SCIENTIFIC SOLUTIONS AND BE
PARTNERING, WE CAN'T DO IT
ALONE, WE CAN ONLY DO IT AS A
PIECE OF PUZZLE. AND THAT MEANS
WORKING TO DEVELOP SAFE
NON-ADDICTIVE EFFECTIVE
STRATEGIES TO PREVENT AND TREAT
PAIN USE MISUSE AND OVERDOSE.
WHAT HAVE WE DONE SINCE WE FIRST
MET AND GATHERED IN WILSON HALL
IN 2019? WE HAVE FUNDED TWO AND
A HALF MILLION DOLLARS WORTH OF
RESEARCH. THAT IS A LOT TO CHECK
UP ONGOING FORWARDS. A THOUSAND
RESEARCH PROJECTS. 42 DEDICATED
PROGRAMS, ALL 50 STATES, PER
CO-RICO AND INTERNATIONAL.
HUNDREDS OF CLINICAL TRIALS WITH
THE SIGNIFICANT EMPHASIS ON
CAUSES OF PAIN AND DISABILITY. A
SIGNIFICANT FOCUS ON MEDICATIONS
AND THERAPEUTIC TREATMENTS FOR
OPIOID USE DISORDER. THESE LED
TO OVER 40 SUBMISSIONS TO IMDs
TO THE FDA AND A LOT OF
PROMISING NEW OPTIONS FOR
TREATING PAIN AND ADDICTION.
IMPORTANTLY, WE ARE DOING THIS
IN PARTNERSHIP. SO WE KNOW THE
SCIENTISTS HAVE THIS INCREDIBLE
EQUITY ENERGY SPIRIT IDEAS. BUT
WE ARE TRYING TO GEESE THE SKINS
WORKING WITH FEDERAL AGENCIES,
WORKING WITH PARTNERS IN THE
PRIVATE SECTOR, WITH
COMMUNITIES, PEOPLE WITH LIVED
EXPERIENCE AND THE NETWORKS THAT
ARE CREATED IN ALL THOSE
DIFFERENT GROUPS. YOU HEARD A
LOT ABOUT THE DIFFERENT
INSTITUTES AND CENTERS INVOLVED
IN THE PAIN CONSORTIUM THAT ARE
INVOLVED IN HEAL AND GETTING
OVERSIGHT. HERE IS A BREAK DOWN
WHERE SOME OF THE HEAL FUND GO.
YOU CAN SEE THERE ARE LOT OF
DOTS BUT NINDS AND NIDA IN SOME
OF THE FOLKS ON THE CALL TODAY,
NCCIH, NCATS, NI NIAMS ARE BIT
HITTERS IN THE ECOSYSTEM BUT WE
WORK THE MAKE SURE IT IS NOT
JUST A VOLUME ISSUE BUT WE ARE
GETTING THE SCIENTIFIC
EXPERTISE, THE COMMUNITY
CONNECTIONS, AND THE
BIDIRECTIONAL LEARNING FROM ALL
OF OUR DIFFERENT CONSTITUENTS
WITHIN NIH. AND IN OUR RESEARCH
PROGRAMS WE SOUGHT TO BUILD
CONNECTS BETWEEN THE DIFFERENT
INSTITUTES AND CENTERS SO
FOCUSING ON THINGS THAT ARE NOT
JUST NECESSARILY A SIMPLE
INDICATION OR A SIMPLE RESEARCH
QUESTION, HOW CAN WE BEST MANAGE
THE NEEDS OF PEOPLE WITH
CO-OCCURRING PAIN AND ADDICTION
HOW WE BUILD A COMMUNITY OF
PRACTICE FOR TEAM BASED RESEARCH
THAT INCLUDES BASIC SCIENTISTS,
CLINICIANS AND OTHER EXPERTS.
