August 11, 2014

June 13–16, 2014
San Juan, Puerto Rico

More than 265 participants from 65 countries explored the adverse health effects of marijuana and related policy issues during the opening plenary session of the 19th Annual NIDA International Forum. The meeting, which was held June 13-16, 2014, in San Juan, Puerto Rico, also focused on new psychoactive substances and the 25th anniversary of the NIDA Hubert H. Humphrey Drug Abuse Research Fellowships. NIDA International Program Director Steven W. Gust, Ph.D., chaired the meeting, which was cosponsored by the Canadian Institutes of Health Research (CIHR). A joint College on Problems of Drug Dependence (CPDD)/NIDA International Forum poster session featured presentations on international research by 130 scientists from the United States and 40 other countries.

NIDA Director Nora D. Volkow, M.D., opened the plenary session by exploring gaps in the scientific evidence on adverse health effects of marijuana. Dr. Volkow described the wide influence marijuana has on brain function and structure, and the strong evidence that marijuana increases risks for addiction to other drugs of abuse, diminished lifetime achievement, motor vehicle accidents, and chronic bronchitis. About 9 percent of all marijuana users become dependent, but that figure increases to 25 to 50 percent with daily use. She reviewed recent scientific research demonstrating the negative impact marijuana use has on brain development, cognitive ability, memory, motivation, and emotions. Marijuana use increased risk of developing psychosis by more than five times and increased by seven-fold the risk of schizophrenia among individuals with a specific genetic polymorphism. Imaging studies found that marijuana use decreased dopamine synthesis and that between 80 percent and 90 percent of adults who used marijuana as adolescents exhibited reduced connectivity in areas of the brain first affected by Alzheimer’s disease.

Susan Weiss, Ph.D., NIDA associate director, chaired a panel discussion providing global perspectives on marijuana policy, research, and knowledge gaps. Jan Copeland, Ph.D., director of the Australian National Cannabis Prevention and Information Centre, described use patterns in Asia and Oceania, noting that few data are collected systematically in the region. She described how easing penalties for marijuana use in the state of South Australia fueled interstate markets and gang involvement, but did not significantly increase use patterns. A New Zealand effort to regulate synthetic cannabis was reversed because of complicated logistics and community concerns. Dr. Copeland reviewed Australian research into pharmacotherapies for cannabis dependence, noting that psychosocial interventions and community education efforts remained the primary interventions and that targeted interventions are needed for special populations such as indigenous, adolescent, and dual-diagnosis groups. Paul Griffiths, M.Sc., scientific director of the European Monitoring Centre for Drugs and Drug Addiction, reported that marijuana is not a primary policy issue in the European Union (EU), but that there is growing recognition that its use affects both health and crime. He added that drug- related offenses are increasing throughout Europe, and three-quarters involve marijuana. Mr. Griffiths reported that eight countries reported decreases and five reported increases in past-year use. The potency of herbal and resin cannabis is increasing, synthetic cannabinoids are generally more potent, and both are associated with adverse medical consequences. Marijuana is the most frequently reported drug by patients who enter treatment, although the range is quite large—2 percent of treatment demand in Bulgaria and 66 percent in Hungary. Mr. Griffiths described research questions in prevention, treatment, epidemiology, and harm reduction. Ambassador Paul Simons, executive secretary of the Inter-American Drug Abuse Control Commission (CICAD), described how presidential-level interest in drug policy led to a public health approach and standardized methodologies that allow cross-national comparisons over time throughout Organization of American States member nations. He added that prevalence and patterns of marijuana use vary widely throughout the region, with marijuana more prevalent than tobacco in the majority of Caribbean countries. Ambassador Simons compared legalization and decriminalization models in the United States, Uruguay, Canada, and Europe, raising questions about health effects and the impact of legalization on neighboring countries, regulatory systems, perceptions of risk, availability, and the risk of diversion to underage users. Synthetic cannabis is available, but use is relatively low. Priscillia E. Hunt, Ph.D., associate economist at the RAND Corporation, described the complex U.S. policies on marijuana. She reported that current proposals to reduce the legal risks to users might not affect prices or supply as much as policy changes that increase the risks of selling marijuana. Dr. Hunt suggested that existing research on decriminalization and medical marijuana would be only marginally useful for understanding the effects of legalization.

Awards of Excellence

NIDA International Awards of Excellence, which recognize individuals for outstanding contributions to international cooperation in drug abuse research and training, were presented for:

  • Excellence in mentoring, to Dennis McCarty, Ph.D., Oregon Health & Science University, for his work with the United Nations Office on Drug Control TreatNet program, the Peruvian National Institutes of Health, colleagues in Vietnam, and as scientific director of the Dutch Summer Institute on Alcohol, Drugs, and Addiction.
  • Excellence in international leadership, to Charles O’Keeffe, M.B.A., Virginia Commonwealth University (VCU), for his work on U.S. and international drug policy, securing approval for buprenorphine, and creating the International Programme in Addiction Studies, an online master’s degree program.
  • Excellence in collaborative research, to Marek C. Chawarski, Ph.D., Yale University, and Vicknasingam B Kasinather, Ph.D., Universiti Sains Malaysia, Malaysia, for their work developing culturally appropriate prevention and treatment interventions for co-occurring opioid and amphetamine dependence and drug-related HIV in Malaysia.
  • Special Recognition to William L. Dewey, Ph.D., VCU, for his significant scientific accomplishments and his devoted service to the addiction research community.

