June 17–20, 2011
NIDA International Forum Focuses on Collaboration Among Research Organizations and Binational Scientific Teams
“Find good partners, start small, and take advantage of every research training and funding opportunity available.”
That was the theme of presenters at the 16th National Institute on Drug Abuse (NIDA) International Forum, which featured reports on U.S. initiatives to improve evidence-based drug treatment, research training, and policy implementation around the world from NIDA, the Fogarty International Center (FIC), and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Panelists offered advice on building international research collaborations that could compete for funding; described recent progress in developing pharmacotherapies to treat addiction; presented research reports from international settings in basic science, HIV/AIDS, epidemiology, prevention, and treatment; and reviewed the challenges of collecting and publishing reliable youth risk behavior data in Muslim-majority countries.
NIDA International Program Director Steven W. Gust, Ph.D., chaired the meeting, which was held June 17–20, 2011, in Hollywood, Florida, as a satellite to the Annual Scientific Meeting of the College on Problems of Drug Dependence (CPDD). More than 255 participants from 51 countries participated in the plenary session, workshops, and networking activities. A joint CPDD/NIDA International Forum poster session featured presentations by 146 U.S. and international researchers.
Awards of Excellence
The NIDA International Program presented its 2011 Awards of Excellence to honor mentors, researchers, and international collaborative work whose efforts support the International Program mission. Awardees included the following: Excellence in Mentoring: Jeffery H. Samet, M.D., Boston University School of Medicine; Excellence in International Leadership: María Elena Medina-Mora Icaza, Ph.D., Instituto Nacional de Psiquiatria Ramón de la Fuente, Mexico; and Excellence in International Collaborative Research: Richard A. Rawson, Ph.D., University of California, Los Angeles (UCLA).
Plenary Features U.S. and International Research Organization Partners
Dr. Gust opened the plenary session by reviewing research training, funding, and scientific exchange initiatives to support international partnerships, such as a recent funding opportunity cosponsored by NIDA and PEPFAR, the National Institutes of Health (NIH) Human Heredity and Health program, NIDA International Program fellowships and online training tools, and scientific publications.
David Shurtleff, Ph.D., NIDA acting deputy director, reviewed NIH international initiatives, the status of the new National Institute on Substance Use and Addictive Disorders, NIDA research priorities, emerging trends in substance use, and the partnership between the Clinical Trials Network and Mexico. He also discussed the neuroimaging project to identify the brain’s structural and functional connection networks—the Human “Connectome”—that will help scientists compare normal and diseased brains as they develop, test, and evaluate new interventions for substance use disorders.
The chair of the CPDD International Committee, Flavio Pechansky, M.D., Ph.D., M.Sc., director of the Center for Drug and Alcohol Research at the Federal University of Rio Grande do Sul in Brazil, described how his Center grew from a $20,000 grant in 1995 to a $6 million grant in 2010, demonstrating how a major drug abuse research program was built through the cumulative effects of many small initiatives.
Reporting on progress and challenges in building country-level capacity for comprehensive HIV prevention for persons who inject drugs, senior public health advisor to PEPFAR Richard H. Needle, Ph.D., M.P.H., described PEPFAR efforts to translate NIDA research into public health programs. Dr. Needle outlined the PEPFAR model for developing sustainable, evidence-based service delivery, policy reform, and financing programs.
James E. Herrington, Ph.D., M.P.H., director of the FIC Division of International Relations, discussed the nutritional, behavioral, and environmental factors contributing to increased morbidity and mortality due to noncommunicable diseases, including substance abuse. Dr. Herrington reviewed the FIC mission of using science to promote global health, highlighting training programs and research funding opportunities it cosponsors with NIDA that support innovative and collaborative international research while contributing to sustainable capacity development.
Dr. Gust also introduced the International Program-supported peer-reviewed supplement to Substance Use & Misuse, which was the topic of a symposium during the CPDD Annual Scientific Meeting. The 20 articles from 12 nations in Volatile Substance Misuse: A Global Perspective present data from countries where volatile substance misuse (VSM) was previously underdocumented, as well as from countries reporting VSM among school populations; discuss medical complications of VSM and the potential for central nervous system recovery with abstinence; and describe successful interventions that address VSM based on cultural understandings.
Successful Grant Applications Supported by International Collaborations
The concluding plenary session featured three researchers who described their experiences in building international research partnerships that have successfully competed for NIH funding and reported on their current research initiatives. All three presenters shared a common theme: find good partners, start small, and take advantage of every research training and funding opportunity available.
Jeffrey H. Samet, M.D., Boston University School of Medicine, described binational clinical research projects on HIV and substance use he is conducting with partners in Russia and India. He described collaborative experiences that (1) teamed with outstanding partners; (2) started small; (3) published the results of each small success and built on those results; (4) encouraged shared decisionmaking and compromises by both partners; (5) relied on frequent communication; (6) expanded the partnership through mentoring and fellowship opportunities, scientific meetings, and related research projects; and (7) took advantage of NIH activities, such as the expertise of program officers, funding resources, review committees, and workshops.
Reminding participants that the goal of international collaboration is not to impose U.S. methods and views on the partner nation, David Metzger, Ph.D., University of Pennsylvania, suggested that successful international collaborations are designed to investigate the challenges all countries face in addressing the common problem of addiction, such as (1) answering scientific questions; (2) providing evidence to inform policy and practice; (3) monitoring the epidemiology of drug use and its consequences; (4) rapidly identifying and responding effectively to emerging problems; (5) improving the efficacy of treatments for drug abuse; and (6) reducing morbidity and mortality related to drug use. Dr. Metzger cited the sense of urgency to treat addiction and reduce its consequences that he shares with his Indonesian partner, Adhi Nurhidayat, M.D., and his University of Pennsylvania colleague, George Woody, M.D., as a major factor in the team’s success, and described how NIDA International Program meetings, fellowships, and research funding opportunities helped establish the Penn-Indonesia partnership.
