National Institute on Drug Abuse
Director's Report to the National Advisory Council on Drug Abuse
May, 1999
Congressional Affairs
Hearings
National Institutes of Health Appropriations Hearings
NIH officials testified in late February and early March 1999 before both the House and Senate Appropriations Subcommittees on Labor, Health and Human Services, Education and Related Agencies. On February 23, 1999, Dr. Harold Varmus, Director, NIH, accompanied by all of the NIH Institute Directors, appeared with Secretary Shalala at a hearing before the Senate Appropriations Subcommittee (Senator Specter, R-PA, Chair). The following day, Dr. Varmus testified before the Labor, Health and Human Services, Education and Related Agencies Subcommittee (Chairman John Porter, R-Ill) of the House Appropriations Committee.
NIDA Appropriations Hearing
On March 2, 1999, Dr. Alan I. Leshner, Director, NIDA, testified before the House Subcommittee on Labor, Health and Human Services, Education and Related Agencies, to discuss the Institute's FY 2000 non-AIDS budget request and to provide information on NIDA's ongoing and planned research activities. The FY 2000 budget request for NIDA is $429.2 million, an increase of $10.3 million (2.4%) above the FY 1999 appropriation. Including the estimated allocation for AIDS in the President's budget request, the total FY 2000 requested funding for NIDA would be $622.8 million, an increase of $14.6 million over the FY 1999 appropriation. Funds for NIDA efforts in AIDS research are included within the Office of AIDS Research budget request.
Dr. Leshner reported that NIDA has had another year filled with major scientific advances that directly benefit the citizens of this Nation, most particularly by enhancing drug addiction treatment. He explained that years of research discoveries brought to us through the use of advanced technologies, coupled with the generous appropriations that NIDA received last fiscal year are enabling the Institute to accelerate establishment of its much-needed National Drug Abuse Treatment Clinical Trials Network. This Network will serve as both the infrastructure for testing science-based treatments in diverse patient and treatment settings and as the mechanism for promoting the rapid translation of new science-based treatment components into practice. Dr. Leshner also described some of the significant discoveries and advances that are impacting the approach to addiction research. He discussed two technologies in particular - molecular genetics and brain imaging. In response to questions, Dr. Leshner described "NIDA Goes to School" - a science-based drug abuse education program aimed at middle school students. The program is available on NIDA's website.
Hearing on "Date Rape Drugs"
On March 11, the Oversight and Investigations Subcommittee (Chairman Fred Upton, R-MI) of the House Commerce Committee held a hearing on "date rape" drugs, specifically including GHB (and its precursor GBL), Ketamine, and Rohypnol and their abuse. The subcommittee pointed out that GHB, GBL and Ketamine are currently not regulated under the Federal Controlled Substances Act, and indicated that it will study whether the federal government is taking enough action to combat the use of date rape drugs.
Dr. Stephen Zukin, Director, Division of Clinical and Services Research, NIDA, testified about what science has come to show about GHB. Other federal witnesses included Nicholas Reuter - Associate Director, FDA; Terrance W. Woodworth, DEA; Patricia Maher - DoJ.
Oversight Hearing on Efforts to Prevent and Treat Drug Abuse
On March 18, 1999, the House Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, chaired by Representative John Mica (R-FL), held a hearing entitled, "Oversight of Agency Efforts to Prevent and Treat Drug Abuse." Mr. Richard Millstein, Deputy Director, NIDA, testified about research on prevention and treatment of drug abuse. Other witnesses included Daniel Schecter, Office of National Drug Control Policy; Joseph Autry III, SAMHSA; and Vicki Verdeyen, U.S. Department of Justice.
In his opening statement Representative Mica expressed his belief that "we cannot tackle the problems of drug abuse and the concurrent social problems, crime, and significant costs to our country, without an approach that addresses simultaneously education, treatment, prevention, enforcement, interdiction and eradication." He said the hearing was intended to focus on several critical elements of this effort, and expressed concern that 136 Floridians died from heroin overdoses in 1997, up from 84 in 1995, and that from 1991 to 1996 the proportion of the nation's 8th graders who said they had tried heroin had doubled.
