National Institute on Drug Abuse
Director's Report to the National Advisory Council on Drug Abuse
May, 1998
Congressional Affairs
FY 1999 APPROPRIATIONS
On March 19, 1998, NIDA Director Alan Leshner testified before the House Appropriations Subcommittee on Labor, Health and Human Services, and Education. Dr. Leshner told the Subcommittee members that NIDA had a "year of exceptional accomplishment", and that "NIDA-supported researchers made enormous strides toward improved understanding, prevention and treatment of one of our Nation's most serious public health problems--drug abuse and addiction." Highlighting NIDA's efforts to launch its first ever large scale multi-center clinical trial for cocaine medication, Dr. Leshner explained that NIDA is capitalizing on a body of current findings that suggest that medications consistently work better when they are used in combination with behavioral therapies. He went on to say that addiction science "has matured to the point where we can take a more systematic approach to rapidly and efficiently test the effectiveness of behavioral, psychosocial and pharmacological treatments in large-scale, multi-site clinical trials."
Dr. Leshner cited some of NIDA's major scientific accomplishments, including the use of functional magnetic resonance imaging (fMRI) to look at the dynamic changes of the brain as an individual takes a drug; research demonstrating the long-lasting neurochemical and neurotoxic effects of methamphetamine abuse; and effective drug addiction treatments such as methadone, LAAM (levo-alpha-acetyl-methadol), and nicotine-replacement therapies. In closing, he emphasized the need for a multi-disciplinary approach to unravel the remaining mysteries of addiction and noted future scientific opportunities in addiction treatment, genetics research, and drug prevention for children and adolescents. The full text of Dr. Leshner's formal statement is available on NIDA's homepage at http://www.nih.nida.gov.
During the question and answer period, Mr. Porter expressed great interest in techniques to effectively deliver the anti-drug message to young people. Dr. Leshner described some of NIDA's collaborative efforts with the private sector and with other federal agencies and pointed out that the arm of government that has taken major leadership in this area is the Office of National Drug Control Policy (ONDCP). He indicated that NIDA works closely with ONDCP to make sure that the national media campaign is scientifically accurate. He also spoke of the phenomenal growth of anti-drug coalitions throughout the country and described the effect of the Practical Theorist series, a publication of the Community Anti-Drug Coalitions of America, supported in part by NIDA, which translates scientific findings for practical use in community settings.
Rep. Hoyer asked Dr. Leshner to comment on the appropriateness of ONDCP's long- and short-term drug prevention strategies in terms of the objectives, time frame, and probability of success. Dr. Leshner called the strategy "positive" because it embraces a rational, systematic approach that incorporates science as the core element for each goal, and explained that we do not expect quick solutions to this complex problem. He emphasized that the strategy is realistic and in line with the current knowledge base and capabilities and reminded Mr. Hoyer that ONDCP will have the opportunity to raise the bar annually, in light of scientific breakthroughs and improvements in technical capabilities. Mr. Hoyer said that General McCaffrey, Director of ONDCP, considers NIDA to be a critically important component of the national drug prevention strategy.
Responding to a question on prenatal cocaine exposure, Dr. Leshner explained that the American public has moved from hysteria over "crack babies" in the 1980s to an excess of indifference. In fact, it has been found that children exposed to cocaine prenatally experience latent and subtle effects, including the emergence of attention deficit problems at ages 5-6 and learning problems at around 10. Also, the aggregate mean IQ of this population is 3 points lower, when compared to children without prenatal cocaine exposure. Currently, 1,400 children need intervention due to prenatal cocaine exposure.
When asked to comment on the existence of best practices in drug-free workplace policy, Dr. Leshner remarked on the importance of research on workplace drug prevention, noting that approximately 70% of addicts are employed. Research has shown that the most successful employee assistance programs are the ones that successfully match the most appropriate treatment modality with the individual employee.
Rep. Lowey expressed an interest in NIDA's Genetics of Addiction Initiative, saying that research will help clarify whether addiction has a biological or socioeconomic basis. Dr. Leshner responded that addiction is a result of interaction between genetics and environmental influences, adding that about 50-70% of an individual's vulnerabilities can be attributed to genetics, but not everyone who carries a genetic load will become addicted.
