Volume 12, Number 2
IOM Panel Hails NIDA's Scientific Record, Recommends Future
Directions in Drug Abuse Research Agenda
NIDA deserves recognition for "building a strong foundation for
continuing scientific progress" that provides benefits not only in
the area of drug abuse, but also in basic neurobiology, psychiatry, pain
research, and related fields of research, according to the Committee on
Opportunities in Drug Abuse Research. The panel of scientists, convened
by the Institute of Medicine (IOM) of the National Academy of Sciences,
has made broad policy recommendations to NIDA for future directions in drug
abuse research. In numerous cases, the committee recommended continuing
NIDA-established research priorities.
The panel includes experts in neuroscience, clinical research and treatment,
psychopharmacology, epidemiology, prevention, AIDS research, fetal and child
develop-ment, public health, law, and public policy. Its findings and recommendations
were published late last year in a 310-page book, Pathways
The 16-member panel said that government policies to control drug abuse
too often pit the goals of law enforcement against those of science and
medicine. By working from what the panel calls a comprehensive public health
perspective, policy-makers can help avoid divisive public debates over whether
drug abuse can be addressed best through drug supply reduction by law enforcement
or by developing medications and treatments to reduce drug demand, the committee
NIDA deserves recognition for
"building a strong foundation for
continuing scientific progress."
The panel said that placing law enforcement goals in competition with
scientific goals creates bureaucratic barriers between research sponsored
by the Department of Justice and that sponsored by the Department of Health
and Human Services.
Because efforts to limit the availability of drugs-called supply reduction-are
seen as the realm of the police and courts rather than a major consideration
for scientific researchers, the effects of law enforcement on the prevalence
and social consequences of drug abuse tend to be overlooked by drug abuse
researchers, according to the panel. Drug abuse research designs should
more fully recognize the powerful influences of drug law enforcement on
the lives and behaviors of drug abusers, the experts said.
In turn, they said, police and prosecutors should also consider broad
issues outside the realm of law enforcement. While drug law enforcement
places few limits on drug abuse researchers, it can place restrictions on
the legitimate practice of medicine. Doctors may under-prescribe because
they are overly concerned about scrutiny of their prescription of controlled
substances as pain or treatment medications, the panel indicated.
The report noted that drug abuse research, even though it now has priority
status, still must compete for funding with other high-priority fields of
health research and with other pressing public needs. A number of mechanisms
were identified by the committe to increase the cost-effectiveness of drug
abuse research. They include maintenance of stable funding, use of the comprehensive
public health framework, and encouraging wider acceptance of drug dependence
as a medical problem. Other mechanisms include better translating of research
findings into practice, raising the status of drug abuse research, and increasing
emphasis on an interdisciplinary approach to research.
NIDA, as the primary Federal funding agency for drug abuse research,
"deserves credit for stimulating and supporting the talented scientists
who have moved the field forward," and "for maintaining a coherent
scientific agenda in the face of shifting political winds," said the
The committee, formed in January 1995 and chaired by University of Virginia
law professor Richard J. Bonnie, made a number of recommendations in key
areas of research and policy, many of them in support of research already
under way at NIDA. Included are recommendations to:
- Expand multidisciplinary research to investigate the combined effects
of biological, psychosocial, and contextual factors in the development
of drug use, abuse, and dependence.
- Evaluate universal versus targeted prevention intervention programs
with regard to effectiveness and cost-effectiveness.
- Expand research regarding drug use and HIV transmission, including
effects of maternal drug use.
- Conduct more research on connections among violence, drug abuse, and
co-occurring psychiatric disorders.
- Intensify research to improve and evaluate the effectiveness of drug
abuse treatment, including investigating strategies to match patients to
the most appropriate forms of treatment, developing treatment medications,
and increasing the efficacy of pharma-cotherapies and psychosocial therapies
to treat individuals with co-occurring psychiatric disorders and drug abuse.
- Address fears that managed care's cost-cutting strategies may undermine
drug abuse treatment programs by examining the organization, financing,
and characteristics of drug abuse treatment in the managed care setting.
- Take steps to recognize the effects of law enforcement controls on
drug availability as an important component of a comprehensive drug abuse
"In the final analysis," said the IOM panel, "the value
of the Nation's investment in drug abuse research is measured in lives saved
and reclaimed, in the success of each young person who stays in school and
joins the work force, and in the happiness of each child nurtured by his
or her parents rather than abused or abandoned by them."
This statement was endorsed by Dr. Timothy P. Condon, NIDA's assistant
director for science policy, who noted that the Institute is committed to
continuing high-quality, results-oriented research and will carefully evaluate
the IOM recommendations in developing future research policy.
Pathways of Addiction: Opportunities in Drug Abuse Research
is available for $49.95 from National Academy Press, Lockbox 285,
2101 Constitution Ave., NW, Washington, DC 20055. To order by phone using
a credit card, call (800) 624-6242.
From NIDA NOTES, March/April 1997
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