NIH-funded study indicates substantial need to expand access to evidence-based treatment among young people. Only 1 in 4 residential addiction treatment facilities caring for U.S. adolescents under 18 years old offer buprenorphine, a medication used to treat opioid use disorder, according to a new study(link is external). Only 1 in 8 offer buprenorphine for ongoing treatment. These findings highlight a significant gap in access to evidence-based addiction treatment among young people. Published in JAMA, this study was supported by the National Institute on Drug Abuse (NIDA) and the National Center for Advancing Translational Sciences (NCATS), both part of the National Institutes of Health, and led by researchers at Oregon Health & Science University (OHSU). There has been a dramatic rise in overdose deaths among young people(link is external) aged 14-18 in recent years, likely driven by illicit counterfeit pills containing fentanyl. For those with opioid use disorder, medications are the most effective treatment options for preventing both return to opioid use and overdose deaths. Buprenorphine is the only medication for opioid use disorder that is approved by the U.S. Food and Drug Administration for use in people aged 16-18. Although buprenorphine is not approved for use among people under the age of 16 in the U.S., some professional medical societies recommend that buprenorphine be considered as a treatment option for opioid use disorder in younger people. “It is tragic to see that young people with opioid use disorder are unable to access buprenorphine in most treatment facilities, despite this medication being the standard of care for people aged 16 and older” said Nora Volkow, M.D., director of NIDA. “Residential treatment facilities provide an opportunity to reach young people with a range of evidence-based supports at a pivotal time in their lives, and it is crucial that buprenorphine is made available as one of those options.” Residential treatment facilities are part of the continuum of care for adolescents with opioid use disorder. However, little is known about specific evidence-based treatment options offered to young people at these facilities, including medications for opioid use disorder. To address this gap, researchers at OHSU sought to determine how many adolescent treatment centers in the U.S. were offering buprenorphine to treat opioid use disorder. Using the FindTreatment.gov(link is external) database, which is maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA), the researchers identified a list of 354 centers across the U.S. that offered treatment for “substance use,” in a “residential/24-hour residential” service setting, and for “children/adolescents” (defined as people aged 17 and younger) to include in the analysis. Researchers called these facilities to inquire about treatment and services offered as potential users of these services for a 16-year-old with a recent non-fatal fentanyl overdose. Between October and December 2022, the study team called the facilities in a random order and confirmed that 160 (45%) of these facilities provided residential treatment to patients under the age of 18. Of the 160 residential addiction treatment facilities found to provide treatment to young patients, the researchers found that 39 facilities (24%) said that they offered buprenorphine to patients aged 16 or older, including through partnership with outside prescribing clinicians, though specific parameters for offering buprenorphine varied by site. For instance, only 20 facilities (12.5%) said that they offered buprenorphine for ongoing treatment. 12 facilities (7.5%) said that they offered buprenorphine to adolescents under 16 years of age. Among the other 121 facilities that did not offer buprenorphine to adolescents or weren’t sure, 57 (47%) indicated that adolescents prescribed buprenorphine by their own clinician could stay on it at least temporarily, although some stated they would discontinue it before discharge. And 27 (22%) required that adolescents were not taking buprenorphine in order to be admitted for residential treatment. Based on these findings, the average person would need to call nine facilities on the SAMHSA list to find one that offered buprenorphine. To find one for an adolescent under 16, they would need to call 29 facilities. “These residential treatment centers see some of the most vulnerable adolescents in our communities,” said lead author Caroline King, M.D., Ph.D., who completed this research as a student in the OHSU School of Medicine. “We need to support these centers to make evidence-based care the norm.” “Buprenorphine is the one medication that’s approved for use in adolescents, and it’s underused in facilities taking care of kids with the most severe opioid use disorder,” said co-author Todd Korthuis, M.D., M.P.H., head of addiction medicine at OHSU. “It’s a big issue, but it’s something that we can change by supporting these treatment centers with education and technical assistance about buprenorphine, better funding to staff these centers, and by letting the public know that buprenorphine is necessary treatment in healing brains.” For more information on substance and mental health treatment programs in your area, call the free and confidential National Helpline(link is external) 1-800-662-HELP (4357) or visit www.FindTreatment.gov.(link is external) About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. For more information about NIDA and its programs. About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs. NIH…Turning Discovery Into Health® Reference: C King, et al. Treatments used among adolescent residential addiction treatment facilities in the United States, 2022(link is external). JAMA. DOI: 10.1001/jama.2023.6266 (2023).