Much of the hearing focused on the ONDCP 1999 National Drug Control Strategy, efforts to deal with the drug problem in the nation's prisons, and the recently released IOM report regarding the medicinal uses of marijuana. Most of the questioning, therefore, was addressed to the ONDCP witness.
In his oral remarks Mr. Millstein explained that science shows that drug abuse is a preventable behavior and drug addiction is in fact a treatable disease. Addiction is a chronic illness, similar to other chronic diseases like asthma, hypertension, and diabetes that have major medications and behavioral compliance issues, and are characterized for many people by occasional relapses. Mr. Millstein described NIDA's National Drug Abuse Treatment Clinical Trials Network as a major effort to move research into real-life settings. He said, "Ultimately, our best treatment is prevention." Mr. Millstein also emphasized the importance of a strong science education program to ensure that the nation's youth have the necessary information to make healthy lifestyle choices. He concluded that a comprehensive public health approach is needed that includes extensive education and prevention efforts, adequate treatment and aftercare services, and research.
Oversight Hearing on the ONDCP Youth Anti-Drug Media Campaign
On March 25, 1999, Dr. Alan I. Leshner, Director, NIDA, testified before the House Appropriations Subcommittee on Treasury, Postal Service, and General Government, Representative Jim Kolbe (R-AZ), Chairman, at an oversight hearing on ONDCP's Youth Anti-Drug Media Campaign. Also testifying were General Barry McCaffrey, Director, ONDCP; and James Burke, Chairman, Partnership for a Drug-Free America.
In his oral remarks, Dr. Leshner briefly described the role of NIDA in the ONDCP campaign, pointing out that research supported by the Institute played a significant role in developing the overall campaign design. He described the effort as the first science-based anti-drug media campaign. The NIDA-supported evaluation of Phase III of the campaign, aimed at determining the effectiveness of the campaign in changing attitudes and behaviors with respect to drug abuse, will begin at the end of the summer. This evaluation, he explained, will consist of three major data collection activities: (1) "The National Survey of Parents & Youth," which will provide data at six-month intervals regarding the nation's reaction to the campaign over four years; (2) _The Longitudinal Community Surveys of Parents & Youth,_ which will provide information about the impact of the campaign at the community level; and (3) an analysis of current long-term national monitoring mechanisms of drug use which will be compared with the information gained from the two new activities above.
Science-Based Approaches to Preventing and Treating Heroin Abuse and Addiction
March 30, 1999 -- At the request of Senator Pete Domenici (R-NM), Dr. Timothy Condon, Associate Director, NIDA, accompanied by Ana Anders, Senior Advisor on Special Populations, testified at a field hearing in New Mexico. The hearing focused on the problem of black tar heroin in northern New Mexico, which recently has been associated with 44 overdose deaths.
Dr. Condon testified about what science is teaching us about drug abuse and addiction, and heroin addiction in particular. He said that while drug abuse brings in its wake a myriad of health, social and economic problems, the good news is that we do have a strong research base that communities can call upon in their efforts to combat drug abuse and addiction. He provided an overview of the science of heroin describing its effects on brain function and the manifestation of these brain changes in development of tolerance and physical dependence. He emphasized that research has shown that integrating medication, such as methadone and LAAM, with behavioral-based therapies is likely to have the most success in treating heroin addiction. In an effort to give treatment providers another effective tool to combat heroin addiction, NIDA is working in collaboration with FDA to bring to market a new medication called buprenorphine. Buprenorphine would not replace methadone or LAAM but would be another component or option for treatment providers. Dr. Condon then described the soon-to-be-launched National Drug Abuse Treatment Clinical Trials Network that will test new behavioral and pharmacological therapies which we hope will be able to design treatments to meet the specific needs of special populations. He concluded by describing the many tools NIDA has made available for the public specifically describing the science-based prevention guide, "Preventing Drug Use Among Children and Adolescents."
