NIDA deserves recognition for "building a strong foundation for continuing scientific progress" that provides benefits not only in the area of drug abuse, but also in basic neurobiology, psychiatry, pain research, and related fields of research, according to the Committee on Opportunities in Drug Abuse Research. The panel of scientists, convened by the Institute of Medicine (IOM) of the National Academy of Sciences, has made broad policy recommendations to NIDA for future directions in drug abuse research. In numerous cases, the committee recommended continuing NIDA-established research priorities.
The panel includes experts in neuroscience, clinical research and treatment, psychopharmacology, epidemiology, prevention, AIDS research, fetal and child development, public health, law, and public policy. Its findings and recommendations were published late last year in a 310-page book, (see bottom of page).
The 16-member panel said that government policies to control drug abuse too often pit the goals of law enforcement against those of science and medicine. By working from what the panel calls a comprehensive public health perspective, policy-makers can help avoid divisive public debates over whether drug abuse can be addressed best through drug supply reduction by law enforcement or by developing medications and treatments to reduce drug demand, the committee reported.
The panel said that placing law enforcement goals in competition with scientific goals creates bureaucratic barriers between research sponsored by the Department of Justice and that sponsored by the Department of Health and Human Services.
Because efforts to limit the availability of drugs-called supply reduction-are seen as the realm of the police and courts rather than a major consideration for scientific researchers, the effects of law enforcement on the prevalence and social consequences of drug abuse tend to be overlooked by drug abuse researchers, according to the panel. Drug abuse research designs should more fully recognize the powerful influences of drug law enforcement on the lives and behaviors of drug abusers, the experts said.
In turn, they said, police and prosecutors should also consider broad issues outside the realm of law enforcement. While drug law enforcement places few limits on drug abuse researchers, it can place restrictions on the legitimate practice of medicine. Doctors may under-prescribe because they are overly concerned about scrutiny of their prescription of controlled substances as pain or treatment medications, the panel indicated.
The report noted that drug abuse research, even though it now has priority status, still must compete for funding with other high-priority fields of health research and with other pressing public needs. A number of mechanisms were identified by the committee to increase the cost-effectiveness of drug abuse research. They include maintenance of stable funding, use of the comprehensive public health framework, and encouraging wider acceptance of drug dependence as a medical problem. Other mechanisms include better translating of research findings into practice, raising the status of drug abuse research, and increasing emphasis on an interdisciplinary approach to research.
NIDA, as the primary Federal funding agency for drug abuse research,"deserves credit for stimulating and supporting the talented scientists who have moved the field forward," and "for maintaining a coherent scientific agenda in the face of shifting political winds," said the committee's report.
The committee, formed in January 1995 and chaired by University of Virginia law professor Richard J. Bonnie, made a number of recommendations in key areas of research and policy, many of them in support of research already under way at NIDA. Included are recommendations to:
- Expand multidisciplinary research to investigate the combined effects of biological, psychosocial, and contextual factors in the development of drug use, abuse, and dependence.
- Evaluate universal versus targeted prevention intervention programs with regard to effectiveness and cost-effectiveness.
- Expand research regarding drug use and HIV transmission, including effects of maternal drug use.
- Conduct more research on connections among violence, drug abuse, and co-occurring psychiatric disorders.
- Intensify research to improve and evaluate the effectiveness of drug abuse treatment, including investigating strategies to match patients to the most appropriate forms of treatment, developing treatment medications, and increasing the efficacy of pharmacotherapies and psychosocial therapies to treat individuals with co-occurring psychiatric disorders and drug abuse.
- Address fears that managed care's cost-cutting strategies may undermine drug abuse treatment programs by examining the organization, financing, and characteristics of drug abuse treatment in the managed care setting.
- Take steps to recognize the effects of law enforcement controls on drug availability as an important component of a comprehensive drug abuse research strategy.
"In the final analysis," said the IOM panel, "the value of the Nation's investment in drug abuse research is measured in lives saved and reclaimed, in the success of each young person who stays in school and joins the work force, and in the happiness of each child nurtured by his or her parents rather than abused or abandoned by them."
This statement was endorsed by Dr. Timothy P. Condon, NIDA's assistant director for science policy, who noted that the Institute is committed to continuing high-quality, results-oriented research and will carefully evaluate the IOM recommendations in developing future research policy.
Pathways of Addiction: Opportunities in Drug Abuse Research is available for $49.95 from National Academy Press, Lockbox 285, 2101 Constitution Ave., NW, Washington, DC 20055. To order by phone using a credit card, call (800) 624-6242.