>> LET ME WELCOME EVERYONE.
I ONLY HAVE 28 PARTICIPANTS ON
MY SIDE.
>> THAT'S OKAY, BECAUSE SOME
PEOPLE ARE ON THE VIDEOCAST,
SOME STAFF ARE ON THE VIDEOCAST
SO IT'S COUNCIL AND ONLY A
HANDFUL OF OTHER NIDA STAFF.
>> OKAY.
SO WITH THAT, I'M THEN GOING TO
WELCOME EVERYONE TO THE 146TH
MEETING OF THE NATIONAL ADVISORY
COUNCIL ON DRUG ABUSE.
IT A PLEASURE TO HAVE YOU HERE
AND WE ALWAYS LOOK FORWARD TO
HEARING YOUR COMMENTS AND GIVE
YOU AN UPDATE OF SOME OF THE
MAIN ISSUES THAT WE ARE DEALING
WITH AS AN INSTITUTE, AND THE
SCIENCE THAT'S EMERGING.
WITH THAT, I'M GOING TO START
FORMALLY THE MEETING AND I'M
READING THE GOVERNMENT -- ACT
REQUIRE THAT AS MANY ADVISORY
COMMITTEE MEETINGS AS POSSIBLE
BE OPEN TO THE PUBLIC.
THIS INCLUDES MEETINGS OF THE
NATIONAL ADVISORY COUNCIL ON
DRUG ABUSE.
TODAY'S MEETING IS OPEN TO THE
PUBLIC AND IS VIDEOCAST AND
RECORDED.
MINUTES OF THE MEETING WILL BE
AVAILABLE ON THE NIDA HOME PAGE,
RECORDINGS OF THE OPEN COUNCIL
MEETINGS ARE POSTED ON THE NIH
VIDEOCAST SITE.
MEMBERS OF THE PUBLIC WHO MAY
WISH TO EXPRESS VIEWS REGARDING
ANY ITEM DISCUSSED DURING THIS
MEETING MAY DO SO BY WRITING DR,
WITHIN 10 DAYS OF THE MEETING.
ANY WRITTEN STATEMENTS BY
MEMBERS OF THE PUBLIC WILL
RECEIVE CAREFUL CONSIDERATIONS.
AT THIS POINT, I'M GOING TO ASK
FOR COMMENTS OR CORRECTIONS FOR
MINUTES TO THE SEPTEMBER 23RD,
2023 MEETING.
A COPY OF THE MEETINGS WERE MADE
AVAILABLE ON THE ELECTRONIC
COUNCIL BOOK UNDER THE NIDA
CURRENT COUNCIL.
I WANT TO ASK FOR A VOTE ON OUR
COUNCIL MEETINGS, I'LL ASK FOR A
MOTION FOR APPROVAL.
SECOND?
ALL IN FAVOR?
MOTION IS CARRIED.
NOW I'M GOING TO ANNOUNCE THE
FUTURE COUNCIL DATES.
THE NEXT ONE WILL BE ON
MAY 7 AND 8, AND THAT'S BOTH OUR
COUNCIL WHICH IS DONE JOINTLY
WITH THE NIAA.
SEPTEMBER 11 AND ON FEBRUARY 4,
2025.
THAT'S ALL OF THE ITEMS THAT ARE
PRESENT BEFORE I GIVE YOU MY
DIRECTOR'S REPORT.
SO ANYTHING ELSE, SUSAN, OR
SHOULD I JUMP IN?
>> JUMP IN.
>> OKAY, I'M JUMPING IN.
LET ME SHARE MY SLIDES.
AND I'LL NEED TO KNOW IF YOU'RE
SEEING THEM.
IS THAT OKAY?
>> PERFECT.
>> WELL, FIRST OF ALL, AGAIN, I
WANT TO REITERATE THAT IT'S A
PLEASURE TO BE ABLE TO PRESENT
TO YOU, AND WHAT I'M GOING TO DO
IS, OF COURSE, HIGHLIGHT SOME OF
THE ISSUES THAT ARE MOST SALIENT
AND THAT ARE DRIVING MANY OF THE
PRIORITIES IN TERMS OF RESEARCH.
EXTREMELY IMPORTANT, I'M SURE
THAT MOST OF YOU KNOW BUT WE
HAVE A NEW DIRECTOR OF THE NIH,
DR. MONICA BERTAGNOLLI, AND
SHE'S THE SECOND WOMAN TO TAKE
THAT POSITION AT THE NIH.
SHE WAS NOMINATED BY PRESIDENT
JOE BIDEN ON MAY 15TH, AND
CONFIRMED BY THE SENATE ON
NOVEMBER 7 OF LAST YEAR, AND SHE
TOOK OFFICE TWO DAYS LATER.
SHE'S THE FIRST SURGEON AND AS I
SAY, THE SECOND WOMAN TO HOLD
THE POSITION OF DIRECTOR OF THE
NIH.
SHE'S A LEADER IN CLINICAL
ONCOLOGY AND HER RESEARCH HAS
FOCUSED ON GENETIC DRIVERS OF
GASTROINTESTINAL CANCER
DEVELOPMENT AND THE ROLE OF
INFLAMMATION ON CANCER DRUG.
SHE HAS LED TRANSLATIONAL
SCIENCE INITIATIVES IN THE NCI
FUNDED COOPERATIVE GROUPS
PROGRAM, WHICH IS THE NCI'S
EQUIVALENT OF THE NATIONAL
CLINICAL TRIALS NETWORK FROM
1994 TO 2011.
SHE'S GROUP CHAIR OF THE
ALLIANCE FOR CLINICAL TRIALS IN
ONCOLOGY, AND NATIONAL CLINICAL
TRIALS NETWORK MEMBER
ORGANIZATION FROM 2011 TO 2022.
AND SHE IS CHIEF OF THE DIVISION
OF SURGICAL ONCOLOGY FOR DANA
FARBER BRIGHAM CANCER CENTER
FROM 2007 TO 2018.
SO SHE HAS HAD A SPECTACULAR
CAREER WITH VERY, VERY STRONG --
VERY STRONG IN CLINICAL
SCIENCES.
BUT ALSO IN BASIC COMPONENTS OF
CANCER DEVELOPMENT.
AND I WANTED TO HIGHLIGHT SOME
OF THE POINTS THAT SHE HAS SAID
BECAUSE I DO THINK THAT IT DOES
REFLECT VERY MUCH WHERE SOME OF
THE PRIORITIES AT THE WHOLE
LEVEL OF THE NIH ARE GOING TO BE
HAPPENING, WHICH ARE ALSO
EXTREMELY TIMELY AND CONSISTENT
WITH MANY OF THE INITIATIVES AT
NIDA.
SO I'M GOING TO QUOTE FROM SOME
OF THE THINGS THAT SHE HAS
BASICALLY EXPRESSED.
OUR WORK IS NOT FINISHED WHEN WE
DELIVER SCIENTIFIC DISCOVERIES.
OUR WORK IS FINISHED WHEN PEOPLE
ARE LIVING LONG AND HEALTHY
LIVES.
NIH RESEARCH ENCOMPASSES THE
LABORATORY, THE CLINIC, AND THE
COMMUNITY.
PATIENTS ARE PARTNERS IN
DISCOVERY.
NIH AIMS TO BRING MORE MEMBERS
OF THE PUBLIC INTO THE RESEARCH
ENTERPRISE AS PARTNERS IN
DISCOVERY.
INCOME, AGE, RACE, ETHNICITY,
GEOGRAPHIC LOCATION, AND
DISABILITY STATUS SHOULD NOT BE
BARRIERS TO PARTICIPATING IN
RESEARCH OR BENEFITING FROM
RESEARCH ADVANCES.
PROGRESS IS ACCELERATED WHEN
ADVANCED SCIENTIFIC METHODS ARE
APPLIED TO DATA THAT INCLUDES
EVERYONE, AND WHEN NEW
DISCOVERIES ARE RAPIDLY -- SOR
SORRY -- AND WHEN NEW
DISCOVERIES ARE RAPIDLY AND
EQUITILY DELIVEEQUITABLY DELI AL
CARE.
YOU CAN SEE WHY THERE IS SO MUCH
EXCITEMENT AMONG THE VARIOUS
INSTITUTE DIRECTORS AND STAFF AT
THE NIH ARE BRINGING SOMEONE
THAT IS SO INCREDIBLY INCLUSIVE
AND SO COMMITTED TO ADVANCING
TRANSLATION AND BRING SOLUTIONS
SO THAT PEOPLE'S LIVES ARE
BETTER.
ANOTHER IMPORTANT ADVANCE THAT
HAS HAPPENED IS THE NIH FELLOWS
UNITED.
ON DECEMBER 7 OF LAST YEAR, A
MAJORITY OF THE VOTING NIH
FELLOWS UNITED VOTED TO BE
REPRESENTED BY THE INTERNATIONAL
UNION OF UNITED AUTOMOBILE,
AEROSPACE AND AGRICULTURAL
IMPLEMENT WORKERS OF AMERICA.
THE FEDERAL LABOR RELATIONS
AUTHORITY CERTIFIED THE
BARGAINING UNIT ON DECEMBER 15,
2023.
AND THE UAW UNIT COVERS
APPROXIMATELY 5,000 NIH FELLOWS.
NIH WILL PARTNER WITH THE UAW TO
NEGOTIATE A COLLECTIVE
BARGAINING AGREEMENT FOR THE
PARTIES.
COLLECTIVE BARGAINING WILL BE
ONGOING THROUGHOUT 2024.
AND WE WILL BE UPDATING YOU AS
DECISIONS ARE MADE.
WITH RESPECT TO THE BUDGET, WE
ARE CURRENTLY ON A CONTINUING
RESOLUTION THAT BASICALLY MEANS
VERY LIKELY FLAT BUDGETS FOR
2025 AND PERHAPS FOR -- WE DON'T
KNOW WHAT WILL HAPPEN IN 2026,
BUT THERE IS A POSSIBILITY THAT
THERE WOULD ALSO BE FLAT
BUDGETS, CONSIDERING THAT THE
COST OF DOING RESEARCH IS
INCREASING, EVEN THOUGH IT'S
SAME BUDGETS AS BEFORE, ACTUALLY
MEANS A DECREASE IN THE BUYING
POWER THAT THOSE DOLLARS IS.
WE ARE AWARE OF THIS, WE ARE
HOPEFUL THAT THERE WILL NOT BE
DRASTIC CUTS BEYOND THOSE THAT
MAY BE INFLICTED IF WE DO GET A
CONTINUING RESOLUTION AND IT'S
NOT RESOLVED.
AND SO WE'RE WORKING WITH THE
POSSIBILITY OF A FLAT BUDGET.
BECAUSE OF THE -- AS I WAS
MENTIONING THE INCREASES IN COST
AND IT IS -- THIS IS GOING TO
RESULT IN A SLOWING OF NEW
DISCOVERIES.
IT WILL -- THERE IS CONCERN THAT
IF THE FUNDS ARE LESS, THIS WILL
ACTUALLY DETRACT OUR YOUNG
INVESTIGATORS TO GO INTO SCIENCE
CAREERS, AND WE MAY LOSE THEM,
AND PARTICULARLY VULNERABLE IS
THAT OUR INTRAMURAL RESEARCH
PROGRAMS AT THE NIH, BECAUSE
BASICALLY MOST OF THE FUNDS GO
INTO PERSONNEL AND THEY CANNOT
BALANCE BY GOING OUT AND BEING
ABLE TO GET ADDITIONAL FUNDING.
SO THAT MAKES IT -- THAT'S WHAT
MAKES THE INTRAMURAL PROGRAM SO
PARTICUPARTICULARLY SENSITIVE TE
SITUATIONS WHERE THE NIH -- ARE
CUT.
SO IN THIS LANDSCAPE, WE HAVE TO
BE VERY AWARE THAT IN ORDER TO
ADVANCE THE SCIENCE, WHICH IS
OUR RESPONSIBILITY, WE NEED TO
ALSO MAXIMIZE AND BE STRATEGIC
AND CREATE PARTNERSHIPS THAT CAN
HELP US DO RESEARCH.
, BECAUSE IT
IS URGENTLY NEEDED.
I WANT TO ALSO HIGHLIGHT OF SOME
VERY, VERY EXCITING ADVANCES
FROM BRAIN, AND THIS WAS LAST
YEAR, THERE WAS A WHOLE VOLUME
OF THE JOURNAL NATURE DEVOTED TO
THE CHARACTERIZATION OF THE
COMPLETE MULTIMODAL CELL CENSUS
OF THE MOUSE BRAIN, AND THIS IS
A PRODUCT OF THE BRAIN
INITIATIVE CELL CENSUS NETWORK,
AND IT'S VERY, VERY EXCITING
BECAUSE IT NOW PROVIDES US AN
INSIDE DIVERSITY OF CELLS IN THE
BRAIN, AND WAY BEYOND WHAT WE
HAD EVER THOUGHT, AND THROUGH
TOOLS THAT AT THE SAME TIME IN
PARALLEL ARE BEING DEVELOPED BY
THE BRAIN INITIATIVE, WE NOW
HAVE THE FEASIBILITY OF
POTENTIALLY MANIPULATING
SPECIFIC CELLS AND UNDERSTANDING
THEIR EFFECTS.
AND WITH THAT, I DO WAS TO ALSO
ALERT YOU AND INVITE YOU TO
ATTEND THE ANIMAL BRAIN
INITIATIVE CONFERENCE, WHICH
WILL TAKE PLACE ON JUNE 17 AND
JUNE 18, AND WHERE YOU WILL HEAR
SOME OF THE MOST EXCITING
ADVANCES THAT HAVE COME OUT OF
THE BRAIN, WHICH INCLUDE TOOLS
BUT ALSO UTILIZATION AND
EXAMPLES ABOUT HOW THESE TOOLS
ARE ILLUMINATING OUR
UNDERSTANDING OF HOW THE BRAIN
OF RODENTS, NON-HUMAN PRIMATES
AND HUMANS ACTUALLY IS ORGANI
ORGANIZED.
SO THERE IS THE CELL CENSUS BUT
THERE IS ALSO THE VERY DETAILED
CHARACTERIZATION OF THE
CONNECTIONS BETWEEN CELLS AND
BETWEEN MULTIPLE CELL AREAS INTO
NETWORKS AND HOW THEN THESE
ULTIMATELY TRANSLATES INTO
BEHAVIOR.
SO EXTRAORDINARILY EXCITING.
SO IF YOU ARE ABLE TO JOIN, YOU
WILL NOT BE DISAPPOINTED.
NOW I WANT TO JUMP INTO NIDA
ITSELF.
I ALWAYS START BY DESCRIBING OUR
BUDGET.
SO HERE ARE THE BUDGETS FOR 2023
AND THE BUDGETS FOR 2024 AND FOR
THE PRESIDENT'S.
THIS IS BASICALLY BECAUSE WE ARE
ON A CONTINUING RESOLUTION, OUR
BUDGETS ARE BASED ON WHAT WE
GOTTEN ACTED IN 2023, AND YOU'RE
SEEING I'VE BEEN PRESENTING THE
BUDGETS AS THE BASE AND DIVIDING
THE BASE SEPARATE FROM THE HILL,
AND THE REASON WHY THIS IS FOR
IS THAT THE HEAL FUNDS WERE
ALLOCATED TO NIDA, AND AN
EQUIVALENT WAS ALLOCATED TO
NINDS, SPECIFICALLY TO ADVANCE
SCIENCE AND KNOWLEDGE THAT WOULD
HELP US ADDRESS THE OVERDOSE
CRISIS.
SO BY PLACING THEM AS A SEPARATE
CATEGORY, IT DOES HIGHLIGHT THE
URGENCY THAT WE -- OF BASICALLY
WHERE WE ARE AND HOW WE WANT TO
USE THOSE FUNDS TO HELP US
ADDRESS THESE OVERWHELMING AND
TRAGIC LOSS OF LIVES FROM THE
OVERDOSE CRISIS.
SO FROM 2022 TO 2023, WE DID GET
AN INCREASE OF FUNDS AND WE GOT
$10 MILLION EXTRA FOR HEAL, AND
WE ALSO GOT -- THE INSTITUTE
ALSO GOT $10 MILLION FOR PAIN.
IN TERMS OF THE INSTITUTE
ITSELF, I AM REALLY, REALLY
EXCITED TO MAKE THE ANNOUNCEMENT
THAT DR. IVAN MONTOYA HAS BEEN
OFFERED AND ACCEPTED THE
POSITION OF DIVISION OF
THERAPEUTICS AT NIDA.
MOST OF YOU KNOW HIM BECAUSE
IVAN HAS BEEN THE ACTING
DIRECTOR FOR THE DTMC FOR MORE
THAN A YEAR, AND BEFORE THAT, HE
HAS BEEN THE DEPUTY DIRECTOR FOR
A LONG, LONG TIME.
SO HE HAS A STRONG, STRONG
KNOWLEDGE ABOUT THE PROCESS OF
THE DEVELOPMENT OF MEDICATIONS
AND ALSO VERY KNOWLEDGEABLE
ABOUT HOW THE NIH WORKS AND THE
INTERACTIONS -- AND HIS
INTERACTIONS WITH THE OTHER
DIVISIONS AND HIS OFFICE HAS
BEEN VERY, VERY PRODUCTIVE, AS
WELL AS HIS INTERACTIONS WITH
THE PHARMACEUTICAL INDUSTRY.
SO IT'S A PLEASURE, WE ARE
REALLY DELIGHTED THAT IVAN HAS
AGREED TO DO THIS -- TAKE ON THE
ROLE OF DIRECTOR OF THAT
DIVISION OF THERAPEUTICS.
AND WE LOOK FORWARD TO MANY
DISCOVERIES.
I ALSO WRANT TO ANNOUNCE TOO
THAT MR. MICHELE RANKIN WILL
ALSO BE THE DIRECTOR FOR OF
OFFICE OF NIDA HEAL.
THIS RESULTED AS -- WHEN IT USED
TO BE THAT HEAL WAS DIRECTED
FROM THE OFFICE OF THE DIRECTOR
OF THE NIH AT THE BEGINNING WITH
THE PURPOSE AND THE MISSION TO
TRY TO STABILIZE THE FUNDING AND
TO CREATE A THROUGHPUT AND,
AGAIN, THAT WILL THEN ULTIMATELY
ENSURE THAT THERE WAS ADVANCES
IN THE FIELD OF OPIOID USE
DISORDER AND OVERDOSE PREVENTION
AND TREATMENT, WHILE AT THE SAME
TIME ENSURING THAT THERE WAS
INTEGRATION FOR RESEARCH THAT
PERTAINED TO PAIN, AND SO NOW
LAST YEAR IT MOVED FROM THE
OFFICE OF THE DIRECTOR INTO THE
TWO INSTITUTES THAT HAVE BEEN
ASSIGNED RESOURCES, NIDA BEING
ONE OF THEM AND THE OTHER ONE
NINDS.
SO DR. MICHELE RANKIN WILL BE
OUR LEAD AT NIDA FOR OVERSEEING
THE RESOURCES THAT ARE PLACED IN
ORDER TO ADVANCE THE SCIENCE FOR
HEAL.
AND MICHELLE HAS BEEN DOING
REALLY THAT ROLE, OVERSEEING AND
ENSURING THAT ALL OF THE
PROJECTS THAT ARE BEING FUNDED
WITH HEAL DOLLARS ARE ACTUALLY
REACHING THEIR GOALS.
NOW LET ME JUMP INTO THE SCIENCE
AND GET YOU AN UPDATE.
SO THIS IS A SLIDE THAT I
ACTUALLY BROUGHT TOGETHER FROM
THE MONITORING THE FUTURE THAT,
AS YOU KNOW, IS A SURVEY DONE,
WE DO WHERE WE'RE ACTUALLY
EVALUATING ON A YEARLY BASIS
TEENAGERS THAT ARE IN 8TH, 10TH
AND 12TH GRADE TO ASSESS THE
PREVALENCE OF DRUG USE AS WELL
AS THEIR ATTITUDES.
AND THIS JUST SUMMARIZES IT,
BECAUSE AS HAS BEEN THE CASE FOR
2022 AND 2021, WE HAVE SEEN A
VERY SIGNIFICANT REDUCTION IN
THE USE OF DRUGS IN OUR COUNTRY
AMONG TEENAGERS.
ACTUALLY HAS BEEN MORE THAN
2021, IT HAS BEEN JUST GOING
DOWNWARD NOW FOR I WOULD SAY --
WITH THE COVID PANDEMIC WE SAW A
DRASTIC DECREASE IN DRUG USE
WHICH WE WERE EXCITED ABOUT
BECAUSE IN GENERAL, WE KNOW ONE
OF THE MOST DANGEROUS PERIODS
FOR DRUG EXPOSURES IS DURING ADD
ADOLESCENCE, AND IT'S ALSO A
PERIOD WHERE THEY'RE MORE LIKELY
TO BE ENTICED INTO TAKING DRUGS.
SO TO SEE SUCH A SIGNIFICANT
CHANGE IN 2020, WHICH WE
ACTUALLY ASCRIBE TO THE FACT
THAT TEENAGERS WERE NO LONGER
ABLE TO BE IN PLACES TOGETHER,
DECREASED THEIR LIKELIHOOD OF
BEING ABLE TO GET EXPOSED TO
DRUGS.
SUBSEQUENT STUDIES HAVE ACTUALLY
EVALUATED THAT, YES, THAT PLAYED
AN IMPORTANT ROLE, AND ALSO THAT
THEY WERE AT HOME AND MANY TIMES
THE PARENTS WERE THERE SO THEY
WERE OVERSEEING THEM.
SO WE WERE CONCERNED THAT ONCE
THE SCHOOLS OPENED UP AND
TEENAGERS WERE ABLE TO GET BACK
TOGETHER AS THEY USED TO, WE
WOULD SEE A RISE IN THE PATTERNS
OF DRUG USE TO THOSE SIMILAR
THAT WE HAD SEEN IN 2019.
AND WHAT WE'VE SEEN IS THAT
THAT'S NOT THE CASE.
NEITHER FOR 2022 NOR 2023, WE
HAVE SEEN THE PREVALENCE OF DRUG
USE REBOUND TO WHAT IT WAS.
IN FACT WE CONTINUE TO SEE IT
DECREASE, AND THAT PERTAINS BOTH
TO ILLICIT DRUGS, WHICH ARE THE
ONES TO THE LEFT, AS WELL AS TO
THALCOHOL AND TOBACCO.
THIS IS ACTUALLY EXTREMELY
NOTABLE IF YOU THINK ABOUT IT.
PARTICULARLY, TOO, IS THE MAIN
CHANGES ARE IN THE 12TH GRADERS
AND THE 12TH GRADERS SORT OF ARE
THE ONES THAT HAD THE HIGHEST
PREVALENCE RATES OVERALL.
THERE'S A FEW AREAS THAT THERE
HAS BEEN WHAT APPEARS TO BE SOME
INCREASES FOR TENTH GRADERS ON
ILLICIT SUBSTANCES, BUT THE
NUMBERS ARE SO, SO VERY LOW OF
THOSE TEENAGERS THAT ARE TAKING
THE COCAINE THAT BASICALLY IT'S
VERY LIKELY TO BE JUST PART OF
THIS ERROR SIGNALS AND
VARIABILITY.
IN THE LEGAL ONES, THE ONE THAT
WE'RE SEEING IS THE INCREASES IN
ALCOHOL BEVERAGES WITH CAFFEINE.
AND WE WILL KEEP AN EYE ON THOSE
TO SEE IF THEY ARE REALLY --
THEY ARE -- THEY WILL CONTINUE
LIKE THAT OR WHETHER THEY ARE AS
I WAS IMPLYING THEY COULD BE
JUST VARIABILITY.
THIS SLIDE I'M SHOWING TO YOU TO
ACTUALLY GET YOU A SENSE OF WHAT
ARE THE -- AND TO THE LEFT, WHAT
IS THE PREVALENCE OF PAST YEAR
DRUG USE AMONG 12TH GRADERS, BUT
I WANT YOU TO LOOK AT THE
RANKING OF THE DRUGS THE
TEENAGERS FAVOR BECAUSE ACTUALLY
THAT GIVES US A PERSPECTIVE IN
TERMS OF WHAT TO LOOK FOR AND
HOW TO INTERPRET FINDINGS AND OF
COURSE TARGET PREVENTION.
ALCOHOL IS THE NUMBER ONE, THE
MOST PREVALENT, WE'VE KNOWN THAT
ALL ALONG, AND IN FACT IT
REFLECTS THE FACT THAT IT IS A
LEGAL SUBSTANCE AND THAT IT'S
WIDESPREAD, AND SO THE
ACCESSIBILITY, THE CULTURE AND
THE NORMS MAKE IT MUCH MORE
LIKELY THAT THEY WILL GET
EXPOSED TO IT, EVEN WHEN IT IS
ILLEGAL FOR TEENAGERS TO CONSUME
IT.
BUT IT HAS BEEN GOING DOWN
SIGNIFICANTLY.
I DO WANT YOU TO KNOW THAT
SECOND ONE, I PUT A LITTLE RED
STAR TO CATCH YOUR EYES WHICH IS
ANY VAPING, BECAUSE ACTUALLY ANY
VAPING NOW HOLDS THE SECOND
FREQUENCY IN TERMS OF FREQUENCY
POSITION WITH MAR MARIJUANA, AND
TYPICALLY ALL THROUGH THE
MONITORING THE FUTURE SURVEY,
MARIJUANA HAS THE SECOND RANKING
IN TERMS OF FREQUENCY AND NOT
ANYMORE.