NIH-supported study could lead to less restrictions for those with hypertrophic cardiomyopathy. Vigorous exercise does not appear to increase the risk of death or life-threatening arrhythmia for people with hypertrophic cardiomyopathy (HCM), according to a study supported by the National Institutes of Health. HCM is a rare, inherited disorder that causes the heart muscle to become thick and enlarged and affects 1 in 500 people worldwide. It has been associated with sudden cardiac death in young athletes and other young people. However, the study, published in JAMA Cardiology, found that people with the disease who exercise vigorously are no more likely to die or experience severe cardiac events than those who exercised moderately or not at all. The observational study, the largest and most extensive to explore the relationship between HCM and exercise, was funded by the National Heart, Lung, and Blood Institute (NHLBI), part of NIH, and questions restrictions from exercise that are often recommended for anyone who has the disease. “Based on these data, we’re learning that we don’t need to universally restrict HCM patients from participating in vigorous exercise, something that’s so important to all of us,” said Rachel Lampert, M.D., a professor of medicine at Yale School of Medicine in New Haven, Connecticut, one of the principal study authors, and a practicing cardiologist who is an expert in arrhythmias in HCM. “Individuals with this condition should talk to a healthcare provider with expertise in HCM about getting back on the field, back in the pool, and back on the court, if that’s what they want to do,” Lampert added. “Getting an expert evaluation is key to determining degree of risk for all HCM patients, and critical before going back to play.” HCM can make it harder for the heart to pump blood because the thickened ventricles (the lower chambers of the heart) become too stiff. This can cause some people to experience shortness of breath, chest pain, fatigue, and, more seriously, a life-threatening irregular heartbeat, known as arrhythmia. In rare cases, HCM can cause sudden death. The condition is typically managed with medications or the use of surgically implanted devices such as an implantable cardioverter-defibrillator (ICD), which can detect an arrhythmia. Recommendations to restrict all exercise for most people with the disease have been based mainly on an abundance of caution in the absence of specific data. Large, detailed, multiyear studies on the health risks of exercise in people diagnosed with HCM have been lacking, until now. For the study, the researchers recruited 1,660 people who either had HCM or the gene for HCM but had not yet manifested the disease (8% of the total). They ranged from ages 8 to 60 and were recruited from 42 high-volume HCM medical centers in the United States and other countries, including the United Kingdom, Canada, Australia, and New Zealand. About 60% of participants were male. The study excluded people who could not exercise for established medical reasons, such as those awaiting heart transplantation or with severe asthma. The participants were divided according to self-reported exercise levels based on a physical activity questionnaire used in research studies. About 15% of the participants reported being sedentary, 43% said they did moderate exercise, such as brisk walking, and 42% said they did vigorous exercise, such as running or fast swimming. The researchers then followed the groups for about three years and looked at the occurrence of four main cardiovascular events during that period: sudden deaths, resuscitated sudden cardiac arrests, arrhythmic syncope (which can include fainting or passing out), and appropriate ICD shocks. To simplify these measurement outcomes, the researchers used a statistical formula that measured a composite of these four events. The researchers found that 77 participants, or 1.5% per year, who reported exercising vigorously died or had severe cardiac events – the same percentage as those who exercised moderately or described themselves as sedentary. The outcome was similar for competitive exercisers (39% of the vigorous group) and for a subgroup of 42 young people who participated in interscholastic competitive sports such as baseball, track, soccer, and basketball. “This finding is significant and provides a measure of reassurance that exercise may be safe for persons with HCM,” said Patrice Desvigne-Nickens, M.D., a medical officer in the Heart Failure and Arrhythmias Branch in NHLBI’s Division of Cardiovascular Sciences. “However, we stress that individuals with the condition should not be exercising until they’ve first had an evaluation by a provider with expertise in HCM about their overall risk of sudden cardiac death. It is important to know that all patients with HCM could potentially be at risk for sudden death.” This study was supported by grant 1R01HL125918 from NHLBI. Preliminary results of the study were previously described during a meeting of the American College of Cardiology in March. About the National Heart, Lung, and Blood Institute (NHLBI): NHLBI is the global leader in conducting and supporting research in heart, lung, and blood diseases and sleep disorders that advances scientific knowledge, improves public health, and saves lives. For more information, visit nihprogram.com About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit nihprogram.com NIH…Turning Discovery Into Health® Study Vigorous Exercise in Patients with Hypertrophic Cardiomyopathy: Results of the Prospective, Observational, Multinational, “Lifestyle and Exercise in HCM” (LIVE-HCM) Study. JAMA Cardiology. doi:10.1001/jamacardio.2023.1042(link is external)

