Advancing Therapeutic Development for Pain and Opioid Use Disorders Through Public-Private Partnerships Proceedings of a Workshop (2018) / Chapter Skim
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1 Introduction and Background
1 Introduction and Background
Pages 1-10
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, yet the federal pain research investment has been minimal, said Christin Veasley, co-founder and director of the Chronic Pain Research Alliance. In parallel with a gradual increased recognition of the problems of treating chronic pain, the opioid epidemic has emerged as a growing public health emergency.
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Moreover, both disorders are misunderstood, and health professionals lack the tools needed for proper diagnosis and treatment, said Walsh. One intervention or strategy by itself will not resolve the opioid crisis, said Nora Volkow, director of the National Institute on Drug Abuse.
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To advance the planning of NIH's anticipated public–private partnerships, the National Academies' Forum on Neuroscience and Nervous Systems Disorders hosted this public workshop that brought together a diverse group of stakeholders from academia, federal agencies, advocacy organizations, and companies developing therapeutics for pain and opioid use disorders (see Box 1-1)
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After stricter clinical guidelines were introduced and education increased, the number of prescription opioids decreased, and some those who were already addicted to the prescription opioids transitioned to heroin, which was cheaper and, in many instances more accessible, said Volkow. This incentivized the black market, and imports of very pure heroin markedly increased in the United States, fueling the heroin epidemic and accelerating the number of deaths due to heroin overdoses, she added.
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The disparity between how opioid use disorder is treated compared with other illnesses perpetuates the crisis. Nickel recounted a statement made by a mother whose two sons died of drug overdoses, "Had they suffered from diabetes or skin cancer, they would have been provided the medical care and attention necessary to live a full life." SELECTED FEDERAL INITIATIVES TO ADDRESS THE CHALLENGE OF TREATING PAIN AND OPIOID USE DISORDERS AND RELATED NATIONAL ACADEMIES' REPORTS A provision in the Patient Protection and Affordable Care Act (ACA)
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• Provide consistent and complete pain assessments. • Designate a lead institute at the National Institutes of Health responsible for moving pain research forward, and increase the support for and scope of the Pain Consortium.
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• Improve access to naloxone and safe injection equipment. The Federal Pain Research Strategy The FPRS was set up under the ACA and includes recommendations made to the Secretary of Health and Human Services to ensure that NIH and other federal agencies are not duplicating efforts.
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Common Fund projects are supported with set-aside funds that NIH uses for projects that are too big and too disorder-neutral for any single agency to support, said Porter. BOX 1-4 Selected Top Priorities in the Federal Pain Research Strategy (NIH, 2017)
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NIH has programs in place to move both non-pharmacological and natural product approaches forward, including the Stimulating Peripheral Activity to Relieve Conditions (SPARC) 4 program, projects exploring brain circuitry and neuromodulation as part of the Brain Research through Advancing Innovative Neurotechnologies® (BRAIN)
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10 THERAPEUTIC DEVELOPMENT FOR PAIN AND OPIOID USE DISORDERS models for pain therapy development. Chapter 4 focuses on clinical efforts to develop non-addictive pain medications, including biomarker-based drug discovery, research under way to prevent the acute-to-chronic pain transition, and a discussion of regulatory issues related to the approval of pain medications.
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