August 9, 2016

June 10–13, 2016
Palm Springs, California

More than 200 participants from 45 countries participated in the 21st Annual NIDA International Forum, held June 10–13, 2016, in Palm Springs, California. International Program Director Steven W. Gust, Ph.D., chaired the meeting. College on Problems of Drug Dependence (CPDD) International Committee Chair Clyde McCoy, M.D., University of Miami Miller School of Medicine, encouraged younger Forum participants to take advantage of the meeting’s education and networking activities to “create partnerships that will last throughout the lifetime of your career” and urged senior scientists to respond to the questions and enthusiasm of junior and international participants.

A joint NIDA International Forum/CPDD poster session featured presentations on international research by 141 scientists from the United States and 45 other countries. Tatiana Yaroslavtseva of Russia received the CPDD International Committee Award for Best International Research Poster for her presentation, “Fatal Overdose in Recently Detoxified HIV-Infected People Who Inject Drugs in St. Petersburg, Russia—Role of Naltrexone?”

Report on the NIH Marijuana and Cannabinoids Neuroscience Research Summit

NIDA Division of Extramural Research Director Susan Weiss, Ph.D., reviewed scientific findings presented during the March 2016 National Institutes of Health (NIH) meeting, Marijuana and Cannabinoids: A Neuroscience Research Summit. Focusing on neurological and psychiatric domains, Summit participants discussed both adverse and potential therapeutic effects of marijuana, other cannabinoids, and the endocannabinoid system. Dr. Weiss described the role endocannabinoids play in brain areas responsible for regulating brain development, memory and cognition, movement coordination, pain regulation and analgesia, immunological function, appetite, and motivational systems and reward. Exogenous compounds, endogenous manipulation, and receptor targets all offer potential therapeutic approaches for marijuana research.

Summit participants described neuroimaging data that support some findings that adolescent marijuana use adversely influences learning, produces effects on memory and attention that outlast intoxication, and appears to have more severe consequences with earlier age of onset or more chronic use. Multiple interacting factors and individual differences influence the effects of adolescent marijuana use and require large longitudinal studies such as the NIH Adolescent Brain Cognitive Development (ABCD) Longitudinal Study. Marijuana research questions include:

  • Does cognitive ability (and corresponding brain alterations) recover with abstinence?
  • What are the parameters of cannabis use sufficient to produce cognitive impairment?
  • How does other drug use (e.g., alcohol, nicotine) influence outcomes?
  • Are there individual, gender, or other differences in susceptibility?
  • How might dose, strain, or potency differences affect cognitive impairment?

Research has found that marijuana use may trigger genetic vulnerabilities for psychosis, with apparent dose-related protective effects from cannabidiol and dose-related negative effects from ∆9-tetrahydrocannabinol. More research is needed to determine the precise nature of the association between cannabis use and the development of schizophrenia, including who is at risk, the effect of potency, differences between synthetic and natural cannabinoids, neurodevelopmental or physiological differences, and potential protective factors.

Summit participants reported that much marijuana policy research does not focus on important details in policy specifics, legalization, economic impacts, and public health outcome measures. They recommended that future research should follow the models developed for evidence-based public health approaches to tobacco control. Important research questions address demand reduction, harm reduction, and preventing underage use.

Dr. Weiss also highlighted international studies conducted or under way in Canada, Germany, The Netherlands, and New Zealand. She noted that international research allows scientists to take advantage of natural experiments in marijuana control, prevention, and treatment.

Report on UNGASS and UNODC

Elizabeth Sáenz, M.D., M.P.H.D.C., MSc., works with the United Nations Office on Drugs and Crime (UNODC) to develop and promote adoption of evidence-based drug treatment programs and policies. She reported on the international drug control system and the recent United Nations General Assembly Special Session (UNGASS) on the World Drug Problem, which adopted goals that highlight drug demand reduction, the International Standards of Treatment of Drug Use Disorders, and evidence-based drug prevention and treatment of substance use disorders.

Dr. Saenz outlined UNODC programs that provide advocacy and policy support, build capacity, improve drug treatment services, conduct assessments, collect data, and develop technical tools. She described how UNODC fosters a continuous dialogue between researchers, policymakers, and treatment providers and stressed that UNODC works to help nations recognize drug use disorders as health problems; address circumstances, conditions, and vulnerabilities that contribute to substance use; and stop discrimination and stigma.