WE'RE SEEING THAT VAPING -- AND
AGAIN, IT REFLECTS THE VERY FAST
UP TAKE OF VAPING BY TEENAGERS
STARTING IN 2017, 2018 AND 2019,
WHEN WE HAVE IN 2019 THE HIGHEST
RATES OF PREVALENCE.
VAPEING HAS GONE DOWN SINCE
THEN, SINCE 2020, BUT IT HAS
REMAINED VERY, VERY HIGH,
BASICALLY 29%.
IF YOU GO LOWER, VAPING NICOTINE
IS THE MAIN DRIVER OF VAPING,
BUT SO IS ACTUALLY VAPING OF
CANNABIS ALSO IS QUITE FREQUENT
AMONG TEENAGERS.
I AM ALSO DISPLAYING THAT
ACTUALLY TO YOUR RIGHT, LSD AND
TO YOUR LEFT ACTUALLY MORE
NOTABLE, HA LEW LE HA LE HALLUC.
-- IN THE PAST YEAR, AND AGAIN,
THIS IS THE HIGHEST THAT WE'VE
SEEN IT.
THEN TO THE RIGHT YOU SEE
PSYCHOTHERAPEUTICS, THE REDS.
I HIGHLIGHT THEM BECAUSE THEY
ARE -- COUGH MEDICINE,
AMPHETAMINES, TRANQUILIZERS,
PRESCRIPTION OPIOIDS SUCH AS
VICODIN AND OXYCONTIN.
THEY CONTINUE TO PERSIST, VAIR
VALUETHEIRVALUES ARE MUCH LOWERT
WE HAVE SEEN IN THE PAST, BUT
THEY ARE AMONG THE DRUGS THAT
TEENAGERS WILL EXPERIMENT WITH,
AND I'LL BRING IT BACK LATER
BECAUSE THIS HAS LED TO SOME
SOME VERY NEGATIVE OUTCOMES.
I DO WANT YOU -- LET'S MOVE TO
THE RIGHT TO SEE THE SLIDES
THERE, AND BASICALLY IT SHOWS
JUST TO GET YOU AN IDEA OF THE
TRENDS THAT I WAS REPORTING ON
WITH RESPECT TO THE DECREASES IN
DRUG USE, IN GENERAL, THESE HAVE
NOT -- THESE HAVE BEEN MUCH MORE
STABLE FOR MARIJUANA, WHERE WE
HAVE NOT SEEN ANY MAJOR
DECREASES, VERY STABLE, PERHAPS
SLIGHTLY WITH 2020 AND THEN THAT
HAS STAYED THE SAME BUT ON THE
OTHER HAND, BUT WHAT HAVE BEEN
KEEPING AN EYE ON IS, AGAIN, NOT
BECOMING COMPLACENT AND SAYING,
WELL, ADOLESCENT DRUG USE IS
GOING DOWN, THAT'S CORRECT.
MARIJUANA IS QUITE STABLE.
AND VAPING IS GOING DOWN, BUT
IT'S A VERY HIGH LEVEL.
BUT LOOK AT THE LOWER ONE TO THE
RIGHT, WHICH ACTUALLY SHOWS THAT
THAT'S THE DAILY CONSUMPTION,
ALMOST DAILY CONSUMPTION OF
MARIJUANA, AND THIS IS
CONCERNING CERTAINLY IN MY BRAIN
BECAUSE OF HOW STABLE IT IS, AND
IT'S BEEN APPROXIMATELY A 6%,
CONSIDERING THAT THE CONTENT OF
THC IN MARIJUANA HAS BEEN
INCREASING SIGNIFICANTLY AND
THAT IT IS THE REGULAR USE OF
MARIJUANA WITH A HIGH CONTENT
ASSOCIATED WITH THE MORE
NEGATIVE OUTCOMES, THIS IS
SOMETHING THAT IS WORRISOME, AND
THAT OBVIOUSLY THAT WE
CAN MONITOR AND FOLLOW CLOSELY
TO SEE WHAT ARE THE CONSEQUENCES
OF REGULAR USE OF MARIJUANA IN
TEENAGERS.
AND HOW DO THESE FINDINGS I'M
SHOWING YOU HERE IN TERMS OF
RANKING OF PREFERENCES OF
TEENAGERS FOR DRUGS -- IN TERMS
OF HOW DO THEY COMPARE WITH THE
ADULTS IN TERMS OF VAPING, ALONG
WITH MARIJUANA, SIDELY SIDE.
IMPORTANTLY THAT COMMENT THAT
WE'VE SEEN THE HIGHER RATES FOR
THE USE OF HALLUCINOGENS.
SO LET'S JUMP, THEN, INTO THE
SURVEY FROM THE NATIONAL SURVEY
OF DRUG USE AND HEALTH FROM
SAMHSA, WHICH WAS JUST RELEASED
LAST YEAR FOR 2022.
AND JUST FOR ADOLESCENTS, THE
NUMBER ONE DRUG IN TERMS OF
PREVALENCE IS ALCOHOL.
THE SECOND ONE ARE TOBACCO
PRODUCTS.
VERY MUCH SIDE BY SIDE WITH
MARIJUANA.
BUT YOU ALSO SEE THAT AMONG THE
FOUR TOP RANKING DRUGS IN TERMS
OF PREVALENCE IS NICOTINE
VAPING.
SO EVEN THOUGH THE NICOTINE
VAPING IS THE HIGHEST AMONG
TEENAGERS, WE'RE SEEING ALSO
VERY HIGH RATES AMONG
INDIVIDUALS THAT ARE 12 YEARS OR
OLDER, WHICH IS WHAT TH THE NSDH
SURVEY IS SHOWING YOU HERE.
THE RED STAR INDICATES
HALLUCINOGENS.
SO NOW HALLUCINOGENS ARE AMONG
THE SIX MOST FREQUENTLY USED
SUBSTANCES IN OUR COUNTRY.
NOW, THIS IS WHERE WE ARE RIGHT
NOW, BUT IT'S ALSO WORTHWHILE TO
LOOK AT ANOTHER INDICATOR FROM
THE NSDUH, BECAUSE IT ACTUALLY
ALLOWS US TO PREDICT WHERE WE'RE
GOING TO BE IN THE FUTURE, WHAT
ARE SOME OF THE CHALLENGES WE'RE
GOING TO BE SEEING.
SO THEY DO REPORT ON PAST YEAR
INITIATES OF SUBSTANCES ON
PEOPLE 12 YEARS OR OLDER, AND I
FIND THESE EXTREMELY HELPFUL.
BECAUSE IF YOU LOOK AT IT FROM
THAT PERSPECTIVE, YOU CAN SEE
THAT NICOTINE VAPING IS THE
NUMBER ONE.
SO EVEN THOUGH NICOTINE VAPING
WAS THE 4,014TH RANKI -- THE 14N
PREVALENCE, THE SECOND ONE IS
FOR ALCOHOL.
AND I FOUND IT QUITE NOTABLE
THAT -- I DON'T THINK I'VE EVER
SEEN ANYTHING LIKE THIS -- BASED
ON THESE NUMBERS AND IT'S CLOSE
TO 50% HIGHER, WHICH MEANS THAT
IT IS -- WE CAN PREDICT AND WE
CAN EXPECT THAT THERE WILL BE
MORE INDIVIDUALS IN THE FUTURE
THAT WILL BE ADDICTION TO
NICOTINE TRIGGERED BY ANYTHING
TEEN VAPING.
AND A LOT OF PEOPLE HAVE BEEN
CONCERNED THAT THIS COULD
TRANSLATE INTO HIGHER USE OF
TOBACCO PRODUCTS
FOR WHICH THERE'S SOME EVIDENCE
THAT THAT ACTUALLY DOES HAPPEN.
BUT IN AND OF ITSELF, IT IS ALSO
LIKELY THAT NICOTINE MAY BECOME
A MUCH MORE PREVALENT BY ITSELF
SUBSTANCE THAT WE HAVE SEEN NOW
FOR MANY YEARS.
YOU ALSO SEE THAT THE THIRD ONE
IN INITIATES CONTINUES TO BE
MARIJUANA.
THAT IS A SERIOUS PROBLEM
BECAUSE WE'VE SEEN ALL ALONG
THAT WITH LEGALIZATION OF
MARIJUANA ACROSS THE STATES,
WE'RE SEEING A SIGNIFICANT RISE
IN THE USE OF MARIJUANA ACROSS
ALL AGES OTHER THAN TEENAGERS,
AS I WAS PRESENTING BEFORE.
I ALSO PUT THIS LITTLE STAR HERE
TO SHOW YOU THAT THE NUMBER
6 ACTUALLY IN NEW INITIATES IS
HALLUCINOGENS.
WHICH MEANS WE ARE TO EXPECT, IF
THINGS AND TRENDS CONTINUE
LIKELY, HALLUCINOGENICS WILL
BECOME MUCH MORE FREQUENTLY USED
THAN WHAT WE HAVE BEEN SEEING
UNTIL NOW, AND WHAT YOU'RE ALSO
STARTING TO SEE IN ADOLESCENTS,
AS I SHOWED.
NOW, ONE OF THE ASPECTS THAT I
LIKE TO TIE IT WHEN I SPEAK
ABOUT THE PREVALENCE OF DRUG USE
AND HOW CONCERNING IT IS THAT
WE'RE SEEING SOME OF THESE
TRENDS, PARTICULARLY WITH
REGULAR USE OF MARIJUANA, AND
CERTAINLY NOW WITH NICOTINE
VAPING AND NICOTINE AND VAPING
OF THCs, WHAT ARE THE
CONSEQUENCES.
THAT IS ACTUALLY WHAT ULTIMATELY
LED US TO START IN PARTNERSHIP
WITH THE ALCOHOL INSTITUTES AND
OTHER INSTITUTES, THE ABCD
STUDY, TO TRY TO UNDERSTAND IN A
PROSPECTIVE DESIGN DOING A STUDY
TO ADDRESS THE QUESTIONS OF WHAT
ARE THE CONSEQUENCES OF EXPOSURE
TO CANNABIS TO THE HUMAN BRAIN,
BRAIN DEVELOPMENT, EMERGENCE OF
PSYCHIATRIC SYMPTOMS AND
DISORDERS, AND ULTIMATELY,
ABILITY TO ACTUALLY SUCCEED AND
PERFORM AS AN ADULT.
THAT'S HOW THE ABCD WAS BORN,
AND WE LAUNCHED IT IN TWEB 17.
-- IN 2017.
IT HAS CONTINUED SINCE THEN,
CHILDREN THAT WERE THEN 9 TO 10
YEARS OLD WHEN THEY WERE
RECRUITED, OF WHICH 96.3% HAVE
BEEN RETAINED SINCE THEN.
PERIODICALLY IMPANELIN IMAGING Y
TWO YEARS, EVALUATING THEM
COGNITIVELY, BEHAVIORALLY, WITH
SURVEYS FOR SOCIAL PATTERNS, TO
ADDRESS PHYSICAL ACTIVITIES WITH
IN DEPTH CHARACTERIZATION OF
THEIR SOCIOECONOMICAL
ENVIRONMENTS, AND DEPOSITING
THAT DATA ON A YEARLY BASIS IN
AN OPEN ACCESS FORMAT TO ALLOW
RESEARCHERS FROM ALL DISCIPLINES
TO BE ABLE TO TAKE ADVANTAGE OF
THETHIS EXTRAORDINARY RICH DATAT
AND ANALYZE IT IN THE WAYS THAT
IN THE PAST, NO DATASET HAVE
BEEN MADE AVAILABLE FOR
UNDERSTANDING THE HUMAN BRAIN
DEVELOPMENT.
THIS PROGRAM HAS BEEN INCREDIBLY
ABLY LED BY DR. DOWLING AND HER
TEAM, AND AGAIN, I WANT TO
REITERATE THAT THIS HAS BEEN
DONE IN CLOSE COLLABORATION WITH
THE ALCOHOL INSTITUTE, AS WELL
AS OTHER INSTITUTES LIKE THE
NIMH.
THIS ACTUALLY -- THE WAY THAT
WE'VE ALSO BEEN MAXIMIZING THE
UTILIZATION OF THESE DATABASES
IS JUST BY PUTTING THEM AS OPEN
ACCESS, BUT ALL OF THE
INSTITUTES YOU SEE HERE HAVE
ALSO REQUESTED PROPOSALS IN
ORDER TO BE ABLE -- ENCOURAGING
RESEARCHERS TO TAKE ADVANTAGE OF
THE DATABASE TO ASK FOR GRANTS
THAT ACTUALLY ENABLE THEM TO ASK
SPECIFIC QUESTIONS.
AND THIS FIGURE HERE SHOWS THE
RELATIVE NUMBER OF GRANTS THAT
HAVE BEEN AWARDED BY THE
DIFFERENT INSTITUTES IN ORDER TO
EXPLOIT THE RICHNESS OF THE AB
ABCD.
THE CONSEQUENCES ARE HERE, THE
PUBLICATIONS.
AS OF NOW, MY UNDERSTANDING IS
THERE ARE 832 PUBLICATIONS, IT'S
PROBABLY MORE THAN THAT BUT
THAT'S THE LATEST NUMBERS I
HAVE.
AND MOST OF THEM ARE BASICALLY
EMPIRICAL DATABASED ON NEW
RESULTS.
OTHERS ARE BASED ON COMMENTARIES
AND ANALYSIS OF THE SIGNIFICANCE
OF THESE FINDINGS.
IT HAS BEEN QUITE EXTRAORDINARY,
AND I WOULD SAY AS SOMEONE THAT
HAS BEEN OVERSEEING HOW THE ABCD
HAS BEEN GROWING AND AS SOMEONE
THAT HAS BEEN INVOLVED IN
NEUROIMAGING, TO ME, IT HAS BEEN
A SPECTACULAR SUCCESS.
NOT JUST AS WE WERE INITIALLY
INTENDING, I DON'T THINK -- I
MEAN, I WAS OBVIOUSLY VERY, VERY
EXCITED ABOUT THIS PROGRAM BUT I
NEVER PREDICTED IT WOULD HAVE
SUCH A GIGANTIC IMPACT, NOT JUST
IN TERMS OF UNDERSTANDING HOW
THE HUMAN BRAIN WORKS, BUT
IMPORTANTLY, ON GIVING US AN
INSIGHT OF WHY SOCIAL
DETERMINANTS OF HEALTH COULD
INFLUENCE THOSE PATTERNS OF
DEVELOPMENT AND ALSO HOW THAT
LEADS TO MENTAL DISORDERS.
IT'S ALSO BEEN INCREDIBLY
CONSEQUENTIAL IN TERMS OF
ADVANCING NEURO IMAGING ITSELF,
AND PREPARING US FOR THE
OPPORTUNITY OF CREATING
DATABASES THAT OF COURSE CAN BE
USED IN ORDER TO BUILD MODELS
FOR ARTIFICIAL INTELLIGENCE AND
MACHINE LEARNING AND PREDICTION.
SO IT HAS BEEN JUST AN
EXTRAORDINARY SUCCESS.
A PART OF THE SUCCESS HAS BEEN
THE OPEN ACCESS FORMAT THAT
ALLOWS, AGAIN, FOR RESEARCHERS
TO REALLY DWELL INTO THE COMP
COMPLEXITY.
IT HAS BEEN SOMETIMES A LITTLE
BIT OF A ROLLER COASTER.
WE HAD WANTED TO BE ABLE TO
RELEASE THE DATA ON A YEARLY
BASIS, BUT WE HAD SUFFERED
ACTUALLY SOME SETBACKS BECAUSE
OF THE DIFFICULTIES OF RELEASING
DATA THAT IS SO COMPLEX, AND SO
FINALLY WE WERE DELAYED BY
ALMOST I THINK ONE YEAR BUT WE
WERE ABLE TO HAVE THE ABCD
5.1 DATA RELEASED AND FINALLY
WILL BE ON TRACK BEFORE TO HAVE
THE ANNUAL RELEASES.
AND THESE VERY SUCCESSFUL ABCD
STUDY ACTUALLY SERVED FOR THE
IPS PRAITION INSPIRATION OF THEN
AND CHILD DEVELOPMENT STUDY,
WHICH ALSO AIMS TO LOOK AT BRAIN
DEVELOPMENT, EXCEPT IN THIS ONE,
WE STARTED WHEN THEY WERE 9 TO
10, AND IN THIS WURNTION WE'RE E
STARTING WHEN THE WOMEN ARE
PREGNANT OR JUST -- A NEWBORN IS
NEW-BORN, IN ORDER TO ACTUALLY
ASK THE SAME QUESTIONS, HOW DOES
THE HUMAN BRAIN DEVELOP, AND TO
FOLLOW THESE NEONATES UNTIL THEY
REACH FOR AT LEAST 10 YEARS.
WE FUNDED THE PROJECTS LAST
YEAR, IN SEPTEMBER OF 2023, AND
27 SITES WERE SELECTED, AND
SINCE THEN, THEY HAVE BEEN ABLE
TO RECRUIT 844 PAIRS, A MOTHER
AND A CHILD.
AND THAT IS 78.2% OF THE
ENROLLMENT GOAL, WHICH IS
ACTUALLY -- WHICH IS GOOD
BECAUSE IT'S AN EXTRAORDINARILY
CHALLENGING STUDY.
IN A WAY, IT'S MORE CHALLENGING
THAN THE ABCD, BECAUSE WHAT
HAPPENS IS WE ARE AIMING TO
RECRUIT AT LEAST 25% OF INFANTS
WHOSE MOTHER HAD BEEN EXPOSED TO
DRUGS DURING PREGNANCY.
AND THIS IS CHALLENGING, BECAUSE
MANY WOMEN ARE AFRAID TO
ACTUALLY SEEK OUT HELP IF THEY
ARE TAKING DRUGS, AND THEY ARE
PREGNANT, FOR FEAR THAT THEIR
CHILDREN WOULD BE REMOVED FROM
THEM, OR IN SOME VERY PUNITIVE
STATES, THEY MAY END UP IN JAIL.
SO CONSIDERING THAT, AND WE WERE
AWARE OF THAT, WE HAD ACTUALLY
DONE -- BEFORE WE DID THE FORMAL
RELEASE LAST YEAR, WE HAD A
TWO-YEAR PILOT PROGRAMMING TO
GET A SENSE OF WHAT WERE THE
CHALLENGES AND ALSO ALLOW FOR
THE DIFFERENT SITES TO DO PILOTS
OF THE DIFFERENT VISITS
DEPENDING ON THE AGE OF THESE
INFANTS.
THIS ACTUALLY SHOWS YOU THE
DIFFERENT SITES.
THERE IS VARIABILITY ON WHERE
THEY ARE RIGHT NOW, AND THIS
PLOT HERE SHOWS YOU OF THE
884 -- 844 INFANTS THAT HAVE
BEEN RECRUITED, 34% HAVE HAD A
HISTORY OF PRENATAL SUBSTANCE
USE, WHICH IS HIGHER THAN WHAT
WAS THE GOAL OF 25, WHICH -- AND
THIS TELLS YOU WHICH ARE THE
MOST FREQUENTLY EXPOSED.
AS YOU CAN SEE, THE MOST
FREQUENTLY EXPOSED COME FROM
ALCOHOL, AND IT IS ALL FOLLOWED
BY -- ACTUALLY BY MARIJUANA, AND
THEN TOBACCO.
AND THEN WE HAVE 4% OF THEM ARE
ACTUALLY ON OPIOIDS.
AND IT ALSO HIGHLIGHTS THAT
EXPOSURES ARE VERY MUCH MORE
LIKELY TO BE POLYSUBSTANCE THAN
A SINGLE SUBSTANCE.
AGAIN, THE PLAN JUST LIKE IT WAS
FOR ABCD IS TO ACTUALLY RELEASE
THE DATA IN AN OPEN ACCESS
FORMAT, SO THAT RESEARCHERS CAN
START TO INVESTIGATE AND TAKE
ADVANTAGE OF THIS TO ADVANCE THE
SCIENCE AND OUR DEADLINE RIGHT
NOW, OUR GOAL, IS TO, BY THE END
OF 2024, HAVE A FULL RELEASE FOR
THE FIRST DATASET FOR ABCD, SO
THIS IS QUITE EXCITING.
AND WITH THAT, HE WA I WANT TO P
INTO THE BIG ELEPHANT IN THE
ROOM OF WHAT HAS BEEN HAPPENING
IN OUR COUNTRY WITH THE OVERDOSE
CRISIS AND THE HOCIA HORRIBLE
MORTALITY THAT IT IMPOSED AND
THE SUFFERING IT MEANS FOR
FAMILIES, FRIENDS AND
COMMUNITIES.
AND THE PROBLEM, UNFORTUNATELY,
EVEN THOUGH THERE HAS BEEN VERY
INTEGRATED EFFORTS TO FIGHT IT
AND RESOURCES, IT CONTINUES TO
GROW, ALBEIT IT IS GROWING AT A
SLOWER PACE.
THE NUMBERS WE HAVE WHICH
CORRESPOND TO THE LAST 12 MONTHS
THAT ENDED IN JULY 2023
INDICATED THAT THERE WERE
111,964 PEOPLE THAT DIED FROM AN
OVERDOSE THAT YEAR, AND THAT'S
2.3% INCREASE FROM THE PRIOR
YEAR.
YES, THIS IS AN INCREASE, BUT AS
I SAY, IT'S SIGNIFICANTLY LOWER
THAN WHAT WE SAW IN 2020, WHEN
THE INCREASE DURING THE COVID
PANDEMIC WAS 30%, AND THEN THE
NEXT YEAR, ON 2021, IT WAS 15%.
SO IT HAS SLOWED DOWN, BUT IT
HASN'T BASICALLY DECREASED AND
IT CONTINUES TO INCREASE, AND SO
IT'S AT VERY, VERY HIGH LEVELS.
WE ARE ALSO MONITORING THE PATH
OF WHAT'S HAPPENING, WE HAVE
BEEN SEEING THAT FOR SEVERAL
YEARS, THAT OVERDOSES FROM
HEROIN HAVE BEEN GOING DOWN.
WE'VE ALSO BEEN SEEING THAT THE
OVERDOSES -- FATALITIES FROM
PAIN MEDICATIONS THAT CONTAIN
OPIATES HAVE BEEN GOING DOWN,
AND WE'VE ALSO BEEN SEEING THAT
FATALITIES FROM METHADONE HAVE
BEEN GOING DOWN.
BUT WE HAVE BEEN SEEING THE MAIN
CULPRIT, FENTANYL, AND JUST LOOK
AT THE NUMBERS OF PEOPLE THAT
OVERDOSE AND DIE FROM FENTANYL
ARE THE DRIVERS, AND THEY
CONTINUE TO INCREASE.
NOW, AS YOU LOOK TO THE RIGHT,
WE HAVE THE STIMULANT DRUGS,
COCAINE AND METHAMPHETAMINE, AND
WHEN YOU LOOK AT THE NUMBERS YOU
SAY IT'S VERY CLOSE TO FENTANYL,
AND THAT IS CORRECT, EXCEPT THAT
THE ISSUE THAT WE NEED TO
UNDERSTAND IS THAT MOST OF THESE
DEATHS, THESE 66 OR CLOSE TO
67,000 PEOPLE DYING FROM
PSYCHOSTIMULANTS, THE MAJORITY
OF THEM ACTUALLY HAD ALSO
FENTANYL.
SO IT IS A VERY FREQUENT
PATTERN, THAT OF SEEING OTHER
DRUGS ACTUALLY IN COMBINATION
WITH FENTANYL, WHICH THEN
INCREASES THE LETHALITY OF THESE
DRUGS AS WE'RE SEEING FOR
COCAINE, WHERE WE SAW A 12.2%
INCREASE IN MORTALITY, AND A
6.4% FOR METHAMPHETAMINE.
SO THESE HAS MADE ACTUALLY
ADDRESSING THE OVERDOSES AND THE
PROTECTION AND THE PREVENTION OF
THESE OVERDOSES MUCH MORE
COMPLEX, BECAUSE IT'S NOT NOW
ONLY PEOPLE THAT ARE SEEKING
OPIOIDS THAT ARE DYING, BUT ALSO
PEOPLE THAT ARE SEEKING OUT
COCAINE AND METHAMPHETAMINE.
SO WE KNOW THAT ALL ALONG
ACTUALLY THAT ONE OF THE MOST
POWERFUL TOOLS THAT WE HAVE FOR
ADDRESSING THE OVERDOSE CRISIS
IS ACCESS TO TREATMENT.
THIS BECAME VERY, VERY EVIDENT
AND URGENT DURING THE COVID
PANDEMIC, WHEN THE SOCIETY
CLOSED, AND THAT FORCED
BASICALLY CHANGING THE PATTERN
BY WHICH WE WERE DEPLOYING THE
TREATMENTS FOR OPIOID USE
DISORDER, MOST NOTELY METHADONE
TO THE OPIATE OR METHADONE M
PRAS, AND BUPRENORPHINE, TO
ACTUALLY RELAX THE PROCEDURE SO
IT WOULD MAKE IT EASIER FOR
PEOPLE TO ACCESS THESE
MEDICATIONS AND TO STAY IN THESE
MEDICATIONS.
AND FROM THE EXPERIENCE WITH THE
COVID PANDEMIC, IT BECAME CLEAR
THAT, YES, DECREASING THE
RESTRICTIVENESS OF PROVIDEING
WITH METHADONE IN OPIATE
TREATMENT PROGRAMS BASICALLY
INCREASED ACCESS TO METHADONE
AND DID NOT RESULT IN AN
INCREASE IN PEOPLE DYING FROM
OVERDOSES FROM METHADONE AS
INITIALLY WAS -- PEOPLE HAD BEEN
AFRAID.
