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Director's Report to the National Advisory Council on Drug Abuse
September, 1995


Congressional Affairs


H.R. 2127 - The FY 1996 Labor, HHS, Education Appropriations Act

On August 4, the House passed H.R. 2127 (the FY 1996 Labor, HHS & Education Appropriations Act) by vote of 219 yeas to 208 nays.

Overall, H.R. 2127 upholds the House Appropriations Committee's July 24 approval of an $11.9 billion FY 1996 budget for NIH. This represents a 5.7%, or $642 million increase over FY 1995, and $166 million more than President Clinton's request. NIDA's funding level would rise to approximately $458 million, a 4.8% increase ($20.9 million) from FY 1995.

With the exception of an amendment offered by Rep. James Moran (D-VA) to earmark $7.5 million in the Office of the Director account for the Office of Alternative Medicine, no floor amendments were adopted which would directly affect NIH. [OAM's increase ($1.9 million over the amount proposed by the Appropriations Committee) would not change NIH's total budget since, as a component of the OD, the funds would simply be reallocated.]

Stated below are selected provisions included in the House Committee Report (H.Rpt. 104-209, Committee Print).

National Institutes of Health

The bill removes the separate appropriation for the NIH Office of AIDS Research, and its funding "would be appropriated to the individual Institutes without an earmark for AIDS." The Committee Report states that:

"... the Committee believes the Director of NIH should decide how much of the total NIH appropriation should be allocated to AIDS research. The Committee expects the Director of NIH to identify the total allocated for AIDS and his intended distribution by institute under the House funding level prior to the conference on the [FY] 96 bill...The Committee wants to make clear that it continues to support the Office of AIDS Research... The Committee assumes that the NIH Director's decisions on allocating AIDS funding will be fully consistent with the plan developed by the OAR..." [pages 57-58]

Chairman John Porter (R-IL), stated that the AIDS earmark was removed in an effort to give scientists more authority to set the biomedical research agenda. He offered assurances that he is not trying to reduce funding for AIDS research; that with increased funding for NIH overall, he expects NIH spending on AIDS to increase.


Other Selected Report Language Pertaining to NIH:

The Committee:

"...directs that research management and support costs at NIH will be reduced 7.5 percent below 1995 levels, and that costs associated with congressional and public affairs functions will be reduced a total of 10 percent below 1995 levels. ..." [page 58].

"...believes ... [indirect costs] is a key area in which savings could be generated." [page 58]

"...believes that the concept of a central planning authority, such as that vested in the OAR, could have broader applicability to other research areas in NIH with trans-Institute scope. ... would like the NIH Director's assessment of the utility of establishing a broader central policy office... that would handle crosscutting issues." [page 59]

"... believes it is critical for NIH to use all the media at its command to publicize the benefits and results of NIH research ... [page 59]

The Committee Report does not include comments about NIDA, other than the following description of its mission:

"...NIDA supports much of the world's biomedical research in the area of drug abuse and addiction. NIDA's basic research furthers knowledge about the ways in which drugs act on the brain to produce drug dependence and about how the brain works. In addition, NIDA research identifies pharmacological and behavioral drug abuse treatments. NIDA conducts research on the nature and extent of drug abuse in the U.S. and monitors drug abuse trends nationwide to provide information for planning both prevention and treatment services. NIDA's mission is also to study the outcomes effectiveness, and cost benefits of drug abuse services delivered in a variety of settings." [page 74]

For NIAAA the Committee said it is

"...pleased that research supported by NIAAA has led to the approval of naltrexone by FDA for alcoholism treatment. The Committee encourages NIAAA to support further research to determine the effects of naltrexone's longer-term use, side effects, and how it reduces alcohol craving." [page 74]

For NCI the Committee said it is

"...disturbed to learn that NCI has funded a research grant studying tobacco industry campaign contributions to State legislators and voting records by those individuals on tobacco control initiatives...does not provide any further funding for this research grant." [page 61]


Substance Abuse and Mental Health Administration

The bill also includes major cuts for mental health and substance abuse programs. It provides $1.8 Billion for FY 96, which is $392 million below the 95 level. The Committee consolidated 26 programs into 6. Selected Committee Report language follows:

" ... the Committee is concerned about the administrative inefficiency inherent in operating three agencies to provide substance abuse and mental health services [referring to CMHS, CSAP and CSAT]. It is particularly concerned about the maintenance of two agencies to administer substance abuse prevention and substance abuse treatment services ... directs the Administrator to begin consolidating substance abuse treatment and prevention activities in a single administrative authority ..." [page 84]

"The Committee is aware of a substantial body of anecdotal evidence which purports to demonstrate the effectiveness and economic efficiency of substance abuse treatment. However, as the 1996 budget hearings revealed, SAMHSA has developed few if any comprehensive evaluation tools, and the Committee has little basis on which to evaluate the effectiveness of the overall federal investment in substance abuse prevention and treatment....directs SAMHSA to submit reliable and comprehensive information regarding the effectiveness of federal substance abuse programs in support of future request for funding." [page 89-90]

Although funding for the block grants does not change, funding for other programs drops dramatically. The mental health programs cut include clinical and AIDS training, community support demonstrations, grants to states for the homeless, and homeless services demonstrations. Substance abuse programs cut include treatment grants to crisis areas, training, AIDS demonstration and training, community partnership grants, public education and dissemination, and comprehensive community treatment programs. Finally, the Committee:

"...directs SAMHSA to re-examine its administrative structure and to streamline management of the agency to improve efficiency, reduce duplication of effort, and contain costs." [page 98-99]


Rescissions Bill Signed Into Law

A new FY 1995 rescissions/emergency supplemental appropriations bill [H.R. 1944] passed both Houses of Congress and was signed by the President on July 27 (P.L. 104-19). It includes a $70 million cut for the NIH -- $60 million to come from intramural construction [according to NIH sources some of these funds had been allocated for the new primate center in Frederick, Maryland and the second phase for the Natcher building], and $10 million from the extramural construction program administered by the National Center for Research Resources.


