National Institute on Drug Abuse
Director's Report to the National Advisory Council on Drug Abuse
(Prepared April 4, 2000)
Appropriations - FY 2001
February 15, 2000 - NIH Overview Appropriations Hearing before the House
Dr. Ruth Kirschstein, Acting Director, NIH, accompanied by the Institute and Center Directors, appeared before the House Appropriations Subcommittee on Labor, Health and Human Services, and Education to discuss the FY 2001 budget request of $18.8 billion for NIH (a $1 billion or 5.6 percent increase over the FY 2000 level). In her opening remarks, Dr. Kirschstein reminded the Subcommittee of various medical breakthroughs that have arisen from collaborative efforts of the scientific community, detailed important scientific advances supported by NIH and then described principles that NIH uses to establish priorities for spending.
In general, the Subcommittee expressed support for the NIH and its activities. The following are some of the key topics of interest expressed by Members.
- "Buying Good Science" Several members expressed concerns about whether NIH is funding better proposals or dipping down to lower-rated applications. Others questioned whether NIH provided adequate supervision and stewardship.
- Funding Increases/Budget Justifications There were a number of questions concerning how NIH would spend additional increases. Among them was a request to provide the "incremental consequences" of a $500 million, $1 billion, and $1.5 billion funding increase for NIH for FY 2001; and the amounts that NIH spent last year on funding per death on diabetes, cancer, heart disease, HIV/AIDS, and stroke.
- Health Disparities and Funding to Minority-Serving Institutions Rep. Jackson asked Dr. Kirschstein several questions about health disparities. He said that the Office of Research on Minority Health (ORMH) should be a freestanding center and discussed his bill, H.R. 2391, to accomplish this. He asked Dr. Kirschstein how NIH is addressing the components of the bill, which includes a strategic plan for the elimination of health disparities, a "seat at the (IC) table" for the center head, grant making authority for the center, and infrastructure improvements at minority institutions.
- Among other topics of interest to the subcommittee were delayed obligations; under-represented states; and whether the Executive Branch was putting the NIH budget through a "political filter."
February 17, 2000 - NIDA Appropriations Hearing
The FY 2001 non-AIDS budget request for NIDA is $496.3 million, an increase of $27.1 million over the FY 2000 appropriation. Including the estimated allocation for AIDS, total support requested for NIDA is $725.5 million, an increase of $38.1 million over the FY 2000 appropriation. Funds for the NIDA efforts in AIDS research are included within the Office of AIDS Research budget request.
In his opening remarks, NIDA Director, Dr. Alan I. Leshner highlighted several of NIDA's ongoing activities and recent research accomplishments and reported that, as promised last year, the National Drug Abuse Treatment Clinical Trials Network is up and running, with 6 nodes already established and 5 more on the way. Moreover, 35 treatment centers have been established, and more are scheduled to open. The network will help eliminate health disparities because minority populations are disproportionately affected by drug abuse, and the network will help us understand better how to treat these populations. Dr. Leshner also discussed NIDA's "Genetics of Drug Addiction Vulnerability" initiative that is to examine the role of genetics in nicotine, cocaine, and heroin addiction. In addition, Dr. Leshner informed the Subcommittee of NIDA's extremely successful information dissemination efforts, including www.clubdrugs.gov and the publications "Preventing Drug Use Among Children and Adolescents: A Research-Based Guide" and "Principles of Drug Addiction Treatment: A Research-Based Guide."
After his remarks, Dr. Leshner fielded questions from the Subcommittee. In response to Mr. Porter, Dr. Leshner explained current drug use trends, including data suggesting a possible downturn in use. Mr. Hoyer asked about treatment for heroin addiction and alternatives to methadone treatment. Dr. Leshner described how new medications (buprenorphine and buprenorphine/naloxone), soon to be approved by the FDA, are likely to be the first such medications to actually be delivered in physicians' offices.
Ms. Pelosi noted that after prevention, substance abuse treatment is the most effective use of funds and asked what the future holds for substance abuse treatment technology. She also inquired as to the percentage of overall drug use for various abused substances. Dr. Leshner responded that drug abuse treatment would benefit from advances in neuroimaging, molecular genetics, information technology, and new understandings in behavioral research. He also noted that in the U.S. there are some 810,000 heroin users and 3 million cocaine addicts, and that in some areas, the use of methamphetamines exceeds cocaine use.