AND SIMILARLY, THE RELAXATION OF
PROVIDING WITH BUPRENORPHINE
TREATMENT FOR THOSE THAT NEEDED
IT WAS ALSO ASSOCIATED WITH NEW
INITIATE AND INCREASED
SUSTAINMENT IN TREATMENT.
SO IT IS VERY EXCITING FOR ME TO
BRING FORWARD THE NEW FEDERAL
REGISTER WHERE IT ACTUALLY IS
ANNOUNCED TARGETING CHANGES TO
THE MEDICATION FOR THE TREATMENT
OF OPIOID USE DISORDER IN WHICH
IT ELIMINATES ONE YEAR OPIOID
ADDICTION HISTORY REQUIREMENT BY
THE OTPs IN ORDER TO BE ABLE
TO GIVE TREATMENT TO PREGNANT
INDIVIDUALS.
IT ALSO INCORPORATES --
REDUCTION PRINCIPLES INTO
TREATMENT, WHICH IS THE FIRST
TIME WE'VE SEEN THIS AS ONE OF
THE ITEMS THAT IS PROMOTED.
IT REMOVES THE REQUIREMENTS FOR
TWO DOCUMENTED INSTANCES OF
UNSUCCESSFUL TREATMENT FOR
PEOPLE UNDER AGE 18, SO THAT
THEY CAN ALSO BENEFIT FROM THE
USE OF MEDICATIONS FOR OPIOID
USE DISORDER IF THEY ARE
TEENAGERS AND REQUIRE THEM.
AND THE MEDICATION ACCESS IS NO
LONGER CONTINGENT ON COUNSELING,
WHICH WAS AN ISSUE THAT MADE IT
VERY HARD SOMETIMES TO PROVIDE
FOR METHADONE EXCEPT IN
METHADONE OPIOID TREATMENT
PROGRAMS.
IT ALSO ALLOWS FOR THE SCREENING
TO BE PERFORMED BY PRACTITIONERS
OUTSIDE THE OPIATE TREATMENT
PROGRAMS, AND THE COVID-19
TAKE-HOME FLEXIBILITIES MADE
PERMANENT -- WERE MADE
PERMANENT, INCLUDING BEING ABLE
TO TAKE METHADONE HOME WITHIN
ONE WEEK OF TREATMENT UNDER
CERTAIN CONDITIONS.
IT ALSO ALLOWS FOR SCREENING FOR
BUPRENORPHINE INITIATION FOR
AUDIO ONLY OR AUDIO-VISUAL
TELEHEALTH UNDER CERTAIN
CONDITION AND ALLOWS ANY
QUALIFYING OPIATE TREATMENT
PROGRAM, THE TIME FRAME WAS
EXPANDED FROM 120 TO 180 DAYS.
AND FINALLY, IT ALLOWS NURSE
PRACTITIONERS AND PHYSICIAN
ASSISTANTS TO ORDER MEDICATIONS
FOR OPIOID USE DISORDER FOR
OPIATE TREATMENT DISPENSING.
SO ALL OF THESE CHANGES ARE
BASICALLY CONSOLIDATING
PRACTICES THAT WILL MAKE IT MUCH
EASIER FOR PEOPLE TO HAVE ACCESS
TO TREATMENT, WHICH, AGAIN, IS
CRUCIAL BECAUSE WE KNOW THAT THE
MOST POWERFUL TOOL THAT WE HAVE
TO PREVENT OVERDOSES IS GIVING
ACCESS TO MEDICATIONS FOR OPIOID
USE DISORDER TO THOSE THAT NEED
THEM.
SO YES, AND THIS IS VERY MUCH
DESCRIBED IN THE HHS OVERDOSE
PREVENTION STRATEGY.
EVIDENCE-BASED TREATMENT
HIGHLIGHTS THE IMPORTANCE OF
MEDICATIONS FOR OPIATE USE
DISORDER, BUT ALSO EXPANDED
ACCESS FOR NALOXONE.
BUT ALSO NOW IN THIS NEW
ADMINISTRATION, IT HAS
HIGHLIGHTED, THE HHS, THE
IMPORTANCE OF HARM REDUCTION
APPROACHES AS A STRATEGY IN
ORDER TO PREVENT OVERDOSE
DEATHS.
AND THIS IS CRUCIAL BECAUSE
WHILE OBVIOUSLY THE IDEAL IS TO
GET PEOPLE INTO TREATMENT AND
ULTIMATELY INTO FULL RECOVERY,
THE REALITY IS THAT THERE ARE
MANY INDIVIDUALS WHO ARE TAKING
DRUGS THAT ARE NOT READY TO GET
INTO TREATMENT AND NOT OFFERING
SOME OF THE INTERVENTIONS THAT
COULD SAVE THEIR LIVES.
ACTUALLY INTERFERES WITH THEIR
GIVING THEM AN OPPORTUNITY TO
EVENTUALLY GET INTO RECOVERY.
SO HARM REDUCTION AIMS TO
PROVIDE SUPPORT TO PEOPLE WHERE
THEY ARE.
IF IT IS HELPING THEM GUIDE THEM
INTO TREATMENT, IT IS BASICALLY
HELP THEM, GUIDE THEM IN HOW TO
USE DRUGS IN A WAY THAT IS LESS
HARMFUL THEN, AND THEN STABILIZE
THEM AND THEN GIVING THEM AN
OPPORTUNITY TO BE READY
EVENTUALLY TO GO INTO TREATMENT,
THEN WE SHOULD DO IT.
WE SHOULD BE ABLE TO PROVIDE AND
PROTECT PEOPLE FROM DYING FROM
OVERDOSES.
IN THE FIELD OF HARM REDUCTION
AND IN THE RESEARCH OF HARM
REDUCTION, THERE ARE SOME
PRACTICES THAT HAVE BEEN
EXTENSIVELY INVESTIGATED.
AND I WILL SAY THE MOST NOTABLE
AND MOST WIDESPREAD RESEARCH HAS
BEEN DONE ON SYRINGE EXCHANGES
AND SYRINGE SERVICES PROGRAMS.
AND THE RESEARCH IS BASICALLY
CLEARCUT SHOWING THAT SYRINGE
EXCHANGE AND SYRINGE SERVICES
PROGRAMS ACTUALLY ARE VERY
EFFECTIVE IN PROTECTING PEOPLE
FROM INFECTIOUS DISEASES, HIV,
HCV.
IT'S ALSO SHOWN THAT IT HELPS
PEOPLE LINK THEM WITH TREATMENT,
AND IT ALSO HAS SHOWN THAT IT --
OPIATE USE DISORDER LU ALSO LINK
THEM FOR TREATMENT FOR OTHER
MEDICAL CONDITIONS AND, BY THE
WAY, IT'S COST-EFFECTIVE.
SO THERE'S NO MORE RESEARCH
NEEDED TO SHOW THAT IT IS
EFFECTIVE.
THE ISSUE, THOUGH, THAT IS VERY
FRUSTRATING IS DESPITE THIS
EVIDENCE, WHY IS IT THAT THEY
ARE NOT IMPLEMENTED?
WHY IS IT THAT THERE ARE SO MANY
PLACES THAT ARE STILL BASICALLY
CLOSED SYRINGE EXCHANGE PROGRAMS
WITH THE CONSEQUENCES AS CAN BE
EXPECTED OF BASICALLY NEW CASES
OF INFECTIONS THAT HAPPEN WHEN
THIS HAS A CURE.
SO FROM THAT PERSPECTIVE ON
RESEARCH, THE QUESTION THAT
LINGERS IS WHAT NEEDS TO BE DONE
TO ACTUALLY MODIFY PRACTICES SO
THAT THERE IS IMPLEMENTATION OF
THIS VERY STRONG EVIDENCE
INITIATIVE.
THERE IS ALSO VERY STRONG
EVIDENCE THAT DISTRIBUTION OF
NALOXONE, WHICH IS THE OPIOID
RECEPTOR ANTAGONIST DRUGS THAT
WHEN APPLIED IN TIME CAN
BASICALLY SAVE A LIFE, I LIKE TO
CALL IT A MIRACLE DRUG, AND I
DON'T LIKE TO CALL ANYTHING
MIRACLE, BUT THE REALITY IS
NALOXONE, I CALL IT A MIRACLE
BECAUSE IF YOU DO GIVE IT IN
TIME AT THE CORRECT DOSE, YOU
WILL SAVE A PERSON'S LIFE.
AND IT HAS MINIMAL NEGATIVE
EFFECTS, SIDE EFFECTS.
SO IF YOU GIVE IT AND SOMEONE
HAS AN OVERDOSE FROM SOMETHING
ELSE, YOU ARE NOT GOING TO HARM
THEM.
BUT THERE IS BASICALLY
ABSOLUTELY SPACE TO DO RESEARCH
TO UNDERSTAND, FOR EXAMPLE, WHAT
ARE THE OPTIMAL DISTRIBUTION
STRATEGIES, WHAT IS THE PATTERN
OF USE IN TERMS OF DOSING, AND
WHO -- POCKETS OF PEOPLE THAT
ARE VERY VULNERABLE THAT ARE NOT
GETTING ACCESS TO NALOXONE IN
ORDER TO BE ABLE TO IDENTIFY
THEM AND ADDRESS IT.
AND THERE ARE OTHER AREAS FOR
WHICH HARM REDUCTION PRACTICES
HAVE BEEN STUDIED LESS.
OVERDOSE PREVENTION SENATORS,
MOST OF THE RESEARCH HAS BEEN
DONE IN STUDIES OUTSIDE THE
UNITED STATES AND BECAUSE OF THE
SUCCESS OF THESE PROGRAMS WHICH
HAVE BEEN SHOWN THERE'S NO TWO
WAYS AROUND IT, THEY SAVE LIVES,
BUT THEY ACTUALLY ARE MEASURED
AGAINST WHAT THE OUTCOMES WILL
BE ACHIEVED BECAUSE THESE
REQUIRE RESOURCES, AND UNDER
WHAT CONDITIONS AND CONTEXT THEY
ARE MOST VALUABLE.
THAT RESEARCH IS NEEDED IN OUR
COUNTRY.
SIMILARLY AS WE'RE SEEING MORE
AND MORE FENTANYL USED TO LACE
OTHER DRUGS, CONTAMINATING THEM,
THE POSSIBILITY OF GIVING TEST
STRIPS FOR INDIVIDUALS THAT ARE
USING DRUGS SO THEY CAN TEST THE
DRUGS BEFORE THEY USE THEM HAS
GENERATED A LOT OF INTEREST IN
SOME STATES.
THEY ACTUALLY -- DOLLARS CAN BE
USED FROM THE STATES IN ORDER TO
PURCHASE THOSE TEST STRIPS IN
OTHER STATES.
THEY ARE STILL CONSIDERED DRUG
PARAPHERNALIA AND, THEREFORE,
ILLEGAL.
SO RESEARCH IS NEEDED TO TRY TO
UNDERSTAND HOW TO OPTIMALLY
DISSEMINATE AND IMPLEMENT THE
USE OF THESE TEST STRIPS,
WHETHER IT IS FOR FENTANYL AND
XYLAZINE, AND HOW TO EDUCATE THE
USERS IF THEY DO HAVE POSITIVE
TESTS ON HOW TO ACTUALLY
MINIMIZE THE RISKS IF THEY
DECIDE TO STILL USE THE DRUGS.
AND TO ME, I'VE PUT THESE OTHERS
BECAUSE OBVIOUSLY PEOPLE ARE
TRYING TO COME UP WITH DIFFERENT
TYPE OF STRATEGIES TO PREVENT
THEM FROM GOING INTO WITHDRAWAL,
FOR EXAMPLE, THE UTILIZATION IN
SOME INSTANCES OF CANNABIS, AND
FROM THAT PERSPECTIVE, THOSE CAN
ALSO BE DESCRIBED IN HARM
REDUCTION PRACTICES, BUT THERE
IS VERY LITTLE RESEARCH IN THAT
RESPECT.
SO TO TRY TO ADDRESS BASICALLY
AND PUSH FORWARD THE CONCEPT OF
THE NEED FOR RESEARCH ON HARM
REDUCTION, LAST YEAR WE
BASICALLY DEPLOYED A HARM
REDUCTION RESEARCH NETWORK THAT
AIMS TO BASICALLY INVESTIGATE
NOVEL HARM REDUCTION APPROACHES,
NOVEL SETTINGS FOR DEPLOYING
THOSE ARMORY D HARM REDUCTION A,
UNDERSTANDING WHAT ARE THE
BARRIERS, AND RESEARCHING
UNDERSTSTUDIED POPULATIONS.
THESE ARE ORGANIZED IN SUCH A
WAY THAT WE STARTED WITH 10
DIFFERENT GRANTS THAT ARE UNITED
THROUGH A COORDINATION CENTER
THAT IS COMPOSED OF FOUR CORES,
ONE FOR COMMUNICATION AND
COORDINATION, ONE FOR DATA
HARMONIZATION AND METHODOLOGY SO
THE DATA IS COLLECTED IN WAYS
THAT THEN CAN BE UTILIZED ACROSS
THE DIFFERENT INVESTIGATORS AND
OTHERS, COMMUNITY AND
STAKEHOLDER ENGAGEMENT, SO THAT
WE CAN BASICALLY HAVE A MUCH
MORE -- HAVE MUCH MORE
ENGAGEMENT OF THOSE PEOPLE THAT
ARE OUT THERE AND MOST
KNOWLEDGEABLE OF WHAT ARE SOME
OF THE CHALLENGES THAT THEY
FACE, AND IMPORTANTLY,
DISSEMINATION AND TRANSLATION.
SO THAT THE KNOWLEDGE CAN BE U
USED BY OTHERS AND SO THAT IT
CAN ADVANCE IT FURTHER.
NOW, I'M GOING TO JUMP FROM THE
HARM REDUCTION TO THIS SLIDE,
WHICH I HAVE SHOWN IN THE PAST,
ACTUALLY I KEEP UPDATING IT BUT
IT SHOWS MORTALITY FROM
OVERDOSES FROM FENTANYL AMONG
TEENAGERS.
I SHOW IT IN BLUE FOR BOYS
TEENAGERS, IN PURPLE FOR GIRLS,
AND IN RED FOR THE AVERAGE.
AND I SHOW IT BECAUSE -- THIS IS
FOR TEENAGERS 15 TO 19, AND YOU
CAN SEE THAT WE SAW A BIG PEAK
DURING THE COVID PANDEMIC, THEN
IT WENT SLIGHTLY DOWN BUT THEN
IT BASICALLY HAS STABILIZED.
AND WE'RE SEEING -- AND IT
RAISES A BIG FLAG BECAUSE WE
HAVE NOT SEEN TEENAGERS DYING
FROM FENTANYL, AND DEATHS FROM
OVERDOSES IN TEENAGERS PRIMARILY
WERE DRIVEN BY ALCOHOL.
SO THIS WAS A DISRUPTION IN
PATTERNS THAT WE HAVE OBSERVED,
WHICH OF COURSE BEGS THE
QUESTION THAT NEEDS THIS
OBVIOUSLY REQUIRE ATTENTION AND
THE WAY THAT I HAVE PRESENTED IN
THE PAST AND I CONTINUED TO
PRESENT IN THE PAST.
IT ALSO HIGHLIGHTS HOW CRUCIAL
IT IS TO DO PREVENTION, BECAUSE
PREVENTION STARTING IN --
ADOLESCENCE, BECAUSE TEENAGERS
IN MONITORING THE FUTURE, WE
HAVE THE LOWEST, LOWEST RATES OF
PREVALENCE FOR HEROIN USE, AND
TEENAGERS DON'T SEEK OUT
FENTANYL.
SO HOW COME THEY END UP WITH
OVERDOSES WITH FENTANYL?
AND VERY LIKELY, BECAUSE THEY DO
SEEK OUT PRESCRIPTION DRUGS,
PSYCHOTHERAPEUTIC PRESCRIPTION
DRUGS.
AND ILLICIT PRESCRIPTION DRUGS
AND PSYCHOTHERAPEUTIC DRUGS,
ULTIMATELY AN AGEE SIX LIKE
OXYCONTIN AND VICODIN OR
HYPNOTICS LIE BENZODIAZEPINES
ARE ILLICITLY MANUFACTURED.
IF THE TEENAGER GETS THEIR HANDS
ON THESE ILLICITLY MANUFACTURED
PILLS THAT ARE LESS EXPENSIVE
THAN THOSE SOLD IN THE LEGAL
MARKET OR THEY ARE GIVEN TO THEM
BY A FRIEND OR WHICHEVER WAY
THEY GET IT, THEY ARE AT RISK OF
OVERDOSING WITH A SINGLE
EXPOSURE.
THIS IS, AGAIN, WHY PREVENTION
BECOMES SO VERY IMPORTANT.
SO LAST COUNCIL, I BROUGHT UP
THE POINT THAT BECAUSE OF THAT,
AS A NATIONAL ACADEMY OF
SCIENCES TO DO A BLUE POINT FOR
A NATIONAL -- I THIS IS BORN OF
THE FRUSTRATION THAT RECOGNIZING
AFTER DECADES OF RESEARCH ON
PREVENTION SCIENCE AND CLEARCUT
EVIDENCE OF PREVENTION
INTERVENTIONS, THESE ARE NOT
IMPLEMENTED.
SO WE WANT THE NATIONAL ACADEMY
TO LOOK INTO THIS AND TO ADDRESS
WHY IS ITNESS SAIR -- WHAT IS
NECESSARY FOR THESE TO BE
IMPLEMENTED.
WHAT ARE THE REQUIREMENTS IN
TERMS OF BEST PRACTICES IN TERMS
OF RESOURCES, IN TERMS OF
POLICIES THAT MAY BE NECESSARY.
AND ULTIMATELY WHAT ARE THE
RESEARCH GAPS THAT WOULD HELP
GUIDE US IN TERMS OF PRIORITY
AREAS THAT HE WITH NEED TO MOVE
FURTHER.
SO THIS IS WHERE WE ARE, AND
THEY HAD THE NATIONAL ACADEMIES
HELD THEIR FIRST IN-PERSON
MEETING, I THINK IT WAS TWO OR
THREE WEEKS AGO.
SO THEY ACTUALLY ARE WORKING AND
AS WE GET THEIR RECOMMENDATIONS,
OF COURSE, WE WILL BE UPDATING
YOU ALL.
BUT IT ALSO CERTAINLY FORCES --
IT CERTAINLY FORCED ME TO THINK,
I MEAN, YES, F THERE IS ALSO AT
THE SAME TIME YOU WANT TO
PREVENT TEENAGERS FROM TAKING
DRUGS, BUT ALSO AMONG THE
TEENAGERS THAT ARE AT HIGHER
RISK AT OVERDOSES, THOSE WHO
ALREADY HAVE A SUBSTANCE USE
DISORDER.
TEENAGERS, BASICALLY THEY DO GET
ADDICTED TO DRUGS, AND IF YOU
LOOK AT THE NUMBERS, THERE ARE
2.2 MILLION ADOLESCENTS AGED 12
TO 17 THAT MEET CRITERIA FOR A
SUBSTANCE USE DISORDER AS OF
2022 IN THE UNITED STATES.
2.2 MILLION.
SO IT'S NOT A NEGLIGIBLE NUMBER.
AND OF THOSE THAT HAVE A
SUBSTANCE USE DISORDER, ONLY .5%
RECEIVE TREATMENT.
ONLY .5%.
I ACTUALLY HAD TO READ AND THINK
ABOUT THAT NUMBER AND THINK HOW
CAN IT BE SO VERY LOW?
WHICH CORRESPONDS TO ONLY 8,000
TEENAGERS RECEIVE TREATMENT.
SO THIS IS AN URGENT, URGENT GAP
THAT NEEDS TO BE ADDRESSED.
AND ALSO IT FORCES, THEREFORE,
INTO UNDERSTANDING TO WHERE ARE
WE WITH THE TREATMENT FOR
ADOLESCENTS THAT HAVE A
SUBSTANCE USE DISORDER, WHERE IS
THE EVIDENCE.
AND THE EVIDENCE IS THERE THAT
PSYCHOSOCIAL TREATMENTS ACTUALLY
ARE EFFECTIVE IN TREATING
SUBSTANCE USE DISORDERS IN
TEENAGERS, WHETHER IT IS
MOTIVATIONAL, COGNITIVE
BEHAVIORAL, FAMILY ORIENTED
THERAPIES, AND B CONTINGENCY
MANAGEMENT, THEY ALL HAVE SHOWN
THAT THEY ARE EFFECTIVE FOR
VARIOUS SUBSTANCE USE DISORDER.
BUT WE HAVE TO RECOGNIZE ALSO
THAT THE EFFECT SIZES ARE SMALL
TO MODEST.
SO THERE IS AN URGENT NEED TO
IMPROVE ACTUALLY ALTERNATIVE
TREATMENTS THAT CAN GET LARGER
EFFECTS.
FROM THE WORLD OF MEDICATIONS
WHERE WE KNOW ALREADY NOW THAT
INDICATIONS FOR OPIATE USE
DISORDER IS THE MOST EFFECTIVE
INTERVENTION THAT WE HAVE, WE
KNOW THAT THERE IS THE
FDA-APPROVED BUPRENORPHINE FOR
OPIOID USE DISORDER IN
INDIVIDUALS THAT ARE 16 YEARS OF
AGE OR OLDER, BUT WE DON'T HAVE,
REALLY, EVIDENCE THAT HAS BEEN
DONE TO EVALUATE THE UTILITY IN
YOUNGER TEENAGERS.
NOR IS THERE DATA, CLINICAL
TRIAL DATA FOR METHADONE, EVEN
THOUGH IT IS ALLOWED TO
ACTUALLY -- AS I WAS COMMENTING
BEFORE, A TEENAGER CAN BE
PRESCRIBED METHADONE THROUGH THE
OPIATE TREATMENT PROGRAM
PROVIDED THAT THEY HAVE FAILED
THROUGH OTHER INTERVENTIONS.
BUT IT IS VERY FEW OF THEM GET
ACCESS TO METHADONE AND WE
REALLY HA HAVE NOT DONE THE
CLINICAL TRIALS THAT COULD
OPTIMALLY HELP US GUIDE WHAT ARE
THE DOSES, HOW TO INTERVENE, AND
WHO SHOULD BE -- UNDER WHAT
CONDITIONS IT IS ACTUALLY
JUSTIFIED.
AND SIMILARLY, NALTREXONE IS
PARTICULARLY INTERESTING AND
MERITS FURTHER INVESTIGATION
BECAUSE IF YOU HAVE TEENAGERS
THAT ARE IN THE EARLY STAGES OF
A SUBSTANCE -- AN OPIOID USE
DISORDER WHERE YOU DON'T WANT TO
ACTUALLY PLACE THEM ON AN OPIOID
AGONIST, EVEN IF IT'S A PARTIAL
AGONIST, NALTREXONE OFFERS
PROTECTION FOR THEM FROM
OVERDOSE, SO -- BUT WITHOUT
RESEARCH, WE REALLY DO NOT KNOW
HOW BENEFICIAL IT COULD BE, BUT
IT ABSOLUTELY SHOULD BE A
PRIORITY IN TERMS OF FUTURE
RESEARCH.
I WANT TO END MY PRESENTATION
JUST BY TWO ANNOUNCEMENTS.
ONE OF THEM IS THE POPULATION
ASSESSMENT OF TOBACCO AND
HEALTH, THE PATH STUDY
CONTINUATION, NATIONALLY
REPRESENTATIVE LONGITUDINAL
COHORT STUDY OF TOBACCO USE, ITS
DETERMINANTS AND IMPACT ON U.S.
POPULATIONS AGE 12 AND OLDER, IT
STARTED COLLECTING DATA SINCE
2013 FOR SEVEN COMPLETED FULL
WAVES AND THREE SPECIAL DATA
COLLECTIONS.
SO THAT'S MORE THAN 45,000
BASELINE ASSESSMENTS.
AND IT HAS LED TO 800
PUBLICATIONS AND THE DATA IS
AVAILABLE FOR RESEARCHERS
THROUGH THIS LINK THAT I'M
SHOWING YOU HERE.
THE PATH STUDY HAS BEEN
SUPPORTED THROUGH TWO CONTRACTS,
FIVE AND EIGHT YEARS, AND ON
FEBRUARY 1ST, A CONTRACT WAS
AWARDED TO WESTAT TO SUPPORT
4 ADDITIONAL WAVES OF DATA
COLLECTION OVER EIGHT YEARS,
FROM 2024 TO 2032.
THE PATH IS ADMINISTERED BY NIDA
AND IS FUNDED PRIMARILY BY THE
FDA CENTER FOR TOBACCO PRODUCTS,
AND THIS YEAR THE FUNDING HAS
BEEN BASICALLY NOW ALSO DONE BY
ADDITIONAL FUNDS FROM NIDA, NCI,
NHLBI, NIMHD, NIAAA, NIDDK,
OBSSR, NIEHS, OTP AND NLM.
AND MY FINAL SLIDE IS ONE THAT I
LIKE TO BRAG ACTUALLY BECAUSE I
THINK IT'S VERY, VERY EXCITING,
IT HI HIGHLIGHTS THE FIRST AWARD
FOR ONE OF OUR TRANSLATION
PROGRAMS WITH OTP THAT BASICALLY
GOT THE NUMBER ONE GOLD MEDAL
FOR BEING THE INSTITUTE AT THE
NIH THAT HAS SPONSORED THE MOST
CHALLENGES.
AND I ALSO WANT TO REITERATE, IT
WAS ALSO, I THINK, THE FIRST
INSTITUTE THAT INITIATED THE USE
OF CHALLENGE TO ACTUALLY ADVANCE
THE SCIENCE.
