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


The biannual meeting of the Community Epidemiology Work Group (CEWG), chaired by Mr. Nicholas Kozel, DEPR, was held in New Orleans on December 13-16, 1994. The CEWG is composed of researchers from 20 selected metropolitan areas of the United States who meet semiannually to report on patterns and trends of drug abuse in their respective areas; emerging drugs of abuse; vulnerable populations and factors that may place people at risk of drug use and abuse; and, negative health and social consequences. Reports are based on drug abuse indicator data, such as morbidity and mortality information, treatment data and local and State law enforcement data. Additional sources of information include criminal justice, correctional, medical and community health data, local and State survey information and research findings from ethnographic studies.

Highlights from findings from the most recent CEWG meeting include:

  • Cocaine is the drug of primary concern in terms of numbers of users and consequences in the communities represented in the CEWG. However, indicator data for cocaine appear to be levelling off or declining in many areas.

  • Indicators of heroin use continue a pattern of general increase that began several years ago. Treatment data from several cities, including Chicago, Boston, Newark, New York City, Minneapolis/St. Paul and St. Louis reflect an increase in younger users. Preliminary indications of a new cohort of younger users also is being noted in Atlanta, Miami, New Orleans, San Francisco and Washington, D.C. Injection is the primary route of use in the West, intranasal use continues to replace injections in New York City, Chicago and Detroit. The emergence of heroin smoking is reported in Atlanta, Chicago and Minneapolis/St. Paul, especially among young users.

  • A variety of opiates other than heroin are abused in various CEWG sites. Specific drugs which have been identified as problematic include among others: propoxyphene in Seattle and Minneapolis/St. Paul; Hydromorphone in Atlanta, New Orleans, New York City, Phoenix, St. Louis and in certain areas of Texas; and codeine-based drugs in Chicago, Detroit and Phoenix.

  • Marijuana indicator data, primarily from treatment programs, emergency rooms and arrestee urinalysis, continue to show increases in many of the CEWG sites. Use of blunts (gutted cigars refilled with marijuana) is reported in diverse areas of the country, including Chicago, Minneapolis/St. Paul, New York City, Philadelphia, San Francisco and Washington, D.C.

  • Abuse of methamphetamine appears to be a regional problem, principally in the Western area of the country, including San Diego, Honolulu, Phoenix and San Francisco. Primary route of administration is by injection in San Francisco and by intranasal or smoking in the other areas. Among other stimulants, availability and use of MDMA (ecstasy) is reported in Atlanta, Dallas, Honolulu, Miami, St. Louis, San Francisco and in Texas, while methcathinone (cat) is reported in Detroit.
  • A variety of illegally diverted or smuggled barbiturates, sedative/hypnotics, tranquilizers and antidepressants are available and abused in many CEWG sites. Of note are recent increases in indicators of flunitrazepam (Rohypnol) reported by treatment program staff and information hotline personnel in Florida and Texas. Increased use of Rohypnol originating in Colombia and Mexico have been reported among adolescents in the South Florida and Texas border area and is frequently used in combination with alcohol. In addition to the CEWG reports, abuse of Rohypnol by heroin addicts, cocaine and other stimulant abusers, and adolescents who use it in combination with alcohol have been noted, thus far, by epidemiologic surveillance networks in other parts of the world, including Western and Eastern Europe, Southeast and South Asia, Australia, North Africa and Central America.

  • Among hallucinogens, an outbreak of jimson weed use was reported in the Northeast, specifically New York and New Jersey and in Texas and resulted in two deaths in El Paso and numerous emergency episodes in Texas and New Jersey. An increase in PCP indicators was reported in Philadelphia and is thought to be combined with marijuana and used in blunts. Information from schools and hotlines in several CEWG sites, including Atlanta, Detroit, Miami and San Francisco suggest an increase in LSD use among youth. LSD use among youth and young adults in increasingly being reported in association with "raves".

NIDA, together with CDC, SAMHSA, and Johns Hopkins University co-sponsored a workshop on February 15-16, held at Johns Hopkins, to review issues related to sterile needles and syringes for drug users who continue injecting.

