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U.S. Department of Health and Human Services: Addressing the Challenges of the Opioid Epidemic in Minority Health and Health Disparities Research in the U.S. (R01 Clinical Trial Optional)

Deadline: November 14, 2018

The objective of the Addressing the Challenges of the Opioid Epidemic in Minority Health and Health Disparities Research initiative is to support multidisciplinary research projects that examine the following: sociodemographic, cultural, economic, epidemiologic, and biological factors in opioid care specific to health disparity populations that increase the risk of opioid overdose (OUD); the consequences of OUD; ways to improve resource availability among defined health disparity populations to reduce opioid treatment gap; and underlying mechanisms for the variation in the prevalence of OUD in health disparities populations. Research projects are encouraged to utilize rigorous innovative multi multidisciplinary approaches with integration of multiple factors that are known to be related to opioid health disparities.

Projects should include a focus on one or more NIH-designated health disparity populations in the United States, which include Blacks/African Americans, Hispanics/Latinos, American Indians/Alaska Natives, Asians, Native Hawaiians and other Pacific Islanders, socioeconomically disadvantaged populations of any race, underserved rural populations, and sexual and gender minorities. Projects should involve collaborations among relevant stakeholders in U.S. health disparity population groups, such as researchers, community organizations, healthcare systems or clinics, clinicians, public health organizations, consumer advocacy groups, and faith-based organizations. As appropriate for the research questions posed, inclusion of key community members in the conceptualization, planning and implementation of the research is encouraged (but not required) to generate better-informed hypotheses and enhance the translation of the research results into practice. Examples of research methods could include, but are not limited to:

  • Prospective, longitudinal cohort studies of the effectiveness of OUD treatment modalities in traditional and non-traditional settings
  • Cluster-randomized, randomized, or pragmatic clinical trials of the effectiveness of new or existing technologies that involves broad inclusion of patients with OUD and adequately reflects the action on the health determinants
  • Participatory engagement of stakeholders (treatment facilities, patients, hospitals, and caregivers, clinicians, community groups, administrators, policymakers) in the formulation of the research and to the extent necessary, in the implementation of the research
  • Decision science modeling and analysis in OUD care and outcomes for health disparity populations
  • Use of large-scale longitudinal data sets, data mining techniques, registries, and integration of quantitative and qualitative analytical frameworks and techniques to address and inform implementation of interventions addressing the opioid crisis
  • The ability to conduct subgroup analysis to determine which interventions work best for specific population groups, including medically underserved and under-represented groups with the intent to focus on reduction of OUD
  • Prospective studies evaluating social, economic, cultural factors in the care of OUD patients from disparity populations across the spectrum of care
  • Descriptive studies using quantitative and qualitative methods to contribute to the understanding of the differences in opioid overdose deaths by race/ethnicity
  • Prospective clinical studies that define the continued use of prescription opioids for more than 4 weeks by race/ethnicity and socioeconomic status

Applications should be relevant to both the objectives of the funding opportunity announcement and to at least one of the participating Institutes’ and Offices’ research interests.

1. National Institute on Minority Health and Health Disparities (NIMHD): NIMHD is interested in several research priorities that could have significant impact on understanding and addressing the opioid crisis in health disparities populations. Potential topic areas include, but are not limited to:

A. Treatment and Health Services:

  • Assess the relationship between access to chronic pain treatment in health disparity populations and OUD
  • Evaluate the relationship between opioid prescribing and OUD demographics, specifically relating to race and ethnicity
  • Evaluate the use of MAT in non-traditional settings: examine multi-disciplinary approach to treatment, including holistic and non-medical models of care; assess the impact of education on prevention and treatment in non-medical settings
  • Assess unique aspects of opioid-specific medication-assisted treatment (MAT) that is used among diverse racial/ethnic groups with OUD
  • Study on integrating substance abuse treatment and recovery services into community health centers, and treatment challenges in primary care setting
  • Address the intersection of chronic pain management and OUD: ways to maintain continuity of care in patients with chronic pain, and strategies to improve services
  • Research on the outcomes of implementation of the CDC Guidelines on management of opioid prescribing in treatment of chronic pain disorders
  • Studies on mechanisms enhancing Clinician-Patient Partnership in opioid prescribing
  • Evaluate the intersection of OUD with mental health disorders
  • Gender-responsive approaches to account for differences associated with OUD
  • Evidence-based practices (MAT, cognitive-behavioral therapy (CBT), etc.) to address gender specific concerns
  • Mechanisms to address concerns for women seeking healthcare across multiple health domains (mental health, substance use, physical health, and sexual and reproductive health)
  • Research on opioid-dependent newborns: consequences of opioid-related neonatal abstinence syndrome (NAS) on growth and development, stigma and long-term behavioral outcomes; the role of dysfunctional parents in the care of these children; burden on foster home care
  • Assess the role of Medicaid and Medicare and OUD treatment modalities, including enhancing payment for MAT
  • Research on pharmacogenomic testing in OUD treatment
  • Research on identifying the most important barriers to providing healthcare services in rural communities and novel strategies to improve mental health infrastructure in these settings
  • Developing specialized MAT maintenance programs for pregnant women with OUD
  • Evaluate the cost-effectiveness of recovery and treatment services for opioid disorders
  • Assess the impact of MAT on OUD treatment and outcomes in criminal justice settings, such as adult drug courts, diversion programs, and correctional settings

