Advancing research translation in addiction and pain: A portfolio analysis of the NIH HEAL initiative.

Background: To date, the NIH Helping to End Addiction Long-term (HEAL) Initiative has funded over 1,000 projects that aim to identify new therapeutic targets for pain and substance use disorder (SUD), develop nonpharmacological strategies for pain management, and improve overdose and addiction treatment across settings. This study conducted a portfolio analysis of HEAL's research to assess opportunities to advance translation and implementation.

Methods: HEAL projects (FY 2018-2022) were classified into early (T0-T1) and later (T2-T4) translational stages. Eleven coders used a 54-item data collection tool based on the Consolidated Framework for Implementation Research (CFIR) to extract project characteristics (e.g., population, research setting) relevant to translation and implementation. Descriptive statistics and visualization techniques were employed to analyze and map aggregate characteristics onto CFIR's domains (e.g., outer setting).

Results: HEAL's portfolio comprised 923 projects (33.7% T0-T1; 67.3% T2-T4), ranging from basic science (27.1%) and preclinical research (21.4%) to clinical (36.8%), implementation (27.1%), and dissemination research (13.1%). Most projects primarily addressed either addiction (46.3%) or pain (37.4%). Implementation-related gaps included the underrepresentation of certain populations (e.g., sexual/gender minorities: 0.5%). T0-T1 projects occurred primarily in laboratory settings (35.1%), while T2-T4 projects were concentrated in healthcare settings (e.g., hospitals: 21.6%) with limited transferability to other contexts (e.g., community: 12.9%).

Conclusion: Opportunities to advance translational and implementation efforts include fostering interdisciplinary collaboration, prioritizing underserved populations, engaging with community leaders and policy stakeholders, and targeting evidence-based practices in nonclinical settings. Ongoing analyses can guide strategic investments to maximize HEAL's impact on substance use and pain crises.