On February 16-18,1995 NIDA cosponsored the North Carolina Governor's Institute regional conference "Advancing Substance Abuse/Addiction Treatment: Applying Current Research" in collaboration with the NIDA Center for the Neurobiological Investigation of Drug Abuse at the Bowman Gray School of Medicine, and the NIDA Center for Community-Based Treatment Research Methods at Research Triangle Institute. Dorynne Czechowicz M.D., Treatment Research Branch, DCSR, was on the conference planning committee and presented on NIDA research priorities at the conference; Gerald Soucy, Ph.D., presented on NIDA's research dissemination program, Timothy Condon, Ph.D., and Lula Beatty, Ph.D., presented on researcher training and development. This meeting brought together basic and clinical researchers, clinicians from different disciplines, teachers and administrators and consumers of services as well to address strategies for disseminating new knowledge and exploring ways in which research can be used to improve treatment services, and to identify future research and research training needs.

On February 22-24, 1995, NIDA co-sponsored a conference on "HIV Infection in Women" in Washington, D.C., which was the first national scientific meeting on HIV infection in adult and adolescent women.

On March 6-7, 1995 NIDA's new Behavioral Sciences Research Branch (DBR) sponsored a workshop entitled "Basic Behavioral Sciences Research in Drug Abuse: New Directions". Fourteen eminent behavioral scientists participated, representing diverse areas of basic behavioral, neurobehavioral, social and cognitive science research, including a researcher from NIDA's Intramural Research Program. The participants spent a day and a half at NIH discussing new ideas and promising research directions that have the potential to improve our understanding of drug abuse. New directions included research into stress and psychopathology, basic social and cognitive processes, issues of resiliency and vulnerability, and potential application of research in other addictions such as overeating and alcoholism to drug abuse research. Particularly highlighted was the need for development of theoretical behavioral models that span both animal and human research.

On March 7, 1995 an Ad Hoc review of the NIDA Medications Development Program (encompassing all activities in various components of NIDA) was held. Representatives of academia, the pharmaceutical industry, FDA and NIMH attended as well as key NIDA personnel. The review was forward focussed, i.e., it was not a retrospective review and critique but an assessment of where NIDA should be headed in the future, given the state of science and the respective strengths and interests of industry, academia, and government.

On March 8, 1995 a meeting was held to present and review the latest preclinical and clinical information available concerning ibogaine. Non-government speakers presented current data to a group of non-government consultants, who will provide their input to NIDA for consideration. FDA and NIDA personnel were also in attendance.

NIDA sponsored a conference on March 14-15 at the University of Maryland Conference Center on the "Impact of HIV Risk and Infection on the Delivery of Drug Abuse Treatment Services" to discuss treatment and research issues.

A NIDA-sponsored workshop entitled "HIV Disease Progression: Opiates and Immune Function" was held on April 3-4, 1995 in Gaithersburg, MD. Nineteen clinicians, epidemiologists, and basic scientists discussed the effects of opiates on various parameters of immune function and on disease progression in animals and humans. The workshop was organized by Drs. Harry Haverkos, Lynda Erinoff, Paul A. Coulis and Ms. Katherine Davenny.

On Friday April 7, 1995 a sharing and exchange meeting was held with NIDA staff and the American Academy of Child and Adolescent Psychiatry (AACAP) as a follow up to the Constituent Organization meeting held in Chantilly, VA last November. This meeting was organized by Dr. Dorynne Czechowicz in collaboration with the NIDA Child and Adolescent Workgroup, Chaired by Dr. Vince Smerglio. NIDA staff presented information regarding current research efforts, funding mechanisms, research training opportunities and strategies for promoting education on the identification, treatment and prevention of drug abuse and addiction in children and adolescents. A number of collaborative activities are being planned as a result of this productive interchange between NIDA staff from all Divisions and the AACAP members. For example, NIDA will hold a day long Institute on Substance Abuse at the AACAP Annual Meeting in New Orleans in October as well as a workshop on grant writing.

On Friday April 28, 1995, a day long NIDA Symposium on New Approaches to Drug Abuse Treatment was held at the American Society of Addiction Medicine annual Medical-Scientific Conference in Chicago, Illinois. The NIDA session was organized by Dorynne Czechowicz, M.D., Treatment Research Branch, DCSR, in collaboration with NIDA Divisions and the American Society of Addiction Medicine. The Symposium was chaired by Richard Millstein, Deputy Director of NIDA. The session addressed behavioral therapies, health services research, pharmacotherapies, and integrating behavioral and pharmacotherapies with emphasis on application of the research to current clinical practice.

