Director

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Directors Report to the National Advisory
Council on Drug Abuse
February 12, 2004
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Richard A. Millstein, J.D. Acting Deputy
Director NIH John E. Fogarty International
Center for Advanced Study in the Health Sciences
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Timothy P. Condon, Ph.D. Deputy Director, NIDA
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NIH Central Steering Committee

• Rotating Members (three year terms)
• Francis Collins Genome Research Institute
• Richard Hodes Aging
• Stephen Katz Arthritis Musculoskeletal Skin
  Diseases
• Donald Lindberg National Library of Medicine
• Stephen Straus Complementary Alternative
  Medicine
• Larry Tabak Dental Craniofacial Research
• Nora Volkow NIDA

• Permanent Members (three largest institutes)
• Andrew von Eschenbach National Cancer
  Institute
• Barbara Albin National Heart, Lung and Blood
  Institute
• Anthony Fauci National Institute of Allergy
  and Infectious Diseases

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Report by National Research Council and IoM
Enhancing the Vitality of the National
Institutes of Health Organizational Change to
Meet New Challenges
Create a public process for considering proposed
changes in the number of NIH institutes or
centers.
2.
4.
Enhance and increase trans-NIH strategic planning
and funding.
Create a Directors Special Projects Program to
support high risk, high potential payoff research.
7.
8.
Promote innovation and risk-taking in intramural
research.
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THE NIH ROADMAP
An Agency-Wide Effort To Identify the Critical
Roadblocks and Knowledge Gaps That Constrain
Rapid Advances in Biomedical Research Progress

• Molecular Libraries and Imaging
• Research Teams of the Future
• High-Risk Research
• Private-Public Partnerships
• Re-engineering the Clinical Research Enterprise

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What Has NIDA Done to Ensure Participation of
Substance Abuse Researchers on the NIH Roadmap?

• Dr. Condon named NIDAs representative for
• the Roadmap
• Program officers have contacted potential
  grantees to
• encourage them to submit grants for Roadmap
  RFAs
• Created a page on NIDA website that
  highlights
• opportunities from the roadmap relevant to
  NIH
• grantees
• Periodic staff meetings with NIDA Director to
  review
• progress and plan strategies

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Ethics Issues at NIH
Concern by congress that there may be conflict
between the role of NIH directors and of NIH
scientists and private partnerships
New Initiatives to Strenthen the NIH Ethics
Program

• Raynard S. Kington, M.D., Ph.D., NIH Deputy
  Director, appointed
• as Deputy Ethics Counselor (DEC) for the NIH and
  the Office of the
• Director, NIH
• Blue Ribbon Panel established to review current
  NIH Ethics policies
• NIH Ethics Advisory Committee (NEAC) established
• (composed of members of the NIH community)

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NIH Consolidation and Centralization Activities
(occurring through several approaches)
Outsourcing studies NIH competes against
outside contractors Extramural Support was
studied last year 656 FTEs now in ICs (22 in
NIDA) will be centralized into a new NIH Office
the MEO Most Efficient Organization --
Implementation Date April 1, 2004.
NIH Administrative Restructuring Plan ARAC
(Administrative Restructuring and Advisory
Committee) Consolidation of functions in several
areas including Personnel, Grants Management,
Budget, Acquisitions, Information Technology,
Facilities, Financial Maagement and EEO
Harmonization of and accountability for achieving
both corporate NIH objectives and IC-specific
objectives Looking at Dual Reporting for
senior IC staff
FTE Ceiling imposed to limit the number of NIH
employees at each institute NIDAs is 373 in
FY04
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NIDA BUDGET
(Thousands)
NonAIDS
AIDS
TOTAL
Increase Over Prior Year
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New NIDA PAs and RFAs

• Prevention Research (Children and Adolescents)

• Novel Approaches to Phenotyping Drug Abuse
  (RFA)
• Behavioral and Cognitive Processes in
  Adolescent Drug Abuse (RFA)
• Animal Models of Adolescent Drug Abuse (RFA)
• Prevention Research for the Transition to
  Adulthood (RFA)
• Consequences of Marijuana Use on the Developing
  Brain (RFA)

• Treatment Interventions

• Medications Development for Cannabis-Related
  Disorders (RFA)

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New NIDA PAs and RFAs

• HIV/HCV

• Drug Abuse Aspects of HIV/AIDS and Other
  Infections (PA)
• HIV/AIDS and Other Infections Among Drug Users
  in the Criminal
• Justice System (RFA)
• Targeted Integrative Research in Drug Abuse
  and HIV/AIDS in
• Pregnancy (RFA)