Richard A. Rawson, Ph.D., UCLA, stressed that flexibility, training, and technical assistance were critical aspects of successful collaborations, whether in identifying partners, setting priorities, expanding relationships, or obtaining funding. Using the example of the UCLA partnerships with researchers in Egypt, Israel, and the Palestinian Territories, Dr. Rawson described how building addiction research, training, and treatment capabilities through international collaboration promoted broader international cooperation while disseminating scientifically supported information to address addiction and its consequences. He added that training and technical assistance activities provide opportunities to build relationships, identify research questions, and develop interest and support for research efforts. Discussing UCLA’s other research collaborations, international conferences, and the United Nations Office on Drugs and Crime TreatNet training program, Dr. Rawson emphasized the importance of finding out what international partners need to address issues in their countries and seeking funding from every available source.
Treatment Medications Research Highlighted
During a plenary session on “Advances in the Development of Medications To Treat Substance Use Disorders,” the panelists highlighted NIDA’s recent progress in identifying, evaluating, and developing pharmacotherapies to treat addiction, focusing on a comparison of methadone versus buprenorphine treatment for pregnant women, naltrexone treatment to prevent opioid use relapse, and promising pharmacotherapies to treat addiction to cocaine and other stimulants. Ivan Montoya, M.D., M.P.H., NIDA Division of Pharmacotherapies and Medical Consequences of Drug Abuse, chaired the session.
Comparing maternal and neonatal outcomes of methadone versus buprenorphine treatment, Hendree Jones, Ph.D., Research Triangle Institute and Johns Hopkins University, reviewed the clinical implications of the Maternal Opioid Treatment: Human Experimental Research (MOTHER) study. She discussed important issues in conducting multicenter, multinational randomized clinical trials and identified areas of future research to be considered in the continuing efforts to establish treatment guidelines for drug-abusing pregnant women, such as the safety and efficacy of Suboxone, the use of methadone and buprenorphine with comorbid alcohol and/or benzodiazepine use, optimizing the ease of buprenorphine induction, factors exacerbating or minimizing neonatal abstinence syndrome (NAS), medications to treat NAS, and short- and long-term outcomes for infants with NAS, including growth, learning, development, and behavior.
Adam Bisaga, M.D., Columbia University, discussed research on long-acting Naltrexone to prevent opioid use relapse, concluding that injectable extended-release Naltrexone achieves 6-month retention rates near 50 percent (approaching those of buprenorphine maintenance but with lower levels of opiate use). He added that behavioral therapy strategies improve adherence to both oral and injectable Naltrexone.
Reporting on research to assess the efficacy of medications approved by the U.S. Food and Drug Administration for other uses, Richard De La Garza, Ph.D., M.S., Baylor College of Medicine, reviewed results of recent studies of doxazosin or modafinil plus escitalopram to treat cocaine abuse and rivastigmine or N-acetyl-cystine to treat methamphetamine abuse. He concluded that a combination of treatment medications might be most effective.
Concurrent breakout sessions featured international research reports judged to be among the best of those submitted for travel awards to the 2011 Forum. Joni L. Rutter, Ph.D., NIDA Division of Basic Neuroscience and Behavioral Research, chaired the session on basic science research, where presenters discussed the neurological bases and effects of comorbid disorders, cannabis, and nicotine. Betty C. Tai, Ph.D., NIDA Center for the Clinical Trials Network, chaired the session on epidemiology, prevention, and treatment research, where speakers discussed opioid substitution therapy and novel drug use surveillance tools. Marsha F. Lopez, Ph.D., M.H.S., NIDA Division of Epidemiology, Services and Prevention Research, chaired the session on HIV/AIDS research, where speakers reported on interventions for drug-related HIV, as well as on developing needs assessments to guide evidence-based prevention-as-treatment programs.
The alumni meeting of the NIDA International fellowship programs was co-chaired by Ms. Dale Weiss, NIDA International Program, and Dr. J. Randy Koch, Virginia Commonwealth University. Current INVEST/CTN Fellow and 2007–2008 NIDA Hubert H. Humphrey Fellow Rushit Ismajli, M.D., M.Sc., Kosovo, chaired a panel discussion that focused on the challenges of collecting and publishing reliable youth risk behavior data in Muslim-majority countries that meet international methodological standards. Panelists included Mohammed F. Al-Afifi, M.Sc., MBBS, Palestinian Territories; 2009–2010 Hubert H. Humphrey Fellow Rawnak Ibrahem Aqrawi, Pharm.D., Iraq; 2007–2008 Hubert H. Humphrey Fellow Fatima El Omari, M.S., Morocco; and 2010–2011 Hubert H. Humphrey Fellow Omar El Shahawy, MBChB, M.P.H., Egypt. Panelists and audience members stressed that the amount and quality of available data in Muslim-majority countries was less likely to be influenced by religious considerations and more likely to be influenced by community factors (such as urban versus rural settings, violence, political instability, cultural norms, stigma, and poverty), research environment factors (such as lack of expertise or funding), the legal status of abused substances, and the willingness of local governments to allow the data to be published.