NIDA's Services Research Branch/DCSR sponsored and participated in a meeting on "The Impact of AIDS on Drug Abuse Treatment," co-chaired by Dr. Barry Brown of the Friends Medical Science Center, University of Maryland and Dr. Frank Tims.

NEURON: NIDA's Extramural Unique Research on Neuroscience- The Neuroscience Workgroup at NIDA has initiated a neuroscience speaker series for the purpose of (1) selfeducation of the latest work in neuroscience, (2) information dissemination to the NIH community of NIDA's progress in neuroscience, and (3) forging closer ties with NIDA's neuroscience researchers. Invitees include recent recipients of a grant in response to the Clinical Neuroscience RFA, and NIDA's MERIT award winners. The guests spend a day meeting with NIDA program, review, and budget staff followed by giving a seminar on the work they have proposed and are undertaking under the neuroscience program. The first guest was Perry Renshaw, M.D., Ph.D. of McLean Hospital who spoke on the latest brain imaging techniques and their direct application to drug abuse research. The next guest (scheduled for June 1) is Laure Buydens, M.D. of the Brooklyn VA Medical Center who will present research on cocaine's effect on the serotonergic system.

Dr. David Johnson, DBR, participated in a panel on "Federal Funding Opportunities for Nicotine Research" at the first annual meeting of The Society for Research on Nicotine and Tobacco on March 25, 1994 in San Diego, CA.

On April 3, 1995, Mr. Joel Egertson of the Medications Development Division attended the Second Southeast Regional Narcotic Treatment Conference in Orlando, Florida. During this 3 day conference, representatives of 11 States formulated a draft set of standards to govern the delivery of narcotic treatment services in the region, and explored the feasibility of developing a central registry of patients being served by programs in those States. The meeting, sponsored by the Center for Substance Abuse Treatment (CSAT), is one in a series of activities NIDA/MDD is working closely with CSAT on relating to the effective use of pharmacotherapy in drug abuse treatment. Additional policy symposia meetings jointly sponsored by CSAT and NIDA were held for the Northeast States (Boston, April 28) and are scheduled for a group of Mid-Atlantic States (Princeton, New Jersey on June 15).

Dr. Frank Vocci of MDD attended the National Conference on "Smoking Cessation: Alternative Strategies" in Washington, D.C., April 10-11, and participated in the session of harm reduction as an alternative goal for cigarette smoking.

On April 12, Dr. Harry Haverkos spoke at the ARC Clinical Case Conference on NIDA's extramural AIDS program.

On May 15, Dr. Haverkos attended the 1995 Council of State and Territorial Epidemiologists Meeting in Austin, TX and spoke on "HIV Prevention-Needle Exchange" in a point/counterpoint format.

On April 6-7, Dr. Robert Battjes, Acting Director, DCSR, participated in a meeting, "Building Bridges Between the Health Maintenance Organization and Health Services Research Communities," held in Coronado, CA. The meeting was co-sponsored by the Group Health Association of America and the Agency for Health Care Policy and Research.

Drs. Rebecca Ashery, DEPR, and Robert Battjes, DCSR, participated in a conference, "Advancing Knowledge for Human Services: A National Conference of Social Work Researchers," held in Arlington, VA, April 9-11. They were discussants to a presentation by NIDA grantee, Dr. David Nurco, on drug abuse research, and also conducted a round table discussion for social work researchers interested in support for drug abuse research. On April 11, Dr. Battjes also presented a poster,"Trends in HIV Infection and AIDS Risk Behaviors Among Injecting Drug Users," as part of the Conference's poster exhibition at the U.S. Capitol.

Dr. Paul A. Coulis, Program Officer, Division of Clinical and Services Research, Clinical Medicine Branch, was appointed to represent NIDA on the Trans-NIH Sleep Research Coordinating Committee.

Dr. Pete Delany made a presentation to the National Association of Deans and Directors of Social Work Programs on "Research Opportunities at the National Institute on Drug Abuse", San Diego, CA on March 2, 1995.

Dr. Pete Delany participated in a panel presentation at the Annual Program Meeting of the Council on Social Work Education "Social Work Research in Substance Abuse," San Diego, CA on March 3, 1995.

Dr. Pete Delany presented a paper entitled "Drug Abuse Research and the Criminal Justice System: Where Are We and Where Are we Going?" at the Association of Criminal Justice Sciences, Boston, MA, on March 11, 1995.