AND WITH THAT, I WANT TO THANK
YOU FOR YOUR ATTENTION, ANDLY
STOP SHARING SO IF THERE ARE
QUESTIONS, I CAN ADDRESS THEM.
THANKS VERY MUCH.
>> NORA, I CAN -- I DON'T
KNOW --
>> GO AHEAD, RAJITA.
>> THANK YOU, NORA, FOR THAT
VERY COMPREHENSIVE SUMMARY OF
THE STATE OF THE SCIENCE AND THE
DATA WITH ADOLESCENTS, THEIR
OVERDOSES AND INITIATION BUT
ALSO DAILY USE GOING UP IS
ALARMING, SO WE SHARE YOUR
CONCERN THERE.
THE QUESTION I WANTED TO RAISE
JUST SORT OF TAKING A STEP BACK
AND DOING MORE OF A LONG VIEW,
CANNABIS IS VERY MUCH PRESENT IN
A LOT OF THIS IN TERMS OF
THINKING OF PREVENTION OF
ADOLESCENTS BUT ALSO ADULTS, AND
WHERE THINGS START IN TERMS OF
SUBSTANCE USE AND MISUSE.
ALCOHOL AND CANNABIS AND
NICOTINE BEING UP THERE AS
PATHWAY DRUG.
ONE THING THAT HAS COME UP IN
OUR REALM AND PEOPLE -- AND FROM
THE PUBLIC HAVE ASKED IS, IS
CANNABIS HARMFUL?
THIS IS ALWAYS COMING UP, WE ALL
HEAR THIS.
AND SO ONE QUESTION I HAD FOR US
SCIENTIFICALLY, IS THERE A PLACE
FOR US TO START THINKING ABOUT
THRESHOLDS OF HARM?
JUST AS WE DO WITH ALCOHOL, WE
HAVE HAZARDOUS DRINKING
THRESHOLDS AND I KNOW HOW WE'RE
INVOLVED IN THE PROCESS OF HOW
THAT CAME ABOUT, WHERE WE WERE
ABLE TO IDENTIFY BINGE DRINKING
THRESHOLDS AND HAZARDOUS LEVELS,
AND I JUST WONDER, LOOKING INTO
THE FUTURE AND EVEN THE CURRENT
TRENDS OF WHERE CANNABIS IS
GOING, WITH LEGALIZATION,
WHETHER IT BEHOOVES US TO
CONSIDER TO THINK ABOUT
INITIATING SOME KIND OF PROCESS
BY WHICH WE CAN DETERMINE
THRESHOLDS OF HARM, SAFE LEVELS
OF CANNABIS.
I KNOW IT'S A THORNY ISSUE, BUT
I WANTED TO RAISE IT AND WHETHER
THERE COULD EVEN BE A WORK GROUP
OR GRANTS, I'M JUST SORT OF
THINKING, BRAINSTORMING HERE, TO
THINK ABOUT THAT, BECAUSE THIS
IS NOT GOING TO GO AWAY AND IT'S
ONLY GROWING IN TERMS OF NUMBER
OF STATES LEGALIZING IT AND
INCREASING NUMBERS OF CHILDREN,
ADOLESCENTS AND YOUNG ADULTS
USING IT AND GOING DOWN THE
PATHWAY OF SUBSTANCE USE
DISORDERS RISK.
>> RAJITA, THANKS FOR BRINGING
THAT UP.
ABSOLUTELY, YO INCREDIBLE
SUGGESTION.
I THINK ONE OF T REASONS WHY WE
PROPOSED A STANDARD UNIT WAS IN
UNDERSTANDING IS THERE A
THRESHOLD OF RISK.
OBVIOUSLY THAT THRESHOLD OF RISK
IS GOING TO VERY MUCH DEPEND IN
PART ON YOUR DEMOGRAPHICS, SO WE
KNOW THAT.
AND ALSO YOUR UNIQUE
CHARACTERISTICS OF DO YOU HAVE A
HISTORY OF PSYCHIATRIC DISEASES,
LIKE PSYCHOSIS, YOU ARE AT MUCH
GREATER RISK.
BUT WITH RESPECT TO THE
THRESHOLD, I THINK WE SHOULD
TACKLE IT ABSOLUTELY.
IN ADOLESCENCE, THAT'S WHAT
ACTUALLY -- WHEN I PROPOSED TO
GEORGE I SAID LET'S DO THIS FOR
THE ABCD, BECAUSE THAT WOULD
ALLOW US TO UNDERSTAND AND NOW
THE TEENAGERS, WHICH ARE 16
YEARS OF AGE, ARE STARTING TO
SMOKE MARIJUANA, BUT WE HAVE
THEIR BRAIN SCAN AND THEIR
BEHAVIOR BEFORE THEY ACTUALLY
STARTED TO USE IT.
AND THE SIZE -- WE POWERED THE
STUDY OF THE ABCD TO BE SURE TO
BE ABLE TO ADDRESS THE QUESTION
OF CANNABIS EFFECTS IN THE BRAIN
DEVELOPMENT OF TEENAGERS, IN
ORDER TO GET THAT SENSE OF
THRESHOLD.
WE HAVE HAD SOME DIFFICULTY
ACTUALLY OF IMPLEMENTING THE
STANDARD UNIT DOSE, SO WE
BASICALLY SAID IF YOU ARE GOING
TO GET MONEY FROM NIDA TO STUDY
THE EFFECTS OF CANNABIS, YOU
HAVE TO MAKE AN ATTEMPT TO
ACTUALLY TRANSLATE IT INTO
STANDARD DOSES.
SO FOR THE ABCD, WE WILL KEEP ON
PUSHING TO TRY TO GET THE PIs
TO PUSH THEIR PEOPLE TO GET
STANDARD DOSES BUT AS OF NOW, I
HAVE NOT SEEN THE UPTICK THAT I
WOULD LIKE TO DO IT.
MEANWHILE -- THAT'S ADOLESCENTS.
BUT YOUR QUESTION IS THRESHOLD,
AND THRESHOLD IS GOING TO BE
AFFECTED BY OTHER FACTORS.
AND WE HAVE VERY LITTLE DATA ON
THAT, AND I THINK WHEN WE'RE
SPEAKING ABOUT HAVING A
GUIDELINE, WE NEED TO BUILD THAT
DATA.
ONE OF THE ASPECTS THAT WE'VE
DONE IS CREATED A REGISTRY FOR,
AGAIN, PEOPLE THAT ARE USING
MARIJUANA, CANNABIS, WHETHER
IT'S MEDICAL OR OTHER PURPOSES,
TO TRY TO GET A BETTER
UNDERSTANDING OF WHETHER IT HAS
NEGATIVE CONSEQUENCES.
WE'RE ALSO IN DISCUSSION WITH
JOSH DENNY, DIRECTOR OF THE
ALL-OF-US PROGRAM THAT BASICALLY
AIMS TO FOLLOW A MILLION PEOPLE
IN THE UNITED STATES WITH THEIR
ELECTRONIC HEALTH RECORDS TO
ENSURE THAT ACTUALLY THERE WILL
BE INFORMATION RELATED TO THE
CONSUMPTION OF DRUGS INCLUDING
MEDICAL CANNABIS AND HE HAS BEEN
OPEN TO DISCUSS IT, BECAUSE THAT
WILL BE AN INCREDIBLE
OPPORTUNITY TO START TO PIECE
OUT WHAT PATTERNS ARE LINKED
WITH HARMFUL EFFECTS.
OTHERWISE I'M AFRAID THAT WE'RE
REALLY IN THE DARKNESS, RAJITA,
BUT I AGREE, AND I THINK THAT IN
FOLLOWING YOUR SUGGESTION
PERHAPS IT MAY BE WORTHWHILE TO
BRING TOGETHER PEOPLE TO THINK
ABOUT WHAT STEPS COULD
ACCELERATE US TO BE IN A
POSITION WHERE WE COULD CREATE
THOSE GUIDELINES.
SO I WISH THEY'D SAY LET'S
CREATE THOSE GUIDELINES, WE
DON'T HAVE THE KNOWLEDGE YET.
>> RIGHT.
THANK YOU.
>> ARPANA.
>> THANK YOU.
I ACTUALLY GOT SO EXCITED BY
RAJITA'S QUESTION, I ALMOST
FORGOT MY QUESTION.
I SECOND HER COMMENT.
I THINK THIS WOULD BE INCREDIBLE
TO DO, ESPECIALLY WITH AS YOU
MENTIONED, NORA, CHANGING
POTENCY LEVELS, SO WHAT OUR
YOUTH ARE GETTING TODAY ARE
PROBABLY NOT WHAT YOUTH RECEIVED
EVEN, YOU KNOW, A DECADE AGO.
BUT I HAVE A COMMENT AND A WISH,
IF YOU WILL.
MY COMMENT IS REALLY TO
CONGRATULATE YOU AND NIDA ON
ABCD AND HBCD.
TO MY KNOWLEDGE, AS SOMEBODY WHO
USES A LOT OF LARGE DATASETS,
THESE ARE UNPREPRECEDENTED
PROJECTS.
THEY'RE LONGITUDAL STUDYING
CHILDREN.
THEY HAVE BIOLOGICAL DATA AS YOU
MENTIONED, THEY HAVE RICH SOCIAL
DETERMINANTS OF HEALTH DATA, AND
THERE ARE NO SUCH DATASETS.
SO I REALLY THINK THIS HAS BEEN
A GAME CHANGER FOR THE FIELD, IN
PARTICULAR, FOR YOUNG PEOPLE,
FOR YOUNG INVESTIGATORS, FOR
TRAINEES, PRE-DOCS, POSTDOCS WHO
ARE ABLE TO DOWNLOAD THESE DATA
WITH THE VERY HIGH STANDARD --
FOR DATA SHARING.
AND TO BE ABLE TO TEST NEW
METHODS, I MEAN, THEY ARE AT THE
FOREFRONT OF METHODS
DEVELOPMENT.
THEY'RE ABLE TO PULL THESE DATA
AND DO THINGS WITH IT THAT I
CAN'T CONCEIVE OF THESE THINGS,
BUT IT'S JUST INCREDIBLE, HOW
MUCH INNOVATION HAS HAPPENED.
THE OTHER THING THAT I WANT TO
COMMENT ON WITH ABCD IN
PARTICULAR AND HBCD FORTHCOMING
IS THE COMMUNITY-FACING
COMPONENT.
WHEN RESEARCH PROJECTS ARE
COMPLETED, THERE IS AN
INFOGRAPHIC OR SOMETHING THAT'S
A VISUAL THAT IS
COMMUNITY-FACING, AND I'VE USED
IT AS A PARENT, I'VE USED IT AS
SOMEBODY WHO SERVES ON SCHOOL
BOARDS, BECAUSE THESE ARE
INCREDIBLY USEFUL TO TALK ABOUT
HOW SOCIAL MEDIA OR VIEWING TIME
OR SLEEP IS INFLUENCED IN YOUTH,
AND TO HAVE SOMETHING EMPIRICAL
THAT CAN BE USED OUTSIDE OF THE
RESEARCH CONTEXT, I THINK HAS
BEEN REMARKABLE.
SO MY WISH IS THAT ABCD AND HBCD
WILL CONTINUE TO THRIVE, AND
THAT THE WAY YOU'VE SET UP HBCD
TO BE A PRECURSOR TO ABCD WHERE
WE'RE SORT OF BRIDGING THE GAP
FROM PRENATAL EXPOSURE THROUGH
TO AGE 9, THAT THERE WILL BE AN
OPPORTUNITY FOR THE ABCD
CHILDREN, YOUTH, TO ACTUALLY
BECOME PARENTS AND COME BACK
INTO HBCD WITH THIS INCREDIBLE
LONGITUDAL PERSPECTIVE.
SO NOT A COMMENT BUT A HOPE THAT
THESE TWO PROJECTS WILL SET US
UP TO HAVE AN OPPORTUNITY TO
JUST GO FULL CIRCLE AND
UNDERSTAND HOW ONE'S OWN
LIFETIME OF BRAIN DEVELOPMENT
AND EXPERIENCE KIND OF SHAPES
THEIR BECOMING A PARENT, THEIR
PRENATAL BEHAVIORS, AND THEIR
OFFSPRING.
I THINK THAT WOULD BE JUST AN
INCREDIBLE OPPORTUNITY BEYOND
WHAT PEOPLE HAVE ALREADY SET UP.
SO THANK YOU VERY MUCH FOR THESE
INCREDIBLE PROJECTS.
>> THANKS A LOT, AND THANKS FOR
THE COMMENTS, AND I COMPLETELY
AGREE.
AND I DO HOPE THAT THE FUNDING
CONTINUES SO THAT WE CAN
ACTUALLY DO THAT.
I MEAN, IT WAS -- YOU SORT OF
SEE THE RICHNESS OF THE
INFORMATION THAT WE HAVE AND THE
COMMITMENT OF THESE TEENAGERS
AND THEIR FAMILIES TO IT SO IT
COULD BE A PITY NOT TO CONTINUE
WORKING ON IT.
BUT SO ABSOLUTELY, WE ARE VERY
AWARE THAT THESE HAVE BEEN
PROJECTS THAT EVEN OF COURSE A
PROJECT LIKE THAT ARE COSTLY IN
TERMS OF THE AMOUNT OF KNOWLEDGE
THAT THEY HAVE GENERATED.
IT HAS BEEN INCREDIBLY
SUCCESSFUL.
SO THANKS FOR BRINGING THIS UP.
ONE OF THE THINGS THAT I LOVE
ABOUT IT, IT EE EQUALIZING SCIE.
BECAUSE ME AS A RESEARCHER,
THROUGH THESE TYPE OF DATABASE,
ANYONE IN A SMALL COLLEGE OR IN
AN INSTITUTION THAT DOESN'T HAVE
THE CAPABILITIES CAN GET THEIR
HANDS ON IT AND TAKE ADVANTAGE
OF IT.
SO IT IS JUST A WONDERFUL -- AND
YES, ARPANA, I HOPE OUR BUDGET
KEEPS ON ROBUST AND THESE, OF
COURSE, ARE PRIORITY PROJECTS
FOR THE INSTITUTE.
KATE?
>> THANK YOU, NORA, FOR ANOTHER
EXCELLENT MEETING AND EXCELLENT
PRESENTATION FULL OF SO MUCH
INTERESTING AND EXCITING
INFORMATION.
I WAS PARTICULARLY INTERESTED IN
THE TRENDS IN SUBSTANCE USE THAT
YOU SHARED.
I'M WONDERING -- MY QUESTION IS
ABOUT XYLAZINE, AND WHETHER THE
USE OF XYLAZINE WITH FENTANYL IN
PARTICULAR IS TRACKING ALONG
WITH THE INCREASES THAT YOU
SHARED.
AND ALSO WANT TO CONGRATULATE
DR. MONTOYA ON HIS VERY
WELL-DESERVED PROMOTION.
>> THANKS, KATE, AND THANKS FOR
HELPING IN THE SEARCH COMMITTEE.
SO I'M VERY, VERY GRATEFUL FOR
YOU.
AND YES, WE HAVE SEEN, I MEAN,
THE TTHE RATE IN WHICH WE'RE SEG
OVERDOSE DEATHS WITH FENTANYL
VERSUS FENTANYL WITH XYLAZINE,
THE RELATIVE PROPORTION VARIES
SIGNIFICANT BY GEOGRAPHICAL
AREA, AND IT'S MUCH HIGHER IN
THE EAST COAST THAN IN THE WEST
COAST, BUT WHAT HAS BEEN
REPORTED IS THAT BASICALLY
THE -- THAT IT IS EMERGING NOW
ALMOST ON EVERY SINGLE STATE,
THERE HAVE BEEN REPORTS OF
FATALITIES ASSOCIATED WITH THE
USE OF BOTH DRUGS.
AND IT HAS BEEN IN GROWING AND
IN SOME PLACES LIKE
PENNSYLVANIA, I THINK SORT OF --
ALMOST LIKE 70% IN SOME
INSTANCES CONTAINED XYLAZINE.
SO THERE'S TREMENDOUS
VARIABILITY BY GEOGRAPHIC
LOCATION.
IT HAS MADE IT MUCH MORE COMPLEX
TO UNDERSTAND THE PATTERNS,
BECAUSE WE DON'T ACTUALLY EVEN
UNDERSTAND XYLAZINE WELL.
AND SO WE KNOW THAT NALOXONE BY
ITSELF IN SOME INSTANCES MAY NOT
BE SUFFICIENT BUT IT IS CRUCIAL
TO ADMINISTER IT BECAUSE IT
ACTUALLY HELPS, BUT IT'S NOT
SUFFICIENT BECAUSE PATIENTS ARE
STILL VERY, VERY HYPOTENSIVE AND
HYPOXEMIA LASTS MUCH LONGER.
AND THE OTHER ISSUE THAT HAS
GENERATED A LOT OF CONCERN IS
THESE HORRIBLE LESIONS THAT
HAPPEN IN THE SKIN OF PEOPLE
THAT GET EXPOSED TO THIS
COMBINATION OF FENTANYL WITH
XYLAZINE OR XYLAZINE WITH
HEROIN.
WE DON'T UNDERSTAND, I MEAN,
THERE'S OBVIOUSLY HYPOTHESIS
ABOUT WHAT MAY BE GOING ON WITH
THESE LESIONS, BECAUSE THEY GROW
VERY FAST, THEY ARE NOT A
TYPICAL TYPE OF LESION THAT YOU
OBSERVE WITH OTHER -- IN OTHER
CASES OF INJECTION DRUG USE, AND
SOMETIMES THEY APPEAR IN AREAS
THAT THEY DON'T INJECT.
LIKE YOU CAN SEE THEM EVEN IN
THE BACK.
SO IT IS BELIEVED THAT THE
HYPOXEMIA FROM THE RESPIRATORY
PRESENT EFFECTS COUPLED TO THE
HYPOTENSION FROM XYLAZINE
ACTUALLY EXACERBATES TISSUE
IRRIGATION, THAT THE SEDATIVE
EFFECTS OF THAT COMBINATION
ACTUALLY LEADS TO PRESSURE
LESIONS BECAUSE PEOPLE ARE
SEDATED FOR HOURS, DON'T MOVE,
BUT IT'S ALSO BEING POSTULATED
THAT PERHAPS -- AND THIS IS A
VERY INTERESTING THOUGHT -- THAT
KAPPA RECEPTOR AGONIST EFFECTS
OF XYLAZINE MAY CONTRIBUTE, AND
PARTICULARLY IF YOU CONSIDER
FENTANYL ALSO HAS SOME XYLAZINE
AGONIST EFFECTS, AND SO WE DON'T
REALLY -- OBVIOUSLY WE'RE ASKING
RESEARCHERS TO LOOK INTO IT, THE
FDA IS WORKING WITH ANIMAL
MODELS FOR THESE LESIONS BECAUSE
IF YOU HAVE THEM, THEN YOU COULD
TRY TO TEST DIFFERENT
INTERVENTIONS TO TACKLE IT.
SO DIFFERENT INTERVENTIONS TO
TACKLE THE OVERDOSES THAT THEY
HAPPEN TO SAVE THEM, BUT ALSO
THIS VERY CHALLENGING PROBLEM
THAT IS ACTUALLY RESULTING --
I'VE MET WITH PEOPLE THAT HAD AN
AMPUTATION FROM IT, AND THEY ARE
DESPERATE.
THEY BASE INCLUDE -- THIS IS ONE
OF THE THINGS THEY WANT TO KNOW,
WHEN YOU ASK THEM, HOW CAN
RESEARCH HELP YOU, TO PEOPLE
THAT ARE TAKING DRUGS, WHAT IS
XYLAZINE DOING TO OUR BODIES, TO
OUR LUNGS, HOW TO TREAT THE SKIN
LESIONS.
SO YES.
MELANIE.
YOU ARE MUTED, MELANIE.
MELANIE --
>> LIKE USUAL.
THANK YOU.
NO, THANK YOU, NORA.
GREAT TALK.
SORRY FOR FOR GETTING THAT I'M
MUTED.
I WAS VERY IMPRESSED BY THE NEW
CHEMICAL ADDICTION TREATMENTS
LIKE CS1103 AND POTENTIALLY
FENTANYL SEQUESTERS THAT WERE
MENTIONED BEFORE, AND I WANTED
JUST TO SORT OF SEE HOW YOU SEE
OVERALL THEM AND POTENTIALLY
OTHERS INCLUDING POSSIBLY THE
GLP AGONIST, YOU KNOW,
TREATMENTS RESHAPING HOW WE ARE
GOING TO TREAT IN THE FUTURE.
>> YEAH, NO, WE ARE VERY EXCITED
AND I THINK WHEN YOU'RE SPEAKING
ABOUT SCWES TRA SCW SEQUESTERS N
REVERSE AN OVERDOSE, YOU KNOW
THAT WITH NALOXONE, YOU ACTUALLY
STILL HAVE A LONGER LASTING
EFFECT OF FENTANYL.
SO IF YOU COMBINE THE NALOXONE
WITH A SCWES TRANT, YOU'RE MUCH
MORE LIKELY TO BE SUCCESSFUL.
AND THERE'S SOME DATA TO SHOW
THAT.
THE SAME THING WITH
METHAMPHETAMINE, WE ABSOLUTELY
HAVE NOTHING RIGHT NOW WITH A
METHAMPHETAMINE OVERDOSE.
SO TO HAVE ALTERNATIVES IS
NECESSARY THERE ARE MULTIPLE
SORT OF STRATEGIES BEING
DEPLOYED WHICH WE HAVE BEEN ABLE
TO DO BECAUSE OF THE EXTRA FUNDS
THAT WERE ALLOCATED UNDER THE
HEAL MISSION OF ADDRESSING THE
OVERDOSE CRISIS.
I THINK THAT IF YOU LOOK AT IT
FROM TIME LINES, WE TRIED TO
ACCELERATE AS MUCH AS POSSIBLE
FROM -- BUT FROM THAT
PERSPECTIVE, WHEN YOU HAVE A
PROBLEM THAT IS ALREADY THERE IN
THE -- A PRODUCT ALREADY IN THE
MARKET AND YOU FIND REPURPOSING,
YOU OF COURSE GET MUCH MORE
EXCITED.
SO WE ARE EXTREMELY EXCITED
ABOUT THE GLP AGONIST BECAUSE
ANIMALS SHOW VERY POSITIVE
EFFECTS IN TERMS OF PREVENTING
DRUG ADMINISTRATION AND RELAPSE,
AND THE CLINICAL DATA, THE
ANECDOTES AND THE ANALYSIS ON
ELECTRONIC HEALTH RECORDS IS
DOCUMENTED TO RISK CONSUMPTION.
SO YES, THIS IS AN AREA THAT IS
EXACTLY PARTICULARLY EXCITING
BECAUSE DRUGS HAVE BEEN APPROVED
FOR OTHER INDICATIONS, IT WILL
BE MUCH FASTER TO BRING INTO THE
CLINIC.
SO SO THAT THAT IS AGAIN AN ARE.
SO WE ARE PURSUING MEDICATIONS
FOR NEW INDICATIONS AND WE'RE
PURSUING COMPLETELY NEW TARGETS,
NEW FORMULATIONS.
-- ANTIBODIES, AND WE'RE ALSO
VERY EXCITED ABOUT
NEUROMODULATION APPROACHES WHICH
ARE REVEALING SOME REALLY
EXCITING RESULTS, PARTICULARLY
WITH THE USE OF ULTRASOUND.
SO THERE IS A LOT OF VERY
PROMISING WORK GOING ON.
>> THANK YOU.
>> CHARLES.
>> I WAS VERY IMPRESSED BY THE
DATA THAT YOU'VE GOT ON THE
NEURODEVELOPMENT FOR CHILDREN
AND RISKS FOR MARIJUANA USE, AND
IT'S A BIG CONCERN.
NOT REALLY KNOWING HOW TO MOVE
IT FORWARD.
AND ALSO, RAJITA'S COMMENT ABOUT
SAFE LEVELS, I THINK IS REALLY
SOMETHING THAT NIDA COULD BE IN
A POSITION TO REALLY VERY
CONSTRUCTIVELY ADDRESS.
I REALLY LIKE THAT IDEA.
THE CREDIBILITY OF SCIENCE
REQUIRES THAT PEOPLE SAY YES,
SAFE LEVELS MIGHT EXIST, AND
THAT'S THEIR EXPERIENCE, BUT
WHEN WE READ IN THE NEWSPAPERS
THE STORIES ABOUT HOW THERE ARE
NOW THOUGHT TO BE NO SAFE LEVELS
FOR WINE CONSUMPTION, NO SAFE
LEVELS FOR ALCOHOL CONSUMPTION,
THERE REALLY IS A CONFLICT
BETWEEN THOSE REPORTS OF NO SAFE
LEVELS AND PEOPLE'S EXPERIENCE
WHERE A BEER EVERY ONCE IN A
WHILE SEEMS TO BE SAFE.
AND SO I DON'T KNOW HOW TO
POLITICALLY WALK THAT LINE.
IT SOUNDS LIKE A VERY DIFFICULT
LINE TO ADDRESS, AND COMING BACK
TO A SPECIFIC SUGGESTION, IT
SEEMS TO ME THAT WE HAVE AN
OPPORTUNITY TO TRY TO GIVE
PATIENTS, PERSONS, MORE DATA
ABOUT THEIR HARMFUL DRUG USE.
I KNOW THAT WHEN I GO SEE MY
PRIMARY CARE PHYSICIAN, I HAVE
TO ANSWER A QUESTION OF HOW MUCH
ALCOHOL AM I COU CONSUMING, ANDF
COURSE PHYSICIANS BELIEVE THAT
MOST PERSONS ARE LYING ABOUT
THEIR CONSUMPTION, THEY
UNDERESTIMATE, THEY UNDERREPORT
WHAT THEY DO.
