National Institute on Drug Abuse
Director's Report to the National Advisory Council on Drug Abuse
(Prepared August 1, 2000)
FY 2001 Funding NIH/NIDA
On July 25, 2000, The House and Senate conferees began work on H.R. 4577, the Labor, HHS, Education and Related Agencies Appropriation bill, which includes funding for NIH. The conference concluded on July 27, 2000, with a report to be filed in September. Early reports indicate that the agreement would provide NIH a $2.7 billion increase over funding levels for FY 2000.
The House passed HR 4577 on June 14, 2000, after several days of debate, by a vote of 217-214. The House approved the funding levels recommended by the House Appropriations Committee when it passed the bill May 24, 2000, including a $1 billion increase for NIH. The measure passed the Senate on June 30, 2000 by a 52-43 vote. The Senate bill included a $20.5 billion budget for NIH, a $2.7 billion increase.
FY 2001 House Appropriations Report Language for NIDA
The Committee provides $788,201,000 for the National Institute on Drug Abuse (NIDA), which is $100,825,000 above the fiscal year 2000 comparable level, and $62,734,000 above the Administration request; however, due to limited funding within the allocation, funding increases in the bill are constrained to the amount proposed in 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.
Centers for Drug Abuse Research and Treatment: The Committee commends NIDA for its strategy of developing and establishing centers for drug abuse research and treatment around the country. Consideration should be given to locating one or more centers in areas where drug trafficking, the production of illegal drugs such as methamphetamine, and drug abuse, is more prevalent.
Clinical Trials: The Committee commends NIDA for launching the National Drug Abuse Treatment Clinical Trials Network. By providing a national research infrastructure to test and disseminate new and improved behavioral and pharmacological treatments in real-life treatment settings the Institute is improving the quality of drug treatment across the country.
Neuroimaging and Drug Abuse: The sophisticated research questions now being probed by NIDA-supported researchers requires advanced state-of-the-art technologies. The Committee commends NIDA for applying the rapidly developing neuroimaging technologies to research in drug abuse treatment and prevention to gain a better understanding of the human brain's underlying circuitry and mechanisms. NIDA is encouraged to expand these research efforts.
FY 2001 Senate Appropriations Report Language for NIDA
The Committee recommends an appropriation of $790,038,000 for NIDA. This is $64,571,000 more than the budget request and $102,662,000 more than the fiscal year 2000 appropriation. The comparable numbers for the budget estimate include funds to be transferred from the Office of AIDS Research.
Mission: Created in 1974, NIDA supports about 85 percent of the world's biomedical research in the area of drug abuse and addiction. The Committee commends NIDA for demonstrating through research that drug use is a preventable behavior and addiction is a treatable disease. NIDA's basic research plays a fundamental role in furthering knowledge about the ways in which drugs act on the brain to produce dependence, and contributes to understanding how the brain works. In addition, NIDA research identifies the most effective pharmacological and behavioral drug abuse treatments. NIDA conducts research on the nature and extent of drug abuse in the United States and monitors drug abuse trends nationwide to provide information for planning both prevention and treatment services. An important component of NIDA's mission is also to study the outcomes, effectiveness, and cost benefits of drug abuse services delivered in a variety of settings.
Behavioral Sciences: The Committee understands that behavioral intervention is a critical, and sometimes only, component of drug addiction treatment. The Committee 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.
Children & Adolescents: Recognizing the devastating impact of drug addiction on children and youth, the Committee commends NIDA's children and adolescent research initiative. The Committee urges NIDA to continue to support its research portfolio in areas of co-occurring mental disorders, developmental consequences, prenatal exposure, genetic vulnerability, and environmental risk factors.
Clinical Trials: The Committee is pleased with NIDA's continuing progress in developing behavioral and pharmacological drug abuse treatments, and supports NIDA's initiative to establish a national drug abuse treatment clinical trials network. The Committee commends NIDA's leadership in forging strong partnerships with treatment researchers and community-based treatment providers to assure that new treatments are tested and incorporated into ongoing drug treatment programs.
Emerging Drug Problems: The Committee is pleased that NIDA has launched a new Club Drug Research and Dissemination Initiative. Given the emergence of club drugs, such as ecstasy, methamphetamine, GHB, and ketamine, the Committee is encouraged by NIDA's proactive efforts to curtail these emerging drug problems and urges NIDA to continue its efforts to develop an even broader array of effective new prevention and treatment approaches to focus on these emerging drug challenges.
Genetic Vulnerability: The Committee understands that both genes and environment influence drug abuse and addiction. The relationship between the two is complex, requiring continued research in areas of behavioral genetics, psychiatric and epidemiological genetics, molecular genetics, and population genetics. The Committee encourages NIDA to continue to pursue this area of drug and addiction research.