Mr. Jackson expressed concerns about NIDA's funding for health disparities and said that the U.S. prison population is overrun with addicts, a big percentage of whom are minorities. He said there is no treatment in prisons, leading to a "revolving door" effect increasing recidivism. He also noted that ORMH must have shared that information with NIDA and asked Dr. Leshner's opinion as to what percentage of the budget increase should be used on this problem. Dr. Leshner explained that NIDA was the source of the information on drug abuse treatment in the criminal justice system and, in fact, had provided it to ORMH. He explained that of NIDA's total budget, $101 million is for health disparities. He noted that drug use rates for young people are lower in African-American and Hispanic populations than for whites, but that in their twenties, that changes. He also noted that there is a disproportionate impact of consequences of drug use among different populations. Dr. Leshner emphasized that the relationship between NIDA and ORMH is very strong because the issue of health disparities is not at all new for NIDA, and that NIDA is spending more than other Institutes in this area.
March 30, 2000 - NIH Overview Appropriations Hearing before the Senate
Dr. Kirschstein delivered the opening statement for NIH's fiscal year 2001 budget before the Senate Appropriations Subcommittees on Labor, Health and Human Services, and Education. Mr. Millstein, Deputy Director, NIDA, who was among those who accompanied Dr. Kirschstein, was asked by Senator Harkin to tell him what progress has been made in research on methamphtetmine abuse and possible treatment options. In response, Mr. Millstein provided a brief update on the NIDA methamphetamine initiative. He explained that the Community Epidemiology Work Group (CEWG) has shown increases in use of methamphetamine in rural areas. He told the Senator that NIDA has already found out more about methamphetamine and violence, heart disease, and brain damage; and NIDA currently is conducting clinical trials in five different potential medications for treatment of methamphetamine abuse. NIDA is hopeful that we will soon be able to apply the growing body of knowledge to treatment populations as well as in prevention.
House Government Reform Subcommittee Hearing
March 14, 2000 - Hearing before the House Government Reform Committee, Subcommittee on Criminal Justice, Drug Policy, and Human Resources, "HHS Drug Treatment Support: Is the Substance Abuse and Mental Health Services Administration (SAMHSA) Optimizing Resources?"
Dr. Leshner was invited to testify at a hearing that was one in a series focusing on SAMHSA's use of resources for drug abuse treatment. Dr. Leshner discussed areas of research and recent accomplishments for NIDA during his testimony. In particular he stressed the potential for practical applications of scientific findings. He also described how NIDA is taking enormous steps to improve the quality of drug addiction treatment in this country by establishing the National Drug Abuse Treatment Clinical Trials Network. Rep. Mica asked both Dr. Leshner and Dr. Chavez, Administrator, SAMHSA, whether SAMHSA's Knowledge Development and Application (KDA) program overlaps with NIDA's research mission and whether this function should be transferred to NIDA. Both replied that the agencies' programs involve minimal overlap. Rep. Mica remained interested in the possibility of moving the KDA program to NIDA and promised future hearings about the use of resources at SAMHSA.
International Drug Summit
February 8, 2000 - At the invitation of Rep. John Mica (R-FL), Chairman, House Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, NIDA Director Dr. Alan Leshner participated in a Demand Reduction Panel of the International Drug Control Summit 2000. The event was conducted in conjunction with the UN International Drug Control Program. The U.S. Congress hosted the annual meeting of the international parliamentarians on February 8 and 9, 2000. The goal was to provide participants from the European Community, Japan, Canada, and the U.S. an opportunity to engage in strategic dialogue on the growing global drug crisis.
Dr. Leshner's statement focused on the role that science can play in confronting the global drug crisis. He shared with the participants some recent science discoveries and described how science has revolutionized our fundamental understanding of drug abuse and addiction. He illustrated his talk by showing a poster graphically illustrating very dramatic, persistent brain changes that last as long as three years after the addict stops taking drugs. He explained that the fact that long-term drug use has changed their brains is in large part why addicted people cannot stop using drugs and is precisely why they need treatment. He also emphasized that drug abuse treatment is as successful as treatment of other chronic, relapsing diseases, such as diabetes, hypertension and asthma. He described how NIDA will improve treatment throughout our country through a variety of activities, but the most dramatic means that will have the greatest impact is the National Drug Abuse Treatment Clinical Trials Network. This network is a vehicle through which we test new treatments in real-life settings with diverse types of patients and through which we can get new science-based treatments into actual use in practice.
January 5, 2000 - Dr. Elizabeth Robertson, Prevention Research Branch Chief, DESPR, accompanied Dr. Timothy P. Condon, Associate Director, NIDA to brief Ali Dekorsky, and several other members from the staff of Sen. Arlen Spector (R-PA), and staffers from the Senate Judicial Committee. The focus of the discussion was on successful Federal drug prevention programs. Other federal agencies participating in the meeting were SAMHSA, ONDCP, and the Department of Education.