IT SEEMS TO ME THAT IF WE HAD
OBJECTIVE BLOOD LEVELS,
BIOMARKERS THAT COULD DOCUMENT
WHAT, IN FACT, WE ARE, IN FACT,
CONSUMING, WHEN I LOOK AT, FOR
EXAMPLE, ARE THERE BIOMARKERS
FOR ALCOHOL CONSUMPTION, THE
ANSWER IS YES, THERE ARE.
THEY'RE NOT WIDELY USED BUT THEY
COULD SIMPLY HELP US GET A
BETTER SENSE AS A PATIENT OR AS
A PERSON REGULARLY HOW DOES OUR
ALCOHOL CONSUMPTION COMPARE TO
OTHERS?
IF WE HAVE AN OBJECTIVE MEASURE
OF WHAT KIND OF ALCOHOL
CONSUMPTION WE HAVE IN RELATION
TO HEALTH RISK, IT WILL BE MUCH
LIKE WHEN WE GET OUR CHOLESTEROL
BLOOD LEVELS CHECKED, THERE ARE
VALIDATED MEASURES FOR
CHOLESTEROL, AND IF WE KNOW OUR
LEVEL IS HIGH, WE'VE GOT RISK OF
HEART DISEASE, THAT'S ALL
OBJECTIVE.
IF WE HAD MEASURES LIKE THAT FOR
ALCOHOL, IT WOULD BE VERY
HELPFUL SINCE SO MANY
INDIVIDUALS USE ALCOHOL AND
UNDERREPORT THEIR CONSUMPTION,
BUT FROM NIDA PERSPECTIVE, FROM
A PUBLIC HEALTH PERSPECTIVE, IS
THERE ANY USE IN HAVING NIDA
VALIDATE BIOMARKERS THAT COULD
BE USEFUL AS A DRUG SCREENING
THAT WOULD BE ROUTINELY
INCORPORATED INTO A HEALTH
CHECK, WHERE INDIVIDUALS WHO
COME TO THEIR PHYSICIAN, FOR AN
ANNUAL HEALTH CHECK, JUST TO GET
A SENSE OF WHERE ARE THEY ON A
SCALE OF DRUG USE, AND ARE THEY
IN A RISKY POSITION, AND
COULD -- I'M NOT SUGGESTING THAT
THIS BE REPORTED TO THE POLICE,
BUT IN TERMS OF PRIVATE
CONVERSATIONS WITH THEIR PRIMARY
CARE PHYSICIANS, COULD A
VALIDATED TEST FOR DRUG USE BE
CONSTRUCTIVE IN WAYS THAT ALLOWS
A PHYSICIAN TO DO MORE THAN JUST
SIMPLY ASK WHAT IS YOUR
CONSUMPTION AND GET A VERBAL
REPORT, BUT ACTUALLY HAVE AN
OBJECTIVE MEASURE THAT COULD
THEN BE VALIDATED AND SAY NO, I
THINK YOUR MARIJUANA USE IS IN
THE RISKY CATEGORY.
AND I THINK WE NEED TO REPORT TO
YOU THAT THIS IS SOMETHING WE
NEED TO TALK ABOUT IN A WAY THAT
IS A HELPFUL SETTING.
BECAUSE RIGHT NOW WE DO HAVE
THAT KIND OF OBJECTIVE DATA.
JUST CONVERSATIONS THAT ARE JUST
NOT SATISFACTORY.
BUT THAT'S SIMPLY MY THOUGHT.
>> NO, AND I AGREE, CHARLES, I
MEAN, I THINK IT WOULD BE REALLY
FANTASTIC TO HAVE SUCH A TEST,
BECAUSE IT WILL BASICALLY MAKE
IT ALMOST AUTOMATIC THAT YOU
WOULD BE EVALUATED, JUST LIKE
YOU SAY, YOU WILL GET YOUR BLOOD
TEST AND THEY EVALUATE YOU.
I THINK THAT IN TERMS OF WITH
ALCOHOL, WHAT'S INTERESTING IS
THAT WHILE THERE ARE TESTS THAT
HAVE BEEN PROPOSED, NONETHELESS,
ONE THAT HAS BEEN USED BY A LOT
OF CLINICIANS TO TRY TO GAUGE
THE EXTENT TO WHICH THERE IS
HARMFUL EFFECTS ARE LIVER
FUNCTION TESTS, BECAUSE THAT
BASICALLY INDICATES WHEN SOMEONE
MAY BE CONSUMING ALCOHOL AT
LEVELS THAT ARE REFLECTED IN THE
MARKER THAT YOU CAN MONITOR.
SO EVEN THOUGH IT'S NOT THE ONLY
THING THAT IS GOING TO MAKE YOUR
LIVER FUNCTION TEST ABNORMAL, IT
IS THE MOST FREQUENTLY ONE.
SO WE SHOULD BASICALLY -- IT
WOULD BE IDEAL AND BUILDING --
AGAIN, IN A WAY THAT NEED THAT
WE HAVE TO BUILD UP KNOWLEDGE OF
WHAT COULD BE A BIOMARKER FOR
EXPOSURE TO DRUGS, SPECIFICALLY
SPEAKING IN TERMS OF CANNABIS,
BECAUSE THAT IS RIGHT NOW THE
MOST URGENT, JUST ON THE BASIS
OF THE HIGH PREVALENCE AND
INCREASED UTILIZATION BY MANY
PEOPLE, AND WE DON'T REALLY KNOW
TO WHAT EXTENT THERE ARE ADVERSE
OUTCOMES.
SO UNDERSTANDING WHAT ARE THE
ADVERSE OUTCOMES AND AT WHAT
THRESHOLD IS A KEY IN ORDER TO
BE ABLE TO PLACE IN TERMS OF
WHAT COULD POTENTIALLY BE A
BIOMARKER THAT IT'S INDICATIVE
OF RISK.
SO IT'S VERY MUCH LINKED WITH A
SUGGESTION THAT RAJITA HAD FOR A
THRESHOLD.
AND I DO THINK IT WOULD BE
EXTREMELY CONSEQUENTIAL TO HAVE
SUCH A BIOMARKER THAT COULD BE
DEPLOYED IN MEDICINE, BECAUSE
ONE OF THE ASPECTS I'VE BEEN
TRYING TO CHANGE IS THE NEGLECT
OF SCREENING FOR SUBSTANCE USE
AMONG MANY PRIMARY CARE
PHYSICIANS, AND HAVING SUCH A
TEST WILL MAKE IT OUGHT MATT
TICK.
AUTOMATIC.
SO WE WILL PULL OUR HEADS
TOGETHER IN TERMS OF WHAT ARE
THE MECHANISMS WE COULD USE TO
TRY TO ACCELERATE THIS SPACE, IN
THIS CASE FOR EXAMPLE,
TRANSLATION AND INNOVATION, HOW
DO WE ENCOURAGE RESEARCHERS TO
GENERATE BIOMARKERS?
SO YES, I SORT OF IMPRINTED YOUR
SUGGESTION IN MY BRAIN, BECAUSE
I THINK IT WILL BE INCREDIBLY
VALUABLE AND IT WILL HELP PEOPLE
UNDERSTAND BETTER AND MAKE
DECISIONS ON HOW MUCH DRUGS THEY
CONSUME OR NOT.
WHICH IS WHAT THEY ARE DOING BUT
THEY'RE DOING BLINDLY, THEY
DON'T REALLY UNDERSTAND WHAT
COULD BE CONSEQUENTIAL.
TRAVIS?
>> THIS IS MY FAVORITE PART OF
THE MEETING EVERY TIME.
THIS CONVERSATION IS ALWAYS SO
RICH.
I JUST -- I THOUGHT I WOULD
MENTION TWO PLACES WHERE I HEARD
MY WORLD INVOKED JUST IN CASE IT
COULD BE USEFUL IN THE FUTURE SO
YOU KNOW I COME FROM BIOETHICS
AND MEDICAL HUMANITIES AND TO
SOME EXTENT PHILOSOPHY, AND WE
FIND OURSELVES FEELING A BIT
LIKE WEIRDOS BECAUSE WE DON'T
ALWAYS DO THE EMPIRICAL OR
SCIENTIFIC WORK, BUT THERE ARE
TWO PLACES, ONE DURING YOUR
PRESENTATION, NORA, AND THEN ONE
DURING THIS CONVERSATION WHERE I
THOUGHT THAT'S BREAD AND BUTTER
BIOETHICS AND CONCEPTUAL WORK
THAT FEELS LIKE THERE'S A REAL
ROLE FOR.
SO ONE OF THEM WAS WHEN, NORA,
YOU BROUGHT UP THE QUESTION OF,
YOU KNOW, WHY DON'T WE EMPLOY
MORE HARM REDUCTION WHEN THE
EVIDENCE IS SO STRONG?
THERE'S A PURELY EMPIRICAL
VERSION OF THAT QUESTION WHICH
IS LIKE PEOPLE MAKE JUDGMENTS,
WHY DO THEY DO IT, WE CAN GO ASK
THEM AND FIND OUT THE ANSWER.
BUT THERE'S ALSO A SPACE THAT
I'VE WORKED IN AND SOME OF MY
COLLEAGUES HAVE WORKED IN, WHICH
IS PEOPLE ARE MAKING MORAL
JUDGMENTS HERE.
THEY'RE LARGELY SAYING THAT
SOMETHING IS WRONG ABOUT THIS
PRACTICE, IT'S SOMETHING MORALLY
WRONG, SO WRAPPED UP IN THE
STIGMA IS THEIR JUDGMENTS AND
THEIR CHOICE.
AND SO THERE'S REAL IMPORTANT
UNTANGLING TO BE DONE ABOUT
WHAT'S REASONABLE TO SAY AND
WHAT'S NOT, SO THAT WE CAN HAVE
A BETTER INFORMED CONVERSATION.
BECAUSE ONE OF THE THINGS THAT I
THINK IS HAPPENING IN YOUR
TRADEMARK TRAVIS EDITORIALIZING,
BUT WHAT HAPPENS IS, PEOPLE HAVE
AN IMPLICIT MORAL PHILOSOPHY
THAT MAKES A TON OF SENSE IN A
LOT OF PLACE, WHICH INVOLVES
THINGS LIKE DESSERTS, LIKE
PEOPLE DESERVE CERTAIN THINGS.
MOST PEOPLE IN THIS ROOM BELIEVE
THAT SOME PEOPLE DESERVE CERTAIN
THINGS, GOOD AND BAD, BASED ON
WHAT YOU'VE DONE IN THE PAST.
BUT THEN THEY APPLY TO A CONTEXT
LIKE DRUG USE, AND THEY GET
SOME, LIKE, MISFIRING JUDGMENTS.
AND THAT SORT OF CONCEPTUAL WORK
CAN BE REALLY IMPORTANT WHEN WE
TRY TO FIGURE OUT HOW DO YOU
MOVE FORWARD ENGAGING THIS
POPULATION.
BECAUSE DATA IS NOT MOVING THE
CONVERSATION FORWARD.
WE JUST KEEP HITTING PEOPLE OVER
THE HEAD WITH DATA SHOWING THAT,
YOU KNOW, HARM REDUCTION WORKS,
AND PEOPLE DON'T CHANGE THEIR
MINDS.
SO SOAP BOX, SORRY, BUT THAT'S
ONE PLACE WHERE I THINK
BIOETHICS AND HEALTH POLICY CAN
BE HELPFUL.
THE OTHER WAS THIS CONVERSATION
THAT WAS JUST HAPPENING ABOUT
HARM, RISK, RISK CATEGORIES AND
THRESHOLD.
YOU KNOW, THERE ARE MANY UNSAFE
LEVELS OF CHEESE CONSUMPTION,
AND WE WOULDN'T PUT IT INTO A
CATEGORY THAT DOCTORS ASK ABOUT
AND THAT KIND OF THREATENS
RAISING STIG MA STIGMA, I THINKN
CHEESE CONSUMPTION IS PROBABLY
UNSAFE TO SOME DEGREE, BUT ALSO
BICYCLING AND SKIING AND ALL
THESE OTHER SORTS OF THINGS.
SO THAT'S JUST A GOOFY WAY OF
SAYING RISK, SAFETY, HARM, AND
ESPECIALLY TRYING TO ESTABLISH A
THRESHOLD OR A THRESHOLD IS
SOMETHING LIKE WE OUGHT NOT TO
GO PAST THIS.
THAT OUGHT IS NORMATIVE, RIGHT?
IT'S OUR JUDGMENT ABOUT WHAT'S
RATIONAL, WHAT'S GOOD FOR YOU,
WHAT'S RIGHT TO DO, WHAT'S RIGHT
FOR THE MEDICAL SYSTEM TO SORT
OF IMPOSE ON.
SO THAT'S JUST -- YOU KNOW,
YOU'VE GOT ME HERE, I SAW SOME
NAILS, THOUGHT I'D OFFER THEM UP
FOR WHAT IT'S WORTH.
>> NO, TRAVIS, THANKS A LOT AND
I'M GLAD THAT YOU BROUGHT IT UP.
WHAT I WOULD SORT OF SAY IS
BRINGING IN FORWARD THAT CHARLES
BASICALLY SUGGESTION AND -- I
WOULD DO A CHOLESTEROL TEST AND
SEE IF YOUR CHEESE IS HARMFUL OR
NOT TO YOU.
AND IF YOUR CHOLESTEROL TEST IS
GOOD, I WOULDN'T WORRY ABOUT IT.
I MEAN, AND I THINK THAT THAT'S
EXACTLY IN TERMS OF THE POINT,
AND THEN YOU CAN MAKE THE
DECISION AND YOU HAVE THAT DATA,
YOU CAN MAKE IT.
SO I DO VERY MUCH RESONATE AND
I'M VERY AWARE HOW STRONG ARE
THE MORAL JUDGMENTS OF WHAT
PEOPLE DESERVE BASED ON THEIR
BEHAVIOR.
BUT THE WAY THAT I PHRASE IT
MYSELF, IS THERE DATA, AGAIN
THINK WE NEED TO CHALLENGE
OURSELVES THAT WE USE TO CHANGE
A POLICY.
I ALWAYS SAY, BECAUSE IF IT'S SO
CONSEQUENTIAL THAT THE POLICY
MAKERS CANNOT IGNORE IT, THEN
YOU HAVE A POLICY, AND ONCE YOU
HAVE A POLICY, THAT ACTUALLY CAN
COMPENSATE EVEN FOR PEOPLE THAT
ARE DISCRIMINATORY AND
STIGMATIZED AND IF THERE'S
POLICIES THAT REQUIRE THAT YOU
DO THIS OR THE OTHER.
, THEN
THAT'S SORT OF THE WAY THAT I
VIEW IT.
BUT WE NEED TO BE VERY AWARE,
OBVIOUSLY, THAT A LOT OF THAT
DIFFICULTY WITH SYRINGE EXCHANGE
PROGRAMS, OF CLOSING THEM, IS
BASICALLY PREJUDICE, AND TO A
CERTAIN EXTENT PERHAPS EVEN WHAT
YOU'RE SAYING, PEOPLE THINKING,
WELL, THEY GET WHAT THEY
DESERVE, SO IT'S -- AND THAT
PERSPECTIVE SOMETIMES
UNFORTUNATELY IS DRIVEN VERY
MUCH BY LACK OF UNDERSTANDING,
SO I THINK THAT'S THE OTHER
ASPECT, WE'RE TRYING TO
DISSEMINATE KNOWLEDGE, SO
HOPEFULLY WE CAN CHANGE THOSE
STIGMATIZING PERCEPTIONS.
SHELLEY, YOU HAD YOUR HAND
RAISED.
>> THANK YOU SO MUCH.
AND I AGREE WITH TRAVIS, THIS IS
ONE OF THE GREAT PARTS OF THIS
MEETING, AND THANKS AGAIN FOR A
COMPREHENSIVE PRESENTATION,
NORA.
YOU KNOW, I'VE BEEN FINDING
MYSELF FOR PART OF THIS
DISCUSSION JUST STUCK BACK ON
THE ADOLESCENT SUBSTANCE USE
DISORDER PAST YEAR DATA AND THE
MINIMAL NUMBERS OF PEOPLE
ACCESSING ANY TYPE OF TREATMENT.
AND THE INCREDIBLE NEED
TREATMENT GAP IN THE UNITED
STATES, AND OF COURSE IT'S FOR
ALL PEOPLE WITH SUBSTANCE USE
DISORDERS, BUT THIS ADOLESCENT
GROUP, IT'S EVEN LOWER THAN WHAT
WE EXPECT IN THE ADULTS, AND I
JUST KEEP GOING OVER THOSE
STATISTICS AND I'VE BEEN TRYING
TO TURN IT INTO SOME RESEARCH
QUESTIONS THAT WE MIGHT BE ABLE
TO, YOU KNOW, WORK ON, AND I
FIND MYSELF THINKING ABOUT THAT
AREA AS BEING KIND OF RIPE FOR
THINGS LIKE, YOU KNOW, MIXED
METHOD STUDIES WHERE WE MIGHT BE
DOING SOME COMMUNITY-BASED
PARTICIPATORY RESEARCH, TO GO
INTO THE COMMUNITIES AND FIND
OUT WHAT THEIR NEEDS ARE AND
WHAT THE BARRIERS AND OBSTACLES
ARE, WHICH COULD BE INCLUSIVE OF
CO-OCCURRING OTHER PSYCHIATRIC
DISORDERS AMONGST THE ADD LE
SENT POPULATION, WHERE IT
BECOMES VERY HARD TO ACCESS ANY
KIND OF CARE FOR ADOLESCENTS.
IT COULD ALSO ACTUALLY SURFACE
EVEN MORE THE LACK OF PROVIDERS,
AND IT DOES SEEM TO ME THAT WHEN
WE COLLECT DATA LIKE THAT, BY
GOING INTO THE COMMUNITY AND
ASKING, AND THEN ACTUALLY LOOK
AT WHAT EXISTS AND WHAT PEOPLE
TELL YOU ARE THE BARRIERS, THAT
OFTEN CAN BE SURFACED TOWARD
CHANGING POLICY.
BECAUSE RIGHT NOW WE JUST REALLY
DON'T HAVE ANY POLICY TO TRY TO
PROVIDE BETTER ACCESS FOR, YOU
KNOW, KIDS AND THEIR PARENTS AND
FAMILIES, AND THE OTHER THING
ABOUT THAT ALSO IS THAT WE'RE
HAVING A REALLY HARD TIME WITH
THE WORKFORCE SITUATION.
SO SOMETIMES WHEN YOU CAN GET IN
AND ACTUALLY ESTABLISH THOSE
DATA, IT CAN HELP US WITH THE
POLICY QUESTIONS THAT COME UP
ABOUT THE WORKFORCE STRATEGY,
LIKE THERE ARE VERY, VERY FEW --
ALMOST NONE OF THEM ARE
ADDICTION TRAINED, IT'S LIKE 30,
MAYBE IT'S 40, I DON'T KNOW, BUT
THAT'S FOR THE WHOLE U.S., AND
I'M JUST TALKING ABOUT
PSYCHIATRY ITSELF BECAUSE THOSE
ARE THE STATISTICS I KNOW THE
BEST, BUT THERE'S JUST A HUGE
GAP NEED SO THAT COULD BE ONE
AREA I WAS THINKING ABOUT FOR
THAT.
A SECOND THING THAT THIS TOUCHES
ON BUT WASN'T A MAIN FOCUS BUT I
JUST WANTED TO MENTION TODAY IS
JUST, AGAIN, WITH THE WORKFORCE
SITUATION IN TERMS OF THE NEW
GENERATION OF ADDICTION
RESEARCHERS, ESPECIALLY
CLINICIAN-SCIENTISTS AND
ESPECIALLY PHYSICIAN SCIENTISTS,
WE'RE REALLY SEEING LIKE A
COMPLETE PLUMMETING OF THAT, AND
A GROUP OF US HAVE BEEN TRYING
TO FIGURE OUT, WHAT KINDS OF
INITIATIVES COULD HAPPEN THAT
MIGHT HELP MOVE PEOPLE WHO ARE
SORT OF IN TRAINING WHO WANT TO
DO THIS BUT FEEL LIKE THAT
TRANSITION FROM FINISHING YOUR
TRAINING, LET'S SAY PSYCHOL PSYY
RESIDENCY TO LIKE AN EARLY
INVESTIGATOR MODE IS ALMOST
IMPOSSIBLE FOR MANY AND THEY GET
BASICALLY MOVED OFF INTO
CLINICAL PRACTICE OR INTO OTHER
FORMS OF THE PRIVATE SECTOR.
I WAS JUST WONDERING ABOUT THE
IDEA OF TARGETED SUPPLEMENTS FOR
PIs WITH GRANTS THAT WOULD
ACTUALLY ENCOURAGE BRINGING IN
CERTAIN YOUNG INVESTIGATORS,
JUNIOR INVESTIGATORS WITH
CERTAIN PROFILES, AND
PARTICULARLY IN THIS INSTANCE
THINKING ABOUT PHYSICIAN
SCIENTISTS WHERE THERE'S LIKE
LITERALLY A PLUMMETING FALLOFF,
I'VE BEEN TALKING TO A LOT OF
PEOPLE WITH R25s RIGHT NOW TO
TRAIN PHYSICIAN SCIENTISTS IN
ADDICTION AND THEY JUST ARE
FALLING RIGHT OFF RIGHT AFTER.
SO AS A SECOND THING AND THEN
THE THIRD THING JUST TO
CHARLES' -- THE WHOLE IDEA OF
THRESHOLDS AND UNFORTUNATELY I
THINK A LOT OF PEOPLE KNOW,
PHYSICIANS ARE VERY POORLY
TRAINED IN ADDICTION, ALL OF IT.
ALCOHOL, MAYBE TOBACCO, THEY'RE
PRETTY WELL TRAINED, BUT NOT
EVEN THERE IN TERMS OF OFFERING,
YOU KNOW, THEY KNOW IT'S BAD FOR
YOU, BUT THEY ALMOST NEVER
OFFER, YOU KNOW, NICOTINE
REPLACEMENT THERAPIES OR ANY OF
THE OTHER KINDS OF TREATMENTS.
THEY'RE NOTORIOUSLY BAD AT THIS,
AND YOU KNOW, I THINK THAT ONE
OF THE CHALLENGES WE HAVE IS HOW
DO WE PRODUCE, TO TRAVIS' POINT,
A GOOD WAY FOR PEOPLE TO TAKE
THE DATA, AND THEN HELP TRANSFER
THE DATA INTO PEOPLE'S SPECIFIC
RISK PORTFOLIOS, YOU KNOW?
BECAUSE FOR EVERY PERSON, YOU
KNOW, THEIR RISK PORTFOLIO IS
DIFFERENT BASED ON THEIR FAMILY
HISTORY, THEIR GENETICS AND
THEIR SOCIAL ENVIRONMENTAL
HISTORY.
SO LIKE I'LL JUST GIVE YOU ONE
BIG EXAMPLE.
FOR WOMEN WHO HAVE A FAMILY
HISTORY OF BREAST CANCER, BASED
ON THE DATA RIGHT NOW, IF YOU'RE
A PHYSICIAN, YOU'RE SEEING A
WOMAN AND YOU WANT TO TALK TO
HER ABOUT MODIFIABLE RISK
FACTORS, DECREASING OR
ELIMINATING ALCOHOL FROM THE
DIET ACTUALLY IS ONE MODIFIABLE
RISK FACTOR, ALONG WITH, YOU
KNOW, EXERCISE AND DIET.
SO IT'S VERY RARE, THOUGH, FOR
PHYSICIANS TO EVER HAVE THOSE
CONVERSATIONS WITH WOMEN.
I KNOW BECAUSE I TALK TO A LOT
OF WOMEN THAT HAVE THESE
CONVERSATIONS, SO I THINK TAKING
DATA AND TRYING TO FIGURE OUT
HOW TO HELP CLINICIAN,
ESPECIALLY PHYSICIANS, FIGURE
OUT HOW TO TALK TO PEOPLE ABOUT
THEIR RISK PORTFOLIO, YOU KNOW,
RATHER THAN MAYBE IT'S NOT
ABSOLUTE THRESHOLDS, IT'S MORE
LIKE LET'S TALK ABOUT WHAT YOUR
RISKS ARE, YOUR INDIVIDUAL
RISKS, YOUR PERSONAL RISKS, YOUR
FAMILY RISKS, AND THEN LET'S
TALK ABOUT EVERYTHING THAT'S
MODIFIABLE HERE, WHICH INCLUDES
DIET, EXERCISE AND YOUR USE OF
ALL SUBSTANCES, ALL OF THEM.
BUT THAT'S NOT THE TRAJECTORY
THAT WE'RE ON RIGHT NOW.
SO I DON'T KNOW, MAYBE THERE'S
ALSO SOME DATA QUESTIONS AND
SOME, YOU KNOW, RESEARCH
QUESTIONS THERE LIKE YOU COULD
RUN SOME IMPLEMENTATION SCIENCE
TYPE OF RESEARCH WHERE YOU'RE
JUST DOING LIKE A PRAGMATIC
TRIAL OF, LIKE, SAME AS USUAL
VERSUS THIS TYPE OF COUNSELING,
YOU KNOW, IN PRIMARY CARE
OFFICES.
IT'S JUST ANOTHER THOUGHT ABOUT
THIS, BECAUSE I THINK WE'RE
PRETTY BAD AT THIS ACTUALLY FOR
PATIENTS.
AND THAT INCLUDES, YOU KNOW,
YOUNG PEOPLE.
