HEAL Initiative: Multilevel Interventions to Reduce Harm and Improve Quality of Life for Patients on Long Term Opioid Therapy (MIRHIQL): Resource Center (U24- Clinical Trial Optional) | RFA DA 23 042

Opportunity Information: Apply for RFA DA 23 042

The HEAL Initiative funding opportunity titled "Multilevel Interventions to Reduce Harm and Improve Quality of Life for Patients on Long Term Opioid Therapy (MIRHIQL): Resource Center" (RFA-DA-23-042) is a National Institutes of Health (NIH) cooperative agreement (U24; clinical trial optional) focused on a specific, often hard-to-define patient group: people who are receiving long-term opioid therapy and are showing harmful opioid-related behaviors, yet do not meet diagnostic criteria for opioid use disorder (OUD). The core idea is to move beyond a simple binary of "OUD vs. no OUD" and instead develop clearer ways to identify, assess, and reduce harm for patients who fall into this ambiguous middle area. The opportunity sits under the broader NIH HEAL (Helping to End Addiction Long-term) Initiative and is aimed at improving safety and quality of life while supporting more balanced, evidence-based clinical decision-making.

A central aim of this announcement is to spur the field toward practical, multi-level solutions. "Multi-level" implies interventions that do not focus only on the individual patient, but also consider clinical workflows, provider behavior and training, health system policies, pharmacy and prescribing practices, care coordination, and broader community or payer-related factors that shape how long-term opioid therapy is managed. The targeted population includes patients whose opioid use may be drifting into risky territory (for example, patterns suggestive of escalating dose pressure, unsafe use, or other harmful behaviors) without crossing the threshold into OUD as formally defined. By emphasizing this group, the grant recognizes a real clinical challenge: clinicians often lack consistent definitions, validated measures, and agreed-upon care pathways for responding to harm signals that are serious but diagnostically "subthreshold."

The opportunity also calls for strong engagement of patients with lived experience. Rather than treating patient input as an optional add-on, the announcement highlights consultation by people who have directly experienced long-term opioid therapy, including the kinds of harms, stigma, and care tradeoffs that can emerge over time. In practice, this means applicants are expected to build patient perspectives into the planning and execution of the resource center's activities, helping ensure that resulting guidance, metrics, and recommendations reflect real-world experience and avoid unintended consequences such as overcorrection, inappropriate tapering, or increased stigma.

A major deliverable envisioned by the funding announcement is the creation of a Resource Center devoted to this clinical area. The Resource Center is intended to help the field develop clearer clinical identification approaches for this "in-between" population and to provide shared metrics that enable balanced assessment of opioid risks and harms. In other words, the center is expected to help standardize how clinicians and researchers describe and measure risk, harm, and functioning among long-term opioid therapy patients who are not diagnosed with OUD, so that studies and clinical programs can be compared, evaluated, and improved using common yardsticks. The emphasis on "balanced assessment" is important: the goal is not only to flag risk, but to support measures that also account for patient well-being and quality of life, reflecting the reality that pain, function, mental health, and safety are intertwined in long-term opioid management.

To guide and legitimize this work, the Resource Center would convene a panel that includes key stakeholders and bioethicists. This reflects the ethical complexity of the topic, where decisions can carry real risks in both directions: ignoring harm signals can lead to overdose or other negative outcomes, while overly aggressive restriction can worsen pain, disability, mental health, or push patients toward dangerous illicit sources. A stakeholder and bioethics-informed panel is meant to help navigate these tensions, develop guidance that is clinically realistic, and ensure that definitions and metrics do not inadvertently cause harm, deepen inequities, or reinforce stigma.

From an administrative standpoint, this is a discretionary funding opportunity using a cooperative agreement mechanism, which generally means NIH expects to have substantial programmatic involvement compared with a standard research project grant. The activity category is listed broadly under education, health, income security, and social services, and the CFDA numbers associated with the opportunity are 93.213, 93.279, and 93.865. The award ceiling is listed as $1,500,000. The original closing date shown is 2022-09-27, and the opportunity was created on 2022-07-11 (useful for context, though applicants typically need to verify whether a reissue or related active announcement exists).

Eligibility is broad and includes many types of U.S.-based organizations and governmental entities. Eligible applicants include state, county, and city or township governments; special district governments; independent school districts; public and state-controlled institutions of higher education; private institutions of higher education; Native American tribal governments (federally recognized); Native American tribal organizations (other than federally recognized tribal governments); public housing authorities and Indian housing authorities; nonprofit organizations with or without 501(c)(3) status (excluding institutions of higher education in those categories); for-profit organizations (other than small businesses); small businesses; and other eligible entities. The announcement also explicitly highlights additional eligible applicant types such as Alaska Native and Native Hawaiian Serving Institutions; Asian American, Native American, and Pacific Islander Serving Institutions (AANAPISIs); Hispanic-serving institutions; Historically Black Colleges and Universities (HBCUs); Tribally Controlled Colleges and Universities (TCCUs); faith-based or community-based organizations; regional organizations; eligible agencies of the federal government; Indian/Native American tribal governments other than federally recognized; and U.S. territories or possessions.

At the same time, the opportunity places clear limits on non-U.S. participation. Non-domestic (non-U.S.) entities and foreign institutions are not eligible to apply, and non-domestic components of U.S. organizations are also not eligible to apply. However, foreign components, as defined in the NIH Grants Policy Statement, are allowed. This distinction typically means the applicant organization must be U.S.-based and eligible, but certain project elements may include foreign components if they meet NIH policy definitions and are justified, while still keeping the primary award and leadership structure within an eligible U.S. entity.

Overall, this opportunity is designed to build shared infrastructure for a challenging clinical problem: how to recognize and reduce opioid-related harm among long-term opioid therapy patients who do not neatly fit OUD criteria, while still protecting patient quality of life and avoiding ethically problematic, one-size-fits-all responses. The Resource Center concept, the explicit role for lived experience voices, and the inclusion of stakeholder and bioethics guidance all point toward a field-building effort meant to create practical definitions, measurable outcomes, and better-aligned interventions across patient, provider, and system levels.

• The National Institutes of Health in the education, health, income security and social services sector is offering a public funding opportunity titled "HEAL Initiative: Multilevel Interventions to Reduce Harm and Improve Quality of Life for Patients on Long Term Opioid Therapy (MIRHIQL): Resource Center (U24- Clinical Trial Optional)" and is now available to receive applicants.
• Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.213, 93.279, 93.865.
• This funding opportunity was created on 2022-07-11.
• Applicants must submit their applications by 2022-09-27. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
• Each selected applicant is eligible to receive up to $1,500,000.00 in funding.
• Eligible applicants include: State governments, County governments, City or township governments, Special district governments, Independent school districts, Public and State controlled institutions of higher education, Native American tribal governments (Federally recognized), Public housing authorities/Indian housing authorities, Native American tribal organizations (other than Federally recognized tribal governments), Nonprofits having a 501 (c) (3) status with the IRS, other than institutions of higher education, Nonprofits that do not have a 501 (c) (3) status with the IRS, other than institutions of higher education, Private institutions of higher education, For-profit organizations other than small businesses, Small businesses, Others.

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