National Institute on Drug Abuse
Director's Report to the National Advisory Council on Drug Abuse
September, 1998
Congressional Affairs
FY 99 Appropriations
On July 15, 1998, the FY 1999 Labor-HHS-Education Appropriations bill was reported out of the full House Appropriations Committee. The House Appropriations Committee's report on the bill also was filed (HRpt. 105-645). The full House has yet to act on the Committee recommendation.
House Report Language for the National Institute on Drug Abuse
"The Committee provides $575,426,000 for ... NIDA, which is $49,234,000 above the fiscal year 1998 comparable level and $859,000 above the Administration request.
Mission
NIDA supported science addresses questions about drug abuse and addiction, which range from its causes and consequences to its prevention and treatment. NIDA research explores how drugs of abuse affect the brain and behavior and develops effective prevention and treatment strategies; the Institute works to ensure the transfer of scientific data to policy makers, practitioners and the public.
Children and Adolescents
Drug abuse affects the children of this country in devastating ways, through prenatal exposure, through growing up in drug abusing households, and through drug abuse by young people themselves. The Committee urges NIDA to continue research on preventing or diminishing the health and developmental consequences associated with drug abuse and addiction, particularly on prenatally exposed children to find out what the long-term consequences of prenatal drug exposure are in later childhood and adolescence. The Committee is particularly interested in the differential effects of drugs on the brain and the behavior of children at different ages.
Clinical Trials
The Committee commends NIDA's extensive progress in developing drug abuse treatments, both behavioral and psychological. NIDA's investment in behavioral and neuroscience research has brought the science of addiction treatment to a point of broad practical application. The Committee encourages NIDA to continue to move forward by supporting research to clarify more specifically what works for which patients, under what circumstances, and for how long. The Committee also encourages NIDA to examine behavioral and pharmacological therapies that are shown to be effective in small scale studies and evaluate them in large multi-site clinical trials.
Coordinating Efforts
The Committee urges NIDA to take the lead in coordinating its research efforts with those of the Knowledge and Development Application programs of the Substance Abuse and Mental Health Services Administration. The Committee requests that NIDA be prepared to give the Committee a progress report on this effort, including recommendations on how to improve the outcomes of this research, at its fiscal year 2000 appropriations hearing.
Drug Abuse Treatment
The Committee commends the progress NIDA has made in neuroscience research and encourages NIDA to continue its efforts to develop pharmacological and behavioral drug abuse treatments.
Methamphetamine
NIDA research has shown that methamphetamine is a powerfully addictive stimulant associated with many physical and behavioral changes. Recognizing that there continues to be a significant problem in methamphetamine use in specific areas of the country, the Committee encourages NIDA to study the development of an anti-methamphetamine medication, to clarify the long-term neurological and behavioral consequences of the use of this drug, and to continue to study the epidemiological trends of methamphetamine use. The Committee also encourages NIDA to support research to develop prevention programs specifically geared toward the unique characteristics of the methamphetamine user as well as research on treatment approaches specifically tailored for polydrug addiction to methamphetamine and other substances.
Nicotine Research
The health consequences of tobacco/nicotine use in this country will not be eliminated until the addiction to nicotine itself is effectively prevented and those currently addicted are effectively treated. The Committee encourages NIDA to: (1) expand its support for basic research on the biological, behavioral, and pharmacological bases of nicotine addiction; (2) conduct basic and applied behavioral research targeting children and adolescents to improve strategies to prevent smoking initiation; and (3) increase support for research that will lead to more effective long-term smoking cessation by developing both nicotine and non-nicotine replacement medications in combination with behavioral strategies. The Committee encourages NIDA to support behavioral research on nicotine and smoking and epidemiological studies that monitor patterns of drug use, including nicotine.
Prevention
NIDA has demonstrated the usefulness of its research to prevention of drug use by developing and distributing over 100,000 copies of the first ever research-based prevention guide, "Preventing Drug Use Among Children and Adolescents." This booklet is the first research-based guide which articulates the principles learned from 20 years of NIDA supported prevention research. It gives practical guidance on how communities can apply these principles to address local drug problems. The Committee urges NIDA to continue to support this useful research and to produce more tools translating research findings into useful guides for parents, educators, treatment providers, and policy makers.
