June 8–11, 2012
Palm Springs, California
More than 260 participants from 61 countries attended the 17th Annual National Institute on Drug Abuse (NIDA) International Forum, which was held June 8–11, 2012, in Palm Springs, California. The meeting focused on the growing public health problem of new and emerging psychoactive substances, which are mostly unregulated compounds that are specifically designed to circumvent drug laws and mimic the effects of illicit drugs by slightly altering the chemical structure of a known drug. A joint College on Problems of Drug Dependence (CPDD)/NIDA International Forum poster session featured presentations by 160 U.S. and international researchers.
NIDA International Program Director Steven W. Gust, Ph.D., chaired the meeting. Dr. Gust and International Program Associate Director Dale Weiss planned the meeting with Moira O’Brien, M.Phil., NIDA Division of Epidemiology, Services and Prevention Research (DESPR), and Paul Griffiths, M.Sc., and Roumen Sedefov, M.D., European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). In addition to the NIDA International Program, financial support for the 2012 NIDA International Forum was provided by DESPR, EMCDDA, the NIDA Office of Science Policy and Communications (OSPC), and the Institute’s Asian American/Pacific Islander Researchers and Scholars Work Group.
NIDA International Awards of Excellence, which recognize individuals for outstanding contributions to international cooperation in drug abuse research and training, were presented to Clyde B. McCoy, Ph.D., University of Miami, for excellence in mentoring, and Paul Griffiths, M.Sc., EMCDDA, for excellence in international leadership.
In addition to the sessions about new and emerging psychoactive substances, participants joined other Forum sessions that focused on network-based models for monitoring drug abuse trends, research reports from around the world, and drugged driving. A session designed for NIDA International Fellowships Program alumni featured international research opportunities in genetics, online resources for researchers from developing countries, and a writing mentor program sponsored by the International Society of Addiction Journal Editors.
The incoming chair of the CPDD International Committee, Jan Copeland, Ph.D., University of New South Wales, Australia, welcomed participants. Addressing shrinking resources around the world, Dr. Copeland urged participants to work more closely together and leverage from each other’s funding sources and areas of expertise. She added that international cooperation is also a terrific opportunity to systematically explore and contrast countries’ differing policy responses to the common problems of substance abuse.
Plenary Session Reviews Challenges Designer Drugs Present for Policymakers, Researchers, and Practitioners
The opening plenary session featured updates from the White House Office on National Drug Control Policy (ONDCP), EMCDDA, and the U.S. Drug Enforcement Administration (DEA). Cecelia McNamara Spitznas, Ph.D., ONDCP, said that strengthening international partnerships in both demand and supply reduction efforts remains a priority for ONDCP, and asked members of the international drug abuse research community to share their insights with the Office. She discussed several international programs funded by the U.S. Department of State, such as a model drug treatment program for Brazilian women; introduction of drug courts in Chile, Costa Rica, Dominican Republic, and Mexico; and projects to develop treatment and prevention protocols for crack-addicted children in Argentina, Brazil, Chile, Paraguay, and Uruguay. Dr. Spitznas cited the NIDA-funded Monitoring the Future school survey and reports to U.S. poison control centers that document increased use of synthetic cannabinoids and cathinones. She also described the U.S. National Drug Control Strategy as a balance of public health and public safety concerns and reported that every dollar invested in an evidence-based prevention program could reduce costs related to substance use disorders by $2 to $18.
Focusing on the conference theme, Mr. Griffiths, who is the EMCDDA Scientific Director, described how new and emerging psychoactive substances, also known as “legal highs,” encompass a wide range of synthetic and plant-derived compounds and products whose composition rapidly adapts to changes in drug control laws. These substances are usually sold via the Internet or in smart/head shops, advertised with aggressive and sophisticated marketing strategies targeted to specific populations, and in some cases intentionally mislabelled. He described how the European Union response to emerging psychoactive substances relies on real-time information exchange and scientific risk assessment tools to quickly develop evidence-based policy responses that are intended to be faster and more effective than previous policy initiatives. EMCDDA also focuses on the added value delivered by European Union-level cooperation. He concluded that globalization, reliance on the Internet as a source of medical information, younger populations who are more willing to experiment with new substances, and cost efficiencies in manufacturing and adapting products have created a dynamic and fluid situation that presents a growing challenge for monitoring, responding to, and controlling the use of new psychoactive substances.