NOT JUST THE ADOLESCENCE, BUT
THAT TRANSITIONAL-AGE GROUP
WHERE WE DON'T REALLY TALK TO
THEM ABOUT ANY OF THIS STUFF
REALLY VERY WELL EITHER, YOU
KNOW, AND TO TRAVIS' POINT, IT
OFTEN SOUNDS TO PEOPLE LIKE IT'S
LIKE A STIGMATIZING CONVERSATION
AS OPPOSED TO A HELPFUL
CONVERSATION, LIKE LET'S TALK
ABOUT YOUR RISKS AND FIGURE OUT
WHAT MIGHT BE BEST FOR YOU AND
WHAT YOU WANT TO TRY.
SO THOSE ARE JUST A BUNCH OF --
>> NO, SHELLEY, THANKS A LOT.
I TOOK NOTE.
I MEAN, YOU'RE PROPOSING SEVERAL
THINGS THAT I THINK COULD BE
VERY, VERY USEFUL.
THEY ARE DISTINCT, BUT IT ALSO
HIGHLIGHTS THAT IN TERMS OF
ADDRESSING THE CHALLENGES THAT
WE HAVE FOR TREATMENT OF
ADOLESCENTS, I MEAN, BECAUSE
AGAIN, THIS IS SUCH A GAP AREA
AND WE BASICALLY HAD TO SAY HOW
CAN WE HELP AND BRING IN SAMHSA,
BECAUSE IT'S A KEY PARTNER IN
TERMS OF TRAINING BUT ALSO IN
TERMS OF PUTTING SUPPORT AND
BRINGING IN NIMH, US, AS YOU SAR
TEENAGERS, IT'S CO-MORBID.
SO IMPLEMENTATION GUIDELINES,
THIS IS AN OPPORTUNITY FOR BIG
DATA, YOU HAD THE DATA, QUALITY
DATA, YOU CAN JUST SAY AYE TO
GENERATE TRAJECTORIES THAT --
RISK.
ALSO IN PRINCIPLE, CAN WE TRAIN
AI ON DATABASES AND GET OUR
HANDS ON DATABASES THAT HAVE
BEEN SYSTEMATICALLY FOR -- BUT
WE ARE WORKING ON THAT, SO
THANKS A LOT, SHELLEY, AND ALL
OF YOU FOR THESE VERY GOOD
SUGGESTIONS.
WE MAY CALL BACK ON YOU AS WE
FOLLOW UP ON THESE
RECOMMENDATIONS.
>> THIS IS THE PART OF THE JOB I
HATE THE MOST, WE'RE ALREADY
ALMOST THROUGH OUR BREAK SO OUR
NEXT TALK STARTS AT 2:30.
DO YOU WANT TO SKIP THE BREAK
AND START A FEW MINUTES LATE?
WE HAVE TWO MORE QUESTIONS.
>> I'LL LET COUNCIL DECIDE.
I MEAN, I THINK THAT --
>> ANNA ROSE, IS IT A LONG
QUESTION OR A SHORT QUESTION?
>> JUST A REALLY SHORT COMMENT
AND I GUESS ONE QUESTION.
THE SHORT COMMENT, REALLY SHORT,
IS THAT EARLIER IN OUR
DISCUSSION, WE WERE TALKING
ABOUT THE POLICY DRUG SITUATION,
WHICH OF COURSE IS SO VERY REAL
WITH FENTANYL UP AROUND OUR
ANKLES AND XYLAZINE COMING UP
AROUND OUR CALVES AND, YOU KNOW,
AT THIS POINT, IT SORT OF
REMINDS ME OF THE EARLY PART OF
NICOTINE PATCH RESEARCH WHEN
THEY MADE CARTOONS SHOWING THAT
YOU HAD PATCHES ON YOUR BODY FOR
EVERYTHING, FOR CHOCOLATE,
FOR -- THE POLYDRUG SITUATION IS
REALLY TRICKY.
SO I LOVE THE IDEA OF THE
SEQUESTERING MEDICATIONS.
HOW WILL WE, THOUGH, APPROACH
THESE VERY, VERY COMPLEX
PROFILES?
IT FEELS A LITTLE BIT IN THE
TRENCHES AS THOUGH WE'RE SORT OF
BATTLING THE WINDMILLS AND WHERE
WE'RE BASICALLY TRYING REALLY
HARD, BUT WE HAVE A NEW WRINKLE
THAT APPEARS, IT SEEMS LIKE
EVERY YEAR OR SO NOW, SO IT'S --
IT WOULD BE ENOUGH JUST TO HAVE
A VERY VEER OPIOID USE DISORDER,
BEFORE FENTANYL AND BEFORE
XYLAZINE AND BEFORE THE
NITAZINES AND BEFORE THE NEXT
TURN.
SO THERE'S A LOT OF SUNSHINE
TODAY HERE IN PHILADELPHIA, BUT
IT'S A REALLY TOUGH SITUATION,
AND I GUESS THAT POLYDRUG
PROFILE AND THAT SITUATION WHICH
IS NOT THE KIND OF THING THAT
REVIEWERS REALLY RESONATE TO
BECAUSE YOU WANT THE PURE STUDY,
YOU WANT THE PURE POPULATION,
YOU WANT THE ONE DISORDER IF YOU
CAN, WHEN, IN FACT, IT'S NOT THE
WAY OUR PATIENTS ARE REALLY
COMING PACKAGED AT THIS POINT.
FOR COCAINE, THE OVERDOSE
DEATHS, IT LIKE, WHAT, 70% OF
THEM HAVE FENTANYL IN THEM NOW.
IT'S JUST A CRAZY SITUATION.
THERE'S A HUGE INTERTWINING OF
THESE THINGS.
SO THAT'S JUST A QUICK COMMENT
IN TERMS OF I DON'T KNOW HOW WE
FIX THAT.
THE OTHER REALLY QUICK THING IS
THAT IN TERMS OF ATTRACTING
YOUNG PHYSICIAN, I DON'T KNOW,
WE'VE TALKED ABOUT IT BEFORE, IF
NIH IS THINKING ANY MORE ABOUT
JUST INCREASING THE BASE SALARY
SPHFOR SOME OF THE TRAINING
STIPENDS.
WE CAN'T BE COMPETITIVE WITH
WONDERFUL YOUNG PHYSICIANS WHO
ARE TRYING TO DECIDE AFTER
RESIDENCY IF THEY WILL BE ABLE
TO START A FAMILY, HAVE A HOME,
HOW WILL THEY DO THAT ON A SPY
STIPEND, AND COMPARE THAT TO
GOING OUT AND RUNNING A CLINIC
FOR TWICE THE AMOUNT.
SO I KNOW MONEY IS MONEY AND IF
YOU TAKE IT FROM ONE PLACE, YOU
DON'T HAVE IT IN ANOTHER.
BUT JUST A PLEA THERE, I RUN A
T32, WE'VE HAD A COUPLE OF CLOSE
CALLS IN GETTING M.D.s, BUT
IT'S JUST VERY, VERY HARD, VERY,
VERY HARD.
THAT'S IT.
>> ANNA ROSE, THANKS VERY MUCH
AND BOTH OF THEM ARE IMPRINTED
IN MY BRAIN AND WE HAVE REQUESTS
FOR APPLICATIONS THAT THAT TACKE
POLYSUBSTANCE USE.
BUT THESE, THE NEED FOR
ATTRACTING YOUNG PHYSICIANS, AND
THE NEED FOR BETTER SALARIES,
I'LL BRING IT UP BUT THE WHOLE
CONSORTIUM NIH LEVEL BECAUSE I
THINK THAT PERTAINS TO EVERYONE.
AND I KNOW THAT SUSAN IS KEEPING
TRACK SO I'M GOING TO ADJOURN
NOW FOR ONE MINUTE OR TWO
MINUTES OR HOW MANY MINUTES,
SUSAN?
YOU'RE MUTED.
>> HOW ABOUT FIVE MINUTES?
LET'S GET BACK AT 2:35 AND WE'LL
START THE PRESENTATION AT THAT
POINT.
SORRY ABOUT THE VERY QUICK BIO
BREAK.
>> BETTER THAN --
>> I MEAN, IT'S BEEN SUCH AN
INTERESTING CONVERSATION, SO THANK YOU ALL.
>> TISHA, WHY DON'T YOU START.
SORRY IT WAS SUCH A SHORT BREAK.
>> NO PROBLEM.
WELL, GOOD AFTERNOON, EVERYONE,
AND I WANT TO THANK NORA AND THE
REST OF THE NIDA TEAM FOR GIVING
ME THE CHANCE TO SHARE WITH YOU
AN UPDATE ON THE WORK THAT WE
ARE DOING AS PART OF THE JUSTICE
COMMUNITY OPIOID INNOVATION
NETWORK.
AND I ALSO WANT TO ACKNOWLEDGE
MY TEAM BEFORE I START.
I GET THE PRIVILEGE OF WORKING
WITH A REALLY WONDERFUL TEAM
HERE AT NIDA TO DO THIS WORK.
WE HAVE LORI, OUR SCIENCE
OFFICER, SHE'S THE ONLY SCIENCE
OFFICER FOR JCOIN, REALLY HELPS
CONNECT THE DOTS ACROSS THIS
REALLY COMPLEX NETWORK.
AND THEN IN ADDITION TO THEIR
OTHER DUTIES AS PART OF THE
SERVICES RESEARCH BRANCH, CARRIE
IS THE PO FOR JCOIN HUBS, JULIA,
SHELLEY, AND MARCY FITS-RANDOLPH
IS OUR MEDICAL OFFICER AND
LEADS -- WE DO A UNIFIED DSMB
ACROSS ALL OF THESE STUDIES SO
SHE LEADS OUR WORK THERE.
SO BEFORE I JUMP IN, I WANT TO
SHARE ACTUALLY THE PICTURE
THAT'S KIND OF HIDING IN THE
BACKGROUND HERE.
AND YOU'LL SEE THROUGHOUT THE
PRESENTATION TODAY SOME PICTURES
INTERSPERSED THAT HAVE COME TO
US BY WAY OF OUR INVESTIGATORS
AND PARTNERS IN THE NETWORK.
AND THIS PICTURE IN PARTICULAR
IS OF THE FRANKLIN COUNTY,
MASSACHUSETTS JAIL OF THE
WOMEN'S RECREATION AREA.
IT COMES FROM THE FRANKLIN
COUNTY SHERIFF'S DEPARTMENT, AND
I THINK THIS PICTURE TO ME IS
MEANINGFUL AND POIGNANT BECAUSE
I THINK IT CAPTURES IN MANY WAYS
THE HUMANITY OF THE POPULATION
THAT WE'RE WORKING WITH, BUT
ALSO MANY PEOPLE SPEND A PERIOD
OF TIME IN THESE SETTINGS IN
JAILS AND PRISONS, BUT THIS
PICTURE ALSO CAPTURES SORT OF
THE IDEA OF WHAT LIES BEYOND.
YOU SEE THE MOUNTAINS IN THE
DISTANCE OF THIS PICTURE, AND I
THINK THAT THAT CAPTURES THE
IDEA THAT IT'S REALLY IMPORTANT
TO THINK NOT JUST WHAT HAPPENS
IN JAILS AND PRISONS, BUT WHAT
HAPPENS AS PEOPLE RETURN BACK TO
THEIR HOMES, BACK TO THEIR
COMMUNITIES AND FAMILIES AND
THEIR CONNECTION AND THEIR PATH
TOWARD RECOVERY.
SO LET ME ALSO THEN KIND OF TURN
TO THE DATA HERE.
NORA KOPFED SOM COVERED SOME OFS
EARLIER.
WE ALL KNOW IN THIS AUDIENCE THE
IMPORTANCE OF UNDERSTANDING THAT
SO MANY PEOPLE ARE LOSING THEIR
LIVES EVERY YEAR TO THIS
OVERDOSE CRISIS, AND WE'VE KNOWN
FOR A LONG TIME THAT THE JUSTICE
SYSTEM IS A REALLY SENSITIVE
PLACE AND THAT THIS TRANSITION
PERIOD IS A SENSITIVE ONE.
WE HAVE MANY STUDIES OVER THE
LAST 10 TO 15 YEARS THAT HAVE
REALLY HIGHLIGHTED THAT THE TIME
AS PEOPLE ARE MOVING BETWEEN
JAILS AND PRISONS AND BACK INTO
THEIR COMMUNITIES IS A PERIOD OF
HEIGHTENED RISK OF RELAPSE AND
MORTALITY.
BUT MORE RECENT STATISTICS ALSO
POINT THAT THIS IS A PLACE WHERE
WE CAN INTERVENE AND CHANGE THE
TRAJECTORY.
RHODE ISLAND WAS ONE OF THE
FIRST STATES IN THE COUNTRY THAT
REALLY EMBRACED OFFERING ALL
THREE MEDICATIONS FOR OPIOID USE
DISORDER IN THEIR JAILS AND
PRISONS, AND WHEN THEY LOOKED AT
SOME MODELING DATA OF THAT, THEY
WERE ABLE TO PROJECT THAT THEY
COULD SEE AS MUCH AS A 31%
REDUCTION IN OVERALL OVERDOSE
RATES AT THE STATE LEVEL BY
EXPANDING THAT APPROACH.
WE'VE STARTED TO SEE STATES
ACROSS THE COUNTRY TAKE ON THIS
APPROACH.
SOME RECENT DATA FROM INDIANA
LOOKED AT THE PEOPLE THAT HAD
LOST THEIR LIVES AND LOOKED AT
WHETHER OR NOT WHAT SYSTEMS THEY
HAD CONTACT WITH IN THE YEAR
LEADING UP TO THEIR DEATH AND
FOUND THAT 1 IN 4 TOUCHED THE
JUSTICE SYSTEM, SO I THINK THIS
REALLY HIGHLIGHTS WHY THE
JUSTICE SYSTEM IS SUCH AN
IMPORTANT SYSTEM TO FOCUS ON AND
TO TARGET INTERVENTIONS TO.
BUT IT'S JUST NOT ENOUGH TO
TARGET THE JUSTICE SYSTEM AND
THINK ABOUT JAILS IN PRISONS IN
THE CONTINUITY OF CARE THAT
HAPPENS WHEN PEOPLE RETURN TO
THEIR HOMES.
AND IN THE COMMUNITIES, THERE'S
A LOT OF WORK TO DO.
THIS CAME UP IN THE DISCUSSION
EARLIER TODAY.
WE KNOW THAT THE BEHAVIORAL
HEALTH SYSTEM IS CHRONICALLY
UNDERRESOURCED, THAT THERE ARE
LOTS OF -- WORKFORCE CHALLENGES,
FUNDING SHORTAGES.
BUT WHAT I'M GOING TO HIGHLIGHT
HERE IS THAT EVEN KNOWING THAT,
EVEN WHEN PEOPLE MAKE THEIR WAY
INTO THE SYSTEM, PEOPLE WHO ARE
COMING INTO THE COMMUNITY
TREATMENT SYSTEM BY WAY OF THE
JUSTICE SYSTEM ARE LESS LIKELY
TO RECEIVE ACCESS TO EFFECTIVE
MEDICATIONS, SO 5% OF JUSTICE
REFERRED PATIENTS.
IN THIS ONE STUDY, RECEIVED
METHADONE OR BUPRENORPHINE
COMPARED TO 40% OF PEOPLE WHO
CAME INTO THE TREATMENT SYSTEM
THROUGH ANOTHER PATHWAY.
AND THIS IS A DISPARITY THAT'S
COSTING LIVES AND REALLY
DEMONSTRATES HOW CRITICAL IT IS
TO BUILD THESE PARTNERSHIPS
BETWEEN THE JUSTICE AND
COMMUNITY-BASED SYSTEMS IN ORDER
TO MAKE A DENT IN THAT.
THAT OBSERVATION IS REALLY SORT
OF WHAT LED US TO OUR VISION TO
THE WAY THAT WE'VE APPROACHED
THE WORK THAT WE'VE DONE IN
JCOIN.
J DN COIN WAS INITIALLY LAUNCHED
AS PART OF THE HEAL INITIATIVE
IN 2018.
IN 2018, WE WERE ABLE TO PUT OUT
A SET OF WHAT WE CALL
ACCELERATOR SUPPLEMENTS, THEN WE
DID A FULL LAUNCH OF THE NETWORK
IN 2019, AND I'LL BE DESCRIBING
THE WORK THAT WE'VE BEEN DOING
SINCE 2019 HERE, BUT ONE OF THE
THINGS THAT WE ORGANIZED AROUND
WAS A CORE MISSION THAT HAS
GUIDED EVERYTHING THAT WE HAVE
DO, AND THAT CORE MISSION IS A
VERY SIMPLE IDEA, THE SIMPLE
IDEA THAT EVERY INDIVIDUAL WHO'S
INVOLVED IN THE JUSTICE SYSTEM
THAT HAS A SUBSTANCE USE
DISORDER SHOULD HAVE ACCESS TO
EFFECTIVE TREATMENT AND THAT
THAT IS SOMETHING THAT SHOULD BE
TRUE, WHETHER SOMEONE IS
DETAINED IN A JAIL OR PRISON OR
THEY ARE IN THE COMMUNITY, AND
TO DO THAT, WE MUST REALLY BRING
TOGETHER PERSPECTIVES OF THE
JUSTICE PARTNERS OF THE
COMMUNITY PARTNERS, AND BECAUSE
WE ARE IN AN AGE OF THE
RESEARCHERS.
SO FIRST AND FOREMOST, OUR GOAL
AS A RESEARCH NETWORK IS TO
GENERATE NEW EVIDENCE ABOUT WHAT
WORKS, BUT ALSO HOW DO WE TAKE
THE THINGS THAT WE KNOW WORK AND
GET THEM INTO PRACTICE?
AND INTO WIDESPREAD PRACTICE.
THE REST OF OUR KIND OF CORE
PRINCIPLES ARE HOW DO WE DO
THAT.
WE WANT TO BUILD A NATIONAL
COLLABORATIVE NETWORK OF
RESEARCHERS WORKING WITH
PRACTITIONERS ACROSS BOTH
JUSTICE AND COMMUNITY-BASED
SETTINGS, THAT AS WE DO THIS
WORK, WE WANT TO BIELD OUT
RESOURCES FOR THE FIELD VERY
RAPIDLY, BECOME A GO-TO TRUSTED
RESOURCE FOR PRACTITIONERS AND
RESEARCHERS ALIKE TO BUILD
CAPACITY AND TO ANGLES TO THIS.
ONE IS ABOUT BUILDING CAPACITY
FOR RESEARCHERS TO DO WORK IN
THIS VERY COMPLEX SPACE, BUT THE
SECOND PIECE OF IT IS TO BUILD
CAPACITY IN THE COMMUNITY TO USE
AND ADOPT AND APPLY RESEARCH AND
APPLY SKILLS IN THEIR OWN WORK
TO DO THAT.
AND HOPEFULLY IF WE CAN BRING
ALL OF THIS TOGETHER, WE CAN BE
ONE PIECE SPEEDING THIS PROCESS
OF SCIENCE TO SOLUTIONS AND
CREATING MEANINGFUL FEEDBACK
LOONS.
SO THIS IS THE VISION THAT
GUIDES ALL THAT WE DO.
BUT SO WHAT IS J COIN, WHAT DOES
THIS ACTUALLY MEAN, WHAT ARE WE
AS A NETWORK?
WE HAVE FUNDED 13 RESEARCH HUBS.
THOSE RESEARCH HUBS ARE FUNDING
MULTISITE CLINICAL TRIALS.
THE MAJORITY OF THE RESEARCH --
BY MULTISITE, THEE ARE TRIALS
THAT ARE HAPPENING IN AT LEAST
FIVE COMMUNITIES, SO VERY LARGE
TRIALS COLLECTING DATA FOR MANY,
MANY PARTICIPANTS.
THE MAJORITY OF THESE ARE REALLY
LOOKING AT THIS PROCESS OF
LINKAGE AGAIN AS PEOPLE ARE
MOVING BETWEEN CARS RAL SETTINGS
BACK INTO THE COMMUNITY SO WE'RE
TESTING SEVEN DIFFERENT MODELS
OF WHAT THAT LINKAGE TO CARE
LOOKS LIKE.
SO HOPEFULLY IF WE GET TO THE
POINT WHERE WE HAVE RESULTS,
THERE'S A WORK GROUP THAT MEETS
PRETTY REGULARLY THAT THINKS
ABOUT THE WAYS ALL THESE STUDIES
ARE SIMILAR AND DIFFERENT TO
EACH OTHER AND WHAT THAT ALL
MEANS.
WE HAVE TWO STUDIES THAT ARE
LOOKING AT STATE-WIDE POLICY
ROLLOUTS.
AT THE TIME WE WERE SOLICITING
APPLICATIONS FOR JCOIN,
MASSACHUSETTS HAD RECENTLY
PASSED A LAW REQUIRING THAT THE
JAILS IN THAT STATE ALL OFFER
MEDICATIONS FOR ALL THREE FORMS
OF MEDICATIONS FOR OPIOID USE
DISORDER SO WE'VE BEEN ABLE TO
PARTNER WITH THAT PROCESS OF
ROLLING OUT THAT POLICY.
LIKEWISE IN NEW YORK, THERE WAS
AN EFFORT TO SCALE A MODEL
FOCUSED ON DRUG COURTS USING
WHAT'S CALLED OPIOID COURT
MODEL.
TWO OF OUR STUDIES ARE
COMPARATIVE EFFECTIVENESS TRIALS
LOOKING AT DIFFERENT
FORMULATIONS OF LONG-ACTING
MEDICATIONS.
AND THIS IS OFTEN A PRAGMATIC
KIND OF QUESTION LIKE WHICH
MEDICATION WORKS BEST, DO THEY
ALL WORK SIMILARLY.
SO THESE TWO STUDIES HAVE REALLY
HARMONIZED THEIR APPROACHES,
HAPPENING IN DIFFERENT PLACES,
ONE IS LOOKING AT THE
LONG-ACTING FORMULATION AT BEUP
BUPRENORPHINE, BOTH COMPARING
THIS TO THE LONG-ACTING VERSION
OF NALTREXONE, AS WELL AS
THERE'S SOME COMPONENTS TOO
COMPARED TO USUAL CARE.
THEN TWO OF OUR STUDIES ARE
REALLY LOOKING MORE AT THE HOW,
SO HOW DO YOU APPROACH THE
IMPLEMENTATION THING, AND WHICH
STRATEGIES WORK BEST TO HELP
SUPPORT ORGANIZATIONS THAT THEY
TRY TO ADOPT THESE BEST
PRACTICES.
ONE OF THE THINGS THAT HAS BEEN
IMPORTANT TO US AS WE STARTED
JCOIN WAS TO REALLY BUILD A
NATIONAL FOOTPRINT.
IF YOU LOOKED, WE DID A
LITERATURE REVIEW EARLY ON, AND
AT THAT TIME, A LOT OF THE
RESEARCH HAD COME REALLY OUT OF
THE NORTHEAST CORRIDOR, AND WE
WOULD HEAR THINGS FROM THE FIELD
ABOUT, WELL, THIS ISN'T RELEVANT
IN THIS PLACE OR THAT PLACE, IT
ONLY WORKS IN THESE KINDS OF
SETTINGS, SO WE'VE REALLY MADE A
PUSH TO MAKE SURE THAT WE'RE
GETTING REACH INTO LOTS OF
DIFFERENT PLACES SO THAT WE CAN
ADDRESS THAT AND MAKE SURE
THINGS WORK LOTS OF DIFFERENT
PLACES.
WE HAVE 140 COUNTIES AND 38
STATES IN PUERTO RICO
PARTICIPATING IN ONE CAPACITY OR
ANOTHER IN OUR RESEARCH.
SO FAR THROUGH THESE CLINICAL
TRIALS, WE'VE RECRUITED NEARLY
23,000 PARTICIPANTS.
SOME OF THIS IS FROM
ADMINISTRATIVE DATA, BUT WE'VE
ENROLLED LARGE NUMBERS OF
PARTICIPANTS AT STAFF IN MANY OF
THESE TRIALS.
PART OF THE GLUE THAT HOLDS
JCOIN TOGETHER, HOWEVER, IS OUR
SUPPORT CENTERS.
THEY HAVE A LOT OF FUNCTIONS.
WE'VE GOT TWO DIFFERENT SUPPORT
CENTERS.
ONE IS THE METHODOLOGY AND
ADVANCED ANALYTICS RESOURCE
CENTER.
THIS REALLY FOCUSES ON DATA,
DATA RESOURCES MODELING AND
SURVEY PROJECTS.
AND THEN WE HAVE A COORDINATION
AND TRANSLATION CENTER WHICH
FOCUSES ON, IN ADDITION TO
COORDINATION FUNCTIONS, REALLY
HOW WE GET THIS RESEARCH OUT
INTO PRACTICE.
AND YOU'LL SEE A LOT OF EXAMPLES
OF BOTH OF THEIR WORK TODAY.
BUT IN ADDITION TO THOSE 13
MULTISITE CLINICAL TRIALS, WE'VE
ACTUALLY EXECUTED 55 ADDITIONAL
RESEARCH PROTOCOLS.
MANY OF THESE ARE HAPPENING IN
THE MAARC AND CTCS ABOUT LU
HAPPENING IN THEIR RESEARCH HUB.
WE'VE GOT NATIONAL SURVEYS,
PILOT PROTOCOLS, MODELING AND
MAPPING STUDIES, DIVERSITY
SUPPLEMENTS AND SMALL GRANTS.
I'LL TELL MORE ABOUT THESE
COMPONENTS IN A MINUTE BUT THE
POINT I WANT TO MAKE HERE IS
THIS IS A REALLY ROBUST NETWORK
OF A LOT OF DIFFERENT
INTERRELATED RESEARCH HAPPENING
AT THE INTERSECTION OF JUSTICE
AND PUBLIC HEALTH AS IT PERTAINS
TO THE OVERDOSE CRISIS.