Social Work Research
The Committee commends NIDA's support for social work research and dissemination on behavioral and psychological treatment and prevention related to drug abuse, addiction, and HIV/AIDS. The Committee also commends NIDA's efforts to support the development of drug abuse treatment and health services research within graduate schools of social work.
On September 3, 1998, the Senate Appropriations Committee approved the HHS-Labor-Education bill.
Draft Senate Report Language for NIDA:
"The Committee recommends an appropriation of $603,274,000 for the National Institute on Drug Abuse [NIDA]. This is $28,164,000 more than the budget request and $77,082,000 more than the fiscal year 1998 appropriation."
In their draft report the Committee emphasized the following areas:
Nicotine Research - encourages NIDA to expand its support for basic research on the biological, pharmacological, and behavioral bases of nicotine addiction.
Clinical Trials - commends NIDA for having launched a major treatment initiative and encourages NIDA to develop a clinical trials infrastructure, and to move rapidly to test the efficacy of promising pharmacological, behavioral, and psychosocial treatment through large-scale, multi-site clinical trials.
Children & Adolescents - urges NIDA to continue research on preventing or diminishing the health and developmental consequences associated with drug abuse and addiction, looking particularly at prenatally exposed children to understand the long-term consequences of drug exposure in later childhood and adolescence.
Methamphetamine - encourages NIDA to study the development of antimethamphetamine medication, to clarify the long-term neurological and behavioral consequences of the use of these drugs, and to continue to study the epidemiological trends of methamphetamine use. The Committee is pleased that NIDA plans a conference in Des Moines, IA, to focus attention and expand understanding of this growing problem.
Treatment - commends NIDA for progress in neuroscience research, and encourages NIDA to continue its efforts to develop pharmacological and behavioral drug abuse treatments.
Social Work - commends NIDA for supporting social work research and for dissemination on behavioral and psychosocial treatment and prevention related to drug abuse, addictions, and HIV/AIDS.
Behavioral Science Research - continues to support NIDA's expansion of its behavioral science portfolio and views NIDA as a model of how to approach its behavioral science and public health responsibilities.
OUTLOOK FOR THE FALL 1998:
In many instances, the two chambers' bills contain dramatically different provisions. In addition, the President has issued veto warnings on the Labor-HHS bill. Should Congress and the President not come to agreement by the October 1 deadline, a continuing resolution is considered likely to keep the agencies running.
Hearings/Briefings
July 28, 1998
At the invitation of the Chairman, Senator Jeffords (R-VT), Dr. Alan I. Leshner, Director, NIDA, testified before the Senate Committee on Labor and Human Resources on "The Science of Addiction and Options for Treatment."
- Members Present: Senators Jim Jeffords (R-VT), Chairman; Mike Dewine (R-OH), Tim Hutchinson (R-AR), Paul Wellstone (D-MN), Jack Reed (D-RI).
- Witnesses: Panel 1: Representative Jim Ramstad (R-MN). Panel 2: Alan I. Leshner, Ph.D., Director, National Institute on Drug Abuse, NIH. Panel 3: David Lewis, M.D., Project Director, Physician Leadership on National Drug Policy; Robert Morse, M.D., Professor of Psychiatry, Mayo Medical School; Ted Suhl, Deputy Director, The Lord's Ranch. Panel 4: June Gertig, J.D., parent; Richard Frank, Ph.D., Professor of Health Economics, Harvard University; Bill Gradison, President, Health Insurance Association of America (HIAA); John S. Saylor, M.D., AMR Corporation.
