presented by Nora D. Volkow, M.D., Director, National Institute on Drug Abuse National Institutes of Health Department of Health and Human Services
Testimony Before the House Subcommittee on Labor-HHS-Education Appropriations
Mr. Chairman and Members of the Committee:
I am pleased to present the Fiscal Year (FY) 2015 President’s Budget Request for the National Institute on Drug Abuse (NIDA). The FY 2015 budget request for NIDA is $ 1,023,268,000, which reflects an increase of $ 7,514,000 over the FY 2014 level of $ 1,015,754,000.
The impact of substance abuse in this country is daunting; the economic toll alone exceeds $700 billion1 a year in health care, crime-related, and productivity losses. NIDA strives to translate the returns of its investments in genetics, neuroscience, pharmacotherapy, and behavioral and health services research into new strategies for preventing and treating substance abuse and addiction. This scientific investment is crucial if we are to tackle rapidly evolving public health threats such as the increase in marijuana use among young people and the growing prevalence of opioid addiction and overdose deaths.
Today’s Basic Science for Tomorrow’s Breakthroughs
There is a fundamental need to understand the complex steps of how body chemistry influences behavior and how their disruption can lead to addiction. A more detailed and personalized account of these steps will lead to a more effective and precise medicine to prevent and treat this complex brain disorder.
In this context, and thanks to recent technological developments, we’ve made important advances in linking genes with behavior. As a result, we now have an unprecedented capacity to screen for thousands of genetic variations and catalogue how they modulate abuse/addiction risk by influencing brain maturation, its neural architecture, and behavioral patterns. NIDA researchers are also pursuing genome and whole individual sequence analysis to identify genes that modulate addiction risk (e.g., genes that regulate drug metabolism), advancing their understanding of how environmental factors (e.g., parental style, drug exposure) can affect the expression of those genes to either strengthen or weaken behavioral patterns through epigenetic changes. The systematic identification of genetic, environmental, and neurocircuitry variations that modulate abuse/addiction risk will revolutionize our prevention and treatment capacities.
Big Opportunities in Big Data
Big data sets are essential platforms for the analysis of complex systems in genetics and epigenetics, proteomics, brain imaging and clinical science. Vast amounts of data are being produced by the overlaying of structural and functional brain imaging information that links the molecular and cellular data with the expression of higher level brain function. A prime example is the new fMRI-based approach to generating images of the functional connectivity (FC) among brain regions in the absence of any specific task, so called resting state (rs) FC. This technique offers a powerful window into circuit-level functions that may generate behavioral responses underlying vulnerability or a diseased state. Open access to such massive databases could lead to the identification of biomarkers of psychiatric illness risk including addiction, their trajectories, and treatment responses that could be translated for clinical use and the optimal management of patients.
Similarly, NIDA is funding the development of an open source, open framework, free National Pain Registry that collects patient demographic and treatment information from around the nation. This information can be used to identify which pain management interventions are most effective for specific chronic pain patients and predict which patients might be at higher risk for opioid addiction. Combined with concerted efforts in the pharmacogenomics of prescription opioids, pain registries are poised to help us maximize the effectiveness of pain treatments while minimizing the likelihood of prescription opioid abuse and addiction.
Nurturing Talent and Innovation
NIDA currently supports a great deal of innovative research on drug addiction and related health problems such as pain and HIV/AIDS and will continue to be at the forefront of training the next generation of innovative researchers. The 6-year old Avant-Garde award is a good example of a program that stimulates high–impact research that could lead to groundbreaking opportunities for the prevention and treatment of HIV/AIDS in substance users. NIDA is now crafting a new kind of award, which blends NIH’s Pioneer and New Innovator award mechanisms. This new opportunity, called the “AVENIR” award, is designed to attract creative young investigators to genetic research on substance use disorders and HIV/drug abuse research. Another example is NIDA’s Cutting-Edge Basic Research Awards (CEBRA), designed to foster highly innovative or conceptually creative research that advances our understanding of drug abuse and addiction. The latest results of this effort include three independent studies exploring the potential benefits of neurofeedback training, transcranial magnetic stimulation, and meditation on facilitating smoking cessation.
Better Pain Management: A Major Goal of Addiction Research
Pain management is an important component of high-quality, compassionate medical care. Opioid analgesics are among the most effective medications for the management of severe pain and frequently used for pain treatment. Unfortunately, the benefits of long term opioid analgesic treatment are accompanied by significant risk of developing drug tolerance (and the need for escalating doses) and hyperalgesia (increased pain sensitivity). Exposure to potentially rewarding substances, like opioid analgesics, may reinforce drug taking behavior for persons with risk factors for addiction and trigger relapse in those that are in recovery. These are intrinsic liabilities of opioid analgesics that clearly increase the risk for diversion, abuse, addiction and overdose.
NIDA recognizes it has a critical role in ensuring the availability of safe and efficacious chronic pain management options while minimizing risk of abuse. This is why we are committed to supporting research to better predict who is at risk of addiction and to develop new classes of effective, non-addicting pain medications. Parallel to these efforts, NIDA is proactively pursuing methods to minimize the risk of overdose with existing medications. For example, NIDA and Lightlake Therapeutics Inc. have partnered to develop an intranasal delivery system of naloxone (an opioid receptor blocker that can rapidly reverse the overdose of prescription and illicit opioids), which could greatly expand its availability and use in preventing opioid-related deaths, a public health problem of epidemic proportion in the U.S.
Health Consequences of Marijuana Use
There is a dangerous and growing misperception that marijuana use is harmless, resulting in its status as the most commonly used illicit drug in the United States with about 12% of people aged 12 and over reporting use in the past year2. Marijuana use has been associated with significant adverse effects, including addiction, cognitive impairment and car accidents. The key to minimizing negative outcomes lies with the intensification of our efforts to educate the public about the dangers of marijuana use and, with the deployment of multipronged, evidence-based strategies to prevent and treat the abuse of and addiction to marijuana and other drugs. To meet this challenge, NIDA has released several funding announcements to encourage research on the impact of changing marijuana policies; and, in partnership with other NIH institutes, is planning a large-scale, prospective study that follows children prior to drug use into early adulthood to determine whether and how marijuana and other commonly used substances (e.g., alcohol, tobacco) affect the developing brain.
Our current approaches to develop next-generation pharmaceuticals take advantage of new technologies using immunotherapeutic or biologic (e.g., bioengineered enzymes) approaches for treating addiction. The goal is to develop safe and effective vaccines or antibodies that target specific drugs, like nicotine, cocaine, and heroin, or drug combinations. If successful, immunotherapies--alone or in combination with other medications, behavioral treatments, or enzymatic approaches—stand to revolutionize how we treat, and maybe even someday prevent addiction.
The field of addiction research continues to benefit from the explosion in genetic knowledge, the advent of precise technologies to probe neuronal circuits, and the emergence of openly accessible big data platforms. NIDA’s research is strategically poised to take full advantage of these and other emerging opportunities to develop the knowledge base that can be used to reduce drug use in this country.
1U.S.DHHS. The Health Consequences of Smoking – 50 Years of Progress: A Report of the Surgeon General. Atlanta, GA, CDCP, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014; Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, Patra J. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet. 2009 Jun 27;373(9682):2223-33; National Drug Intelligence Center (2010). National Threat Assessment: The Economic Impact of Illicit Drug Use on American Society. Washington, DC: United States Department of Justice.
2 Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.