An Opportunity to Get Ahead of the Overdose Crisis
For many Americans, drug use ‘prevention’ conjures memories of early public health campaigns using fearsome imagery and catchy slogans to deter substance use. Campaigns implored youth to “just say no” to drugs, and the public received stark warnings: “this is your brain on drugs.”
Prevention science has matured, transformed, and expanded as a field throughout the early twenty-first century. No longer a buzzword, prevention today refers to scientific evidence that informs effective strategies to address substance misuse before it starts and in populations with the most critical needs.
Prevention science focuses on social factors
Prevention scientists have established that substance use disorders (SUD) are the product of complex social, environmental, biological, and psychological factors – also known as social determinants of health (SDoH). Our field adapts evidence-based strategies to populations with known risks. We answer important questions about which intervention strategies work, for which at-risk populations, in which settings, to what extent, and under what conditions. We rigorously evaluate strategies for their economic value, sustainability, feasibility, community acceptance, and ability to serve populations with elevated risks of substance misuse.
New evidence suggests that investments upstream – in primary and secondary prevention strategies that help people avoid risk factors and circumstances that lead to SUD long before onset of an addiction – are making an impact. Primary prevention focuses on the root causes of substance use and presents the added benefit of addressing associated problems such as depression, anxiety, and poor academic performance.
Research shows that intervening at the earliest stages of life through the justice, healthcare, and educational systems can lead to better substance use and SUD-related outcomes long-term. Our field tests strategies to address powerful drivers of SUD in youth, including childhood trauma, hopelessness, unemployment, and housing insecurity. Prevention scientists recognize that that individual, family, societal, and community-level factors influence youth mental, emotional, and behavioral (MEB) development, and positive MEB health protects against substance use. However, we are now pursuing questions of when and how to intervene to promote positive MEB development in specific groups of youth.
Drug overdose deaths can be prevented
The Centers for Disease Control and Prevention data estimated that more than 100,000 American lives – the most ever counted – were lost to drug overdose deaths in 2021. A recent article in the Journal of the American Medical Association noted that, since 2020, adolescents experienced a greater increase in overdose deaths than any other age group. Science suggests that prevention programming redirects the path of many youth who are otherwise bound toward SUD and overdose. In a recent article, the American Journal of Preventive Medicine endorsed prevention strategies, including school-based prevention programming and increased access to behavioral health, as promising approaches to responding to an evolving overdose epidemic.
The President’s National Drug Control Strategy (NDCS) released in April 2022 includes multiple references to prevention with efforts to prevent SUD in high-risk groups not yet affected. The “whole of government” approach spans multiple departments and agencies including the Departments of Justice, Education, and Health and Human Services. The NDCS complements the Fiscal Year 2023 (FY23) President’s Budget Request, which was released in late March 2022 and proposed increases to various opioid-related accounts. At the National Institutes for Health (NIH), for example, the Administration requested almost $200 million more in funding to expand its Helping to End Addiction Long-term (HEAL) Initiative – including the Initiative’s prevention programming.
The HEAL Prevention Cooperative
The HEAL Prevention Cooperative (HPC), a collaborative of 10 prevention-focused research projects across the country, is just one piece of this NIH initiative. The HPC Coordinating Center, based at RTI International, supports these 10 projects in conducting evidence-based interventions designed to reduce substance misuse and overdose death in young people. These efforts will culminate in a collective of cross-site data on substance use intervention effectiveness and outcomes in targeted youth and young adult populations, and specifically those with known risk factors for SUDs.
HPC research projects complement four themes evident in the NDCS:
- intervening early in life (i.e., youth and young adults),
- reaching marginalized and minority populations,
- delivering through digital health technologies, and
- addressing SUD comorbidities.
HPC investigators at Yale University collaborate with 15 school-based health centers to deliver and assess the implementation of the PlaySMART® videogame, which builds valuable life and decision-making skills. Another team of investigators at the RAND Corporation and UCLA work with American Indian and Native American urban young adults to influence youth behavior through community wellness gatherings, discussions of Native American identity and traditions, and personal network visualization exercises. Investigators at The Ohio State University explore whether a Housing First initiative that places homeless youth with stable housing, in combination with preventive services, decreases their chances of developing SUD.
More HPC Projects
Researchers within the collaborative also focus on risk factors such as co-morbid conditions or juvenile justice system involvement: HPC projects underway in Massachusetts and Oregon are all evaluating whether early treatment of mental health conditions can preempt substance use later in adolescence. Similarly, projects at the University of Washington and Texas Christian University are empowering youth and young adults involved in the juvenile justice system through strategies such as teaching emotional regulation and pairing with a “safe adult” as they transition back into communities.
HPC projects transitioned to electronic program delivery during COVID-19 to serve marginalized and underserved youth. A team from Emory University and Cherokee Nation Behavioral Health pivoted from conducting in-person screenings and brief intervention to virtual visits to reach students in rural schools. University of Michigan investigators planned remote intervention delivery to patients in Emergency Departments (ED) from a telemedicine hub; however, the team pivoted to engage youth post-ED visit in their homes or other locations, with staff working remotely as well.
Conclusion
As we enter a new year, the Administration and Congress continue to deliberate on the ongoing federal response to the opioid crisis. Currently, their plan prioritizes substance use treatment services and harm reduction strategies. Research underscores the power of prevention in getting ahead of – not trailing behind – the overdose crisis alongside these approaches.
The content of this opinion article is solely the responsibility of the authors and does not necessarily represent the official views of NIH, the NIH HEAL Initiative, NIDA, or the participating institutions and organizations. The authors are investigators who are part of the HEAL Prevention Cooperative, a collaborative of 10 research projects across the country funded by the Helping to End Addiction Long-term® Initiative.
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