March 2, 2000 - Dr. Frank Vocci, Director, Division of Treatment Research and Development, NIDA, briefed Rep. Kay Granger, R-TX, at her request. Rep. Granger was interested in scientific and medical information relating to detoxification of adolescents from various drugs of abuse and the effects of drugs on the adolescent brain and body, treatment effectiveness, and cost issues. Mary Mayhew, OSPC, accompanied Dr. Vocci.
March 23, 2000 - Dr. Joseph Frascella, Chief Neurobiology Branch, Division of Treatment Research and Development, participated in a briefing by ONDCP for staff to Sen. Bob Graham (D-FL), concerning Ecstasy. Dr. Frascella provided scientific information about the drug's toxicity, effects, and treatment and prevention approaches. He was accompanied by Keith Van Wagner, OSPC.
April 4, 2000 - Dr. Lula Beatty, Chief, Office of Special Populations, NIDA, briefed Earl Smith, staff to Congressman Charles Rangel (D-NY). Mr. Smith requested information about African American adolescents and young adults concerning trends in drug use, medical and other health consequences of drug abuse, and treatment and prevention approaches. Dr. Cindy Miner, Deputy Chief, Science Policy Branch, and Mary Mayhew, OSPC, also participated.
Bills of Interest
H.R. 2130 - Date Rape Prevention Act - On February 8, 2000, President Bill Clinton signed the Hillory J. Farias and Samantha Reid Date-Rape Drug Prohibition Act into law. Sponsored by Fred Upton (R-MI) this bipartisan bill aimed at curbing the abuse of three sedatives that have emerged as so-called "date rape" drugs, was approved August 5, 1999 by the House Commerce Committee. The measure would add GHB (gamma hydroxybutyric acid, also known as Liquid Ecstasy) and GBL (gamma butyrolactone) to Schedule I, and ketamine to Schedule III of the Controlled Substances Act (CSA). The legislation also would require the Justice Department to assist with the development of forensic tests to detect the ingestion of GHB or related substances; direct the HHS Secretary to submit annual reports to Congress estimating the number of sexual assault cases involving date-rape drugs; and require the HHS Secretary to develop a national awareness campaign to educate people about the dangers of date-rape drugs and the strong CSA criminal penalties that could be imposed on those who abuse them. The bill was passed by the House on October 12, and was amended and passed by the Senate on November 19, 1999.
H.R. 2260 - Pain Reduction Relief Promotion Act of 1999 - Passed in the House on October 27, 1999 by a vote of 271-156. The bill was then sent to the Senate where it was placed before the Judiciary Committee on November 19, 1999. The bill was introduced on June 17, 1999 by Rep. Henry Hyde (R-IL) and is designed to amend the Controlled substances Act to promote pain management and palliative care without permitting assisted suicide and euthanasia.
H.R. 2391- National Center for Research on Domestic Health Disparities Act - This bill, originally introduced by Rep. Jesse Jackson, Jr. (D-IL) on June 30, 1999, has 15 new co-sponsors. Eighty-five Congressmen now endorse H.R. 2391, including nine Republicans, and one Independent. The bill would create at NIH a National Center for Research on Domestic Health Disparities, responsible for coordinating its activities with the national research institutes; developing a comprehensive plan for minority health research at NIH; and ensuring the inclusion of members of minority groups in clinical research. H.R. 2391 also would provide an advisory committee for the Center and authorize $100 million for FY 2000 and such sums as may be necessary for the four succeeding years, in addition to other authorizations of appropriations for the other agencies of the NIH. In addition, the bill would authorize the Center Director to carry out a program to facilitate minority health research by providing for research endowments at centers of excellence. H.R. 2391 was referred to the House Committee on Commerce.
H.R. 2987 - Methamphetamine Anti-Proliferation Act of 1999 - On September 30, 1999, Rep. Chris Cannon (R-UT) introduced this bill to provide for the punishment of methamphetamine laboratory operators, provide additional resources to combat methamphetamine production, trafficking, and abuse in the United States, waive certain requirements for practitioners who dispense schedule IV and V narcotic drugs for maintenance treatment or detoxification treatment, and for other purposes. H.R. 2987 was referred to the House Commerce Health and Environment Subcommittee on October 20, 1999. Further action is still pending.