Medications Development: The Committee encourages NIDA to study the development of anti-addiction medications, to clarify the neurological and behavioral benefits of the use of pharmacological agents, and develop an understanding of how best to use these medications.
Methamphetamine: The Committee is very disturbed by the explosion in methamphetamine abuse across the nation. The problem is especially acute in Iowa and other Mid-western states. The Committee again urges NIDA to expand its research on improved methods of prevention and treatment of methamphetamine abuse.
National Drug Abuse Clinical Trials Network: The Committee commends NIDA's leadership in continuing to recognize the importance of behavioral and social science research, and is especially pleased that this is reflected in the recent NIDA reorganization, which elevates behavioral research in both the Division of Neuroscience and Behavioral Research and the Division of Treatment Research and Development. The Committee believes NIDA could consider evaluating these promising behavioral treatments in clinical trials through its new National Drug Abuse Clinical Trials Network.
Neuroscience: The Committee recognizes that basic neuroscience provides a foundation for NIDA's research portfolio. Basic neuroscience research has advanced the field's understanding of drug abuse and addiction. The Committee urges NIDA to continue its efforts to develop new areas of neuroscience research.
New Genes & Drug Abuse: The Committee supports research efforts to identify many of the genes that may play a role in addiction. Seizing upon these opportunities could lead to a more complete picture of the disease of addiction.
Nicotine Research: The Committee recognizes that the consequences of nicotine addiction are substantial to adults, children, and adolescents, and commends NIDA's support of research yielding effective replacement therapies and behavioral interventions. The Committee encourages NIDA to continue to support research on the prevention and behavioral and pharmacological treatment of nicotine addiction. The Committee supports NIDA's ongoing research in the basic sciences, behavioral and medical treatments, genetic vulnerability, and epidemiology of nicotine use and abuse.
Trans-disciplinary Tobacco Research Centers: The use of tobacco products remains one of the nation's deadliest addictions. The Committee strongly supports NIDA's continuing efforts to address this major public health problem through its comprehensive research portfolio. The Committee is pleased that NIDA has teamed with the National Cancer Institute and an outside foundation to establish the Trans-disciplinary Tobacco Use Research Center (TTURC). This multifaceted approach should lead to an increased understanding of how nicotine acts in the brain and body and lead to new strategies for treating nicotine addiction and preventing tobacco use, particularly by teens and younger children.
Vulnerability To Addiction Initiative: The Committee commends NIDA for launching its ''Vulnerability to Drug Addiction Initiative'' and encourages NIDA to support research to identify genes associated with drug abuse and addiction. Increasing our understanding of why some people are vulnerable to drug abuse and addiction while others are not, will speed progress in treating and preventing these critical problems.
Congressional Briefings and Hearings
May 8 - At their request, Dr. Timothy P. Condon, Associate Director, NIDA, briefed the majority staff of the Senate Judiciary Committee about current research on steroid abuse. Dr. Condon described what anabolic steroids are, how they are taken, possible public health consequences, trends in use, and provided an overview of NIDA's Anabolic Steroid Initiative.
June 13 - At the request of the Senate Caucus on International Narcotics Control (Sen. Charles Grassley, R-IA, Chair), Dr. Timothy P. Condon, Associate Director, NIDA, briefed a bi-partisan group of Senate staff on what is known about ecstasy and current research efforts underway.
July 11 - The House Government Reform Subcommittee on Criminal Justice, Drug Policy and Human Resources (Rep. John Mica, R-FL, Chair) held a hearing on "Evaluating the National Youth Anti-Drug Media Campaign." Witnesses included Barry McCaffrey, Director, Office of National Drug Control Policy. Also asked to testify were NIDA contractors, David Maklan, Ph.D., Vice President, Westat, Inc. and Robert Hornik, Ph.D., Professor, Annenberg School for Communication.
July 25 - The Senate Caucus on International Narcotics Control (Sen. Charles Grassley, R-IA, Chair) held a hearing on "Ecstasy: Underestimating the Threat," to examine the rising trend of use and trafficking patterns of the club drug ecstasy. The Caucus requested that NIDA submit a statement for the record addressing scientific research on the medical and social consequences of the drug along with the implications this research has for the nation's drug policy. Dr. Donald Vereen, Deputy Director, ONDCP, submitted the statement on behalf of NIDA. Also testifying were witnesses from the Department of State, U.S. Customs, and DEA.