Panel Discussions

Three panel discussions focused on “new” psychoactive substances, international efforts to educate physicians to treat addiction, and globalization and health consequences of waterpipe tobacco.

The “new” psychoactive substances (NPS) situation is constantly changing. Jane Maxwell, Ph.D., a research professor at the University of Texas at Austin, is developing use estimation techniques for new psychoactive substances. She chaired a session to provide an overview on NPS use and emerging trends around the world that also included presentations by Paul Griffiths, M.Sc., European Monitoring Centre on Drugs and Drug Addiction; Michael Farrell, FRCP, FRCPsych, University of New South Wales, Australia; and Mustafa al’Absi, Ph.D., University of Minnesota Medical School.

Mr. Griffiths provided an update on NPS from the European perspective, reporting that globalization and technological developments have contributed to an international problem that changes rapidly and limits the ability of international organizations and individual governments to monitor and respond effectively. He predicted that the already blurred lines between medicines, illicit drugs, NPS, and food supplements will contribute to increasing polydrug use and drug interactions as well as increasingly potent and sophisticated NPS.

Dr. Farrell noted that NPS use is a significant practice among psychostimulant users, and that riskier patterns of binge use and overdose are common among poly NPS users. He added that online marketplaces—such as the “Dark Net”—recover quickly from law enforcement disruptions or scams perpetrated by other illicit marketers.

Dr. al’Absi reviewed dramatic increases in the use of khat and synthetic cathinones from the traditional African and Arabian markets to Australia, the United States, and Western Europe. He described progress and achievements of the Khat Research Program to promote international research on khat use and related mental health and substance use problems.

The need to educate physicians to treat addiction is being increasingly recognized across the globe. Yet few initiatives exist on national levels to train physicians to address addiction and related comorbidities. Jeffrey Samet, M.D., M.A., M.P.H., Boston University School of Medicine/Boston Medical Center, chaired a session detailing training efforts under way in Vietnam, Russia, Switzerland, and the United States.

Le Minh Giang, M.D., Hanoi Medical University, Vietnam, and Gavin Bart, M.D., Ph.D., University of Minnesota Hennepin County Medical Center, described a Vietnamese addiction training program supported by the President’s Emergency Plan for AIDS Relief, the Substance Abuse and Mental Health Services Administration, and the Embassy of France in Vietnam. The program focuses on workforce development to transition from guards at compulsory commitment facilities to treatment staff capable of supporting evidence-based drug courts and medication-assisted therapy for people who inject drugs. The training program is being designed to adapt to emerging drug use trends and to create a medical school training infrastructure that can expand after the international funding expires.

Edwin Zvartau, M.D., Ph.D., D.M.Sci., First St. Petersburg Pavlov Medical University, Russia, described how government-mandated changes in medical education and primary care medicine prompted development of cross-disciplinary curricula about alcohol and drug use. The curricula were designed to harmonize and unify addiction topics and teaching methods across all theoretical, medical-biological, and clinical university departments. A cross-disciplinary task force will coordinate implementation and updates. A 2014 government study reported that addiction medicine training in Switzerland differed among the country’s medical schools and often depended upon a single faculty member’s interest in the topic.

Nicolas Bertholet, M.D., Lausanne University Hospital, Switzerland, described efforts to create an addiction subspecialty through the Swiss Society of Psychiatry and a certification program in addiction medicine through the Swiss Society of Addiction Medicine. Medical schools are encouraged to establish mandatory, interdisciplinary, pre- and postgraduate addiction medicine training that prepares primary care physicians to recognize addiction as a chronic medical disease and to screen patients for treatment.

Dr. Samet described the opportunities for international physicians to participate in the Boston Medical Center’s 4-day Chief Resident Immersion Training Program. Because chief residents play a key role in training U.S. physicians, the program uses a “train-the-trainer” model to provide chief residents with state-of-the-art methods to diagnose and manage addiction and to teach about addiction medicine.

Use of waterpipes is increasing at a global level. Kevin Walton, Ph.D., who serves as the NIDA Program Official for clinical trial grants evaluating new therapeutics for smoking cessation, chaired a session that presented research on prevalence, health impact, and treatment that is endeavoring to keep pace with the increasing use of waterpipes and growing public health concern.