Michelle D. Walker, Ph.D., DEA, described the legal steps the agency can use to limit use of these new psychoactive substances under the U.S. Controlled Substances Act, including permanent or temporary scheduling, which use five levels of restricted access based on the abuse potential of a substance. Temporary scheduling permits quicker action than permanent scheduling and is used when a substance poses imminent danger to public health. A third tool permits DEA to classify a substance analogue at the same scheduling level set for the substance it mimics chemically and pharmacologically. Dr. Walker reported that an increasing number of products marketed as legal highs contain multiple cathinones, but that neither the buyer nor the distributor usually knows which chemicals are actually present in the products. She noted that these legal highs are reportedly more addictive and dangerous, and may cause more powerful highs compared with chemically similar substances. DEA is collecting information from law enforcement and public health officials to better inform the public of emerging drug threats and enable quick action to classify new substances as analogues of scheduled drugs.
The synthetic drug market is extraordinarily dynamic, with new substances replacing known compounds in a product almost as soon as the first compounds are identified. NIDA Acting Deputy Director David A. Shurtleff, Ph.D., moderated a panel of researchers who discussed the latest research findings on detecting new compounds, assessing their effects, and monitoring use trends. Volker Auwaerter, Prof. Dr. rer. nat., a forensic scientist at University Medical Center Freiburg, Germany, reported that when compared with cannabis, the synthetic drugs are more effective in producing psychoactive effects and also more toxic, with increased potential for tolerance, addiction, persistent psychosis, and changes in DNA. Dr. Auwaerter added that detection of the synthetic compounds is complicated: metabolites must be identified for accurate urinalysis; laboratory procedures must be updated regularly because the chemical composition of the products changes frequently; and results can be misinterpreted. Michael Baumann, Ph.D., NIDA Intramural Research Program, described the Institute’s Designer Drugs Initiative, which gathers information about new substances through partnerships with outside agencies, validates target compounds, conducts preclinical and clinical pharmacology studies of the compounds, and disseminates information about the synthetic drugs. He described recent studies of “bath salts,” which often contain the cathinone MDPV. The synthetic stimulant is 10 times more potent than cocaine, displays a unique pharmacology when compared with other cathinones, and is associated with the adverse effects of “bath salts,” such as agitation, combative or violent behavior, tachycardia, hallucinations, paranoia, and confusion. Dr. Baumann suggested that emergency departments might be able to manage the adverse effects of bath salts through antagonism of excess dopamine signaling. Barry Logan, Ph.D., National Medical Services Labs, Inc., reported that traditional screening tests are limited in detecting and classifying synthetic drugs because many products contain multiple, chemically similar compounds. Dr. Logan added that by the time a laboratory has developed and validated an immunoassay for a synthetic drug, which can take 6 to 9 months, the substance has already been replaced with a new compound that is not identified by the newly developed test.
Breakout Sessions Expand Focus on Designer Drugs
Two breakout sessions also focused on new and emerging psychoactive substances. The global updates session, which was chaired by Mr. Griffiths, featured reports on the appearance and use of the new drugs; monitoring or early warning systems; and responses such as risk assessment, control, and changes in legislation. Dr. Sedefov outlined the underlying causes leading to use of new and emerging psychoactive substances, such as globalization, production advances, interactive marketing, and users’ willingness to experiment. Tomas Zabransky, M.D., Ph.D., Charles University in Prague, Czech Republic, reported that users in EurAsia switch from drugs such as heroin to synthetic stimulants because of cost, availability, and policy changes such as a police focus on heroin. The stimulant users report more risky behaviors related to injecting and sexual activity, but the biggest risk is directly related to clumsy drug preparation procedures. Dr. Zabransky suggested that harm reduction interventions, including instructions in safe drug preparation and injection procedures, might also serve to prevent HIV transmission in the population. Beate Hammond, M.B.A., reported on a UNODC project in Latin America, Africa, and Asia. The Global SMART Programme offers regional workshops, international collaboration exercises, and access to United Nations laboratory services to help nations select key regions in a community, nation, or region to monitor and analyze emerging trends in synthetic drug use in order to develop effective, evidence-based prevention, treatment, or policy interventions. Michael Farrell, Ph.D., Australian National Drug and Alcohol Research Centre, explained how Australia is monitoring emerging drug trends and described how the nation integrates legislative strategies with monitoring efforts. Ruri Kikura-Hanajiri, Ph.D., Japanese National Institute of Health Sciences, described the numerous varieties of designer drugs available in Japan and discussed drug control efforts in the country.