The ground-breaking study provides national and state-level estimates of the economic burden of health disparities by race and ethnicity and educational levels. New research shows that the economic burden of health disparities in the United States remains unacceptably high. The study, funded by the National Institute on Minority Health and Health Disparities (NIMHD), part of the National Institutes of Health,  revealed that in 2018, racial and ethnic health disparities cost the U.S. economy $451 billion, a 41% increase from the previous estimate of $320 billion in 2014. The study also finds that the total burden of education-related health disparities for persons with less than a college degree in 2018 reached $978 billion, about two times greater than the annual growth rate of the U.S. economy in 2018. The findings from this study by researchers from NIMHD; Tulane University School of Public Health and Tropical Medicine, New Orleans; Johns Hopkins Bloomberg School of Public Health, Baltimore; Uniformed Services University, Bethesda, Maryland; TALV Corp, Owings Mills, Maryland; and the National Urban League were published in JAMA.  This study is the first to estimate the total economic burden of health disparities for five racial and ethnic minority groups nationally and for all 50 states and the District of Columbia using a health equity approach. The health equity approach set aspirational health goals that all populations can strive for derived from the Healthy People 2030 goals. It establishes a single standard that can be applied to the nation and each state, and for all racial, ethnic, and education groups. It is also the first study to estimate the economic burden of health disparities by educational levels as a marker of socioeconomic status.  “The exorbitant cost of health disparities is diminishing U.S. economic potential. We have a clear call to action to address social and structural factors that negatively impact not only population health, but also economic growth,” said NIMHD Director Eliseo J. Pérez-Stable, M.D. Key findings from the study included: Economic burden by racial and ethnic minority groups National estimates State estimates Economic burden by educational levels National estimates State estimates “The results of this study demonstrate that health inequity represents not just unfair and unequal health outcomes, but it also has a significant financial cost,” said lead author Thomas LaVeist, Ph.D., dean of Tulane University School of Public Health and Tropical Medicine. “While it surely will cost to address health inequities, there are also substantial costs associated with not addressing them. Health inequities is a social justice issue, but it is also an economic issue.” Researchers collected and analyzed data from four databases to estimate the burden of racial and ethnic and education-related health inequities: 2016-2019 Medical Expenditure Panel Survey, 2016-2019 Behavioral Risk Factor Surveillance System, 2016-2018 National Vital Statistics System, and 2018 American Community Survey. Specifically, estimates were produced using medical care costs, lost labor market productivity, and premature deaths for Asian, AI/AN, Black/African American, Hispanic/Latino, and NHPI populations. Previous estimates did not include the AI/AN and NHPI populations as together they constitute about 2.5% of the U.S. population. Education-related inequities were estimated for adults without a four-year college degree, who were categorized into three education groups (adults with less than high school/GED, those with high school/GED, and those with some college).  While the economic burden of racial and ethnic and education-related health disparities is significant, the researchers noted that the burden could be reduced if investments are made to address structural contributors to known inequities, including racism and socioeconomic inequalities. They also recommended that federal and state health policymakers and offices of minority health could use these estimates to inform areas where policies and programs are most needed to address health inequities.  National Institute on Minority Health and Health Disparities (NIMHD): NIMHD leads scientific research to improve minority health and reduce health disparities by conducting and supporting research; planning, reviewing, coordinating, and evaluating all minority health and health disparities research at NIH; promoting and supporting the training of a diverse research workforce; translating and disseminating research information; and fostering collaborations and partnerships. For more information about NIMHD, visit www.nihprogram.com. About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nihprogram.com NIH…Turning Discovery Into Health® References LaVeist TA, Pérez-Stable EJ, Richard P, et al. The Economic Burden of Racial, Ethnic, and Educational Health Inequities in the US. JAMA. 2023. DOI: 10.1001/jama.2023.