B. Education:

  • Studies on the role of incorporating opioid prevention strategies as part of the health education curriculum and enforcing continuing education on opiates prescribing clinicians
  • Research on measuring the influence of pain management, behavioral health and addiction education in all US medical schools through accreditation requirements

C. Social/Cultural/Economic:

  • Role of culture/acculturation process in the etiology of OUD
  • Assess the link between economic, physical, and psychological problems and the opioid crisis (“crisis of despair”).
  • Assess the role of economic upheaval/deprivation, impact of youth migration from rural areas, unemployment, and inequality in the era of opioid crisis.

D. Epidemiology/Technology:

  • Address OUD risk and resiliency factors in health disparity populations, including gender differences
  • Study on natural progression of mediators and moderators of addiction and recovery, and sequelae in individuals with OUD
  • The impact of OUD in specific health disparity subpopulations (e.g., by Latino national origin or heritage, by AI/AN tribe, by geographic location)
  • Assess the impact of fentanyl in opioid overdose deaths, the role of distribution of fentanyl test kits and effects of expanding forensic toxicology testing
  • Study the role of geographic information system (GIS) and real-time opioid prescription tracking systems in enhancing public health surveillance
  • Develop novel mechanisms to improve opioid overdose surveillance in order to track the rapidly changing illicit opioid market of fentanyl and its derivatives

E. Community Level Interventions:

  • Assess the role of Public Education: studies on the impact of bystander Narcan administration on the prevalence of OUD
  • Research on assessing the impact of Community-Based Medication Disposal Programs/drug take-back efforts on OUD

2. National Institute of Aging (NIA) is interested in applications that address aspects of the opioid crisis in health disparities populations across the life course, including late life. Such topics include, but are not limited to, the following:

  • Medicare/Medicaid dual eligible recipients
  • Role of disability (including work-limiting disability) on the patterning of pain and opioid use in middle and later life
  • Health care delivery and access in rural areas among middle-aged and older Americans
  • Opioid use in nursing homes and other residential care facilities
  • Behavioral economics techniques integrated with Electronic Health Records (EHRs) to produce low-cost pragmatic interventions designed to improve adherence to recommended pain treatment guidelines
  • Effectiveness of health care systems and regulatory actions in distinguishing between appropriate and inappropriate opioid use
  • Impact of opioid treatment guidelines on clinical, functional, and quality of life outcomes in older adults across settings, particularly acute, post-acute, palliative care, and end-of-life settings

3. National Institute of Child Health and Human Development (NICHD) areas of programmatic interest include obstetric and pediatric clinical studies focused on, but are not limited to, the following topics:

  • Developing specialized MAT maintenance programs for pregnant women with opioid use disorder
  • The role of prenatal care in optimizing pregnancy outcomes in women with opioid use disorder
  • Assessment of fetal well-being during pregnancy in women with opioid use disorder to optimize neonatal outcomes
  • Studies of postpartum care and support for women with opioid use disorder to optimize maternal and neonatal outcomes
  • The role of pharmacogenomics in opioid use disorder treatment
  • Studies on opioid-dependent newborns and consequences of neonatal abstinence syndrome related to opioid
  • Research on safe and effective outpatient management strategies for neonatal opioid withdrawal syndrome including optimal follow-up

4. National Institute on Alcohol Abuse and Alcoholism (NIAAA) is interested in applications that:

  • Address the role of alcohol use in the development of opioid addiction, morbidity, and mortality
  • Provide data on opioid and alcohol use presentation to emergency departments and in fatalities
  • Address the potential effectiveness of addiction treatment services, such as for alcohol use disorder, in treating opioid misuse

5. Office of Research in Women’s Health (ORWH) is interested in the following:

  • Gender-responsive approaches to account for differences associated with OUD
  • Evidence-Based Practices (MAT, CBT, etc.) to address gender specific concerns
  • Gender specific approaches to address the mental health, reproductive and sexual health, and physical health of women with opioid use disorders

Amount: Application budgets are not limited but need to reflect the actual needs of the proposed project. The maximum project period is 5 years.

Eligibility: Higher education institutions; nonprofits with or without 501(c)(3) IRS Status; for profit organizations; governments; and other organizations including independent school districts, public housing authorities/Indian housing authorities, Native American tribal organizations, faith-based or community based organizations, and regional organizations.

Link: https://www.grants.gov/web/grants/view-opportunity.html?oppId=302934

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