A CORE ELEMENT, A CORE FEATURE
THAT'S REALLY INFUSED WITH
EVERYTHING WE DO IS THE IDEA OF
THIS COLLABORATION.
I JUST WANT TO DEMONSTRATE FOR
YOU HOW IT IS INTERWOVEN THROUGH
THE WHOLE FABRIC OF THE NETWORK.
OUR HUBS IN EACH OF THE
COMMUNITIES ARE EXECUTING THE
TRIALS IN, HOW ARE
REPRESENTATIVES FROM BOTH THE
JUSTICE AND BEHAVIORAL HEALTH
PERSPECTIVES IN THOSE
COMMUNITIES AND OUR STEERING
COMMITTEE WHICH OVERSEES THE
WHOLE NETWORK, WE'VE GOT EACH OF
THE HUBS ALSO HAVE A NAMED
SENIOR JUSTICE AND BEHAVIORAL
HEALTH COMMUNITY PARTNER WHO'S
BEEN REALLY FOUNDATIONAL TO THE
WAY THEY'VE THOUGHT ABOUT THEIR
RESEARCH.
OUR COORDINATION AND TRANSLATION
CENTER ORGANIZES A NUMBER
COMMITTEES.
WE'VE GOT A NATIONAL
PRACTITIONER BOARD OF KEY
THOUGHT LEADERS ACROSS MULTIPLE
DIFFERENT DISCIPLINES AND
PERSPECTIVES, AS WELL AS A
STAKEHOLDER BOARD WHERE WE PULL
TOGETHER PROFESSIONAL
ASSOCIATIONS AGAIN FROM MULTIPLE
DISCIPLINES AND PERSPECTIVES,
AND WE DO A LOT OF WORK TOO TO
REACH OUT TO OUR COLLEAGUES AT
VARIOUS AGENCIES, THE DEPARTMENT
OF JUSTICE, SAMHSA, TO MAKE SURE
WE'RE AWARE OF AND COMMUNICATING
WITH OUR PARTNERS IN THE FEDERAL
STAYS WHO ARE SPACE WHO ARE DOIK
FNGHT.
WORK.
JUST OVER FOUR YEARS IN OF
LAUNCHING THE CORE OF THE
NETWORK, I THINK WE'RE NOW ON
THAT KIND OF UPHILL TRAJECTORY
OF PUBLICATIONS.
AT OUR LAST COUNT, WE HAD 157
PUBLICATIONS.
THIS QR CODE IF YOU SCAN IT WILL
TAKE YOU TO A PUBMED DATABASE
WHERE WE'RE GOING TO KEEP ADDING
TO THIS AS IT GROWS.
IT'S STILL GOING TO BE ANOTHER
COUPLE OF YEARS, COVID SLOWED
DOWN OUR CLINICAL TRIALS
ALTHOUGH SOME ARE NEARING
COMPLETION, IT'S STILL GOING TO
BE A COUPLE YEARS BEFORE WE HAVE
RESULTS FROM THOSE TRIALS, BUT
IN THE MEANTIME, WE'RE PUTTING
OUT A LOT INTO THE FIELD, AND
ONE WAY -- AND I THINK EVEN
THESE EARLY FINDINGS ARE HAVING
A SIGNIFICANT IMPACT ON OUR
UNDERSTANDING OF THESE ISSUES
AND ON THE FIELD.
ONE INDICATOR OF THAT IS IN THIS
RCR METRIC.
IF YOU'RE NOT FAMILIAR WITH THIS
METRIC, RCR STANDS FOR RELATIVE
CITATION RATIO.
THIS IS A METRIC CREATED BY
NIH'S OFFICE OF EXTRAMURAL
RESEARCH.
AND RCR2.41 REALLY JUST MEANS
THE PUBLICATIONS COMING OUT OF
JCOIN SO FAR ARE BEING CITED TWO
TO THREE TIMES MORE OFTEN THAN
THE AVERAGE PAPER PUBLISHED IN
THE FIELD OF THOSE PAPERS.
SO THAT'S ONE METRIC TO THINK
ABOUT IT.
RATHER THAN AS A COLLECTION OF
R01s TO REALLY CREATE
SYNERGIES AND COLLABORATIONS.
SO IN JCOIN, OUR NETWORK
INFRASTRUCTURE INCLUDES MULTIPLE
WORK GROUPS, AND THOSE WORK
GROUPS HELP FIND AREAS OF COMMON
INTEREST.
THEY'VE ALSO WORKED TO COME WITH
COMMON MEASURES THAT ARE
INCORPORATED INTO ALL OF THE
STUDIES.
ALL OF OUR INVESTIGATORS ARE
PUTTING THEIR DATA INTO A COMMON
PLATFORM, BUT WE'VE ALSO TRIED
TO SEE IF IT'S REALLY WORKING TO
BUILD RELATIONSHIPS.
SO THIS GRAPHIC I'M SHOWING YOU
HERE ON THE RIGHT COMES FROM A
PAPER PUBLISHED WITH -- BY LORI
AS THE SCIENCE OFFICER WITH SOME
OF OUR METHODOLOGY, OUR MAARC
COLLEAGUES.
REALLY WHAT IT DEMONSTRATES IS
THAT OVER TIME, THIS JCOIN
STRUCTURE HAS CREATED MORE
INTERIOR RELATIONSHIPS AMONG THE
DIFFERENT RESEARCH HUBS AND HAS
RESULTED IN LOTS OF DIFFERENT
COLLABORATIONS AND SYNERGIES, SO
THIS IS ONE OF THE REASONS WHY
WE THINK TAKING THIS NETWORK
APPROACH IS A USEFUL APPROACH
AND I THINK IN THE FUTURE, WE'LL
SEE MORE OF THAT.
BUT I WANT TO GIVE YOU JUST A
COUPLE OF EXAMPLES OF INDIVIDUAL
PAPERS AND THE WAY WE THINK
ABOUT TRANSLATING THAT RESEARCH
FOR IMPACT.
THIS IS A PAPER FROM THE
MASSACHUSETTS JCOIN HUB THAT WAS
LOOKING AT THAT EFFORT TO OFFER
ALL THREE FORMS OF MEDICATION IN
MASSACHUSETTS JAILS.
THE TITLE OF THE PAPER IS
"UNCOMMON AND PREVENTABLE
PERCEPTIONS OF DIVERSION OF
MEDICATION FOR OPIOID USE
DISORDER."
THIS PAPER WAS BASED ON SOME OF
THEIR EARLY WORK, AND IT'S VERY
RESPONSIVE TO A CONCERN WE OFTEN
HEAR FROM OUR JUSTICE PARTNERS
ABOUT REASONS WHY THEY DON'T
WANT TO OFFER BUPRENORPHINE
BECAUSE THEY'RE AFRAID OF
DIVERSION, THEY'RE AFRAID IT
CREATES A SAFETY AND SECURITY
RISK WITHIN THERE'S SECURE
ENVIRONMENTS, AND SO WHAT THIS
PAPER DID IS IT SHOWED THAT IN
MASSACHUSETTS, THEY'VE BEEN ABLE
TO COME UP WITH A SET OF
PROTOCOLS TO REALLY MITIGATE
THOSE RISKS AND MAKE THEM VERY
MANAGEABLE.
FROM THIS PUBLICATION, WE PUT
THEM IN OUR NEWSLETTER IN A NICE
LITTLE SUMMARY.
WE'VE GOT 5,000 NEWSLETTER
SUBSCRIBERS, AND THIS GETS
BLASTED OUT.
AND THEN FOR SOME OF OUR PAPERS,
WE FOLLOW UP WITH THAT WITH A
WEBINAR, PARTICULARLY WHEN WE'RE
SENSING THERE'S A LOT OF
INTEREST IN THE FIELD, SO JUST
LAST DECEMBER THERE WAS A
WEBINAR FROM THE INVESTIGATORS
ON THIS THAT WAS WELL ATTENDED.
ANOTHER UNIQUE DISSEMINATION
PATHWAY THAT WE HAVE WITHIN
JCOIN IS A PODCAST THAT HAS
GOTTEN QUITE POPULAR,
45 EPISODES SO FAR, 13,000
DOWNLOADS, AND THEY'VE
INTERVIEWED MOST IF NOT ALL OF
THE INVESTIGATORS AT THIS POINT
AND THEY DO LOTS OF NICE LITTLE
INTERESTING EPISODES ON
DIFFERENT FINDINGS OR
PRINCIPLES.
WE ALSO TURN THIS FINDING INTO
AN INFOGRAPHIC SORT OF
DISTILLING DOWN THE KEY ELEMENTS
OF THE FINDING, AND THEN BLAST
OUT PIECES OF THIS ON SOCIAL
MEDIA REALLY TO CREATE
ENGAGEMENT.
AND WHAT WE'VE HEARD FROM OUR
PARTNERS WHO WERE PART OF THIS
WORK IS THAT THIS IS HELPFUL TO
THEM BECAUSE WHENEVER THEY'RE
GETTING CALLS FROM OTHER JAILS,
IT GIVES THEM A RESOURCE TO
POINT PEOPLE TO AND HELPS THEM
MANAGE THAT INTEREST LEVEL.
IN THIS CASE ONE OF THE THINGS
WE'VE HEARD BACK, THERE WAS
OUTREACH FROM MAIN JAILS AND
THOSE MAINE JAILS HAVE ADOPTED
THE DIVERSION PROTOCOLS
DEVELOPED IN MASSACHUSETTS AND
IT IS I THINK IN PART A RESULT
OF THIS SORT OF TRANSLATION
STRATEGY TO REALLY GET THE WORD
OUT TO SUPPORT THE WORK OF
OTHERS TO DO THAT.
A SECOND EXAMPLE ALSO FROM
MASSACHUSETTS, I THINK
ILLUSTRATES SOME DIFFERENT
PRINCIPLES OF HOW WE TAKE OUR
APPROACH TO THIS TRANSLATION.
HERE THIS PUBLICATION FOCUSED ON
A BUDGET IMPACT TOOL RELATED TO
HOW TO INCORPORATE MEDICATIONS
IN TO THE JAILS.
AND AN UNUSUAL FEATURE HERE, IF
YOU LOOK AT THE CO-AUTHOR LIST,
THE SHERIFF OF MIDDLESEX HOUSE
OF CORRECTIONS IN MASSACHUSETTS,
AS WELL AS THE PERSON IN CHARGE
OF THE BUDGET IN THE MIDDLESEX
JAILS AND THEN -- WHO LEADS THE
TREATMENT WORK WITHIN THE
FRANKLIN COUNTY JAILS IN
MASSACHUSETTS, WHERE MANY OF THE
PICTURES I'VE BEEN SHOWING YOU
ARE.
AND THEY'RE CO-AUTHORS OF THIS
PUBLICATION, AND THIS
PUBLICATION IN PART WAS SPARKED
FROM A CONVERSATION BETWEEN THE
INVESTIGATORS AND THE ECONOMISTS
WHO ARE PART OF THE VARIOUS
JCOIN STUDIES ABOUT HOW THEY
WERE THINKING ABOUT HOW THEY
WERE GOING TO PRACTICALLY
IMPLEMENT THIS GUIDANCE.
WHETHER THEY WERE GOING TO
BECOME AN OTP OR SUBCONTRACT IT
OUT IS SORT OF A MAKE OR BUY
QUESTION.
AND SO THIS PUBLICATION IS THE
RESULT BUT THEY ALSO DEVELOPED A
DOWNLOADABLE TOOL THAT WAS
PUBLISHED AT THE SAME TIME AS
THIS PUBLICATION THAT OTHER
JAILS CAN GO AND DOWNLOAD AND
PUT IN WHAT THEIR PARTICULAR
ASSUMPTIONS ARE AND SEE BASED ON
THE EXPERIENCES OF THESE JAILS,
I BELIEVE THERE'S ALSO
CONSULTATION WITH SOME OF THE
MARYLAND JAIL TO ANOTHER STUDY
WITHIN THE JCOIN NETWORK.
DOING
THAT.
THEY DID A WEBINAR AS WITH THE
OTHER PAPER, BUT ONE OF THE
OTHER UNUSUAL THINGS JUST FOUR
MONTHS AFTER THIS PAPER WAS
PUBLISHED, WE HAD THE
INVESTIGATORS BEING APPROACHED
AND INVITED BY SAMHSA'S GAIN
CENTER TO COME AND PRESENT WHERE
THEY BRING IN TEAMS FROM ACROSS
THE COUNTRY WHO ARE OUT
THERE TRYING TO DO THIS WORK AND
TO TALK THROUGH THIS TOOL AND
HOW THE TOOL CAN BE USED.
WE ALSO DO MAKE SURE WE ARE
GENERATING DATA AND RESOURCES
THAT ARE USEFUL FOR THE RESEARCH
COMMUNITY.
WE'VE GOT A NICE DATABASE OF
DIFFERENT POLICIES THAT ARE
PARTICULARLY RELEVANT IN THE
WORK THAT WE DO THAT MIGHT BE OF
INTEREST TO OTHERS AROUND LAWS
ABOUT DRUG INDUCED HOMICIDE
LAWS, MEDICAID COVERAGE FROM
MOUD, THINGS OF THAT NATURE.
WE'VE GOT OUR CORE MEASURES
PUBLISHED.
THIS IS A TOOL I THINK IS REALLY
COOL CALLED THE OPIOID
ENVIRONMENT POLICY SCAN.
THE TEAM DOES A LOT OF REALLY
FANTASTIC GEOSPATIAL ANALYSES,
AND THEY TOOK AND COMBINED
MULTIPLE EXISTING DATASETS,
GEOCODED THEM AND PUT THEM INTO
A SINGLE RESOURCE TOOL THAT
OTHER RESEARCHERS CAN DOWNLOAD
AND USE FOR WHATEVER YOUR OWN
RESEARCH QUESTIONS ARE.
AS AN EXAMPLE OF ONE OF OUR
COLLABORATIONS WITH OTHER
FEDERAL AGENCIES, A TEAM FROM
SEVERAL DIFFERENT INSTITUTIONS
LED BY THE UNIVERSITY OF
CHICAGO, BY ROGAN AND ABRAHAM
AND ANDREWS DID WORK TO LOOK AT
ALL THE FUNDING THAT WENT OUT
FROM -- I BELIEVE IT WAS 11 OR
12 DIFFERENT FUNDING AGENCIES IN
2019 AND 2020 AND MAPPED OUT AND
ANALYZED AS TO RELATES TO LOTS
OF DIFFERENT FACTORS.
THIS IS AN INTERACTIVE MAP THAT
YOU CAN ACCESS AND LO LOOK AT TE
DATA YOURSELF, AND WE'RE WORKING
TO MAKE SURE THE DATA THAT CAN
BE EASILY SHARED WIDELY IS BEING
MOVED ON TO THE HEAL DATA
PLATFORM AND WE HAVE AN INTERNAL
PLATFORM TO FACILITATE EARLIER
STAGE SHARING BEFORE IT'S READY
FOR PUBLIC CONSUMPTION.
AS WE TRACK THE DATA ON THE
REACH WE'RE HAVING, SO FAR WE'VE
ENGAGED 16,000 UNIQUE
STAKEHOLDERS FROM OUR PUBLIC
EVENTS AND THE TAKEAWAY I WANT
YOU TO GET FROM THIS CHART IS
THAT WE'RE REACHING LOTS OF
DIFFERENT AUDIENCES.
SO RESEARCHERS, STATE AND LOCAL
GOVERNMENT, LIVED EXPERIENCE,
AND THAT IS PART OF OUR GOAL,
THAT WE'RE ALWAYS HAVING ALL OF
THESE DIFFERENT AUDIENCES IN
MIND IN MAKING SURE TO CREATE
PRODUCTS THAT ARE OF INTEREST TO
VARIOUS AUDIENCES.
AND WHILE WE'RE WAITING FOR THE
RESULTS OF THE CLINICAL TRIALS,
THERE ARE SOME INDICATIONS JUST
ANECDOTALLY THAT WE'VE HEARD
ABOUT THAT ARE REALLY
DEMONSTRATING TO ME THAT WE ARE
HAVING A REAL IMPACT IN THE
FIELD.
WE'VE HEARD OF 15 DIFFERENT
JURISDICTIONS THAT HAVE
PERMANENTLY ADDED OR EXPANDED
THEIR OFFERING OF MEDICATIONS
FOR OPIOID USE DISORDER AS PART
OF THEIR USUAL JAIL SERVICES DUE
TO THEIR JCOIN EXPOSURE.
JUST ONE EXAMPLE OF THAT IS A
FLORIDA JAIL IN A TRIAL LED BY
WISCONSIN THROUGH OUR
COORDINATION TRANSLATION CENTER
THAT COMPLETED THEIR OTP
CERTIFICATION.
WE'VE HEARD FROM OUR KENTUCKY
PARTNERS THAT THEY CREDIT THE
OPPORTUNITY TO WORK TOGETHER
THROUGH JCOIN AS SOMETHING THAT
HAS STRENGTHENED THEIR
RELATIONSHIP AND CONTRIBUTED TO
THEIR OWN EFFORTS IN KENTUCKY TO
APPLY FOR AN 1115 WAIVER TO
EXPAND THEIR OFFERINGS OF
MOUDs IN JAILS WITHIN
KENTUCKY, AND IN INDIANA, WE
HAVE A PI THAT'S ON A STATE TASK
FORCE USING HIS JCOIN DATA TO
RECOMMEND UNIVERSAL SCREENING
FOR JUVENILES AT ARREST.
THERE'S STATE LEGISLATION
PENDING.
THEN IN THE CATEGORY OF KIND OF
UNEXPECTED BUT REALLY VERY
WELCOMED FINDINGS, MANY OF OUR
LINKAGE FACILITATION EFFORTS USE
PEER MODELS BUT HAVE FOUND THAT
SOMETIMES IT QUITE HARD TO HIRE
PEERS THAT HAVE A HISTORY OF
JUSTICE INVOLVEMENT.
WE'VE HAD TWO HUBS THAT HAVE
REALLY WORKED TO CHANGE THEIR HR
POLICIES WITHIN THEIR OWN
UNIVERSITIES WITH BARRIERS TO
HIRING PEOPLE WITH LIVED
EXPERIENCE, WITH SUBSTANCE USE
DISORDER OR, IN PARTICULAR,
CRIMINAL JUSTICE INVOLVEMENT.
IN FACT, ONE OF OUR PARTER INS
WAS EVEN RECENTLY A PARTNER WHO
HAS A -- WHO LEADS A MAJOR
ORGANIZATION BUT HAS A HISTORY
OF JUSTICE INVOLVEMENT WAS NAMED
AS FACULTY AT YALE.
I THINK REALLY SIGNALING THAT
THERE IS MUCH MORE PROMISING
WORK TO COME IN THAT REGARD.
I WANT TO TURN TO TALKING ABOUT
OUR EFFORTS AROUND BUILDING
CAPACITY, FOUR DIFFERENT
ELEMENTS THE WAY WE'VE
STRUCTURED THE NETWORK, ONE IS A
TRAINING PROGRAM CALLED THE LEAP
INVESTIGATOR PROGRAM.
WE'VE GOT A SMALL GRANTS PROGRAM
WE CALL THE JCOIN RAPID
INNOVATION GRANTS, ON-DEMAND
TECHNICAL ASSISTANCE PROGRAM,
AND NUMEROUS COURSES, WEBINARS
AND PODCASTS.
SO I'LL GIVE YOU A LITTLE BIT OF
DETAIL ON EACH OF THESE.
THESE FACES HERE ARE ALL
PARTICIPANTS WHO'VE BEEN PART OF
OUR LEARNING EXPERIENCES TO
ADVANCE PRACTICE SCHOLARS AND
INVESTIGATORS PROGRAM.
WE'VE HAD 90 TRAINEES SO FAR.
WE BUILT BASICALLY AN R25 INTO
OUR COORDINATION AND TRANSLATION
CENTER INFRASTRUCTURE.
AND THEY'VE REALLY DONE A GREAT
DEAL OF WORK WITH THIS AND I
THINK ARE BUILDING FOUNT DAITION
OF THE FUTURE OF THE FIELD.
SO I'M GOING TO TAKE YOU THROUGH
THE TWO DIFFERENT COMPONENTS OF
THIS PROGRAM.
THE FIRST COMPONENT IS REALLY
ABOUT FOLKS THAT ARE ON THE
VERGE OF LAUNCHING THEIR NIH
CAREER.
IT'S A TWO-YEAR PROGRAM.
AND IT PROVIDES INTENSIVE
MENTORING, GRANTSMANSHIP WORK,
FUNDS FOR PILOT WORK.
WE'VE HAD 24 PARTICIPANTS IN
THIS SO FAR, BUT REALLY TRIES TO
HELP SET THEM UP TO BE
INDEPENDENT INVESTIGATORS, AND
HAS BEEN QUITE SUCCESSFUL IN
THAT.
WE'VE HAD 11 NEW NIH OR CDC
AWARDS MADE TO PARTICIPANTS IN
THIS PROGRAM, EITHER DURING OR
AFTER THEIR PARTICIPATION IN THE
PROGRAM, LOTS MORE APPLICATIONS
IN THE PIPELINE.
BUT I THINK IMPORTANTLY, WHAT
THIS HAS HELPED TO DO IS
DIVERSIFY THE FUTURE OF THE
FIELD.
THIS IS DIVERSIFYING FROM A
GEOGRAPHIC PERSPECTIVE, FROM A
DISCIPLINARY PERSPECTIVE,
GENDER, UNDERREPRESENTED
MINORITY AND EVEN SORT OF -- WE
HAVE A THIRD OF THE PARTICIPANTS
HERE WHO ARE FIRST GENERATION
COLLEGE.
SO THESE ARE THE FACES I THINK
OF THE FUTURE OF THE FIELD, AND
WE'VE BEEN VERY EXCITED TO SEE
THEM PARTICIPATE IN THIS, BUT
THEY ALSO, WHEN THEY ARE
PARTICIPATING IN THIS PROGRAM,
THERE'S A SECOND PART OF THE
PROGRAM THAT ACTUALLY HAS MORE
PARTICIPANTS.
THIS HAS FOCUSED ON TWO
DIFFERENT SIDES OF THINGS.
ONE FOR PEOPLE WHO ARE LITTLE
BIT EARLIER STAGE, MAYBE
POSTDOCS OR DOCTORAL STUDENTS,
AS WELL AS PRACTITIONERS.
AND THIS ELEMENT, THE LEAP
SCHOLARS TRACK FOR THE PROGRAM
REALLY FOCUSES ON FOUNDATIONAL
TRAINING AND HOW TO CONDUCT,
INTERPRET OR APPLY RESEARCH.
IN
JUSTICE SETTINGS.
WE'VE HAD 66 PARTICIPANTS SO
FAR, FROM A VARIETY OF
DISCIPLINARY PERSPECTIVES.
IN CONTRAST, THIS IS A SHORTER
PROGRAM, JUST ONE YEAR, AND THE
PARTICIPANTS HAVE ENJOYED IT SO
MUCH, THEY'VE REQUESTED AN
ALUMNI PROGRAM, WHICH THEY'VE
LAUNCHED.
AGAIN, THIS IS CREATING NICE
GEOGRAPHIC DIVERSITY, GENDER,
FROM PEOPLE WHO ARE THE FIRST IN
THEIR FAMILY TO GO TO COLLEGE,
AND I KNOW THIS MAKES THIS SLIDE
BUSY, BUT WHAT I WANT TO
EMPHASIZE HERE IS WE'RE REALLY
PULLING FROM PEOPLE THAT ARE
COMING FROM DIFFERENT KINDS OF
BACKGROUNDS THAN WHAT WE
TRADITIONALLY SEE IN NIH
RESEARCH.
YOU SEE IN TERMS OF OUR
NON-ACADEMIC PARTNER -- OR
NON-ACADEMIC AFFILIATIONS OF
PARTICIPANTS, THESE ARE PEOPLE
COMING FROM SHERIFF'S
DEPARTMENTS AND TRIAL COURTS AND
RE-ENTRY RESOURCE CENTERS AND
TREATMENT ORGANIZATIONS, AND
FROM THE ACADEMIC SIDE, PEOPLE
COMING FROM NON-RESEARCH ONE
INSTITUTIONS OR INSTITUTIONS
THAT ARE OUTSIDE OF OUR JCOIN
NETWORK, SO WE'RE TRYING TO
SPREAD OUR REACH OUT INTO THE
FIELD AND GET A BROADER REACH
WITH THIS COMPONENT OF THE
TRAINING PROGRAM.
I WANT TO TURN NOW AND TALK A
LITTLE BIT ABOUT THE WORK WE'VE
DONE TO TRY TO FUND SMALL GRANTS
AND INNOVATION GRANTS.
THIS IS A PICTURE OF THE VAN
USED BY CODAC HEALTHCARE.
CODAC HEALTHCARE IS THE PARTNER
FOR BROWN UNIVERSITY'S RESEARCH
HUB.
AND CODAC IS LED BY LINDA
HURLEY, WHO IS THE CEO OF CODAC
AND IS ONE OF OUR JCOIN
PARTNERS.
BUT LINDA -- AS THEY'VE BEEN
ROLLING OUT THESE MOBILE
SERVICES, LINDA HAD LOTS OF
REALLY INTERESTING QUESTIONS
ABOUT HOW THINGS WERE WORKING
AND WANTED TO EVALUATE
COMPONENTS OF THIS, AND THOSE
QUESTIONS WERE DIFFERENT THAN
THE QUESTIONS THAT THE JCOIN
RESEARCH HUB WAS FUNDED TO DO.