NOTE: Congressional testimony of NIDA witnesses are available at the NIDA website: http://www.nida.nih.gov/. Click on "What's New". You may also wish to visit the NIH website: http://www.nih.gov/. Legislative information is available under the Office of the Director, Office of Legislative Affairs and Analysis.
Congressional Briefings
NIDA staff participated in several briefings for congressional staff and Members. On March 25, 1999, Dr. Alan I. Leshner was the keynote speaker at a Congressional Briefing "From Bench to Trench: Research-Based Approaches to Treating Drug Abuse and Addiction in Real-Life Settings" sponsored by the College on Problems of Drug Dependence, Inc. Other speakers were Dr. Thomas McLellan, Ph.D., University of Pennsylvania and Dr. Patricia Ordorica, University of South Florida. Dr. Warren Bickel served as moderator. On March 12, 1999, at the request of Senator Carl Levin (D-MI), Dr. Leshner, and Dr. Frank Vocci, Director, Division of Medication Development, provided a briefing on the current status of research on anti-addiction medications for the Senator. In February and March 1999, Dr. James Cooper, DCSR, participated in two briefings for Oversight and Investigations Subcommittee staff of the House Commerce Committee on issues related to several so-called date rape drugs.
Bills of Interest
HR 88 - On January 6, 1999, Rep. George Brown, D-CA, introduced the "Treasury and General Government Appropriations Act, Amendment" which would repeal a requirement regarding data produced under Federal grants and agreements awarded to institutions of higher education, hospitals, and other nonprofit organizations. The bill responds to a growing concern in the research community about the provision's effect on the privacy of human research subjects, the potential for theft of intellectual property, and the potential administrative costs for granting agencies and grant recipients. The provision was included in the omnibus appropriations package last session without any discussion or hearings on the subject. HR 88 was referred to the House Committee on Government Reform.
HR 278 - On January 6, 1999, Rep. Sweeney (R-NY) introduced HR 278, the "Drug Research Restriction Provision." The bill would "prohibit federally sponsored research pertaining to the legalization of drugs." The bill was referred to the House Committee on Government Reform.
HR 626 - Feb. 8, 1999, Rep. Sanders (I-VT) introduced the Health Care Research and Development and Taxpayer Protection Act. It would require any federal agency or non-profit entity that undertakes Federally funded health care research and development, and is to convey or provide an exclusive right to use such research and development for a drug or other health care technology, to enter into a reasonable pricing agreement with the Secretary of HHS. The bill was referred to the House Committee on Commerce.
HR 837/S 465 - On February 24, 1999, Representative George Miller (D-CA) and Senator Paul Wellstone (D-MN) introduced, respectively, H.R. 837 and S. 465, the Mental Health Juvenile Justice Act, which contains a number of provisions regarding access to mental health and substance abuse treatment programs and services for juveniles who come into contact with the juvenile justice system. Section 6 of the bill would establish a Federal Coordinating Council on Criminalization of Juveniles With Mental Disorders, to study and coordinate the criminal and juvenile justice and mental health and substance abuse activities of the Federal Government, and whose membership would include NIMH, as well as: the Office of the Secretary, HHS; the Office for Juvenile Justice and Delinquency Prevention; the Social Security Administration; the Department of Education; SAMHSA; and representatives from children's mental health advocacy groups. H.R. 837 was referred to the Committee on Education and the Workforce, the Committee on the Judiciary, and the Committee on Commerce. S. 465 was referred to the Committee on the Judiciary.
HR 1065 - On March 10, 1999, Representative Stupak (D-MI) introduced H.R. 1065, "The Date Rape Prevention Act of 1999," which would require the Attorney General to add to schedule III of the Controlled Substance Act the "date rape" drugs ketamine hydrochloride (ketamine) and gamma hydroxybutyrate (GHB). The bill also provides for additional penalties (the same as schedule I or II drugs), and requires the Attorney General to establish a program to provide materials to young people in high school and college with education about the use of controlled substances in the furtherance of rape and sexual assault. H.R. 1065 was referred to the House Committees on Commerce, and on the Judiciary.