Wasim Maziak, M.D., Ph.D., Florida International University, described how factors such as reduced perceptions of harm, lack of effective policies, Internet-fueled popularity, marketing aimed at young people, and commercialized production have contributed to increased use of waterpipes. Despite reduced perceptions of harm, he noted that tobacco consumed with a waterpipe exposes users to 1.7 times more nicotine, 6.5 times more carbon monoxide, and 46.4 times more tar than cigarettes do. Dr. Maziak suggested that researchers develop waterpipe-specific surveillance instruments and policymakers develop evidence-based waterpipe prevention programs and control policies.

Tracey Barnett, Ph.D., University of Florida, reported that waterpipe tobacco is now the second most commonly used tobacco product among adolescents, with use highest among most young adult populations. She added that waterpipe use is increasing significantly, particularly among females and African Americans, and is linked to future cigarette and other tobacco product use.

Caroline Cobb, Ph.D., Virginia Commonwealth University (VCU), discussed significant toxicant exposures and disease risks for waterpipe users whether they smoked tobacco or tobacco-free products, and recommended that future waterpipe research include tobacco-free controls. She noted that researchers need to examine misperceptions of harm for all waterpipe products, and that regulating tobacco-free products will challenge policymakers.

Kawkab Shishani, Ph.D., Washington State University, reviewed differences between daily and intermittent waterpipe users, reporting that intermittent users have more difficulty quitting smoking than do daily waterpipe users. She presented studies that found intensive behavioral and contingency management interventions were effective at promoting smoking cessation among intermittent waterpipe users. Dr. Shishani stressed, however, that no treatment guidelines exist for intermittent waterpipe users and more research is needed, particularly on the effect of social context.

International Networking Session and Publishing Workshop

NIDA International Program Associate Director Dale S. Weiss co-chaired the NIDA International Networking Session with J. Randy Koch, Ph.D., VCU. Office of Science Policy and Communications Director Jack Stein, Ph.D., discussed how NIDA uses social media—such as Twitter, LinkedIn, Facebook, and YouTube to engage its audience. Dr. Stein also described how National Drug and Alcohol Facts Week and its related online Chat Day have “gone global” thanks to participants in the NIDA International Forum.

NIDA Hubert H. Humphrey Drug Abuse Research Fellow Jessica Beltran, M.D., Peru, described how the 2015–2016 Humphrey Fellows learned to implement National Drug and Alcohol Facts Week events when they return to their home countries by developing activities near the VCU campus.

David Otiashvili, M.D., Ph.D., is a 2003–2004 NIDA Humphrey Fellow who focuses on harm reduction, HIV and drug use prevention, and policy research at the addiction research center Alternative Georgia. He described binational and regional research projects and addiction research training programs in the Republic of Georgia established in collaboration with his Humphrey Fellowship colleague Tomas Zabransky, Ph.D., who conducts epidemiology, prevention, and policy research at Charles University in Prague.

The International Society of Addiction Journal Editors (ISAJE) supported a workshop on preparing research for publication. ISAJE President Richard Pates, Ph.D., editor of the Journal of Substance Use, and ISAJE Board Member Richard Saitz, M.D., M.P.H., Boston University School of Public Health and editor of Addiction Science & Clinical Practice, led the workshop. 

Awards of Excellence

NIDA International Awards of Excellence recognize individuals for outstanding contributions to international cooperation in drug abuse research and training. During the NIDA International Forum, these awards were presented for:

  • Excellence in mentoring, to J. Randy Koch, Ph.D., Virginia Commonwealth University, for his work with the VCU Hubert H. Humphrey Fellowship Program on Substance Abuse Prevention, Treatment, and Policy to improve the delivery of health care services and promote evidence-based prevention and treatment of substance abuse throughout the world.
  • Excellence in international leadership, to Marya Hynes, Organization of American States (OAS), for her work coordinating regional research and training programs, establishing strategic partnerships among Latin American political agencies and international substance abuse research organizations, and launching several NIDA-OAS initiatives, including REDLA – the Latin American Epidemiology Work Group.
  • Excellence in collaborative research, to Mustafa al’Absi, Ph.D., of Minnesota Medical School, for his work investigating the concurrent use of khat and tobacco, building research capacity in the Middle East and North Africa, and establishing the Africa and Middle East Congress on Addiction to help local scientists address issues in addiction and related psychiatric disorders.