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Posts Tagged ‘ONDCP’

NIDA and ONDCP – American policy on addiction research

June 20th, 2010

At this year’s College on Problems of Drug Dependence (CPDD) Annual Meeting, I got to hear, and talk to, some of the most influential players in the American addiction research field. Here are a few highlights from their talks and our discussion:

Dr. Nora Volkow of NIDA talked about a shift from Genome Wide Association Studies (GWAS), which have been the most recent popular advance in genetics addiction research and into more Deep Sequencing work. The hope is that this will allow us to begin untangling some of the GWAS findings that have seemed counter-intutitive or puzzling. Deep sequencing should let us see what genes really are associated with addiction specifically, not just as markers.

Dr. Volkow also brought up the numerous issues of medications for addictions including the Nabi Nicotine Vaccine, Vivitrol (a Nalexone depot that helps opiate users who wouldn’t take it otherwise), and a host of new medications that are being developed or considered. An interesting idea here was the use of drug combinations which are showing great promise in providing enhanced treatment results (similar to HIV treatment that benefited greatly from drug cocktails). These include combining vernicline and bupropion for smoking and naltrexone and buprenorphine for cocaine (that’s not a type even though both have been typically thought of for opiate addicts).

Dr. Tom McLellan, who I personally believe is one of the most informed and thoughtful people we have when it comes to addiction research in this country, talked about our need to expand the reach of treatment to the drug abuse earlier in the problem cycle. While about 25 million people are considered drug addicts in this country, more than 65 million are drug abusers. By finding ways to reach those people in primary care (as in doctor offices) settings before they develop the full blown addiction we’re used to talking about we can do better. He also mentioned the idea of anonymity in recovery playing a role in the continued stigmatization of addiction, a topic I’ve written about recently.

Stay on the lookout for more amazing new addiction research knowledge!


Posted in:  Drugs, Education
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Enforcement Vs. Prevention and Treatment – Solving our addiction problem requires all three

January 30th, 2010

A pair of handcuffs is not an unfamiliar picture for many drug addictsThe U.S. policy regarding the drug problem is still centered mainly on the enforcement of its drug laws and intervention in the drug supply both within the U.S. and in neighboring countries. There is no question that this “crusade” has had an impact. Importing a kilogram of cocaine into the US costs approx $15000 (an average kilogram sells for $10,000-$15000) while sending a regular package weighing the same costs about $100 (1).

The result of the focus on enforcement

Still, the recent assassination of the Mexican “drug czar”, and the escalation of violence just south of the U.S.-Mexico border point to another fact: Where there’s money, there’s a way. Drug cartels will find a way to deliver their product as long as customers are waiting on the other side of the border. One of the battles in this war has to be fought on the prevention/intervention side. Dr. McLellan’s selection as deputy drug czar brought with it a lot of hope regarding the role of treatment in the big-picture. Still, bureaucracy moves slowly, and there have been few visible changes in policy to date, aside from the well needed symbolic nature of dropping the term “War on Drugs” from our lexicon.

What about treatment?

Unfortunately, health insurance companies in the United States rarely covers any of the cost involved in drug treatment, even though at least 42 states require them to do so by law! Even when they do, insurance companies often limit coverage to 30 days of residential treatment. I’ve made it clear before, but I feel that the notion that 30 day treatment can work needs to be removed from our consciousness (2). I realize this may require hypnosis…

Anyway, without funding, the hope of making drug treatment truly affordable and accessible is small and dwindling as it requires more medical treatment, which is obviously costly. I hope that this aspect of health care coverage finds its way into the ongoing debate, especially given the high, and increasing prevalence of drug abuse in this country.

As it stands, the U.S., with little more than 5% of the world’s population is consuming somewhere between 50%-70% of the world’s drugs. Talk about a problem with our GDP…

And prevention?

I can tell you, without a doubt, that saving someone from ever becoming an addict is the biggest cost saver in this entire equation. It would remove crime costs, treatment costs, and incarceration and court costs right out of this whole thing. The problem, obviously, is that we don’t know with certainty who will, and who won’t, become an addict. There are some recent advances, and I think that as technology (specifically imaging), and our knowledge (specifically about genetics and its interaction with environmental stress), improves we will be able to do a much better job of this.

I work on some projects that assess the cost benefit of treating rather than merely jailing drug users (prop 36 in CA). I can’t wait for us to have the knowledge to allow for the same analyses regarding prevention.

Citations:

(1) Reuter & Pollack (2005). how much can treatment reduce national drug problems?

(2) McLellan, Lewis, O’Brien, & Kleber (2000). Drug Dependence, a Chronic Medical Illness Implications for Treatment, Insurance, and Outcomes Evaluation.


Posted in:  Opinions, Treatment
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