Data are the first nationwide estimates on the incidence of new chronic pain and new high impact chronic pain. A study from the National Institutes of Health shows that new cases of chronic pain occur more often among U.S. adults than new cases of several other common conditions, including diabetes, depression, and high blood pressure. Among people who have chronic pain, almost two-thirds still suffer from it a year later. These findings come from a new analysis of National Health Interview Survey (NHIS) data by investigators from the National Center for Complementary and Integrative Health (NCCIH) at the NIH, Seattle Children’s Research Institute, and University of Washington, Seattle, and are published in JAMA Network Open. “Understanding incidence, beyond overall prevalence, is critical to understanding how chronic pain manifests and evolves over time. These data on pain progression stress the need for increased use of multimodal, multidisciplinary interventions able to change the course of pain and improve outcomes for people,” said Richard Nahin, Ph.D., lead author and lead epidemiologist at NCCIH. Overall, the study found that the rate of chronic pain and high-impact chronic pain (HICP) among adults is approximately 21% and 8%, respectively. Chronic pain is pain that is experienced on most days or every day in the past three months; and HICP is pain that limits life or work activities on most days or every day during the past three months. The links between the widespread burden of chronic pain and the country’s opioid epidemic underscore the urgency to understand and address the issue of pain.  The study assessed reports of pain among survey participants and compared their experiences in 2020 to their baseline status in 2019. The study offers several key findings: “This study doesn’t just demonstrate the terrible burden of pain in this country. While 10% of people who recover from chronic pain give us hope, we have an urgent scientific imperative to expand our tools to fight pain so we can restore many more to a pain-free life,” said Helene M. Langevin, M.D., director of NCCIH. “The onset of any chronic condition is a pivotal moment and early intervention can make a significant difference in the toll that the condition takes on the individual.” The NHIS is a nationally representative survey from 50 states and the District of Columbia. The survey is conducted annually by the Centers for Disease Control and Prevention’s National Center for Health Statistics. About the National Center for Complementary and Integrative Health (NCCIH): NCCIH’s mission is to define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative health approaches and their roles in improving health and health care. For additional information, call NCCIH’s Clearinghouse toll free at 1-888-644-6226. Follow us on Twitter(link is external), Facebook(link is external) , and YouTube(link is external). About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov. NIH…Turning Discovery Into Health® References Nahin RL, Feinberg T, Kapos FP, Terman GW. Estimated Rates of Incident and Persistent Chronic Pain Among US Adults, 2019-2020. JAMA Netw Open. 2023. doi: 10.1001/jamanetworkopen.2023.13563

It’s been estimated that every 18 minutes in the United States, a newborn baby starts life with painful withdrawals from exposure to opioids in the womb. It’s called neonatal opioid withdrawal syndrome (NOWS), and it makes for a challenging start in life. These infants may show an array of withdrawal symptoms, including tremors, extreme irritability, and problems eating and sleeping. Many of these infants experience long, difficult hospital stays to help them manage their withdrawal symptoms. But because hospital staff have no established evidence-based treatment standards to rely on, there is substantial variation in NOWS treatment around the country. There also are many open questions about the safest and most-effective way to support these babies and their families. But answers are coming. The New England Journal of Medicine just published clinical trial results that evaluated care for infants with NOWS and which offer some much needed—and rather encouraging—data for families and practitioners [1]. The data are from the Eating, Sleeping, Consoling for Neonatal Opioid Withdrawal (ESC-NOW) trial, led by Leslie W. Young, The University of Vermont’s Larner College of Medicine, Burlington, and her colleagues Lori Devlin and Stephanie Merhar. The ESC-NOW study is supported through the Advancing Clinical Trials in Neonatal Opioid Withdrawal (ACT NOW) Collaborative. ACT NOW is an essential part of the NIH Helping to End Addiction Long-term (HEAL) Initiative, an aggressive effort to speed scientific solutions to stem