BILLS OF INTEREST
HR2634, the "Drug Addiction Treatment Act," passed the House on Wednesday, July 19, 2000, by a vote of 412-1. The bill was introduced by Rep. Tom Bliley, R-VA, on July 29, 1999. The measure would allow qualified physicians to prescribe certain anti-addiction medications in an office setting, including buprenorphine and buprenorphine/naloxone, medications for opiate addiction developed under a CRADA between NIDA and Reckitt & Colman Pharmaceuticals, Inc. In a statement before the House Commerce Subcommittee on Health and Environment in July 1999, NIDA Director, Dr. Alan Leshner, said "Medications such as buprenorphine and buprenorphine combined with naloxone have been found to be safe and efficacious as a treatment for opiate dependence.... In research settings, buprenorphine products have been found to be medications that will be well tolerated by addicts and have low value and desirability for sale on the street. These factors make this medication a prime candidate to be administered in less traditional environments, thus expanding access to populations who do not have access to methadone programs or are unsuited to them, such as adolescents." A similar provision passed the Senate in November 1999 as part of the "Methamphetamine Anti-Proliferation Act," S 486 (Ashcroft-MO).
HR 2987, the "Methamphetamine Anti-Proliferation Act of 1999," was introduced September 30, 1999, by Rep. Chris Cannon (R-UT). The bill was referred to the Committee on Commerce and to the Committee on the Judiciary. On July 25, 2000, full Committee consideration and markup was held by the House Judiciary Committee. The Committee voted to report the bill as amended in the nature of a substitute. As reported, the bill contains a provision similar to HR2634.
HR4923, the "Community Renewal and New Markets Act of 2000," introduced by Rep. Watts, (R-OK), on July 24, 2000, passed the House. The bill includes language about faith-based treatment for substance abuse. Related bills: S1594 (Kerry, D-MA) which incorporates language similar to S2779, the "American Community Renewal and New Markets Act," which the Senate sought to add as an amendment to the estate tax bill (HR8).
HConRes 371 - Adopted by the House on July 24, 2000, the measure aims to raise awareness of the prevalence of drug and alcohol abuse in the U.S. September is National Alcohol and Drug Addiction Recovery Month which recognizes individuals who have undergone successful treatment and those who have dedicated their lives to helping people recover from addiction. The sponsor, Rep. Jim Ramstad, (R-MN), said he especially wants to draw attention to drug and alcohol use among youth.
S2527, the "Drug Treatment and Research Enhancement Act" was introduced on May 9, 2000, by Sen. Charles Grassley (R-IA), Chairman, Senate Caucus on International Narcotics Control, to reinforce the national drug control effort. The bill provides additional resources to anti-drug coalitions and parent groups, amends the PHSA to authorize grants to non-governmental organizations to help professionals participate in coalitions and identify and help youth affected by family substance abuse, and strengthens research efforts concerning how to better treat addiction. Section 5 amends the PHSA to establish a National Drug Abuse Treatment Clinical Trials Network and provides an authorization of appropriations for such a Network to conduct large-scale drug abuse treatment studies in community settings using broadly diverse patient populations. The bill also encourages NIH to work with private industry to promote research into pharmacological options that could be used in support of drug treatment efforts.
S2612, the "Ecstasy Anti-Proliferation Act of 2000," was introduced May 23, 2000, by Sen. Bob Graham (D-FL) to combat ecstasy trafficking, distribution, and abuse in the U.S., and for other purposes. In part, the bill urges that greater emphasis be placed on education of young people and of state and local law enforcement agencies. It also encourages adequate funding for NIDA to accomplish the following: identify those most vulnerable to using ecstasy and develop science-based prevention approaches; understand how ecstasy produces its toxic effects and how to reverse neurotoxic damage; develop treatments, including new medications and behavioral treatment approaches; better understand the effects that ecstasy has on developing children and adolescents; and translate research findings into useful tools and ensure their effective dissemination. The bill was referred to the Committee on the Judiciary.
S2779, the "American Community Renewal and New Markets Empowerment Act," a bill to provide for the designation of renewal communities and to provide tax incentives and tax credits, was introduced by Sen. Santorum, (R-PA), on June 22, 2000. In part, the bill would amend authorities of the Substance Abuse and Mental Health Services Administration (SAMHSA) under Title V of the PHSA. It also contains provisions relating to standards for substance abuse treatment professionals and includes under Title IV (Faith Based Substance Abuse Treatment), language concerning educational qualifications for counselors and other personnel in drug treatment programs.
S2868, the "Children's Public Health Act of 2000," was introduced on July 13, 2000, by Senator William Frist (R-TN). The bill would amend the PHSA with respect to children's health. Provisions address several areas of pediatric research including traumatic brain injury, asthma, oral health, autism, and rare diseases. Title II - Maternal and Infant Health, Sec 399L, contains provisions relating to CDC concerning research on prenatal smoking, alcohol, and illegal drug use. Title II, Sec 399N - Prevention Research to Ensure Safe Motherhood, authorizes the Secretary, HHS, acting through CDC, to "carry out activities to expand research relating to ...preventing smoking, alcohol and illegal drug usage before, during, and after pregnancy." Title IV - Pediatric Research, Sec. 421. Long-Term Child Development Study would authorize NICHD to conduct a national longitudinal study of environmental influences on children's health.
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