The second breakout session on new and emerging psychoactive substances, which was chaired by Dr. Sedefov, focused on the implications these substances have on prevention and treatment interventions. David Wood, Ph.D., Guy’s and St. Thomas’ Hospital and King’s College London, reported on acute toxicity reported by United Kingdom emergency departments, accentuating the urgency of developing information about the toxicity of these substances. He suggested triangulating data in order to classify new psychoactive drugs into clinical toxicity groups, providing a roadmap for future efforts to develop treatment guidelines. Chris Rosenbaum, M.D., University of Massachusetts Medical School, conducted an interactive discussion about the clinical effects of emerging psychoactive substances that also underscored the urgency of establishing methods to detect exposure to these substances and manage their adverse effects. Artur Malczewski, M.A., Polish National Bureau for Drug Prevention, described how rapidly and dynamically the drug scene in Poland was transformed by new psychoactive substances and how difficult it remains to respond to continually changing substances and patterns of use. He concluded that wide coalitions are required to address the subject.
Additional Sessions Focus on Monitoring Drug Use, Drugged Driving, International Research Advances, and Fellowships
Ms. O’Brien planned a workshop that focused on network-based models for monitoring drug abuse trends, providing practical information and examples regarding: (1) establishing, operating, and maintaining networks; (2) adapting to address new and emerging drugs, issues, and technologies; and (3) using network information. James N. Hall, Ph.D., Nova Southeastern University, described the NIDA Community Epidemiology Work Group, which links areas at the community, state, national, and regional levels; optimizes existing data as drug indicators; and periodically convenes to examine data and trends across areas. In a second presentation, he described how Florida changed its laws in response to community epidemiology findings on prescription opioid abuse, regulation of GHB and Rohypnol, “Good Samaritan” laws that encourage observers to call emergency personnel when a companion has overdosed, and sales of synthetic marijuana. Caleb Banta-Green, Ph.D., M.P.H., M.S.W., University of Washington, described how using wastewater treatment plant data offers researchers as well as local public health and law enforcement officials a promising tool to document emerging drug use trends and provide data on drug use in areas where data did not exist previously. Marya Hynes, M.H.S., Inter-American Drug Abuse Control Commission (CICAD), discussed how the Organization of American States is developing regional and national drug information networks using two different, evidence-based models to capitalize on existing strengths and address specific needs for drug use data in member states. Jane Mounteney, Ph.D., and Mr. Griffiths described how EMCDDA developed, maintains, adapts, and uses its Reitox and National Focal Point networks to gather drug use statistics and develop evidence-based policy responses. Jane C. Maxwell, Ph.D., University of Texas at Austin, suggested additional data sources for monitoring drug abuse trends, such as poison control center data, toxicology data on deaths, law enforcement semi-annual reports, price and purity data, reports by HIV/AIDS and other sexually transmitted disease outreach workers, research studies and surveys, and the Internet.