SR 47 - On February 12, 1999, Senator Frank H. Murkowski (R-AK) introduced SR 47, to designate the week of March 21 through March 27, 1999, as "National Inhalants and Poisons Awareness Week." The resolution encouraged parents to learn about, and discuss with their children, the dangers of inhalant abuse. The resolution was agreed to in the Senate on March 18.
S 324 - On January 28 Senator Hatch (R-OR), with Senators Levin (D-MI) and Moynihan (D-NY) introduced S 324 "The Drug Addiction Treatment Act of 1999". The bill amends the Controlled Substances Act with respect to registration requirements for practitioners who dispense narcotic drugs in schedule IV or V for maintenance treatment or detoxification treatment. The bill was referred to the Committee on the Judiciary. Sponsors of the bill indicate that it would allow qualified physicians to prescribe schedule IV and V anti-addiction medications in physicians' offices without an additional DEA registration if certain conditions are met. These conditions include certification by participating physicians that they are: licensed under state law; have the training and experience to treat opiate-dependent patients; have the capacity to refer patients to counseling and other ancillary services; and they will not treat more than 20 patients in an office setting unless the Secretary HHS adjusts that number. Senator Levin said "This will allow for a promising new drug, buprenorphine, to be used in the treatment of opiate addiction in physicians' offices."
S 326 - On March 18, 1999, the Senate Committee on Health, Education, Labor and Pensions [Senator Jeffords (R-VT), Chairman] approved 10-8 the "Patients Bill of Rights Act" which would provide new patient protections under group health plans. In addition to patient protection provisions, the bill contains provisions regarding: individual rights with respect to access to personal medical information; prohibiting genetic discrimination in health insurance; reauthorizing and renaming the Agency for Health Care Policy and Research (AHCPR) as the Agency for Healthcare Research and Quality; and permitting contributions towards Medical Savings Accounts through the Federal Employees Health Benefits Program (FEHBP). During the mark-up, an amendment offered by Senator William Frist (R-TN) was approved that would require the Institute of Medicine to examine the use of clinical trials. In addition, Title II, regarding individual rights with respect to access to personal medical information, was deleted from the reported bill.
S 423 - On February 11, 1999, Senator John McCain (R-AZ) introduced "The Addiction Free Treatment Act of 1999." The bill would (in part) restrict Medicaid reimbursements and funding through the Substance Abuse and Mental Health Services Administration for methadone and LAAM maintenance programs; require that methadone or LAAM treatment programs have as their primary objective the elimination of drug addiction, including "addiction" to methadone or LAAM; require that methadone and LAAM maintenance programs be limited to 6 months; require that patients be subject to frequent drug testing for all narcotics; terminate methadone or LAAM treatment for any patient who tests positive for any other illegal narcotic during the duration of their methadone or LAAM treatment; and require the Director of NIDA to complete a study within three years of enactment of the Act concerning "(1) the methods and effectiveness of nonpharmacological heroin rehabilitation programs; and (2) the methods and effectiveness of methadone-to-abstinence programs." The bill was referred to the Senate Committee on Finance.
S 562/HR 988 - On March 8, 1999, Senator Tom Harkin (D-IA) introduced "The Comprehensive Methamphetamine Abuse Reduction Act," which would provide for a comprehensive, coordinated effort to combat methamphetamine abuse (MA). Research provisions would amend NIDA authorities to permit its Director to make grants to expand interdisciplinary research and clinical trials relating to MA and addiction and other biomedical, behavioral and social issues relevant to such abuse. This bill is the companion to H.R. 988, introduced by Representative Leonard Boswell (D-IA) on March 4, 1999. S. 562 was referred to the Senate Committee on the Judiciary.
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