June 11-14, 2004
Caribe Hilton
San Juan, Puerto Rico

Symposium Executive Summary

The 2004 NIDA International Forum, Progress Through Collaboration, was held in conjunction with the College on the Problems of Drug Dependence (CPDD) Annual Meeting from June 11-14 in San Juan, Puerto Rico. Speakers included Puerto Rican Secretary of Health Dr. John Rullán; Dr. Vladimir Poznyak, World Health Organization; Dr. Juana Tomas-Rossello, United Nations Office on Drugs and Crime; and Dr. Astrid Eberhart, Canadian Institutes of Health Research. The Forum is an integral component in NIDA's efforts to assist scientists from around the world in exchanging information and establishing collaborative drug abuse research projects. The meeting featured a day-long symposium; International Program networking, poster, and planning sessions included in the overall CPDD agenda; and pre-conference workshops. More than 200 scientists from 51 countries participated in the symposium, which focused on the status of HIV/HCV infection among drug users in Iberoamerica, research and funding activities conducted by other international drug abuse research organizations, and the international research priorities set by NIDA's divisions. The Forum was chaired by Dr. Steven W. Gust, NIDA International Program (IP) Director, and featured remarks by NIDA Deputy Director Dr. Timothy Condon, Dr. M. Patricia Needle, IP; Dr. Steven Goldberg, Intramural Research Program (IRP); Dr. David Shurtleff, Division of Basic Neurosciences and Behavior Research (DBNBR); Dr. Jack Stein, Division of Epidemiology, Services and Prevention Research (DESPR); and Dr. Frank Vocci, Division of Pharmacotherapies and Medical Consequences of Drug Abuse (DPMC).

Update and Future Direction of NIDA's International Drug Abuse Research

NIDA Deputy Director Dr. Timothy Condon introduced the Institute's recent reorganization and described how the changes support the overall NIDA research theme on the interaction of drug abuse and HIV/AIDS. The Institute has also developed priorities in four main research areas: 1) prevention programs that employ scientific findings about physiological and behavioral development to reach children and adolescents; 2) the interaction of environmental factors and genetic predisposition to affect individual vulnerabilities to addiction; 3) development of pharmacotherapies and treatment programs that address the medical consequences of drug abuse; and 4) methods to address global increases in marijuana and inhalant abuse.

NIDA International Program Director Dr. Steven W. Gust cited increased participation in the NIDA International Forum as evidence of the Institute's expanding international focus. The 2001 Forum included 68 participants from 26 countries; the 2004 Forum included 219 participants from 51 nations. Dr. Gust reviewed NIDA International Program activities, including funding opportunities, binational agreements, and international meetings, noting that during Fiscal Year 2003, NIDA funded 133 international research projects and that NIDA-funded international research teams published 136 scientific articles indexed in PubMed. Dr. M. Patricia Needle, International Program Senior Advisor, discussed global trends in drug use, citing United Nations data that track worldwide increases in abuse of cannabis, opiates, and amphetamine-type stimulants and the expansion of cocaine abuse from the Americas to Western Europe. Dr. Needle reviewed the four NIDA competitive programs that support international research training and exchange opportunities: 1) INVEST Research Fellowships are 12-month, postdoctoral appointments with a NIDA funded researcher in the United States; 2) the 10-month NIDA Humphrey Drug Abuse Research Fellowships for mid-career professionals combine academic training at a U.S. university and research experience with a NIDA grantee; 3) Distinguished International Scientist Collaboration Awards (DISCA) support 1- to 3-month research exchange visits by senior scientists from other countries to a NIDA grantee in the United States; and 4) Distinguished International Scientist Collaboration Awards for U.S. Citizens and Permanent Residents (USDISCA) support 1- to 3-month research exchange visits by senior NIDA grantees to senior scientists in other countries. Dr. Needle also outlined forthcoming NIDA International Program initiatives, such as online- or CD-based training modules. The first module, Understanding Pharmacotherapies for Opiate Addiction, is currently in development.