FY 1999 Funding Request:
For NIDA, the President's budget request for FY 1999, including the AIDS allocation, is $576.3 million, a 9.3 percent increase over FY 1998. The President's request of $14.798 billion for the NIH in FY 1999 is an increase of $1.15 billion (or 8.4%) over the FY 98 appropriations, and is part of a plan to increase the NIH budget to $20 billion by 2003, a 46 percent increase in NIH funding over the next five years.
SENATE APPROVED BUDGET PLAN
Before leaving for Spring recess, the Senate passed its FY 1999 budget resolution, S.Con.Res. 86, which outlines Congressional spending and revenue priorities for the $1.73 trillion federal budget. The Committee Report accompanying the budget resolution states the plan, as approved by the Senate Budget Committee, assumes an 11 percent increase in NIH funding for FY 1999.
- The Senate agreed by voice vote to a "sense of the Senate" amendment offered by Senator Connie Mack (R-FL) that the NIH budget should be increased by $2 billion in FY 99 and doubled over the next 5 years.
- The Senate rejected an amendment by Senator Specter, Chair of the Senate Appropriations Subcommittee with jurisdiction over NIH, to add $2 billion to the health portion of the budget to ensure his subcommittee would have adequate funds to provide the increase for NIH.
- Passed by voice vote was an amendment to prohibit the use of marijuana for medicinal purposes. The language was offered by Sen. Smith (R-OR) and was intended to specifically exempt "federally sponsored research." According to Senate staff, an error by the clerk resulted in omission of the research exemption, but subsequent efforts corrected the error.
- The Senate also agreed by voice vote to a "sense of the Senate" resolution that the next budget submission by the President and next Congressional budget resolution should reclassify all civilian research and development activities, including the NIH, within the "General Science, Space, and Technology" portion of the budget, also known as budget function 250. Currently NIH is in the budget function 550 (health).
DR. LESHNER TESTIFIES BEFORE THE SENATE
Nicotine Addiction
On February 10, 1998, at the request of the Senate Committee on Labor and Human Resources, Dr. Leshner testified on the topic of nicotine addiction.
Acknowledging that "just as with other drugs, ultimately our best treatment is prevention," Dr. Leshner emphasized that "Never before has the momentum for addressing this public health crisis been greater. There are tremendous scientific opportunities, based on at least two decades of scientific accomplishments."
Describing how emerging basic research is reinforcing what earlier studies indicated about the highly addictive nature of nicotine, he explained that recently scientists have been able to prove that some of nicotine's most important effects are exerted through the very same brain circuits as those of other drugs of abuse, supporting the convergence of data pointing toward at least one major commonality among all drugs of abuse: they all elevate levels of the neurotransmitter dopamine. This change in dopamine is believed to be a fundamental root of all addictions.
NIDA researchers are unraveling the mysteries of not only smoking as an addiction, but the findings give new insights that may be relevant to other addictions as well. Through NIDA's leadership, there are a variety of effective pharmacological and behavioral treatments to select from to help people conquer their smoking addiction, but we need more. Addiction researchers have developed a number of new pharmacological weapons to combat nicotine addiction and researchers are working on a number of non-nicotine replacement therapies as well. The preeminent compound in this line is Buproprion, trade name Zyban ®, which is showing promising results in treating nicotine addiction. In conclusion, Dr. Leshner pointed out that, as with all other disorders, it is research on addiction that provides hope for even more effective prevention and treatment approaches.
Addiction and Recovery
On a panel that included such celebrities as Bill Moyers and Carroll O'Connor, Dr. Alan Leshner testified before the Senate Appropriations Committee on March 24, 1998 to talk about what the science shows about drug addiction and recovery. Dr. Leshner delivered an optimistic message, saying that although drug addiction is a difficult disease to treat, drug abuse treatment does work --in fact, just as well as other established medical treatments. He said the most effective treatment approaches must attend to all of the addiction's biological and behavioral components. After describing NIDA's research and research dissemination efforts, Dr. Leshner reaffirmed NIDA's commitment to continuing to take the science to those who need it --the American public.