S. 486 - Methamphetamine Anti-Proliferation Act of 1999 - On August 5, 1999, S. 486 was reported to the Senate with an amendment in the nature of a substitute and without a written report by the Senate Committee on the Judiciary. The bill has been placed on the Senate Legislative Calendar. S. 486 was introduced on February 25, 1999, by Sen. John Ashcroft (R-MO) and, as reported, includes several provisions of interest to NIH. S. 486 would require the head of each department, agency, and establishment of the Federal Government to place anti-drug messages on appropriate Internet websites; require the Secretary, HHS, to submit annually to Congress a report on the problems caused by methamphetamine consumption, and the incidence of and treatment available for methamphetamine abuse; authorize the Center for Substance Abuse Prevention to carry out school-based programs regarding the dangers of abuse and addiction; authorize the Director, NIDA, to expand current and on-going interdisciplinary research and clinical trials with treatment centers of the National Drug Abuse Treatment Clinical Trials Network relating to methamphetamine abuse and addiction; require the Secretary, HHS, in consultation with the Institute of Medicine, to conduct a study on the development of medications for the treatment of addiction to methamphetamine; and waive the requirement for practitioners, who dispense narcotic drugs to individuals for maintenance or detoxification treatment, to annually obtain a separate registration for that purpose. The language of S. 324, The Drug Addiction Treatment Act, was swept into S. 486 during markup. On November 19, 1999, S. 486 passed the Senate and was then referred to the House. On February 4, 2000 the bill was referred to the House Commerce Health & Environment Subcommittee.
S. 976 - The Youth Drug and Mental Health Services Act - On May 6, 1999, Sen. William Frist (R-TN) introduced The Youth Drug and Mental Health Services Act, which authorizes SAMHSA and introduces some new youth-related programs. On July 28, 1999 the bill was ordered reported by the full Senate Health, Education, Labor & Pensions Committee with an amendment in the nature of a substitute. Under the bill SAMHSA would end the practice of requiring states to expend a certain portion of federal funds on specified programs, but states would be required to file more comprehensive progress reports. The bill also would set up grant programs under SAMHSA to support: youth and adolescent substance abuse prevention and treatment initiatives; mental health initiatives designed to combat teen violence; mental health and substance abuse programs for the homeless; emergency funds for mental health and substance abuse needs; and treatment services for juvenile delinquents. The bill did not include a provision that would have permitted blending of substance abuse and mental health block grant funds without accountability for the purpose of servicing individuals diagnosed with co-occurring substance abuse and mental health disorders. Instead the bill restated current law. The Committee amended the bill by adopting a charitable choice provision that permits religious organizations to receive federal funds to provide alcohol and drug treatment and prevention services. On November 3, 1999 the bill was passed by the Senate with Unanimous Consent. S. 976 was then sent to the House and referred to the House Commerce Subcommittee on Health and Environment on November 12.
S. 1507 - Native American Alcohol and Substance Abuse Program Consolidation
Act of 1999 - On August 5, 1999, Sen. Ben Nighthorse Campbell (R-CO) introduced S. 1507, the Native American Alcohol and Substance Abuse Program Consolidation Act of 1999. This bill would require the Secretary of the Interior, in cooperation with specified Federal agencies (including NIH), to authorize an Indian tribe to coordinate and consolidate Federally funded alcohol and substance abuse programs. According to Sen. Campbell's introductory remarks, funds available through NIH and NIAAA include several different grant programs for minorities and the prevention of alcohol abuse that could be integrated with other programs into a single program. S. 1507 was referred to the Senate Committee on Indian Affairs and hearings were held on the bill. On March 29, 2000 the Committee on Indian Affairs ordered S. 1507 to be reported with an amendment in the nature of a substitute favorably.
S. 1561 - Date Rape Control Act of 1999 - On August 5, 1999, Sen. Spencer Abraham (R-MI) introduced S. 1561, the Date Rape Control Act of 1999, which would amend the Controlled Substances Act to require the Attorney General to add gamma hydroxybutyric acid to Schedule I and ketamine to Schedule III. It also would require the Secretary of HHS to submit to Congress reports on the number of incidents of the abuse of date-rape drugs that occurred in the most recent one year period, and to develop a plan, in consultation with the Attorney General, for carrying out a national campaign to educate the public on the dangers of date-rape drugs. Finally, the Secretary of HHS would be required to establish an advisory committee to make recommendations to the Secretary on issues related to date rape. After being referred to the Senate Committee on the Judiciary, S. 1561 was incorporated as an amendment into H.R. 2130, a bill that eventually was passed by both the House and Senate.
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