Dr. Mac Horton, presented on "Drug Abuse Treatment Research" at the Spring Grove Hospital Center's Psychology Lecture Series on March 3, 1995.

Dr. Timothy P. Condon, Acting Deputy Director, OSPC, spoke February 17, 1995 in Greensboro, North Carolina to the North Carolina Governor's Alcohol and Drug Abuse Institute on research and training priorities at NIDA.

Dr. Timothy P. Condon, Acting Deputy Director, OSPC gave a presentation on the "Research Training Opportunities in Neuroscience" to the Annual Meeting of the Association of Neuroscience Departments and Programs on April 24, 1995 in Washington, DC.

J.C. Comolli, SPB/OSPC was invited to "The Role of Alcohol and Other Drugs in Child and Family Violence" meeting sponsored by The Johnson Institute Foundation. Other invited participants included researchers, practitioners and advocacy leaders brought together to discuss research and policy issues, and public awareness regarding this topic. The meeting was held in Orlando, Florida February 23-25, 1995.

Dr. Lula Beatty presented a session on "Proposal Development" at the conference of the North Carolina State University Association for the Concerns of African-American Graduate Students in Raleigh, NC, February 25, 1995.

Dr. Lula Beatty presented a session on "Making Our Families Stronger Again" at the conference of the Washington Alliance of Black School Educators in Seattle, WA, on March 17, 1995.

Dr. Lula Beatty presented a seminar on research opportunities at NIDA for faculty and students in psychology at George Washington University in Washington, DC, on March 30, 1995.

Dr. Lula Beatty participated in a meeting on African American males, violence and substance abuse sponsored by the Office of National Drug Control and Policy, in Washington, DC, on April 5, 1995.

Dr. Lula Beatty participated in a focus group on "The Maafa, the Media and the Mind" sponsored by the Association of Black Psychologists on April 22, 1995.

Dr. Lula Beatty attended a conference on grant development for minority scholars at the University of MD, College Park on April 21, 1995.

Pamela Goodlow presented a session on research opportunities at NIDA at the National Association For Equal Opportunity in Higher Education in Washington, DC, on March 17, 1995.

Dr. Coryl Jones ERB/DEPR, Dr. Vince Smeriglio CMB/DCSR, and Dr. Elizabeth Rahdert TRB/DCSR, NIDA representatives to the Steering Committee of the NICHD/NIDA/ACYF/CSAT Maternal Lifestyle Study, met April 4, 1995, to review the progress on the interagency agreements and cooperative agreements with Brown University, University of Miami, University of Tennessee, and Wayne State University. Recruitment has been completed (N = 2,300 of 19,000 mother/infant dyads screened by meconium assay and verification, medical history, and interview to establish cocaine exposure, heroin exposure, and matched control groups); the oldest infants have reached 12 months of age; developmental assessments and maternal batteries are on schedule with approximately 7% of infants not being reared by their biologic mother at the time of 4, 8 or 12 month assessments. Recruitment objectives had to be changed due to changes in drug use patterns (reduction in prenatal cocaine exposure) and the impact of managed care in some settings (geographic dispersion of patients formerly seen in public and university teaching hospitals). One outcome already accomplished by this study has been the refinement of procedures for meconium assay and verification for use in epidemiologic studies.

Richard H. Needle, Ph.D., M.P.H. gave a presentation on HIV-related findings from NIDAsponsored research at the University of Washington Alcohol and Drug Institute in Seattle, Washington on February 23, 1995.

Richard H. Needle, Ph.D., M.P.H. gave a presentation on HIV prevention research at the Henry M. Jackson Foundation Friday afternoon seminar series, on March 3, 1995.

Helen Cesari, M.Sc. represented DEPR's Community Research Branch at the "HIV Risk Assessment Outcome Measures Meeting" in New Orleans, LA on April 25 - 26.

Elizabeth Lambert, M.Sc. gave a presentation on the local impact of drug abuse in the Washington, D.C. metropolitan area, at the George Washington University Symposium, "Substance Abuse '95: Progress in Policy and Practice," on March 25, 1995.

Elizabeth Lambert, M.Sc. represented DEPR's Community Research Branch at the Maryland State Epidemiology Work Group at the University of Maryland in College Park, on May 12, 1995.