• Training

• Research Education Grants in Drug Abuse and
  Addiction (PA)

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PAs and RFA With Other NIH Components
8 New PAs and 4 New RFAs (Totaling 9.8 Million)
Focus predominantly on CO-MORBIDITY Mental
illness Alcoholism HIV
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NIDA/SAMHSA Addiction Technology Transfer Center
(ATTC) Blending Initiative
BLENDING TEAMS
Members of CSATs ATTC Network NIDA Researchers
Training materials and products to help
program managers, administrators and policy
makers use Addiction Severity Index
(ASI) results for management and program planning
decisions
Buprenorphine awareness training and materials
for non-physicians in the drug abuse and
addiction field
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Society for Neuroscience Annual Meeting
Opening Plenary Lecture THE ADDICTED HUMAN
BRAIN Nora D. Volkow, M.D., Director, NIDA
 
NIDA-Sponsored Mini-Convention
 
Growth in Drug Abuse-Related Presentations

2002 471 of 13, 393 2003 576 of 16,155
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We Recently Released Our New Website for Teens!
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NIDAs Primary Healthcare Outreach Initiative
Educational Seminar for Primary Health Care
Providers Co-sponsored by NIDA and the Sheppard
Pratt Health System Sheppard Pratt Conference
Center Baltimore MD December 17, 2003 Tent at
New Years Eve Spectacular (widely attended
alcohol- drug- and smoke-free community event)
Co-sponsored by NIDA in collaboration with the
Maryland Chapter of the American Academy of
Pediatrics, coalition partners and corporate
sponsors Baltimore MD December 31, 2003
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Science Highlights
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Percent of Students Reporting Past Month Use of
Any Illicit Drug
GREAT NEWS!!
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19.4
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18.2
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17.3
17
16
2001
2002
2003
11 Decline 2001 to 2003
Monitoring the Future Study 2003
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Percent of Students Reporting Abuse of Pain
Killers in Past 12 Months in 2003
WORRISOME NEWS
12.0
10.5
10.0
7.2
8.0
Percent
8th Grade
6.0
10th Grade
4.5
12th Grade
3.6
4.0
2.8
1.7
2.0
0.0
Oxycontin
Vicodin
Source Monitoring the Future Study, 2003.
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Numbers of New Abusers of Prescription Drugs
1965-2001
Source SAMHSA, 2002 NSDUH
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Millions of Americans Abuse Prescription Drugs
Use of Prescription Drugs for Non-Medical
Purposes 2002 National Survey on Drug Use and
Health
4.4 million
4.5
4
Millions of Americans
3.5
3
2.2 million
2.5
2
1.2 million
1.5
1
0.5
0
Sedatives
Stimulants
Pain Relievers
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Why Has the Abuse of Prescription Drugs Increased?

• Increasing numbers of prescriptions
• (greater availability)
• Attention by the media and advertising
  (television and newspaper)
• Easier access
• (e.g. internet availability)
• Improper knowledge and monitoring
• (adverse effects go unrecognized)

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As Prescriptions Increase Emergency Room Visits
For Non-Medical Abuse Have Also Increased
Hydrocodone
prescriptions
Number of Prescriptions (in 1000s)
emergency
Oxycodone
prescriptions
emergency
Source SAMHSA, DAWN, 2002
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Increased Media Attention
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Availability on the Internet Delivered
in the Privacy of your Home
Some reasons why you should consider using this
pharmacy No prescription required!
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Other Reasons for Concern

• These drugs can have serious medical
  consequences i.e lethal overdose with pain
  killers, psychosis with stimulant medications
• Misuse in elderly populations who are
  particularly sensitive to adverse medical
  reactions
• Increase use by adolescents of drugs that may
  have long term effects in brain development

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How Does NIDAs Science Help Fight Prescription
Drug Abuse?
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Continue Research on Prescription Drugs and on
Treatment and Prevention
When analgesics are injected they are much more
addictive than when taken orally hence
formulations that can interfere with the drug
effects if injected would decrease its diversion
and abuse
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Example for Marihuana As Perceived Risk
Increases Use Decreases
What could have accounted for this reduction?
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Reporting Use Reporting Harmfulness
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30
20
10
0
'75
'77
'79
'81
'83
'85
'87
'89
'91
'93
'95
'97
'99
'01
'03
Year

• Education of patients, physicians, pharmacists
  and the public

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Development of Alternative Medications with no
Drug Abuse Potential
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FY 2005 and Beyond
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NIDA FY 2005 Initiatives

• Prevention Research (Children and Adolescents)