Update on New Psychoactive Substances

Mr. Griffiths also chaired a panel discussion focused on new psychoactive substances (NPS). He reported that heroin use in the EU declined by nearly half between 2007 and 2012, replaced by synthetic opioids and hallucinogens. Mr. Griffiths described the EU early-warning system, which monitors more than 350 NPS and identifies more than one new substance weekly. Synthetic cannabinoids represent the largest group, but production is diversifying from chemical groups into plant- and medicine-based NPS. He described public health challenges, including highly potent NPS being mistaken for legitimate prescription or over-the-counter medicines, with adverse health consequences. Claudia Rimondo, M.A., Italian Department of Anti-Drug Policies, described the Italian National Action Plan to prevent NPS use and online sales, which balances health and law enforcement approaches to address rising use of marijuana and synthetic cannabis among young people. The plan employs an early warning system to track drug use and health consequences and identify trafficking patterns and new criminal organizations. Other efforts include training local and regional laboratories, clinical centers, physicians, and law enforcement officials to identify NPS; implementing school- and family-based prevention interventions; updating drug control laws and closing online and retail sales outlets; promoting research; and building partnerships with regional and international organizations. Marya Hynes, M.H.S., Organization of American States, presented the Synthetics Monitoring: Analyses, Reporting and Trends (SMART) collaboration between the United Nations Office on Drugs and Crime and CICAD. In Latin America, the SMART program operates through the CICAD Inter-American Observatory on Drugs, which coordinates with 13 national drug observatories to administer surveys and questionnaires, prepare reports, and hold regional workshops. Ms. Hynes reported that NPS use is reported in at least nine countries, is increasing among young people, and may be associated with fatalities. She added that there are few hard data and the region needs to expand the SMART early warning system as well as regional and cross-national programs to address NPS use. Jane Maxwell, Ph.D., University of Texas at Austin, discussed how NSP use in the United States might have peaked in 2011, but the number of substances increases annually and use patterns change dramatically from year to year. She added that amphetamine-type stimulants are being replaced by new formulations of highly potent cathinones that use phenylacetone, which is legal in Mexico, to avoid bans on precursor chemicals such as ephedrine and pseudoephedrine. Dr. Maxwell described how use of NPS increases as perceptions of harm decrease, the need for prevention interventions to inform parents and adolescents about harms associated with synthetic substances, and a recent resource, Will They Turn You Into a Zombie? What Clinicians Need to Know about Synthetic Drugs, which is available from the Addiction Technology Transfer Center Network.

NIDA Humphrey Fellowships 25th Anniversary

NIDA International Program Associate Director Dale S. Weiss and J. Randy Koch, Ph.D., VCU, co-chaired the international networking session. NIDA Associate Director Susan Weiss, Ph.D., described the Institute’s National Drug Facts Week, which engages teens and communities in online discussions about the impact of drug abuse. Joni Rutter, Ph.D., director of the NIDA Division of Basic Neuroscience and Behavioral Research, described opportunities for international cooperation through U.S. National Institutes of Health programs. Forum participants joined current and former officials and fellows to celebrate the 25th anniversary of the NIDA Hubert H. Humphrey Drug Abuse Research Fellowships. The U.S. Department of State funds Hubert H. Humphrey Fellowships in 16 fields of study. Former President Jimmy Carter, who signed the legislation establishing the fellowships, recorded a message lauding the Humphrey Fellowships as an effective tool in meeting complex global challenges like public health. Judy Gibson, who heads the Humphrey Fellowship Program at the Institute of International Education, reviewed the history of the program and shared reflections from NIDA Humphrey alumni. Former NIDA International Program Director M. Patricia Needle, Ph.D., described how the HIV epidemic among drug users prompted international scientists to contact NIDA and drove the Institute’s decision to establish international fellowship programs. She described how NIDA Humphrey alumni multiplied their experiences as fellows by expanding drug abuse and drug-related HIV/AIDS research and practice in their home countries. She added that the NIDA International Forum was created after the first NIDA Humphrey Fellows recognized a need for an international presence at the CPDD meeting, and that fellows became the core of larger regional and international networks that foster ties between NIDA grantees and researchers from other countries. Robert L. Balster, Ph.D., coordinator of the NIDA Humphrey Fellowship Program at VCU, chaired a panel discussion by Humphrey Fellowship alumni who discussed how the fellowship affected their careers in drug abuse. The panelists included Rawnak Aqrawi, Iraq; Chinyere Okonkwo, Nigeria; Riza Sarasvita, Indonesia; and Dr. Montoya of NIDA.

Breakout Sessions

Four breakout sessions explored aspects of addiction treatment in more depth:

  • Advances in Addiction Research in Canada—Canadian health agencies have adopted an integrated approach to brain health research. CIHR speakers reported on recent advances and new initiatives to address dual diagnoses, cultural interventions, and capacity building in addiction research.
  • Vaccination for Addiction and AIDS—Jacques Normand, Ph.D., director of the NIDA AIDS Research Program, and Yu “Woody” Lin, Ph.D., NIDA Division of Clinical Neuroscience and Behavioral Research, co-chaired this session that discussed translating innovative research into clinical practice. Speakers reported on the latest efforts to develop vaccines to protect against HIV/AIDS, heroin, and cocaine addiction.
  • Substance Use Treatments: Secondary Analyses Using the Clinical Trials Network (CTN) Datashare—Betty Tai, Ph.D., and Carmen Rosa, M.S., both of the NIDA Center for Clinical Trials Network, co-chaired the session on the value of conducting secondary analyses to advance knowledge of evidence-based treatments. Speakers presented information about the CTN public datashare website, methods, and results of secondary analyses conducted using the datasets.
  • Advances in Treatment for Marijuana Dependence—Ivan D. Montoya, M.D., M.P.H, deputy director of the NIDA Division of Pharmacotherapies and Medical Consequences of Drug Abuse, chaired this session about the latest research on pharmacological treatments for marijuana dependence.