Peter Hartsock, Ph.D. represented DEPR's Community Research Branch at the April 6 Yale University colloquium in recognition of the first NIDA-funded research program on needle exchange, in New Haven, Connecticut. Others participating in the Yale colloquium were researchers from Harvard University's International AIDS Program and the Director of the Epidemiology and Prevention Office in Rome, Italy.

Peter Hartsock, Ph.D. represented DEPR's Community Research Branch at the Florida State Epidemiology Work Group (SEWG) in Tallahassee, on March 1. A major aim of the SEWG was to develop a joint Florida and related area (e.g., Caribbean) surveillance and research capability for drug abuse and drug-related correlates, including HIV/AIDS, violence, and crime, with special focus given to substance abuse in rural areas and among minorities.

Mario De La Rosa, Ph.D. served as a panelist on the lack of drug abuse research among Hispanic populations at the NIDA Conference on Hispanic Issues in January, in Rockville, Maryland.

Mario De La Rosa, Ph.D. participated in NIDA's Minorities in Drug Abuse Research Workshop on January 18-19, in Bethesda, Maryland.

Mario De La Rosa, Ph.D. participated in an American Psychological Association meeting to review the current status of research on violence held in February, in Washington, D.C.

Dr. James Colliver met with the Epidemiology Subcommittee of the Interagency Methadone Policy Review Board which was formed at the request of the DHHS Counsel to the Secretary for Drug Abuse Policy to discuss the interpretation of data on methadone-related deaths reported by medical examiners and to make recommendations regarding future research into the topic. Dr. Colliver is providing methodological advice regarding mortality data, record linkage, and other research issues.

Dr. James Colliver of DEPR represented NIDA at a workshop on data disclosure issues related to the ADD HEALTH Survey, a major, prospective longitudinal study of the health and healthrelated behaviors of adolescents being conducted by grantees of the National Institute on Child Health and Human Development with input and support from other NIH ICDs including NIDA. Dr. Colliver assisted in defining approaches to providing access to the survey data for research purposes while preventing inappropriate disclosure of data on particular individuals, schools, and communities.

Dr. James Colliver and Andrea Kopstein of DEPR assisted in developing drug questions for the National Longitudinal Survey of Youth (NLSY). They recently represented NIDA at a Technical Review Meeting on the planned NLSY 1996 Cohort (NLSY96) sponsored by the Bureau of Labor Statistics. Discussion at the meeting focused on the survey sample and the questionnaire design and contents.

Dr. Coryl Jones ERB/DEPR participated as discussant in the Federal Forum on Childhood Research on Child Abuse and Neglect sponsored by the U.S. Interagency Task Force on Child Abuse and Neglect of which she is a member.

On March 27, 1995 Arthur Hughes gave a presentation titled: "Overview of Drug Use Among African Americans." to the "African American Materials Development Meeting, How to Reach African Americans with Research Results."

Sari Izenwasser was invited to present a seminar entitled:"Neurochemical Mechanisms of Tolerance and Sensitization to Cocaine." Department of Pharmacology, Boston University School of Medicine.

Amy H. Newman was invited to present a seminar as a participant in the 27th Annual Mardi Gras Symposium in Chemistry "Drugs of Abuse: Recent Advances in Chemistry and Pharmacology." held in New Orleans, Louisiana, in February, 1995. Her topic: Novel Benztropine Analogs are Potent Dopamine Uptake Inhibitors without Cocaine-like Behavioral Profiles.

Amy H. Newman was invited to present a seminar entitled: Novel Benztropine Analogs Are Potent Dopamine Uptake Inhibitors Without Cocaine-Like Behavioral Profiles for the Department of Medicinal Chemistry, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia in March, 1995.

Dr. Toni Shippenberg of the Behavioral Pharmacology and Genetics Section, Preclinical Pharmacology Laboratory, Division of Intramural Research, was invited to speak about therapeutic potential of opioid ligands in the treatment of cocaine abuse at a NIDA Medications Development Meeting, held in Rockville, MD, in March 1995.

Dr. Edythe D. London presented a lecture entitled, "PET Studies in Substance Abuse" at the School of Hygiene and Public Health, Johns Hopkins Medical Institutions, on
Jan. 9, 1995.

Dr. Edythe D. London presented a lecture entitled "PET Studies of Drug Abuse" at the National Heart, Lung and Blood Institute, National Institute of Health, Bethesda, MD, on February 10, 1995.

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