the national opioid public health crisis and improve lives. The latest study puts to the test two different approaches to care for newborns with NOWS. The first approach relies on the Finnegan Neonatal Abstinence Scoring Tool. For almost 50 years, doctors primarily assessed NOWS using this tool. It is based on a scoring system of 21 signs of withdrawal, including disturbances in a baby’s nervous system, metabolism, breathing, digestion, and more. However, there have been concerns that this scoring tool has led to an overreliance on treating babies with opioid medications, including morphine and methadone. The other approach is known as Eat, Sleep, Console (ESC) care [2]. First proposed in 2014, ESC care has been adopted in many hospitals around the world. Rather than focusing on a long list of physical signs of withdrawal, this approach relies on a simpler functional assessment of whether an infant can eat, sleep, and be consoled. It emphasizes treatments other than medication, such as skin-to-skin contact, breastfeeding, and care from their mothers or other caregivers in a calm and nurturing environment. The ESC care approach places an emphasis on the use of supportive interventions and aims to empower families in the care and nurturing of their infants. While smaller quality improvement studies of ESC have been compelling, the question at issue is whether the Eat, Sleep, Console care approach can reduce the time until infants with NOWS are medically ready to go home from the hospital in a wide variety of hospital settings—and, most importantly, whether it can do so safely. To find out, the ESC-NOW team enrolled 1,305 infants with NOWS who were born after at least 36 weeks gestation. The study’s young participants were largely representative of infants with NOWS in the U.S., although non-Hispanic Black and Hispanic infants were slightly overrepresented. The babies were born at one of 26 U.S. hospitals, and each hospital was randomly assigned to transition from usual care using the Finnegan tool to the ESC care approach at a designated time. Each hospital had a three-month transition period between the usual care and the ESC to allow clinical teams time to train on the new approach. The trial primarily aimed to understand if there was a significant difference in how long newborns with NOWS spent in the hospital before being medically ready for discharge between those receiving usual care versus those receiving ESC care. Researchers also assessed infants for safety, tracking both safety events that occurred during the hospital stay and events that occurred after the baby left the hospital, such as non-accidental trauma or death during an infant’s first three months. The reported results reflect 837 of the 1,305 infants, who met the study definition of being medically ready for discharge. Infants who were discharged before meeting the study criteria, which were informed by the 2012 American Academy of Pediatrics recommendations for monitoring of infants with NOWS, were not included in the primary analysis. Among the 837 infants, those who received ESC care were medically ready for discharge significantly sooner than those who received usual care. On average, they were medically ready to go home after about eight days compared to almost 15 days for the usual care group. Many fewer infants in the ESC care group were treated with opioids compared to the usual care group (19.5 percent versus 52.0 percent). In more good news for ESC care, there was no difference in safety outcomes through the first three months despite the shorter hospital stays and reduced opioid treatment in the hospital. Infants who were cared for using the ESC care approach were no more likely to visit the doctor’s office, emergency room, or hospital after being discharged from the hospital. More long-term study is needed to evaluate these children over months and years as they continue to develop and grow. Many of the infants in this study will be evaluated for the first two years of life to assess the long-term impact of ESC care on development and other outcomes. These findings offer encouraging early evidence that the ESC care approach is safe and effective. Although there was some variability in the outcomes, this study also shows that this approach can work well across diverse hospitals and communities. The ESC-NOW trial is just one portion of the NIH Heal Initiative’s ACT NOW program, focused on gathering scientific evidence on how to care for babies with NOWS. Other studies are evaluating how to safely wean babies who do receive treatment with medication off opioids more quickly. The ACT NOW Longitudinal Study also will enroll at least 200 babies with prenatal opioid exposure and another 100 who were not