NIH – Digital Technologies to Address the Social Determinants of Health in Context of Substance Use Disorders (SUD) (R41/R42 Clinical Trial Optional)

January 4, 2021 by


The purpose of this Funding Opportunity Announcement is to support research applications for commercializable, digital products that aim at positively affecting the fundamental social and environmental conditions that are risk factors for the populations affected by substance use/misuse or Substance Use Disorders (excluding Alcohol Use Disorder).


Substance use, including misuse of opioids, is a high-risk behavior associated with immediate and long-term health consequences. Understandably, multiple initiatives to address the opioid crisis in the United States aim to improve pain management, access to medication-assisted treatment, and use of overdose-reversing medications. Moreover, public health experts have also long recognized the impact of social determinants on health outcomes. According to the World Health Organization (WHO), “the social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.” Growing research is demonstrating that social determinants of health (SDH) play a far greater role in health outcomes than previously expected.

The health of people with SUD is inextricably bound to their social environment. Drug-taking and drug-use risk behaviors are affected by social processes, and, in this situation, health is a product of both drug-use behaviors and social determinants. Social determinants can directly shape health risk behaviors. SDH can be manifested in the living conditions and resources that indirectly exacerbate the consequences of drug use. For example, inadequate housing can increase the likelihood of infectious disease transmission, while the stable social relationships can offer protective financial and emotional resources, and more cohesive neighborhoods can have a greater likelihood of providing appropriate support and care.

Although illicit drugs are used by people of all income ranks, drug-related morbidity and mortality are disproportionately higher among lower income groups. Numerous studies have shown the existence of a social gradient, in which rates of morbidity and mortality decrease directly and proportionately with each increase in level of income or education. Factors such as poor access to risk-reduction information and differences in quality of information received may play a role in stratifying the health risks. People with lower socioeconomic status experience difficulties with receiving the appropriate preventive care, have limited access to medical care, and frequently receive substandard medical care.

People affected by SUD or drug use make up a significant proportion of the homeless in the United States. 10%-25% of homeless people are estimated to have substance use disorders, with estimates of lifetime prevalence of 25%- 63%. Drug-attributable mortality rates in homeless are reported to be 8 to 17 times higher than those in general population. Homelessness influences the well-being of this population because of associated high-risk behavior, inadequate access to medical care, and failure/inability to comply with treatment regimens. In general, regular attendance of a drug treatment program, such as methadone maintenance treatment, is associated with significant reductions in drug use. The lack of basic information about the drug treatment program locations, treatment options, and access to the program, including limited access to logistics and technology as well as financial literacy, impedes access to medical care. Enrollment in methadone programs is thus inversely associated with homelessness.

Effects of incarceration on health relate to the cycle of incarceration (release and reentry), which increases morbidity and mortality for incarcerated drug users and limits their access to health resources. According to the Bureau of Justice Statistics, 58 % of people incarcerated in state prisons and 63 % of the sentenced population in local jails meet criteria for persons with substance use disorders. Injection drug-use rates for prisoners are about 20 times higher than for the general population. Longer incarceration episodes are associated with increased injection drug use. Limited availability of housing, benefit programs, and preventive and treatment services in these communities upon release compounds their health problems. Incarceration is thus a risk for disease amplification both within prisons and in the communities where the inmates come from and return to. Research evidence warns about a high likelihood of drug-related death immediately after prison release, with mortality from overdose that is up to 8 times higher in the first 2 weeks after release than in the next 10 weeks and the relative risk of death from drug overdose is more than 120 times higher in this population. Overall, the mortality of former prisoners during the first year after release was up to 40 times the age-adjusted rate in the general population. The likely factors associated with this high mortality include loss of tolerance to opiates while in prison, the increased opportunity for drug use, and other high-risk behavior but also the limited scope of employment and psychological stress associated with re-entry into the community.

Key Dates:

Open Date (Earliest Submission Date): December 26, 2020
Letter of Intent Due Date(s): December 26, 2020
Application Due Date(s): February 26, 2021

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Filed Under: Funding Opportunities