HOW CAN WE LEVERAGE POTENTIAL OF
MED TECH FOR TREATING PAIN AND
ADDICTION, ALL THOSE THERAPEUTIC
DEVELOPMENT PROGRAMS MOVE
FORWARD HOW CAN WE USE DEVICES
AND IMAGING TO INCREASE OUR
UNDERSTANDING. NORA ALREADY
MENTIONED TRIBAL COMMUNITIES,
THAT IS A HUGE BOTH CHALLENGE IN
TERMS OF REALLY HIGH RATES OF
OVERDOSE BUT ALSO INCREDIBLE
SOURCE OF KNOWLEDGE AND INSIGHT
INTO THE HUMAN EXPERIENCE. AND
HOW WE CAN TREAT PAIN AND
PREVENT SUBSTANCE USE DISORDER
AND OVERDOSE USING THAT
KNOWLEDGE. CARE MODELS FOR
TREATING BOTH ADDICTION AND
MENTAL HEALTH CONDITIONS,
INCLUDING REALLY BUILDING ON
WHAT WE KNOW ABOUT PRIMARY CARE
AND HOW PEOPLE IN THE REAL WORLD
RECEIVE TREATMENT FOR THOSE
HEALTH CONDITIONS. LASTLY
BUILDING ON THE VAST ARRAY OF
SCIENTIFIC EXPERTISE ACROSS NIH
THERE IS INTERESTING SCIENCE
GOING ON IN THE BRAIN IN THE
BLOOD AND UNDERSTANDING HOW THE
BODY WORKS, SO HOW CAN WE USE
THAT TO ENHANCE EXPEDITE THE
DEVELOPMENT OF NEEDED TREATMENTS
INCLUDING ANTIBODIES AND
VACCINES FOR HER NGUYEN FENTA
FENTANYL, AND OTHER OPIOIDS. I
WILL START. I WILL KEEP GOING
WHERE WE STARTED BY ARE THE
PROBLEMS WE ARE SEEKING TO
ADDRESS THROUGH HEAL RESEARCH,
MANY PEOPLE WITH OPIOID USE
DISORDER DO T NO RECEIVE
APPROPRIATE TREATMENT IN SPITE
OF OUR LIFE SAVING INTERVENTIONS
AND THOSE WHO DO RECEIVE ACCESS
TO RECEIVE MEDICINE OFTEN DON'T
STAY ON LONG ENOUGH TO ACHIEVE
LONG TERM RECOVERY. PAIN IS
COMPLEX. PEOPLE EXPERIENCE PAIN
DIFFERENTLY. DIFFERENT TREATMENT
ALSO WORK DIFFERENTLY IN
DIFFERENT PEOPLE WITH DIFFERENT
PAIN CONDITIONS. THE NEED TO
BALANCE WHAT WE HAVE AS
TREATMENTS FOR PAIN INCLUDING
OPIOID WITH THE RISKS OF BOTH
OPIOIDS AS MEDICATION AND ALSO
RISK OF ADDICTION IN LONG TERM.
AND THE NEEDS OF ALL OF THE
DIFFERENT GROUPS NORA MENTIONED,
WOMEN AND MOTHERS EXPOSED TO
OPIOIDS, THERE IS INFANTS BORN
EXPOSED TO OPIOID AND OTHER --
SPECIFIC POPULATIONS WITH
SPECIFIC NEEDS. NEXT SLIDE
PLEASE. SOME OF THE CROSS
CUTTING TOPICS BUILT AS PROGRAMS
ASKING QUESTION HOW CAN YOU
ADDRESS STIGMA HEAD ON. HOW CAN
YOU WORK WITH COMMUNITY
ORGANIZATIONS, HOW CAN YOU MEET
PEOPLE WHERE THEY ARE THROUGH
HARM REDUCTION APPROACHES AND
HOW CAN YOU WORK WITH THE
PRIVATE SECTOR AND OUR PARTNERS
IN PHARMACEUTICAL COMPANIES TO
TAKE THE MEDICATIONS WE HAVE AND
MAKE THEM MORE USER FRIENDLY
MORE EFFECTIVE. SO THIS -- I
THINK THERE IS A POP UP HERE, WE
CAN SKIP PAST THAT. HERE IS ALAN
YOU ASK HOW THINGS ARE GOING
HERE, IT IS JUST A FEW SIGNALS,
A FEW OF THOSE THOUSAND PLUS
STUDIES SOME SHOWING, I TOLD YOU
ABOUT THIS BEFORE HOW ACCESS TO
MEDICATION FOR TREATMENT OF
OPIOID USE DISORDER CAN REDUCE
REARREST, IN RURAL JAILS IN
MASSACHUSETTS. HOW BUPRENORPHINE
IS PROVIDED IN THE EMERGENCY
ROOM AND THE ERA OF FENTANYL,
DEADLY OVERDOSES. HOW WE CAN USE
IMAGING PATIENT SPECIFIC
SIGNATURES TO UNDERSTAND PAIN,
UNDERSTAND SEVERE PAIN, WHAT THE
EXPERIENCE IS AND TARGET THAT
FOR FUTURE PRECISION MEDICINE
APPROACHES. LASTLY HOW WE CARE
FOR INFANTS BORN EXPOSED TO
OPIOIDS THESE ARE AT RISK MOMS.
