This Notice of Special Interest (NOSI) calls for research on stigma in the context of chronic pain management and opioid use or opioid use disorder (OUD). As part of NIH’s Helping to End Addiction Long Term (HEAL) Initiative, NIH will support supplements to current HEAL awards to address the challenges for people affected by the opioid crisis from stigma, discrimination and prejudice related to chronic pain management in the context of opioid use and/or opioid use disorder and its treatment. This NOSI calls for applications that integrate and incorporate stigma research into ongoing HEAL funded chronic pain and OUD studies in order to address stigma that is occurring in the context of chronic pain and/or OUD. Because stigma research may require large clinical or community networks, the supplement program is designed to leverage the many networks already being developed through HEAL awards. This supplement program is not intended to support research on basic processes (e.g. cultural attitudes) but rather to result in strategies to enable rapid implementation of changes.

A total of up to $3.5 million is available to supplement existing HEAL grants and cooperative agreements, for up to 1 year, to evaluate strategies to reduce stigma and improve treatment, management and services for people with chronic pain and/or OUD. Supplement requests do not need to address all possible aspects of stigma in the context of chronic pain and /or OUD, but it is encouraged when appropriate to consider piloting multi-layer, multicomponent interventions to address stigma in these contexts.

Background

50 million adults in the United States have chronic daily pain. 19.6 million adults experience chronic pain that interferes with daily life or work activities. Misuse and addiction to opioids, including prescription pain relievers, synthetic opioids such as fentanyl, and heroin have become a serious national health crisis. More than130 people die every day from an opioid-related drug overdose. Stigma can be a barrier to treatment for both people with chronic pain in the context of being treated with opioids and also for people with OUD not related to painful conditions. Appropriate care is needed to address the suffering of people with pain and/or OUD and it is critical to address the challenges associated with stigma of living with these conditions, seeking care and support for pain management and/or recovery from OUD.

Stigma can be a barrier to treatment of both painful conditions and substance abuse. Studies suggest that people with chronic pain who are receiving or who have previously received opioid treatment face stigma from their healthcare providers, family, friends, coworkers, the health care system, and society in general.

Stigma is also a major barrier to implementation of programs and treatments for chronic pain or opioid use disorder, such as medication assisted treatment and naloxone. People with chronic pain with problematic opioid use report significant perceived stigma associated with methadone and buprenorphine treatment. Stigma can also lead to severe consequences when people with chronic pain with long term opioid use face acute opioid withdrawal due to stigma. Chronic pain is often stigmatized by itself and some approaches to address the opioid crisis have led to stigma related to addictions to be also applied to people with chronic pain.

Stigma can be a challenge for people with pain and/or substance use disorders, their families, caregivers, and clinicians. Reducing barriers to care that exist because of stigma is crucial to care for people and for treatment effectiveness for both chronic pain management and/or OUD.

Research Objectives

In order to effectively reduce stigma related to the treatment of chronic pain in the context of the opioid crisis and/or the stigma related to OUD, NIH is encouraging the submission of applications for supplements to active grants to provide evidence-based data to inform strategies to reduce stigma and build resilience to discrimination for those with chronic pain and/or OUD.

High priority supplements will:

• Analyze strategies to reduce stigma, discrimination and prejudice related to chronic pain management and/or OUD that impact areas such as prevention, management and treatment access and effectiveness and recovery;
• Use existing psychometrically validated tools to measure stigma and only with very compelling rationales, support the development of any new measurement tool.

Research areas of interest include:

• • Prejudice by care providers that undermine treatment and health QOL
  • Strategies to address stigma in a variety of contexts that includes: among healthcare providers, workplace colleagues, emergency responders, family and friends and others;
  • The impact of internalized and anticipated stigma on prevention, management, treatment and recovery;
  • The adaption and application of existing theories of health related stigma to chronic pain and/or OUD in reducing stigma;
  • Rather than the creation of new measurement tools, the use of psychometrically validated measures of stigma in other populations (e.g. HIV, mental illness) and their application to these populations.
  • Analyses of combinations of approaches that are known to reduce discrimination and prejudice in a variety of situations (workplace- supervisors, colleagues; family and friends, healthcare providers, emergency responders, community);
  • Strategies to address internalized stigma;
  • Approaches to build resilience to discrimination and prejudice in these populations
  • First stage development of multicomponent approaches that could be expanded and implemented for large scale multicomponent research projects.

Researchers may find materials related to the 2017 meeting: The Science of Stigma Reduction that was sponsored by the National Institutes of Health (NIH) helpful.

Description of circumstances for which administrative supplements are available.

Application and Submission Information

Applications for this initiative must be submitted using the following opportunity or its subsequent reissued equivalent.

• PA-18-591 - Administrative Supplements to Existing NIH Grants and Cooperative Agreements (Parent Admin Supp Clinical Trial Optional)

All instructions in the SF424 (R&R) Application Guide and PA-18-591 must be followed, with the following additions:

• Application Due Date(s) Applications will be accepted through May 29 , 2020 , by 5:00 PM local time of applicant organization. The NOSI expires on May 30 , 2020
• For funding consideration, applicants must include “NOT-OD-20 -101” (without quotation marks) in the Agency Routing Identifier field (box 4B) of the SF424 R&R form. Applications without this information in box 4B will not be considered for this initiative.
• Requests may be for one year of support only.
• The Research Strategy section of the application is limited to 6 pages.
• The parent award must be active when the application is submitted. The project and budget periods must be within the currently approved project period for the existing parent award.
• Applications non-responsive to the terms of this Notice will be not be considered for this initiative.
• Review criteria, in addition to those described in PA-18-591, include the following:
  • Does the PI(s)/PD(s) have expertise in stigma, pain management and/or addiction appropriate for the study of stigma and chronic pain and opioid use?
  • Does the application propose to engage people with chronic pain and/or those with OUD, providers, other relevant stakeholders in identifying key questions regarding stigma and chronic pain management and opioid use and treatment?
  • If successful, does the application have the potential to be implemented broadly

• Administrative supplement applications to PA-18-591 must use the application form package with the Competition ID that contains “FORMS-F-ADMINSUPP”. In addition, the process for Streamlined Submissions using the eRA Commons cannot be used for this initiative.

• Investigators planning to submit an application in response to the NOSI are strongly encouraged to contact the appropriate Institute or Center contact listed in the NOSI to discuss the proposed project in the context of the parent award. Questions specific to this NOSI should be sent to the contact listed in the NOSI.