Other NIDA officials outlined the international research priorities set by their divisions and offices. Dr. Steven Goldberg, IRP, reviewed the current research activities of NIDA's seven intramural research branches, the types of international collaborations each branch is seeking, and examples of current cooperative research. He also presented results from two multicollaborative studies: 1) an investigation of caffeine and adenosine-dopamine receptor interactions by scientists at the IRP, University of Barcelona, Spain; Karolinska Institute, Sweden; Istituto Superiore di Sanita, Italy; University of Athens, Greece; Institute of Psychiatry and Neurology, Poland; and the University of Bonn, Germany (Journal of Biological Chemistry 278:47, pp. 46741- 46749, 2003); and 2) a study of the dopamine D3 receptor and drug-associated cues by researchers at the IRP; INSERM, France; and Institut fur Pharmakologie und Toxikologie, Germany. Dr. David Shurtleff, DBNBR, identified several areas for potential international cooperation, including proteomics, genetics (including human molecular genetics, pharmacogenetics, and model organisms such as knock out mice), human laboratory-based research, and animal models of addiction. DBNBR also participates in a program to develop international research in neurological and neuro-developmental impairment, including sensory, motor, cognitive, and behavioral deficits. Dr. Jack Stein, DESPR, summarized division research priorities designed to promote integrated approaches to address individual and environmental interactions that contribute to drug abuse and impact both practice and public policy, particularly in the areas of prevention research among children and adolescents, new models and approaches to treatment services, and HIV/AIDS prevention and treatment research. Dr. Frank Vocci, DPMC, outlined international research priorities in clinical neurobiology, behavioral therapy, medications development, and medical consequences of drug abuse, which include nicotine addiction in the developing world, cross-cultural issues in treatment adherence, drug-related sleep disorders, pharmacotherapies for pregnant opioid addicts, and the interaction between drug addiction, HIV, and associated medical conditions

HIV and HCV Infection Among Drug Users in Iberoamerica

Puerto Rican Secretary of Health Dr. John Rullán discussed concerns about the high prevalence of alcohol abuse in the territory and described a comprehensive treatment center that is under construction. Dr. Hector Colón, Central University of the Caribbean, Puerto Rico, chaired the session on HIV and hepatitis C (HCV) infection among drug users in Iberoamerica. Dr. Octavio Campollo, University of Guadalajara, summarized researchers' conclusions that very little data exists about the relationship of drug use and infection with hepatitis or HIV in Mexico. Only 2.5 percent of 322 drug-dependent individuals were injection drug users (IDUs), but 12 percent were HIV-positive, confirming that sexual transmission is the primary vector of HIV infection in Mexico. Dr. Juan Carlos Valderrama-Zurián, University of Valencia, reported that Spain has the highest rate of HIV infection among European Union countries, despite a decade-long drop in prevalence of injection drug use. Dr. Juan Carlos Reyes-Pulliza, Central University of the Caribbean, described a study of Puerto Rican IDUs that concluded that the risk of infection with HCV increased with the length of time an individual had been injecting drugs, homelessness, using speedballs, receiving tattoos in jail, and a history of other sexually transmitted diseases. Dr. Flavio Pechansky, Federal University of Rio Grande do Sul, discussed his NIDA-funded research on the correlation of rapid increases in cocaine abuse with the incidence of HIV infection among poor, heterosexual Brazilians.

Reports from International Organizations

Representatives of five other institutes updated Forum participants on international drug abuse funding and research activities supported by their organizations. Mr. Gregg Davis, Fogarty International Center (FIC), U.S. National Institutes of Health (NIH), discussed FIC efforts to reduce disparities in global health by supporting international research training, promoting strategic alliances and collaborative networks, and conducting research. FIC research initiatives focus on international collaborative research, HIV/AIDS and related illnesses, infectious diseases, new foreign investigators, biodiversity, health and economic development, tobacco, stigma, environment and economic development, and brain disorders. FIC training programs focus on infectious diseases, genetics, maternal and child health, environmental and occupational health, population, trauma, and clinical, operational, and health services research. Ms. Margaret Murray, NIH National Institute on Alcohol Abuse and Alcoholism (NIAAA), described the Institute's cooperative funding agreements to support international training efforts and research on alcohol-related issues in genetics, neuroscience, epidemiology, stigma, gender, infectious diseases, and culture; prenatal exposure to alcohol and fetal alcohol syndrome; health risks and benefits of alcohol consumption; and prevention and treatment of alcoholism. Ms. Astrid Eberhart, Canadian Institutes of Health Research, identified the institute's strategic priorities in addiction research, including first-episode events in addiction and neurological and mental illnesses, co-occurrence of brain disorders with other health problems, co-morbidity, regenerative medicine and neuroscience, and nicotine addiction and tobacco abuse. She also discussed such emerging issues as discrimination and stigma, placebo effects, neurodevelopment and early life events, computational neurosciences and artificial intelligence, and bioethics. Dr. Vladimir Poznyak, World Health Organization, reviewed the primary activities supported by the Management of Substance Abuse Unit: 1) developing effective prevention and treatment programs through education, awareness, and support; 2) compiling epidemiological data on alcohol and drug abuse; 3) the interconnection of substance abuse and HIV/AIDS; and 4) building capacity through training programs and fellowships for researchers from countries with fewer resources. Dr. Juana Tomas-Rossello, United Nations Office on Drugs and Crime summarized the expanding Global Assessment Program, which employs a common reporting system, disseminates methodological standards, and helps nations improve resources and training for data collection efforts. The program has increased the response rate, accuracy, and completeness of the agency's Annual Report on Drug Abuse. UNODC also develops and disseminates prevention and treatment best practices through the use of resource and mentoring centers, training programs, and demonstration projects that focus on youth, amphetamine-type stimulants, the criminal justice system, and HIV/AIDS.