Communities Ready to Take on Bold Initiative to Slash Fatal Overdose Numbers

Coalitions of communities in four states hit hard by the opioid epidemic appear ready to take on the challenge of an ambitious federally supported initiative to test strategies to reduce fatal overdoses by 40% in just three years.

As Sharon Walsh, PhD, principal investigator for the Kentucky research site in the newly announced Healing Communities Study, described the sentiment among the study's selected participants at the Rx Drug Abuse & Heroin Summit in Atlanta, the opioid crisis “has been going on long enough that we really need to be bold.” Walsh directs the Center on Drug and Alcohol Research at the University of Kentucky.

National Institutes of Health (NIH) Director Francis Collins, MD, PhD, and the director of NIH's National Institute on Drug Abuse (NIDA), Nora Volkow, MD, used much of Tuesday's State of the Science plenary session at the conference to outline the Healing Communities Study. Formally announced last week, the study involves a $350 million commitment from NIDA to research sites in four states, each of which had to bring together at least 15 participating communities as well as a state agency partner in order to be eligible for the grant. The four selected states are Kentucky, Massachusetts, New York and Ohio.

This study is part of NIH's Helping to End Addiction Long-Term (HEAL) initiative, funded at $500 million a year and announced at the time of last year's Rx Summit as an effort to speed the pace of solutions to the opioid crisis.

Following podium presentations by Collins and Volkow, the two leaders joined Walsh and Kentucky recovery community organization founder Alex Elswick in a panel discussion to review Kentucky's plans in more detail. Much of the state's initiative will seek to bolster a relatively lagging evidence base around the recovery support services that are considered crucial to long-term wellness.

“Once someone is in evidence-based care and is in remission, not all their other problems have been solved,” Walsh said. “This is an opportunity to gather more evidence about what is effective. … We can then export that to places without sufficient recovery support in place.”

The model that Kentucky's research community has been impressed with is used at Elswick's organization Voices of Hope, a Lexington recovery community organization that he founded and that just opened its first brick-and-mortar center in January. Elswick, who is in long-term recovery, said he hopes through this national initiative to see recovery support elevated beyond its typical “redheaded stepchild” status in the continuum of services.

People who meet him will conclude that he has found recovery because he was strong enough to overcome addiction, but Elswick flatly rejects that notion. “I'm in recovery because I got access to evidence-based care and a continuum of care,” he said. Because a friend of his since childhood did not have access to the same services, Elswick said, he's currently in a county jail on drug charges.

Medications alone not enough

Volkow's talk touted the clear benefits of medication treatments for opioid dependence, reducing mortality risk by 70% in users. But the fact that 50% of patients on medication treatment still relapse within six months suggests that new and expanded therapeutic strategies must be employed as well, she emphasized.

She mentioned several ongoing and emerging priorities in NIDA-supported research, including:

• Alternative formulations of medications for greater effectiveness and ease of patient use. Volkow said the injectable version of buprenorphine could have much greater potential to counteract the stronger derivatives of fentanyl.

• The potential development of vaccines to combat addiction generally, and the possible role of monoclonal antibodies in the fight against methamphetamine.

• This summer's expansion of NIDA's Clinical Trials Network, to allow for a focus on subjects such as expanding medication treatment in rural areas through technology.