Obama Transition Suggestions From the Friends of NIDA

The Friends of NIDA (www.thefriendsofnida.org) is a lobbying group which

advocates for a level of resources for NIDA that reflects the tremendous personal, social and economic burden of drug abuse and addiction.

Most of their mission is to lobby Congress for *additional funding for NIDA, for health-care parity (treating drug abuse disorders like any other medical problem) and for various other programs which may bring science-based solutions to bear on drug abuse.
The Friends of NIDA has issued a statement and requested that anyone with any connections to the Obama transition team bring it to their attention. It makes for a really nice summary of the general argument of this lobbying effort so I thought I'd bring it to your attention DearReader.


I put up the document here in case you want to read it.
A few highlights:

"Drug abuse and addiction are major burdens to society; economic costs
alone are estimated to exceed half a trillion dollars annually in the United States,
including health, crime-related costs, and losses in productivity. However,
staggering as these numbers are, they provide a limited perspective of the
devastating consequences of this disease," Dr. Nora Volkow, Director of the
National Institute on Drug Abuse, Congressional Testimony, 3/1/07

Drug Abuse and Addiction are major burdens to society.
The costs of drug abuse and addiction to our nation are staggering.
• Fourteen percent of patients admitted to hospitals have alcohol/drug abuse and
addiction disorders. Almost 20 percent of all Medicaid hospital costs and nearly
$1 of every $4 Medicare spends on inpatient care is associated with substance
abuse.
• 70 percent of individuals in state prisons and jails have used illegal drugs regularly.
Drug offenders account for more than one-third of the growth in state prison
population and more than 80 percent of the increase in the number of prison
inmatess since 1985.
• The economic burden in the United States for addiction is twice that of any other
disease affecting the brain, including Parkinson's and Alzheimer' Disease, as well
as all the others.

And yet the advocacy / public policy side struggles to make politicians, the public and the pharmaceutical industry understand that drug abuse disorders are huge problems.
The document also issues a six point request to the Obama Transition Team.

1. Review pending appointments of the Secretary of Health and Human Services, the Director of the Office of National Drug Control Policy and the Director of the National
Institutes of Health, to ensure that each will bring a research-informed approach to the
medical problems of addiction to tobacco, alcohol and other drugs...

Highly important of course. If the leadership and management that is responsible for health care and health care science doesn't get it, very little change in approach is going to happen. Unlike cancer, AIDS and Alzheimer's Disease, one cannot assume that people in line for these types of positions will automatically understand the importance of dealing with substance abuse disorders.

2. Recognize that drug addiction is a brain disease with behavioral, genetic, environmental and development components as proven by research supported by the National Institute
on Drug Abuse.

Nice NIDA branding there guys! But yes, we still have plenty of uninformed idiots running around who persist in thinking that addictions to many drugs are "psychological" meaning that they are somehow not real and not medical in nature. Understanding of the science is essential for individuals to release their firmly-felt gut feelings about the nature of substance dependence- something that is essential for understanding how best to create policy that will be effective.

3. Increase our nation's investment in the National Institute on Drug Abuse. We
recommend a 50% budget increase over the next five years. ...

Oh yes, totally endorse this one! (I did point out that Friends of NIDA is primarily a lobbying group with a single "client"*)

4. Recognize that it is essential to expand science- and evidence-based addiction treatment programs to reduce health care costs of this devastating disorder. Treatment programs
should be integrated with prevention strategies to form a comprehensive health care
reform. Supporting addiction research is an obvious, reasonable and cost-effective
strategy for improving our nation's health and reducing health care costs, and should be
considered in any health care reform proposal.

You would really think this would be a no-brainer, right? Sadly it is not...

5. Create a Targeted Medications Development Venture Capital Fund within the
Department of Health and Human Services. This will bring needed private sector
investment to the development of medications specifically targeting drug abuse and
addiction. There are many promising drugs in the pipeline waiting to get to the next stage
in their development.