A session co-chaired by Dr. Copeland and Flavio Pechansky, M.D., Ph.D., Federal University of Rio Grande do Sul, Brazil, explored cross-national patterns of drugged driving, issues in measurement and interpretation of drug-impaired driving, the range of policy responses, and gaps in the relevant evidence base. Anthony Liguori, Ph.D., Wake Forest University School of Medicine, discussed the potential of the STISIM Driving Simulator in researching understudied classes of drugs and combinations of drugs and their impact on driving. Jørg Mørland, M.D., Norwegian Institute for Public Health, described how the country assesses impairment levels for non-alcohol substances and reviewed Norway’s new, impairment-based traffic legislation. Dr. Pechansky discussed the differences between North American and South American countries in addressing drunk driving, stressing the need for data collection, legal reform, and improved enforcement in South America. Dr. Maxwell presented findings from Texas studies on impaired drivers in treatment, concluding that not being abstinent at 60-day follow-up after treatment was predicted by more past-year driving under the influence arrests or living in a household where the patient was exposed to alcohol and drugs.
OSPC Acting Director Susan Weiss, Ph.D., chaired a breakout session that featured international research reports on using electronic media to track drug use trends, assessing the prevalence of prescription drug misuse among adolescents, treating opioid dependence with Naltrexone or buprenorphine, instituting drug courts, and identifying factors that inhibit injection drug users from participating in voluntary HIV testing. Evgeny Krupitsky, Ph.D., St. Petersburg Bekhterev Research Psychoneurological Institute and St. Petersburg State Pavlov Medical University, Russia, summarized a series of research projects studying oral, implantable, and injectable Naltrexone as a treatment medication for opioid dependence. His studies demonstrate the efficacy of injectable Naltrexone, which offers an evidence-based pharmacotherapy that is non-narcotic, non-addictive, and long acting. Catalina Lopez Quintero, Ph.D., Hebrew University, Israel, presented research documenting the increased incidence of prescription drug misuse among young people in Colombia. Suzanne Nielsen, Ph.D., University of Sydney, Australia, discussed research exploring whether use of different prescription opioids and different use patterns in Australia versus the United States would result in different conclusions about the efficacy of buprenorphine in treating prescription opioid users, raising important issues for international research teams to consider as they adapt treatment protocols across cultures. Jiang Du, Ph.D., Shanghai Mental Health Center, China, described a mixed-methods approach to identifying factors related to voluntary HIV testing among injection drug users that identified barriers to treatment in China. Mario Sobrinho, Ph.D., Public Ministry of Sao Paulo, Brazil, described a study implementing drug courts in the city that suggests ways in which drug courts can influence entry into treatment.
NIDA International Program Associate Director Dale Weiss chaired a session designed for NIDA International Fellowships Program alumni that focused on international genetics research, online resources for international researchers, and recruitment opportunities for the NIDA Hubert H. Humphrey Drug Abuse Research Fellowships. NIDA Division of Basic Neuroscience and Behavioral Research Acting Director Joni Rutter, Ph.D., discussed NIDA’s genetic research priorities and potential areas for international collaboration. Nita Bryant, Ph.D., and Kimberly Brady, M.S., Virginia Commonwealth University, discussed how they developed an open-access research guide to drug and alcohol studies to support information needs of NIDA Hubert H. Humphrey Drug Abuse Research Fellows from developing nations. The compilation of resources, search tips, and tutorials to improve information literacy is available at http://guides.library.vcu.edu/drugs-alcohol. Peter M. Miller, Ph.D., Medical University of South Carolina and president of the International Society of Addiction Journal Editors (ISAJE), described the ISAJE Writing Mentor Program, a free service that provides individual, online mentoring on writing and revising reports of completed research for publication. Dr. Miller reported that 11 researchers from low- and middle-income countries have already taken advantage of the ISAJE Writing Mentor Program, and said that publishing results is the most difficult part of conducting research. Lauren Stewart, Institute of International Education, led a discussion with current and former fellows about ways to increase applications to the NIDA Hubert H. Humphrey Drug Abuse Research Fellowship, which is jointly sponsored by the U.S. Department of State and the NIDA International Program.
*The First International Multidisciplinary Forum on New Drugs was held May 11–12, 2011, in Lisbon, Portugal, and hosted by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). This Second Interdisciplinary Forum was co-sponsored by EMCDDA and NIDA.
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2014 NIDA International Forum
June 13 – 16, 2014
San Juan, Puerto Rico