Senate Approves Funds for ONDCP

On August 5, the Senate voted to restore approximately $8 million for ONDCP, averting a move to close it down for at least a year. An amendment to restore the money [offered by Senator Richard Shelby (R-AL) for Senators Orrin Hatch (R-UT) and Joseph Biden, Jr. (D-DE)] passed on a voice vote. Senator Hatch said "I, along with many of my colleagues, think that the drug czar's office needs to be reorganized." He added that the Senate Judiciary Committee, which he chairs, will look at changes in staffing and mission. [On July 27, the Senate Appropriations Committee had approved an appropriations bill (H.R 2020) which would have removed all funding for the Office.]


Other Bills of Interest


Congressionally-Mandated Reports

S. 790, the Federal Reports Elimination and Sunset Act, passed the Senate on July 17. Immediately upon enactment, it would extend the due date of the jointly prepared NIDA, NIAAA and NIMH health services research report. It also would terminate the statutory requirement for all annual and other periodic congressionally-mandated reports 4 years after the bill is signed into law -- two exceptions are reports required under the Inspector Generals' Act and the Chief Financial Officers Act. Congress would have to specifically reauthorize those reports it wants to continue receiving.


Hearings/Briefings


Tobacco

On August 10th, President Clinton outlined the Administration's strategy to regulate tobacco sales and advertising to help reduce smoking among youth and keep nonsmoking children from starting. The nation has responded to the problem of illegal drug use among teens and drunken driving, Clinton noted at a White House news conference. "It is time to take a third step to free our teenagers from addiction and dependency," he said.

That same day, the Food and Drug Administration issued proposed rules to regulate the sale and distribution of tobacco products to youth. The FDA hopes to reduce access to cigarettes and decrease the "positive" images that make smoking attractive.

President Clinton invited Congress to pass legislation to achieve similar goals and thus prevent FDA intervention. However, as soon as the proposed rules were issued some members of Congress warned of a potential legislative battle on the issue. Also, industry groups filed suit to stop the FDA from instituting its tobacco regulations and from regulating cigarettes.

But some members, even those who support the tobacco industry, indicated a willingness to work on legislation. Senator Wendell Ford (D-KY), whose home state is the nations's Number 2 producer of tobacco, said he would introduce legislation after the August recess that would achieve the president's goals without hurting producers.



Dr. Leshner Testifies at SAMHSA Reauthorization Hearing

The Senate Labor & Human Resources Committee [chaired by Nancy Kassebaum (R-KS)] invited Dr. Alan I. Leshner, Director, NIDA, to testify at its July 27 hearing on the "SAMHSA Reauthorization, Flexibility Enhancement, and Consolidation Act." Other witnesses included Dr. Philip Lee, Assistant Secretary for Health; Nelba Chavez, Administrator, SAMHSA; Mathea Falco, Drug Strategies; John Walters, formerly with ONDCP; and Ellen Weber, Legal Action Center, NY.

Dr. Leshner emphasized that 20 years of research has shown us the true nature of addictive disorders -- we now know that addiction is a brain disease that is expressed in behavioral ways and in a social context. He stated that drug abuse treatment can and does work and we know that the benefits to society far outweigh the costs. He went on to discuss the importance of pharmacological and behavioral treatment research. Senator Kassebaum asked Dr. Leshner several questions about methadone therapy and LAAM; discussed the Institute's activities in information dissemination; and asked about the effectiveness of coercive treatment.


Congressional Requests


The GAO has been asked by the House Labor/HHS appropriations subcommittee chairman John Porter (R-IL) to undertake an assessment of the costs of NIH-supported intramural and extramural research to determine how much Federal funding is spent on actual research. GAO has been directed to determine: (l) a breakdown of the categorical costs that "constitute the major expenditures for Federal research, i.e., research costs, costs for complying with Federal and State regulations, costs associated with animal research, etc."; (2) a percentage breakdown of these associated costs with the hopes of determining how much of the Federal dollar is in fact spent on actual research; and (3) a list of the primary regulations and their accompanying costs.


Other Items of Interest


Budget Resolution

The Congressional budget blueprint for fiscal years 1996 through 2002 [H.Con.Res. 67], approved by the House and Senate on June 29, 1995, contains the following provisions related to research which have not been widely publicized.

Sec. 304. Sense of the Congress Assumptions

"It is the sense of the Congress that the aggregates and functional levels included in this budget resolution assume that ... (6) science and technology development are critical to sustainable long-term economic growth and priority should be given to Federal funding for science and basic and applied research."

Sec. 309. Sense of the Senate on the Assumptions

"It is the sense of the Senate that the aggregates and functional levels included in this budget resolution assume that ... (3) in furtherance of the goals of the Decade of the Brain, full funding should be provided for research on brain diseases and disorders."


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