FAMILIES, HOW WE CAN PROVIDE
HIGH QUALITY CARE THAT EMPOWERS
PEOPLE AND FAMILIES AND PROVIDES
A LONG TERM AND HEALTHY FUTURE
FOR INFANTS AND CHILDREN. THERE
HAVE IS STILL A LOT OF WORK TO
DO. THANK GOODNESS THE
MULTI-DISCIPLINARY WORKING GROUP
WILL STILL BE INVOLVED IN
HELPING US. THE NUMBER OF
CHRONIC PAIN CASES IS NOT
GETTING PERT BETTER. THE POPULAN
IS AGING. WE STILL NEED TO
DEVELOP EFFECTIVE APPROACHES AND
MAKE SURE EVERYONE HAS ACCESS TO
THEM AND CONTINUE TO TRY THEM AS
THEY ARE HEALTH CHANGES OVER
TIME. OVERDOSE DEATHS ARE NOT
GOING DOWN, THEY ARE GOING UP.
AND AS WALTER ALLUDED TO,
COMPANIES ARE NOT INVESTING IN
THE PAIN SPACE IN SPITE OF -- IN
THE PAIN SPACE OR TO LESSER
DEGREE IN THE SUBSTANCE USE
DISORDER SPACE COMING UP WITH
THERAPEUTICS WE SO DESPERATELY
NEED. SO THERE IS A LOT TO DO AS
A HEAL COMMUNITY. SOME OF THE
DIRECTIONS YES TAKING TO ADDRESS
THOSE GAPS, YOU WILL HEAR ABOUT
OVER THE NEXT COUPLE OF DAYS. I
THINK ACTUALLY THESE YOU HEARD
ABOUT IN MAY INCLUDING WAYS TO
CARE AND PROVIDE HIGH QUALITY
PAIN MANAGEMENT SOLUTIONS FOR
PEOPLE IN RURAL POPULATIONS,
PEOPLE WHO ARE ALREADY ON LONG
TERM OPIOID THERAPY FOR PAIN AND
PEOPLE WITH SICKLE CELL DISEASE
WHO EXPERIENCE PAI PAIN. WE HAVE
RESEARCH COMING THROUGH ON THE
QUALITY AND RELIABILITY OF CARE
FOR SUBSTANCE USE DISORDER. WAYS
OF MEASURING HUMAN PAIN AND PAIN
CONDITIONS AND WAYS TO KEEP OUR
RESEARCH ENTERPRISE MOVING
TOWARDS COMMERCIALIZATION MOVING
TOWARDS ACCESSIBLE AND TANGIBLE
TREATMENTS FOR PEOPLE WITH PAIN,
THAT LITTLE STAR IS ASSIGNED TO
NODES THAT WE ARE HOLDING A PAIN
MEETING ON OCTOBER 4 AND 5 AND I
HOPE EVERYONE TUNES IN AND
PROVIDES PARTNERS TO CHAT WITH
AND EXPLORE POSSIBILITIES FOR
BRINGING THEIR IDEAS AND NEW
TREATMENTS INTO THE CLINIC. NEXT
SLIDE PLEASE. THIS IS ALWAYS A
TOPIC FOR DISCUSSION BUT WE
DON'T REALLY HAVE TIME TO DO IT
RIGHT NOW. HERE IS WHERE ALL OUR
HEAL RESOURCES GOES -- GO. BREAK
DOWN AS YOU CAN SEE WE PUT A TON
OF RESOURCES OUT THERE OVER THE
