By Clinical Research News Staff 

August 20, 2024 | Last week, the National Institutes of Health (NIH) has launched the Native Collective Research Effort to Enhance Wellness (N CREW) Program, an effort support Native American communities to lead public health research to address overdose, substance use, and pain, including related factors such as mental health and wellness. The planned program funding totals approximately $268 million over seven years.  

Despite the inherent strengths in Tribal communities, and driven in part by social determinants of health, Native American communities face unique health disparities related to the opioid crisis. For instance, in recent years, overdose death rates have been highest among American Indian and Alaska Native people. Research prioritized by Native communities is essential for enhancing effective, culturally grounded public health interventions and promoting positive health outcomes. 

“Elevating the knowledge, expertise, and inherent strengths of Native people in research is crucial for creating sustainable solutions that can effectively promote public health and health equity,” said Nora D. Volkow, M.D., director of NIH’s National Institute on Drug Abuse (NIDA) in a statement about the program. “As we look for ways to best respond to the overdose crisis across the country, it is crucial to recognize that Native American communities have the best perspective for developing prevention and therapeutic interventions consistent with their traditions and needs. This program will facilitate research that is led by Native American communities, for Native American communities.” 

In Response to Need 

The N CREW program will support research projects that are led directly by Tribes and organizations that serve Native American communities, and was established in direct response to priorities identified by Tribes and Native American communities. 

Many Tribal Nations have developed and continue to develop innovative approaches and systems of care for community members with substance use and pain disorders. During NIH Tribal Consultations in 2018 and 2022, Tribal leaders categorized the opioid overdose crisis as one of their highest priority issues and called for research and support to respond. They shared that Native communities must lead the science and highlighted the need for research capacity building, useful real-time data, and approaches that rely on Indigenous Knowledge and community strengths to meet the needs of Native people. 

The N CREW Program focuses on: 

1. Supporting research prioritized by Native communities, including research elevating and integrating Indigenous Knowledge and culture 

2. Enhancing capacity for research led by Tribes and Native American Serving Organizations by developing and providing novel, accessible, and culturally grounded technical assistance and training, resources, and tools 

3. Improving access to, and quality of, data on substance use, pain, and related factors to maximize the potential for use of these data in local decision-making. 

“Native American communities have been treating pain in their communities for centuries, and this program will uplift that knowledge to support research that is built around cultural strengths and priorities,” said Walter Koroshetz, M.D., director of NIH’s National Institute of Neurological Disorders and Stroke (NINDS) in the same statement. “These projects will further our collective understanding of key programs and initiatives that can effectively improve chronic pain management for Native American and other communities.” 

NIH hopes the program will lead to more sustainable community solutions stemming directly from the development of culturally-relevant research and data projects and increased capacity for research that is driven by Tribes and Native community priorities, according to the program FAQ page. Projects driven by Tribes and Native communities are best suited to reduce overdose-related health inequities, NIH believes. The hoped-for program outcomes include building and enhancing Helping to End Addiction Long-term (HEAL)-related research capacity; clear understanding of data sharing concerns and potentially building a Data Archive and supporting cross site collection of outcomes data; and integration of Indigenous Knowledge in NIH research.  

Two Phase Approach  

The first phase of the program will support projects to plan, develop, and pilot community-driven research and/or data improvement projects to address substance use and pain. In this phase, NIH will also support the development of a Native Research Resource Network to provide comprehensive training, resources, and real-time support to N CREW participants. 

The second phase of the program, anticipated to begin in fall 2026 and continue for five years, will build on the work conducted in the initial phase of the program to further capacity building efforts and implement community-driven research and/or data improvements projects. Additional activities that support the overarching goals of the N CREW Program may also be identified as the program develops. 

The N CREW Program is led by the NIH’s NIDA, NINDS, and National Center for Advancing Translational Sciences (NCATS), with participation from numerous other NIH Institutes, Centers, and Offices. The N CREW Program is funded through the NIH Helping to End Addiction Long-term Initiative (or NIH HEAL Initiative), which is jointly managed by NIDA and NINDS. For the purposes of the N CREW Program, Native Americans include American Indians, Alaska Natives, and Native Hawaiians. Projects will be awarded on a rolling basis and publicly listed. 

This new program is part of work to advance the Biden/Harris Administration’s Unity Agenda and the HHS Overdose Prevention Strategy.