- Dr. Leshner's testimony focused on the current state of the science of addiction. He noted that brain changes produced by heavy drug use can last a very long time after an individual stops using drugs and that brain physiology is only one component of addiction. Behavioral and social context elements are also important factors related to addiction and relapse. Research has shown that the integration of behavioral and pharmacological treatments, in ways specific to an individuals's needs, is likely the best way to treat addictive disorders. Dr. Leshner stressed that NIDA is committed to working intensively with the drug abuse professional community to actively transfer scientific knowledge in a proactive way into the community setting to improve addiction treatment in this country. To accomplish this, NIDA is planning to launch a National Drug Treatment Clinical Trials Network that will provide the infrastructure to ensure that all potential addiction treatments are tested in real life settings. He said, "Moving treatments from the laboratory, to the clinic, to the community is the next rung of the ladder for national treatment improvement."
- In response to an inquiry from Senator Jeffords regarding difficulties involved in treating long-time addicts, Dr. Leshner responded that treatment before someone is "fully addicted" is preferable. Senator Wellstone asked about the efficacy of prescription treatment for substance abuse. Dr. Leshner responded that the best treatments address both pharmacological and behavioral problems. Senator Dewine asked Dr. Leshner what policy implications we should take from his testimony. He responded that there is no question that drug addiction is an illness. Once addicted, a person is ill, and he or she must be treated.
July 23, 1998
The House Commerce Subcommittee on Oversight and Investigations (Chairman Joe Barton R-TX) held a hearing on drug testing policy issues. Dr. Ed Cone, Acting Chief, Clinical Pharmacology Branch, NIDA testified. SAMHSA and FDA also testified.
July 21, 1998
At the request of staff to Senator Edward Kennedy (D-MA), Dr. Alan I. Leshner participated in a briefing for Senate staff on the science of needle exchange.
July 10, 1998
At their request, Dr. Frank Vocci, Director, Division of Medications Development, NIDA, briefed the Majority Staff of the House Committees on Commerce and Judiciary on the science of buprenorphine.
Miscellaneous Bills of Interest
S. 2347 --On July 23, 1998, Senator Tom Harkin (D-IA) introduced S. 2347, the Comprehensive Methamphetamine Abuse Reduction Act of 1998, to provide for a coordinated effort to combat methamphetamine abuse, including expanded interdisciplinary research by NIDA related to methamphetamine abuse and addiction issues. The bill (in part) would amend Section 464N of the Public Health Service Act (PHSA) by adding a section on expanding methamphetamine research and would authorize appropriations for NIDA in the amount of $16 million for FY 99 and such sums as may be necessary in succeeding fiscal years to carry out that section. The bill was referred to the Senate Committee on Labor and Human Resources.
H.Res. 423 --On May 12, 1998, H.Res. 423, a resolution "expressing the sense of the House with respect to winning the war on drugs to protect our children", was passed by the House. The resolution was introduced on May 7 by Representative J. Dennis Hastert (R-IL).
H.R. 4135 --On June 24, 1998, Representative Edolphus Towns (D-NY) introduced H.R. 4135, a bill that would amend Section 491(a), PHSA, by requiring the HHS Secretary to establish a program for the collection of information relating to the use of children and individuals with mental disabilities as subjects in biomedical and behavioral research. The program may include a requirement that Institutional Review Boards submit reports containing information related to: a description of the research subjects, the nature of the research, the objective of the research, the reasons for the use of these subjects, and the source of funding. The Secretary must make this information available to the public on a regular basis, and in an annual report. The bill was referred to the House Committee on Commerce.
H.R. 4170 --On June 25, 1998, Representative Gil Gutknecht (R-MN) introduced a bill to amend Title IV of the PHSA to establish a National Center for Bioengineering Research. This legislation would establish, within NHLBI, a National Center for Bioengineering Research, and would authorize appropriations for the center in the amount of $750,000 for each fiscal year for the general operation of the Center. For general bioengineering activities, the legislation would authorize to be appropriated $20,000,000 for each of the fiscal years 1998 through 2007, to be allocated at the discretion of the Director of NIH among the bioengineering activities being carried out by the national research institutes and other agencies of NIH. H.R. 4170 was referred to the House Committee on Commerce.
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