PAST SEVERAL YEARS IN DIFFERENT
AREAS OF PRE-CLINICAL AND
CLINICAL RESEARCH AND PAIN
MANAGEMENT, NEW TREATMENTS TO
PREVENT AND TREAT OPIOID
ADDICTION. CLINICAL RESEARCH AND
PAIN MANAGEMENT, RESEARCH ON
INFANTS AND CHILDREN, NOT ALL
THERAPEUTIC OPTIONS AND CROSS
CUTTING RESEARCH, YOU WILL HEAR
ABOUT THIS OVER THE NEXT TWO
DAYS AT A MORE GRANULAR LEVEL IN
THE CLOSED SESSION. NEXT SLIDE
PLEASE. OVER TIME HERE IS HOW
THE RESEARCH BREAKS DOWN AS A
BALANCE I EXPECT THAT THIS WILL
HIT A STEADY STATE IN THE COMING
YEAR OR TWO BUT WE WILL CONTINUE
TO BE SOURCE OF DISCUSSION AND
FUTURE PLANNING FOR THE HEAL
MULTI-DISCIPLINARY WORKING GROUP
AND ITS DIFFERENT INSTITUTES AND
CENTERS INVOLVED, IMPORTANTLY WE
HAVE A REALLY SIGNIFICANT
PORTION OF THE HEAL RESEARCH
PORTFOLIO THAT ADDRESSES BOTH
PAIN AND ADDICTION FOCUS CANNING
ON CO-OCCURING CONDITIONS,
STIGMA, INEQUITIES IN HEALTHCARE
P INTEGRATE VOICES, LIVED
EXPERIENCE, DATA DRIVEN
APPROACHES, TRAINING AND WORK
FORCE. I WILL TELL YOU MORE
ABOUT THE TRAINING AND WORK
FORCE DEVELOPMENT EFFORTS AT THE
BEGINNING OF OUR MEETING
TOMORROW. SO NEXT SLIDE PLEASE.
HERE WE CAN NOW TURN TO AGENDA
WE ARE QUITE OVERTIME AND WE
WILL HAVE TO FIGURE OUT HOW TO
GET THROUGH THE AGENDA AS WE
BEST CAN. BUT TODAY'S MEETING
WILL FOCUS ON RESEARCH UNDER
CONSIDERATION FOR FUNDING
THROUGH HEAL IN THE SPACES OF
PREVENTING AND TREATING OPIOID
MISUSE AND OVERDOSE. NOVEL
THERAPEUTIC OPTIONS FOR TREATING
OPIOID USE DISORDER AND
PREVENTING OVERDOSE AND
TRANSLATION OF RESEARCH TO
PRACTICE FOR TREATMENT OF OPIOID
ADDICTION. TOMORROW WE WILL TALK
ABOUT MOSTLY PRE-CLINICAL AND
TRANSLATIONAL RESEARCH AND PAIN
MANAGEMENT WITH A LITTLE BIT OF
THE CROSS CUTTING AND CLINICAL
RESEARCH INCLUDED TOO. NEXT
SLIDE PLEASE. I ALREADY GOT
THERE. SO NEXT SLIDE PLEASE. I
THINK WE ALREADY HAVE A LOT OF
DISCUSSION THAT I WILL NOW OPEN
IT UP FOR ANY ADDITIONAL
REMARKS, FACTS BEFORE WE CLOSE
THE OPEN SESSION AND MOVE TO
DISCUSSION IN THE INDIVIDUAL
POINTS.
>>OKAY. THANK YOU VERY MUCH.