As the lead federal agency supporting scientific research on drug use and its consequences, the mission of the National Institute on Drug Abuse (NIDA) is to advance science on the causes and consequences of drug use (including nicotine) and addiction and to apply that knowledge to improve individual and public health. Over the last four decades, NIDA-supported research has revolutionized our understanding of drug use and addiction, driving a new understanding of the neurobiological, genetic, epigenetic, social, and environmental factors that contribute to substance use disorders. These advances have helped to transform how drug use and addiction are conceptualized. Society’s responses to drug use have often been shaped by the misconception that people with addictions are morally flawed and lacking in willpower, resulting in an emphasis on punishment rather than prevention and treatment. Today, thanks to groundbreaking scientific discoveries about the brain and its role in addiction, society’s views are changing in ways that will enable us to respond more effectively to the problem.
Drug use and addiction represent major public health challenges in our nation. In 2014 alone, more than 47,000 Americans died as a result of an unintentional drug overdose*, and the past few years have seen rapid increases in babies born with neonatal abstinence syndrome, an unprecedented outbreak of HIV, an increasing prevalence of hepatitis C, and new synthetic drugs flooding the market. The combined consequences of drug use and addiction take an enormous toll, creating individual suffering, lost productivity, and stress and heartache for family and friends. And while research has identified many evidence-based prevention and treatment strategies, there remains a frustrating "bench-to-bedside gap" that persists in our field—a failure of dissemination and adoption of effective interventions so they can actually improve the lives of individuals, families, and communities.
Despite these challenges, this is a time of great opportunities. The last few years have seen tremendous advances in technologies with applications in research, including gene sequencing and manipulation, increasingly sensitive imaging technologies, mobile health tools, and electronic health records. A shift in culture is promoting open access and data sharing to allow diverse data sets to be broadly accessible to researchers. Advances in information technologies and analytics capabilities are producing unprecedented capacity to integrate and analyze these data and enabling novel research into the complexity of a disorder that is driven by the dynamic interactions of diverse biological, social, environmental, and behavioral mediators. In addition, national investments in basic research, including President Obama’s BRAIN and Precision Medicine Initiatives, have us poised to accelerate neuroscience, genetics, and health services research. In parallel, ongoing health care and criminal justice reform efforts, as well as changing state drug policies (e.g., legalization of marijuana for medicinal or recreational use) are creating new opportunities for policy research on how to maximize public health benefits and increase access to prevention and treatment services. Finally, increased public concern related to the ongoing opioid overdose epidemic is fostering widespread collaborative efforts to address this public health crisis. This plan reflects our commitment to leverage these opportunities to drive scientific advances that will help address current public health needs related to substance use and addiction while providing transformative solutions for the future.
Updating our strategic plan provided an opportunity to step back and reflect on the scientific and technological advances of the last few years and to re-envision what science can accomplish over the next 5 years. Our main goals throughout this process were to undertake an inclusive and thoughtful approach to developing our strategic priorities that emphasized innovative approaches to addressing scientific challenges. Developing this plan was a collaborative effort incorporating guidance from the National Advisory Council on Drug Abuse, scientific and clinical experts, stakeholder organizations, and the public.
This plan outlines our broad goals across basic science, prevention, treatment, and public health; identifies four priority focus areas that we believe present unique opportunities to be leveraged over the next 5 years; and reflects a flexible, dynamic approach that will allow us to adapt to new scientific and technological advances and changing public health needs, and to take advantage of scientific opportunities as they arise.
While exploring all of the exciting new opportunities in our field, we considered many real-world practicalities. How do we balance the needs of people suffering with substance use disorders right now with longer-term investments in basic research at a time when NIH has lost 22 percent of its purchasing power? How can we ensure that treatment interventions developed through NIDA-supported research can be sustainably implemented in today’s health care landscape? How do we encourage more research that reflects the complexities of substance use disorders in the real world, including polydrug use, physical and mental health comorbidities, changing risks across the lifespan, and the impacts of poverty and social inequality, among others? This plan aims not only to expand our knowledge of the effects of drug use and addiction on the individual, the community, and society, but to increase the traction of what is learned by effectively translating new findings into real-world interventions, reaching a greater number of people and getting the most out of limited prevention and treatment resources.
The NIDA Strategic Plan for 2016 to 2020 reflects the optimism we feel at this juncture about our prospects for advancing addiction science as we enter the second half of the decade. I want to thank everyone who contributed their thoughts and expertise along the way. I hope that you will continue to work with us to achieve these ambitious goals.
Nora D. Volkow, M.D.
National Institute on Drug Abuse
* This number represents all overdose deaths that were attributed to drugs based on ICD-10 codes for prescription drugs (T36-T39, T40.2-T40.4, T41-T43.5, and T43.8-T50.8), prescription opioid pain relievers (T40.2-T40.4), benzodiazepines (T42.4), antidepressants (T43.0-T43.2), heroin (T40.1), and cocaine (T40.5).