SELECTED BILLS OF INTEREST
Tobacco Legislation
S. 1415 -On November 11, 1997, Senator McCain (R-AZ) introduced the "Universal Tobacco Settlement Act." This bipartisan bill, approved by the Senate Commerce Committee during markup April 1, includes research funds for NIH and would establish an NIH Office of Tobacco Related Research. The bill, renamed ATobacco Products Control Act of 1998," would give NIH $2.5 billion annually from FY 1999 to 2008. This bill is expected to go to the Senate floor in May.
Among other provisions, the bill would authorize the NIH Director, in consultation with the National Tobacco Task Force, to use tobacco revenue to "conduct or support epidemiological, behavioral, biomedical, and social science research (including the training of researchers) related to the prevention and treatment of tobacco addiction and the prevention and treatment of diseases associated with tobacco use." According to the proposal, an NIH "tobacco-related research initiative" should be established by the Director of NIH in consultation with a National Tobacco Task Force. The task force would include the NIH Director, the Surgeon General, Administrator of AHCPR, public health officials and advocates, and would be chaired by a CDC representative. The task force would coordinate tobacco-related research activities in accordance with a research agenda that would be developed by IOM.
S. 1492 -On November 8, 1997, Mr. Kennedy (for himself, Mr. Lautenberg, Mr. Durbin, Mr. Reed and Mr. Kerry) introduced "Health and Smoke Free Children Act." The bill was referred to the Committee on Labor and Human Resources.
S. 1530 -On November 13, 1997, Senator Hatch (R-UT) introduced, "Placing Restraints on Tobacco's Endangerment of Children & Teens Act." Committee hearings were held in February and March by the Senate Judiciary Committee.
S. 1638 -On December 12, 1997, Senator Conrad (D-ND) introduced the "Healthy Kids Act." The bill was referred to the Committee on Finance.
S. 1648 -On Feb. 12, 1998, Senator Jeffords (R-VT) introduced the "Preventing Addiction to Smoking among Teens Act" or the "PAST Act." The bill would provide $2.5 billion annually to NIH for research funding for FY 99 -2008. The bill has two co-sponsors, Senators Susan Collins (R-ME) and Mike Enzi (R-WY), and was referred to the Committee on Labor and Human Resources.
S. 1889 --On March 31, 1998, Senator Tom Harkin (D-IA) introduced the "Kids Deserve Freedom From Tobacco Act of 1998," The bill would allocate yearly to NIH a certain percentage of a trust fund financed by taxes and penalties on tobacco manufacturers. Within NIH, funds would be allocated to the Institutes and Centers in the same proportion as they are otherwise appropriated. The director of each center would be required to appropriately prioritize the use of funds made available from the Fund for tobacco-related diseases and conditions, including those affecting women and minorities.
Medical Privacy
S. 1921 --On April 2, 1998, Senator James Jeffords (R-VT) introduced the "Health Care Personal Information Nondisclosure Act of 1998." The purpose of the bill is to establish strong and effective mechanisms to protect against the unauthorized and inappropriate use of protected health information, to promote the efficiency and security of the health information infrastructure, and to create incentives to turn personal health information into nonidentifiable health information for oversight, health research, public health, law enforcement, judicial, and administrative purposes. The bill has a number of provisions that would have an impact on health researchers: it delineates (1) the types of researchers who can gain access to protected health information, (2) the conditions under which researchers may obtain information, (3) access of research participants to their own health information and (4) the extent to which researchers may share information with others.
Federal Reports Elimination
S. 1364 --On March 10, 1998, the Senate Committee on Governmental Affairs marked-up and ordered favorably reported S. 1364, the Federal Reports Elimination Act of 1997, which seeks to eliminate "unnecessary and wasteful Federal reports." Included in the list of DHHS reports to be eliminated are the following: the biennial report of the NIH Director; the NIH annual report on administrative expenses; the annual report of the National Kidney and Urologic Diseases Interagency Coordinating Committee; the annual reports of the National Diabetes Advisory Board, the National Digestive Diseases Advisory Board, and the National Kidney and Urologic Diseases Advisory Board; the annual reports of the Arthritis and Musculoskeletal and Skin Diseases Interagency Coordinating Committee and Advisory Board; the report on health services research; the triennial report on drug abuse; the family planning and population research report; the sudden infant death syndrome research report; report of the Task Force on Aging Research; chronic fatigue syndrome research report; and the report on end-stage renal disease.
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