Fiscal Year 2006 Budget Information

Congressional Justification

Authorizing Legislation: Section 301 of the Public Health Service Act, as amended.

This document provides justification for the Fiscal Year 2006 activities of the National Institute on Drug Abuse, including HIV/AIDS activities. A more detailed description of the NIH-wide Fiscal Year 2006 HIV/AIDS activities can be found in the NIH section entitled "Office of AIDS Research" (OAR).

Introduction

Supporting and conducting science that will help prevent and treat drug abuse is the ultimate goal of the National Institute on Drug Abuse (NIDA). The economic burden of drug abuse on our society is estimated to be more than $484 billion per year according to the Office of National Drug Control Policy (ONDCP) and the Robert Wood Johnson Foundation. As the world's largest supporter of research on the health aspects of drug abuse and addiction, NIDA supports a comprehensive research portfolio that continues to bring us new knowledge about addiction and has led to our current understanding of addiction as a disease. From research we know that addiction is a chronic relapsing disease associated with long lasting changes in the brain and the body that can affect all aspects of a person's life. Having more widespread acceptance of the disease model of addiction is a top priority for the Institute, our patient population, and the field. We are making progress in this area by working with others to bring science to communities across the country and convincing them that addiction is a preventable and treatable disease, and in turn reducing the stigma associated with addiction.

New research supported by NIDA and others is revealing that drug addiction is a "developmental disease." That is, it often starts during the early developmental stages in adolescence and sometimes as early as childhood. Last year almost 3 million 12-17 year olds reported using illicit drugs. This is a time when the brain is undergoing major changes in both structure and function. We now know that the brain continues to develop throughout childhood and into early adulthood. Exposure to drugs of abuse at an early age may increase a child's vulnerability to the effects of drugs and may impact brain development. NIDA has increased its emphasis on adolescent brain development (see the "Initiatives" section for more information) to better understand how developmental processes and outcomes are affected by drug exposure, the environment and genetics. Recent advances in genetic research have enabled researchers to start to investigate what genes make a person more vulnerable, which genes protect a person against addiction, and how genes and environment interact. As part of the prevention portfolio we are also involving pediatricians and other primary care physicians to develop tools, skills and knowledge to be able to screen and treat patients as early as possible, including patients with mental disorders who may be at a high risk to develop addiction. We know that if we do not intervene early, drug problems can last a lifetime, making prevention a high research priority.

Treatment is another priority area for NIDA. Tremendous effort is underway to develop, test, and ensure the delivery of evidence-based interventions to all practitioners and patients across the country. Building on advances from our basic neuroscience and behavioral research program NIDA has introduced a number of effective medications and behavioral treatments. For example, there are about 60,000 people who are being treated with a medication that NIDA helped to develop. Buprenorphine, sold under the brand name Suboxone is the very first medication that can be prescribed by physicians in their office setting to patients who are addicted to heroin or prescription pain killers. Our increased understanding of the brain mechanisms involved in addiction is providing us with new targets for addiction, including testing new compounds for America's most abused illegal substance -- marijuana. NIDA is developing new treatments for marijuana abuse and addiction, especially for adolescents and those who suffer from co-occurring mental illnesses.

We are also continuing to look for more innovative, efficacious, and cost-effective ways to treat patients for a variety of addictions, including addiction to nicotine. Because data tell us that there are about 46 million people who smoke cigarettes and that about 70% report that they want to quit, NIDA is encouraging more research on smoking cessation quitlines. Quitlines can provide telephone-based counseling, and in some cases nicotine replacement therapies to smokers who want to quit smoking. When they're used as part of a comprehensive tobacco control plan, they can help increase smoking abstinence rates and reach out to new audiences, like pregnant smokers and minority populations. (See our nicotine "Story of Discovery.") We are also trying new approaches, like the Internet, to reach out to new populations and to recruit patients for our clinical trials, particularly adolescents and young adults who may be in need of treatment. For example, we have placed an electronic ad so that individuals who conduct searches for "no prescription Vicodin" and similar requests will now be invited to read the patient recruitment brochure on "Buprenorphine/Naloxone-Facilitated Rehabilitation for Heroin Addicted Adolescents/Young Adults," conducted through NIDA's Clinical Trials Network or to contact the study site nearest to them. This innovative recruitment effort exemplifies how we are using our National Drug Abuse Treatment Clinical Trials Network (CTN) to help respond to emerging public health needs like prescription drug abuse and the increases in patients who are seeking treatment for both substance abuse and mental disorders, like attention deficit hyperactive disorder (ADHD). (See the "Initiatives" section for more information.)

Another important treatment priority for NIDA is curtailing the spread of HIV/AIDS. Because illicit drug use can impact decision-making and increase the likelihood that an individual will engage in risk-taking behaviors, treatment for drug abuse is, itself, HIV prevention. Drug abuse treatment can reduce activities related to drug use that increase the risk of getting or transmitting HIV. NIDA is especially interested in reducing HIV/AIDS rates in racial and ethnic minority populations, which are disproportionately affected by this disease. Almost half of HIV/AIDS cases occur among African Americans even though they constitute only about 12% of the population according to the latest Census data. Understanding the factors that are driving this epidemic in these populations is an important research area for NIDA.

Recognizing substance abuse as a disorder that can affect the course of other diseases, including HIV/AIDS, mental illness, trauma, cancer, cardiovascular disease and even obesity is critical to improving the health of our citizens. We have launched several efforts to reach out to numerous professions within the medical community. For example, to reach psychiatrists we partnered with the American Psychiatric Association at their annual conference to focus on how to better integrate the science of addiction into psychiatric practice. Topics such as comorbidity of substance abuse and mental illness, the effects of substance abuse during pregnancy on children, and the effects of stress and trauma on substance abuse disorders will help the 30,000 psychiatrists in attendance better diagnose and treat patients with substance abuse disorders.

In these times when science is advancing very rapidly, but resources may not be, it is imperative that we retain the flexibility to address issues of concern and to meet scientific needs. NIDA has initiated a number of activities to ensure we are best utilizing our resources and identifying the most critical research priorities. We are doing this systematically in light of two major factors: National needs and scientific opportunities. We have reached out to our National Advisory Council and others to assist us in our priority setting exercises. Some of the new and expanded initiatives that we think will improve the health of all Americans, especially those directly affected by drug abuse and addiction, are presented here.

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