“We have effective tools, such as medication-assisted treatment, but we still need better ways to treat opioid addiction and manage pain in an effective, personalized way,” Health and Human Services Secretary Alex Azar said in a news release.

In keeping with NIH’s mission, the $945 million provides no direct services to people affected by the opioid epidemic and chronic pain, but will be used to fund research by 375 grantees in 41 states designed to guide future efforts. The money comes from NIH’s Helping to End Addiction Long-term (HEAL) initiative, launched in 2018.

In a briefing for reporters, NIH Director Francis S. Collins described the commitment as “unprecedented for NIH,” and said it “represents the urgency of this crisis.”

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Included in the grants, he said, is one to Dartmouth College to study ways of initiating drug treatment in hospital emergency rooms rather than days later at treatment centers. Another will help a small company test a device worn on the wrist to detect biomarkers for stress and cravings in an effort to determine how long people need to continue treatment. A third will look at best practices for the care of hundreds of thousands of infants who have been born to mothers who used opioids during pregnancy.

Projects directed at pain include one that will test the effectiveness of acupuncture on low back pain, Collins said. Medicare has previously announced that it will pay for acupuncture for people involved in that research.

The Trump administration and Congress have devoted $9 billion to treatment and prevention of opioid abuse in the nearly three years since Trump took office, according to HHS. Still, only a fraction of those who need treatment receive it, particularly medication-assisted treatment with anti-addiction drugs such as buprenorphine. More than 400,000 people have died of overdoses from prescription narcotics, heroin and illegal street fentanyl since 1999, according to government data.

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Azar noted progress against the drug crisis, including early data that show a small decline in overdose deaths in 2018; there has also been a sharp downturn in opioid prescribing and a vast increase in the availability of naloxone, the antidote to opioid overdoses carried by first responders and others.

In April, the HEAL initiative funded a $353 million effort to reduce deaths from opioid overdoses by 40 percent over three years in four states hit hard by the epidemic.