• Gene/Environment Interactions
• Drug Exposure and the Developing Prenatal Brain
• The Effects of Drugs of Abuse Across the
  Lifespan
• Impact of Drugs, Risky Behavior and HIV on
  Adolescent Brain
• Drug Abuse Prevention and Treatment in Primary
  Care System
• Neurobiological Processes Underlying
  Co-morbidity

• Treatment Interventions

• Pharmacogenetics and Medications Development

• Training

• Using Science to Improve Providers Knowledge
  and Skills

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Systems and Translational Research Approaches in
Addiction

• Infrastructure Development and the Creation of
  Translational Research Centers

DRUGS OF ABUSE
social
behavior
neuronal circuits
protein expression
genome
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Brain, Behavior Health Roadmap
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Brain, Behavior Health Initiative Mission
To develop the knowledge and the technology
necessary for understanding how the human brain

• works and molds human behavior,
• how genes and environmental factors mold its
  development and function
• how it changes throughout the lifespan
•  

This knowledge will help to better understand
brain diseases including ADDICTION, and to
develop strategies to promote optimal health
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FIRST MILESTONE Create a matrix that will

• Catalog ongoing projects that pertain
• to a brain/behavior/health initiative
• Identify scientific questions
• Identify research areas of redundancy and areas
  that
• need to be developed
• Identify technology or infrastructure that needs
  to be
• developed
• Optimize chances for integrating efforts across
  research
• centers, institutes and agencies.

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Matrix is based on a systems approach including da
ta from all levels of biology genes, proteins
and their complexes, cell, circuits, behavior
individual and social. The matrix includes
projects in laboratory animals and implicitly
addresses development and gender.
Social Network
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BRAIN BEHAVIOR HEALTH ROAD MAP
2. Infrastructure Projects
3. Need for Technology
1. Scientific Question
SOCIAL NETWORKS
BEHAVIOR
CIRCUITS/ PATHWAYS
CELL
PROTEIN
GENE
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PAs and RFA With Other NIH Components
PAs
National Cooperative Drug Discovery Groups for
the Treatment of Mood Disorders or Nicotine
Addiction (NCDDG-MD/NA) Mechanisms of Alcoholic
Pancreatitis Neurotechnology Research,
Development and Enhancement Bioengineering
Research Partnerships HIV/AIDS, Severe Mental
Illness and Homelessness (with NIAAA and
NIMH) Ruth L. Kirschstein National Research
Service Awards for Individual Predoctoral
Fellows (F31) ELSI Regular Research Program
(R01) ELSI Small Grant Research Program
(R03)   Transdisciplinary Tobacco Use Research
Centers (with NCI and NIAAA) Group Therapy for
Individuals in Drug Abuse or Alcoholism
Treatment Screening and Intervention for Youth in
Primary Care Settings HIV/AIDS, Drug Use and
Highly Vulnerable Youth Targeting Research Gaps
(with NIMH)
RFAs
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Monitoring the Future Study 2003 Percent of
Students Reporting Any Illicit Drug Use in Past
Year, by Grade
60
50
12th Grade
40
10th Grade
30
20
8th Grade
10
0
75
77
79
81
83
85
87
89
91
93
95
97
99
01
03
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Recent NIDA Staff Appointments/Changes
Office of the Director
Cheryl Kassed, M.S.P.H., Ph.D., Special Assistant
to the Director Helen Cesari, M.S., Special
Assistant to the Deputy Director
Office of Science Policy and Communication
Susan Weiss, Ph.D. Chief, Science Policy
Branch Robin Mackar, M.P.H. Deputy Chief,
Science Policy Branch Gayathri Jeyarasasingam
Science Policy Branch
Office of Extramural Affairs
Mark Green, Ph.D. Deputy Director
Division of Epidemiology, Services and Prevention
Research
Arnold Mills -- Acting Chief, Epidemiology
Research Branch Kevin Conway, Ph.D. Deputy
Chief, Epidemiology Research Branch Yonette
Thomas, Ph.D. -- Deputy Chief, Epidemiology
Research Branch Jessica Campbell, Ph.D.
Epidemiology Research Branch Elizabeth Genexi,
Ph.D. Prevention Research Branch
Division of Treatment Research Development
Steve Oversby, Psy.D. Medications Research
Grants Branch Jennifer Wong, Ph.D. Regulatory
Affairs Branch
Center on AIDS and Other Medical Consequences of
Drug Abuse
Jag H. Khalsa, Ph.D. Acting Head, Medical
Consequences Unit Denise Burns
Center for the Clinical Trials Network
Theresa Montini, Ph.D. Arnaldo R. Quinones, M.D.
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NIDA-Sponsored Mini-Convention