Now this is interesting. It comes from the reality that BigPharma has not seen substance abuse as a profitable disease target and the fear that they do not now and never will. Some industry people dispute this latter but it is clear that development of substance-abuse pharmacotherapy is pretty limited. There are promising developments and even approved medications but we need more. Why? The answer explains the lack of interest from BigPharma: the medications to date don't work terribly well. They may only be useful for a fraction of individuals in dependence treatment and are far from the silver-bullet, one-for-all treatments that are easy to understand and market.

6. Expand the Department of Defense's commitment to drug abuse research and its investment in evidence-based substance abuse programs for our nation's returning war
heroes.

I think this is asking for substance abuse to be added to the DoD's Congressionally Directed Medical Research Programs, as was recently done for melanoma by a single anonymous Senator. Recognize the earmark / pork barrel for scientists?
I ask this of you Dear Reader. Take a few minutes to read the supporting remarks for this call to action. Especially you, my drug-policy-skeptical friends! It isn't citation heavy but it does describe some scientific findings and if you want to know more about a particular assertion it shouldn't be too difficult to find related stuff on PubMed.
Obama called the nation to service in his acceptance speech. One way to serve is to become more educated so that you can be a better advocate for what is best for the US in all of your normal daily routines. So please, Go Read.
__
*Federal agencies cannot lobby Congress for more funds in a direct sense. Yes, the NIH IC directors spend a lot of time reporting to Congress but this is a bit different.

3 responses so far

  • juniorprof says:

    There are promising developments and even approved medications but we need more. Why? The answer explains the lack of interest from BigPharma: the medications to date don't work terribly well. They may only be useful for a fraction of individuals in dependence treatment and are far from the silver-bullet, one-for-all treatments that are easy to understand and market.
    There is also another problem nicely shown by the recent catastrophic failure of worldwide CB1 antagonist programs (for smoking cessation or obesity). Mucking with reward can lead to some pretty serious side effects including leading to other psychiatric conditions, such as suicidal ideation as shown by the CB1 antagonist trials. I'm not saying that there aren't other avenues to explore that might be fruitful for this worthy cause; however, I think that BigPharma is quite right to be very cautious about this right now when many of them are teetering on the brink of financial ruin. This, of course, means that more basic science knowledge is needed and that NIDA should be interested in expanding their breadth of basic science research into other areas of drug abuse that might lead to new therapeutic avenues. This requires more risk taking in terms of funding which requires more dollars, to be sure.
    In terms of therapeutics, I think I would be more interested in seeing avenues explored that look into treating the symptomology of withdrawal, in its various forms, rather than avenues that attempt to reduce drug seeking over the longer term. I know this is a well explored area in the lit but I don't get the impression that it is a major focus on the part of pharma.

  • leigh says:

    every time i throw statistics on drug abuse into some piece of writing, i find myself thinking anew how staggering they really are. this type of thing really makes me feel like what i do on a daily basis, though sometimes it seems really mundane, matters.
    i have already found myself thinking of this healthcare proposal and how drug abuse treatment fits in to it. i recall reading my own craptastic health insurance policy and seeing the benefits were very limited- as expected, given the cost.
    the main issue, i think, is that our relatively limited inroads to drug abuse as a scientific problem directly limit the treatment options available. the more we know, the better. it takes money to save money- in this case, spending on research to develop more effective treatments. but on the other hand, doesn't it almost universally take spending now to save in the long run? i do find myself wondering where the hell all this money is going to come from...

  • The problem is that Volkow, chief of NIDA, is biased in favor of a wrong theory of addiction causation, the hijacked brain hypothesis, the moral basis of addiction. The correct theory, Hypoism, the genetic theory, if acknowledged and used would turn around the addiction epidemic. Hypoism's prevention and recovery methods are free.
    http://www.nvo.com/hypoism/thehypoismaddictionhypothesis/
    http://www.nvo.com/hypoism/hypoismhypothesis/

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