NIDA-SPONSORED MINI-SYMPOSIUM on
Interactions Between Drugs of Abuse and Pharmacotherapeutics Used in the Treatment of Infections, Drug Abuse,
and Mental Disorders

Washington, DC
April 13, 2002

Contents

• Overview
• The HIV-Infected Substance Abuse Patient as a Research Subject
• Antiretroviral Therapy in Injection Drug Users with HIV Disease-Using Drug Interactions to Design More Effective Treatment
• Interactions Between Methadone and Antiretroviral Medications
• Mechanisms for Pharmacokinetic and Pharmacodynamic Interactions between Psychoactive and Antiretroviral Medications
• Pharmacogenomics of Antiretrovirals and Drugs of Abuse Interactions
• Research and Policy Implications: NIDA Support for Research on Drug Interactions

Background

Published and unpublished research presented in national and international forums (NIDA/NIH 1999 workshop [http://www.nida.nih.gov/MeetSum/Interactions.html]; 2nd International Workshop on Clinical Pharmacology of HIV Therapy, Noordwijk, the Netherlands, April 2001) suggests that there are significant pharmacokinetic and pharmacodynamic interactions among various anti-infective medications used in the treatment of infections including HIV, hepatitis C, and tuberculosis, resulting in significant potential for adverse health consequences. However, very few studies have been published or presented on interactions between drugs of abuse (e.g., cocaine, marijuana, opiates, amphetamines, and misused benzodiazepines), agents used to treat substance abuse (e.g., methadone, LAAM, buprenorphine), and antiretroviral pharmacotherapeutic agents. Based on these facts, Dr. Charles Flexner of Johns Hopkins School of Medicine and Jag Khalsa, Ph.D. of NIDA's Center on AIDS and Other Medical Consequences of Drug Abuse (CAMCODA), in collaboration with Dr. Frank Vocci of the Division of Treatment and Research Development (DTRD) and Dr. Steve Gust of the Office of the Director (OD, NIDA), organized a mini-symposium at the 3rd International Workshop on Clinical Pharmacology of HIV Therapy, Washington, DC, April 13, 2002, where experts in HIV pharmacology, substance abuse, pharmacogenomics, and pharmacokinetic modeling presented current data on the subject of drug-drug interactions. The article below summarizes the six presentations made at the well-attended mini-symposium.

Agenda

Chair: Charles W. Flexner, M.D., Johns Hopkins University School of Medicine, Baltimore, Maryland.
Co-chair: Jag H. Khalsa, Ph.D., Center on AIDS & Other Medical Consequences of Drug Abuse (CAMCODA), National Institute on Drug Abuse, NIH, Bethesda, Maryland.

Participants

Charles Flexner, M.D., Ph.D.
Associate Professor of Medicine & Pharmacology
Johns Hopkins University School of Medicine
Baltimore, MD
E-mail: flex@erols.com

Gerald Friedland, M.D.
Professor of Medicine and Epidemiology & Public Health
Director, Yale AIDS Program
135 College Street, suite 323
New Haven, CT 06510-2483
E-mail: gerald.friedland@yale.edu

John Gerber, M.D.
Professor of Medicine and Pharmacology
Division of Clinical Pharmacology
University of Colorado Health Sciences Center
4200 East, 9th Avenue
Denver, CO 80262
E-mail: john.gerber@uchsc.edu

David Greenblatt, M.D.
Professor and Chair
Department of Pharmacology & Experimental Therapeutics
Tufts University
136 Harrison Avenue
Boston, MA 02111
E-mail: dj.Greenblatt@tufts.edu

Thomas Kakuda, PharmD
Senior Research Associate
Abbott Laboratories
338 Turkshead Lane
Redwood City, CA 94065
E-mail: thomas.kakuda@abbott.com

Jag H. Khalsa, Ph.D.
Pharmacologist/Health Scientist Administrator
Center on AIDS & Other Medical Consequences of Drug Abuse
National Institute on Drug Abuse
6001 Executive Blvd., Room 5198, MSC 9593
Bethesda, MD 20892-9593
Telephone: (301) 443-1801/2159
Fax: (301) 594-6566
E-mail: jk98p@nih.gov

Elinore McCance-Katz, M.D., Ph.D.
Associate Professor of Psychiatry and Epidemiology and Social Medicine
Albert Einstein College of Medicine of Yeshiva University, Department of Psychiatry
Montefiore Medical Center
111 E. 210th Street
Bronx, New York 10467
E-mail: emccance@montefiore.org