SOMETIMES WE CAN EXPLORE
SUPPLEMENTS FOR THOSE IDEAS, BUT
THAT TO ME ENCAPSULATES ONE OF
THE CHALLENGES.
SOMETIMES WE'LL HEAR QUESTIONS
FROM THE FIELD.
I'M DOING THIS REALLY COOL
THING, HOW DO I SEE IF IT'S
WORKING, AND OFTEN WE DON'T HAVE
A GOOD ANSWER FOR THAT.
WE KNOW THAT THE NIH PROCESS CAN
BE VERY DIFFICULT TO NAVIGATE,
ESPECIALLY IF YOU DON'T HAVE
THAT EXPERIENCE OR YOU'RE NOT
COMING FROM A UNIVERSITY
EXPERIENCED WITH NIH GRANTS, AND
SO WE BUILT INTO JCOIN THE IDEA
OF THIS SMALL INNOVATION GRANT
PROGRAM.
THIS IS ADMINISTERED BY A
COORDINATION CENTER.
IT IS STILL VERY COMPETITIVE,
AND IT GOES THROUGH A RIGOROUS
REVIEW.
THE REVIEWERS ARE PART OF A
JCOIN -- JOINT JCOIN-WIDE
COMMITTEE THAT INCLUDES
PRACTITIONERS.
THE SIZE OF THESE AWARDS IS
ABOUT ON PAR WITH AN R03, BUT
THEY'RE MEANT TO REALLY, AGAIN,
EXPAND OUR REACH TO NEW IDEAS,
NEW PEOPLE, NEW SETTINGS, FEWER
BARRIERS TO ENTRY, SO THAT WE
CAN REALLY SEED THE MOST
INNOVATIVE IDEAS OUT IN THE
FIELD AND MAYBE GENERATE SOME
MOMENTUM THERE.
WE'VE MADE 13 OF THESE AWARDS
SINCE 2020.
IT HAS EXPANDED OUR JCOIN
PORTFOLIO IN NUMBER OF
MEANINGFUL WAYS, INCLUDING THE
KINDS OF PEOPLE THAT WE'RE ABLE
TO FUND.
SO WE WERE ABLE TO FUND LINDA TO
FOLLOW UP ON HER IDEA AS A
PRACTITIONERS, WO WE'VE HAD ONE
AWARD GO TO A LEAP PARTICIPANT,
FOUR TO RESEARCHERS COMING FROM
NON-RESEARCH 1 INSTITUTIONS, TWO
TO PEOPLE THAT ARE COMING FROM
VERY DIFFERENT DISCIPLINARY
BACKGROUNDS, AND WE'VE SEEN LOTS
OF REALLY GREAT IDEAS, AND
THOUGH IT'S NOT REALLY THE POINT
OF THIS PROGRAM TO LEAD TO
PUBLICATIONS OR NIH AWARDS,
THESE PROGRAMS HAVE DONE THAT AS
WELL.
SO WE'VE HAD FOUR PUBLICATIONS
COME OUT OF THESE SMALL GRANTS,
AS WELL AS ONE NIH AWARD, AND SO
WE'VE BEEN REALLY HAPPY WITH HOW
THAT HAS WORKED.
BUT WE KNOW EVEN WITH THAT,
THERE'S STILL BARRIERS TO ENTRY,
IT'S STILL A COMPETITIVE PROCESS
AND WE KNOW THAT OUR PARTNERS
ARE OUT THERE EVERY DAY STILL
TRYING TO DO THIS WORK, TRYING
TO FIGURE OUT IF WHAT THEY'RE
DOING IS WORKING.
THIS IS ANOTHER PICTURE THAT'S
COMING TO US COURTESY FROM
FRANKLIN COUNTY OF SORT OF THIS
PROCESS OF WHAT DELIVERING THESE
SERVICES IN A JAIL LOOKS LIKE.
AND WE'LL SOMETIMES GET CALL
FROM PEOPLE OUT THERE DOING
THIS, AND WE ALSO BUILT IN
ANTICIPATING THOSE KINDS OF
QUESTIONS IN A TRADITIONAL
STRUCTURE, WE DON'T OFTEN HAVE A
WAY TO RESPOND TO THAT, WE DON'T
HAVE THE RESOURCES TO DO THAT.
BUT WE BUILT INTO JCOIN THIS
IDEA OF TECHNICAL ASSISTANCE
PROGRAM.
WE WERE ABLE TO WORK WITH BJA
AND ESTABLISH AN MOU, THEY
PROVIDED US FUNDING TO DO THIS.
BUT IT BASICALLY BRIDGES THE
TYPE OF WORK THAT TYPICALLY
HAPPENS IN SAMHSA AND BJA
GRANTS, PROVIDING TRAINING AND
TECHNICAL ASSISTANCE TO BE ABLE
TO PROVIDE ON-DEMAND TECHNICAL
ASSISTANCE REALLY FOCUSED ON
RESEARCH AND EVALUATION NEEDS.
AND AGAIN, THIS I HAS PROVEN QUE
POPULAR OVER THE FIRST, I GUESS,
18 MONTHS OF OPERATION, WE HAD
93 TA REQUESTS THAT HAD COME
THROUGH.
WE'VE HAD MORE SINCE THEN, AND
THE KINDS OF REQUESTS THAT WE
GET ARE THINGS LIKE LOGIC MODELS
FOR PROGRAM EVALUATION, HELPING
AN AGENCY THINK THROUGH HOW TO
DO DATA-DRIVEN DECISION-MAKING,
WE HAVE A REALLY NICE EXAMPLE
FROM SOUTH DAKOTA WHERE THE WORK
THAT WAS DONE IN TRYING TO HELP
THE AGENCY IN TURN LED TO
ANOTHER TOOL THAT IS BEING PART
OF WHAT IS DISSEMINATED OUT TO
SUPPORT OTHERS AS THEY DO THEIR
WORK.
AND WHAT OUR TECHNICAL
ASSISTANCE GROUP DRAWS ON IS
REALLY A RICHNESS OF WHAT WE'VE
BEEN ABLE TO PUT INTO OUR
TRAINING AND ENGAGEMENT CENTER.
WE DEVELOPED A NUMBER OF
DIFFERENT RESOURCES, INCLUDING
FULLY DEVELOPED COURSES.
WE'VE GOT 50 COURSES.
MOST OF THESE COURSES ARE
SHORTER.
THEY MAY RANGE FROM 30 MINUTES
TO TWO HOURS IN CONTENT.
WE'VE GOT 20 MORE IN
DEVELOPMENT.
WE'VE HAD QUITE A BIT OF
ENGAGEMENT WITH 6400 COMPLETIONS
OF THESE COURSES WITH COMPLETION
RATES THAT EXCEED INDUSTRY
AVERAGES, BUT I THINK WHAT'S
SPECIAL ABOUT THIS IS THIS
APPROACH THAT HAS REALLY BEEN
SPEARHEADED BY THE ADDICTION
POLICY FORUM WORKING THROUGH --
AS PART OF THE COORDINATION AND
TRANSLATION CENTER THAT, THEY'VE
REALLY SPEARHEADED AN APPROACH
OF PARTNERING WITH KEY
ASSOCIATIONS, AND TAILORING THE
CONTENT TO THOSE ASSOCIATIONS.
SO ON THE TOP LEFT OF THE SCREEN
HERE, YOU SEE THERE'S AN MAT
COURSE FOR CORRECTIONAL LEADERS
THAT WAS DEVELOPED IN
CONJUNCTION WITH THE
CORRECTIONAL LEADERS OF AMERICA.
THESE ARE THE PEOPLE WHO ARE
EXECUTIVES OF PRISONS AND OTHER
SIMILAR CARS RAL SETTINGS.
AND THEN A SIMILAR COURSE BUT
THIS ONE DEVELOPED WITH IN
PARTNERSHIP WITH THE NATIONAL
CENTER FOR STATE COURTS AND
TARGETED TOWARDS JUDICIAL
LEADERS.
IN EACH OF THESE, WE HAVE EXTRA
CONTENT FROM THOSE PARTNERING
ORGANIZATIONS REALLY TAILORING
TO THEIR MEMBERSHIP AND
DISSEMINATING IT OUT.
I MENTIONED THE PODCAST EARLIER,
WE'VE GOT A NUMBER OF SHORT
MODULES, WE'VE HAD 18 WEBINARS
THAT HAVE BEEN QUITE POPULAR,
THE MOST POPULAR WAS ON
XYLAZINE, SO WE CONTINUE TO
BUILD THIS ROBUST SET OF
RESOURCES THAT ARE AVAILABLE FOR
OTHERS TO USE.
AND I'M VERY PLEASED TO SAY THAT
KOWN JCOIN AS WE COME TO THE END
OF A NORMAL FIVE-YEAR CYCLE, WE
HAVE RECEIVED SUPPORT TO MOVE
AHEAD WITH A SECOND ITERATION OF
JCOIN WE'RE CALLING INFORMALLY
JCOIN 2.0, AND THE FIRST STEP IN
THAT PROCESS IS TO CONTINUE OUR
SUPPORT INFRASTRUCTURE THAT
GIVES US A LOT OF THE THINGS I
JUST TALKED ABOUT, SMALL GRANTS
PROGRAM, THE SURVEYS, OUR DATA
INFRASTRUCTURE.
THOSE ARE RFAs THAT WERE
RELEARELEASED LAST YEAR AND WE E
TO BE ABLE TO I A NOUNS AWARDS
LATER THIS SUMMER FOR THAT
CONTINUITY OF INFRASTRUCTURE.
AND WE ALSO PUBLISHED LAST FALL
A NOTICE OF INTENT TO PUBLISH A
FUNDING OPPORTUNITY FOR HUBS TO
DO NEW RESEARCH.
THIS IS EXPECTED TO BE PUBLISHED
THIS SUMMER WITH APPLICATIONS
DUE IN WINTER OF 2025 AND THEN
AWARDS NEXT SUMMER.
AND JUST TO GIVE YOU A LITTLE
BIT OF A FLAVOR OF THE KINDS OF
THINKING THAT WE'RE DOING HERE
AND THAT IS DEMONSTRATED IN THAT
NOTICE, THIS IS THE IDEA OF A
SEQUENTIAL INTERCEPT MODEL, IF
YOU'RE NOT FAMILIAR WITH WORK IN
THE JUSTICE SETTING, THIS IS A
WAY TO SIMPLIFY A VERY COMPLEX
SYSTEM, THINKING ABOUT ALL THE
DIFFERENT POINTS OF INTERSECTION
FROM LAW ENFORCEMENT TO WHAT
HAPPENS AFTER SOMEONE IS
ARRESTED, TO WHAT THE COURTS DO,
WHAT HAPPENS IN JAILS AND
PRISONS, WHAT HAPPENS WHEN
PEOPLE ARE RETURNED TO THEIR
COMMUNITIES.
IN JCOIN, AND MOST OF OUR PRIOR
JUSTICE WORK AT NIDA IN GENERAL,
WE'VE FOCUSED REALLY ON THE
RIGHT-HAND SIDE OF THIS SLIDE,
AS WE LOOK FORWARD TO THE
FUTURE, WE REALLY HOPE WE CAN
START BUILDING THE EVIDENCE BASE
ALSO ON THE LEFT HAND OF THIS.
SO ALL THE PIECES CAN COME
TOGETHER.
AND AGAIN I'LL REFER YOU TO THE
NOTICE IF YOU WANT TO LEARN MORE
ABOUT THE KINDS OF THINGS WE'RE
THINKING ABOUT THAT REALLY,
AGAIN, THOSE EARLIER INTERCEPT
POINTS, BRINGING IN LIVED
EXPERIENCE, CONTINUING TO PUSH
ON IMPLEMENTATION SCIENCE,
UNDERSTANDING IMPACTS OF
CHANGING POLICY, CO-OCCURRING
CONDITIONS, AND LOTS OF OTHER
THINGS RELATED TO SPECIAL
POPULATIONS AND WAYS THAT WE GET
THESE TOOLS OUT THERE.
AND I'LL JUST START TO CLOSE
HERE BY SAYING THAT TOMORROW
WE'RE REALLY EXCITED, WE'VE BEEN
INVITED TO PROVIDE A PLENARY
SESSION AT THE HEAL SCIENTIFIC
MEETING.
YOU'LL HEAR -- AND WE GET TO
REALLY FEATURE OUR PARTNERS AND
THESE RELATIONSHIPS BETWEEN THE
INVESTIGATORS AND THEIR
PARTNERS.
WE'VE GOT A TEAM FROM KENTUCKY
COMING AS WELL AS THE
MASSACHUSETTS TEAM.
AND THEN LATER THIS SUMMER IN
JUNE, WE WILL HAVE A MEETING TO
REALLY CELEBRATE ALL OF THE
SCIENTIFIC FINDINGS THAT WILL BE
I THINK A 2 1/2 DAY MEETING HERE
IN NORTH BETHESDA AND AS SOON AS
WE HAVE MORE INFORMATION, I'M
HAPPY TO DISSEMINATE THAT.
AND SO I'LL JUST CLOSE BY THE QR
CODE CAN TAKE YOU TO
JCOINCTC.ORG, IT HAS ALL OF
THESE RESOURCES.
BUT I REALLY WANT TO THANK ALL
THE DIFFERENT PEOPLE THAT ARE
PART OF MAKING THIS WORK HAPPEN
BUT ESPECIALLY PEOPLE AND THEIR
FAMILIES AND THE WORKERS OUT
THERE TRYING TO GET HELP TO
PEOPLE WHO NEED IT.
SO THANK YOU FOR THE OPPORTUNITY
TO SHARE THIS WORK WITH YOU.
>> THANK YOU, IT SHA.
TISHA.
THAT WAS FANTASTIC!
ARE THERE QUESTIONS?
I SEE MELISSA'S HANDS.
>> HI.
AS THE DOGS BEGIN TO BARK.
FIRST OF ALL, AS YOU WERE
SPEAKING, I WENT OVER THE
WEBSITE FOR JCOIN AND THE
RESEARCH CORE.
WOW!
IT'S INCREDIBLE!
THANK YOU FOR THE -- SOMETHING
IS COMING UP AT ME.
THANK YOU FOR SHARING, AND
YOU'VE BEEN SO BUSY.
AND I JUST WANTED TO OFFER A
COMMENT WHICH I THINK BLENDS THE
EARLIER COMMENTS WHEN WE WENT
OVER TIME WITH THIS TALK THAT
YOU GAVE, WHICH WAS EXCELLENT.
THE FIRST MAYBE FIVE OR SEVEN
MINUTES OF YOUR PRESENTATION
REALLY REMINDED US ABOUT THIS
PROCESS OF STRATIFICATION THAT
EVEN GETS PEOPLE TO HEALTHCARE
ENCOUNTERS OR TREATMENT
ENCOUNTERS IN THE FIRST PLACE,
AND YOU ADDED IN THIS COMPLEX
LAYER OF, YOU KNOW,
INCARCERATION, AND I THINK JUST
GOING BACK TO OUR PRIOR
CONVERSATION, REMINDING ALL OF
US THAT REALLY PROBABLY THE
HEALTHCARE SYSTEM ISN'T GOING TO
BE OUR ANSWER, AND TRAINING
PHYSICIANS IS IMPORTANT BUT IN
TERMS OF IMPACT, WE KNOW THAT
ACTUALLY THOSE INVESTMENTS TEND
TO WIDEN INEQUITIES IN THESE
HEALTH OUTCOMES, AND SO I JUST
WANT US TO BE AWARE OF THAT AND
HAS THAT AS AN ADDENDUM TO OUR
COMMENTARY PRIOR, ALL THANKS TO
YOU, TISHA, FOR KIND OF POINTING
THAT OUT TO US.
>> THANK YOU.
>> OTHER QUESTION, COMMENTS?
WELL, I DON'T SEE ANY, SO AGAIN,
THANK YOU, TISHA.
IT REALLY IS AN AMAZING BODY OF
WORK, AND I THINK WE ARE ALL
REALLY APPRECIATIVE OF
EVERYTHING YOU'VE DONE SO FAR
AND LOOK FORWARD TO EVERYTHING
YOU'VE GOT PLANNED GOING
FORWARD.
>> WELL, THANK YOU FOR THE
SUPPORT AND THANK YOU TO MY TEAM
AGAIN.
REALLY AN INCREDIBLE TEAM I GET
TO WORK WITH, AND I APPRECIATE
NORA'S SUPPORT AND LEADERSHIP'S
SUPPORT AS WELL.
THANK YOU.
>> I'M GOING TO DO A MUCH LESS
EXCITING PRESENTATION ON MERIT
AWARDS AND SORT OF FILL US IN
FROM WHERE WE LEFT OFF AND WHAT
WE'VE BEEN TALKING ABOUT AT NIDA
IN TERMS OF THE FUTURE OF THESE
AWARDS SO I'M GOING TO SHARE MY
SCREEN.
SORRY, I'M TRYING TO SWITCH IT.
BEFORE I SHARE.
OKAY.
I'M GOING TO STOP SHARING
BECAUSE I WANT TO MAKE IT A
SLIDE SHOW FIRST.
SORRY.
SORRY, GUYS.
ACTUALLY CAN I ASK YOU TO SHARE
MY SLIDES?
>> I DON'T HAVE THEM, SUSAN.
>> RIGHT.
OKAY.
SO AGAIN, I'M GOING TO COME BACK
TO THIS DISCUSSION WHICH HAS
BEEN ONGOING NOW FOR A LITTLE
OVER A YEAR.
SO JUST AS A REMINDER, THE
CURRENT NIDA MERIT GUIDELINES
ARE -- THE FOCUS OF IT IS TO
RECOGNIZE INVESTIGATORS WHO HAVE
DEMONSTRATED OUTSTANDING
PRODUCTIVITY DURING THEIR
RESEARCH.
WITH THE IDEA THAT WE ANTICIPATE
THAT THEY WILL CONTINUE TO DO
SUCH STRONG WORK TRYING TO HAVE
WORK THAT HAS BEEN VERY
IMPACTFUL TO THE FIELD.
THESE ARE I A WARDS THAT ARE
GIVEN TO APPLICANTS WHO ARE
NOMINATED BY THE INSTITUTE
STAFF, AND THESE ARE PRESENTED
AS YOU KNOW TO COUNCIL FOR YOUR
CONSIDERATION, AND THE FINAL
SELECTIONS HAVE BEEN MADE BY THE
INSTITUTE DIRECTOR.
THE REQUIREMENTS THAT WE'VE HAD
FOR THESE AWARDS HAVE BEEN THAT
THE PERSON HAS PREVIOUSLY SERVED
AS A P.I. OF ONE OR MORE
INVESTIGATORS INITIATED PROJE
PROJECTS, THAT THEY HAVE AN
IMPRESSIVE RECORD OF SCIENTIFIC
ACHIEVEMENT, THAT THEIR
APPLICATION SCORED IN
5 PERCENTILE OR BETTER IN ONE OF
THE PREVIOUS TWO REVIEW CYCLES,
THAT IT AN UNAMENDED AM KAI AND
THAT THERE IS A TIME COMMITMENT
OF 15% OR MORE TO THE GRANT.
SO WHEN WE STARTED TO THINK
ABOUT THIS AND TALK ABOUT THIS
WITH OUR -- WITH COUNCIL AND
WITH THE WORK GROUP THAT WE
FORMED, WHICH I'LL COME TO IN A
MINUTE, WE ALSO LOOKED AT WHAT
OTHER ICs WERE DOING AROUND
NIH, AND I'VE HIGHLIGHTED FOR
YOU THE SIX OTHER ICs THAT ARE
STILL USING THE MERIT AWARD, OR
STILL USING IT IN THE SAME WAY
THAT I JUST DESCRIBED, THEREFORE
ESTABLISHED INVESTIGATORS WHO
HAVE A VERY IMPRESSIVE TRACK
RECORD.
AND YOU CAN SEE THAT FOR MANY OF
THE INSTITUTES, THEY EITHER
NEVER USED IT, THEY DISCONTINUED
IT, OR THERE ARE TWO OTHERS.
ONE IS FROM NCI, WHICH I WILL
SORT OF GIVE YOU THE BOTTOM LINE
OF WHAT I'M GOING TO SUGGEST,
BUT WE'RE ACTUALLY THINKING OF
TRYING TO MODEL OUR MERIT ON THE
STRATEGY THAT THEY'RE USING.
THEY NOW ONLY GIVE MERIT AWARDS
TO ESIs.
THESE ARE 7-YEAR AWARDS AND
THEY'RE DONE IN TWO PHASES, FOUR
YEARS AND THREE YEARS, I THINK.
AND NINDS ALSO HAS A 7-YEAR
AWARD WHICH IS SIMILAR TO THE
MERIT AWARD.
IT IS ALSO MOSTLY EXPERIENCED
INVESTIGATORS, ALTHOUGH THEY
COULD BE MID CAREER P.I.s, BUT
IT'S A SEVEN-YEAR AWARD.
ONE IS FIVE AND TWO, ONE IS FOUR
AND THREE.
ACTUALLY THE NINDS ONE IS FOUR
YEARS AND THREE YEARS.
SO THE OTHER INSTITUTES ARE NO
LONGER USING THIS MECHANISM.
IN MAY, WE FIRST BROUGHT THIS TO
YOUR ATTENTION WHEN WE PRESENTED
SOME HISTORICAL INFORMATION ON
THE MERIT AWARDS THAT WE HAVE
BEEN GIVING OVER THE YEARS.
AND HOW THE OTHER INSTITUTES USE
IT, WHICH IS THE SLIDE I JUST
SHOWED YOU.
THERE WERE A NUMBER OF CONCERNS
THAT WERE EXPRESSED, INCLUDING
THE FACT THAT THERE'S A LACK OF
GENDER AND RACIAL ETHNIC
DIVERSITY IN THE AWARDEES,
THERE'S A LACK OF DIVERSITY IN
THE SCIENTIFIC AREAS
REPRESENTED.
MOST OF THE MERIT AWARDS HAVE
GONE TO BASE BASIC SCIENCE
RESEARCHERS.
AS I SAID, THE CRITERIA CAN ONLY
BE MET BY EXPERIENCED
INVESTIGATORS WHO ALREADY HAVE A
HISTORY OF OUTSTANDING
CONTRIBUTIONS AND WHO ARE LIKELY
TO CONTINUE TO GET FUNDED BASED
ON THEIR HISTORY AND THEIR
PERFORMANCE.
SO WE DECIDED TO CONVENE A
WORKING GROUP TO FURTHER DISCUSS
THE FUTURE OF THE MERIT AWARDS
AND TO PROVIDE SOME
RECOMMENDATIONS TO COUNCIL.
SO THESE ARE THE PEOPLE WHO WE
INVITED TO BE ON THE WORKING
GROUP.
THEY WERE ALSO INVITED TO JOIN
US FOR THIS DISCUSSION.
PAUL KENNY IS ON, I'M NOT SURE
IF ANY OTHER MEMBERS OF THE
GROUP THAT ARE NOT ALSO STILL ON
COUNCIL ARE ON, SO MELISSA IS
ON.
SO WE HAD A COUPLE OF -- WE HAD
A FEW MEETINGS AND WE HAD A
DISCUSSION ABOUT HOW THESE
AWARDS HAVE BEEN AWARDED IN THE
PAST, AND THE NEXT SLIDE SHOWS
THE RECOMMENDATIONS FROM THE
COUNCIL WORKING GROUP.
IN GENERAL, THEY WERE FACIAL
ABOUT CONTFAVORABLEABOUT CONTINE
CONSIDERATIONS.
THAT OTHER GRANT MECHANISMS BE
CONSIDERED, THAT EQUITY SHOULD
BE CONSIDERED, THEY SHOULD
PRIORITIZE RESEARCH FOCUSED ON
HEALTH EQUITY, AND THAT DURING
THE RENEWAL PHASE, WE REQUIRE
DEMONSTRATION OF PROMOTING OR
ADVANCE EQUITY IN THE FIELD.
FOR LESS EXPERIENCED
INVESTIGATORS, THERE COULD BE A
DEMONSTRATION OF AN
INCORPORATION OF DIVERSE
PERSPECTIVES BY REQUIRING A
PEDP, WHICH IS SOMETHING THAT
WE'RE USING NOW FOR A LOT OF OUR
FUNDING OPPORTUNITIES.
TO ALLOW FOR MULTI-P.I. AWARDS,
AND THERE WAS STILL A PREFERENCE
FOR THE 10 YEARS OF AWARDS BUT
DESPITE THE FACT THAT OTHER
ICs ARE OFFERING 7-YEAR
AWARDS.
SO NEXT SLIDE, PLEASE.
SO AT NIGH DA WE HAD NIDA, WE HE
FOLLOW-UP DISCUSSIONS WITH
SENIOR STAFF AND THROUGH EMAIL,
AND SOME OF THIS IS BASICALLY
WHERE WE KIND OF WOUND UP.
WE STARTED THINKING ABOUT WHAT
WE'RE TRYING TO ACHIEVE WITH
THIS.
SOME OF THE GOALS BROUGHT UP BY
THE WORK GROUP LIE ENHANCING THE
DIVERSITY OF THE INVESTIGATORS,
MAKING SURE THAT THERE'S
MENTORING OF INVESTIGATORS FROM
UNDERREPRESENTED GROUPS IN NIDA
RELEVANT AREA, ADVANCING EQUITY,
THESE ARE EXTREMELY IMPORTANT
FOR NIDA, AND THEY ARE VALUES
THAT WE ADHERE TO, BUT WE WERE
NOT SURE THAT THIS AWARD COULD
SORT OF ACHIEVE EVERYTHING THAT
WE WANTED.
AND THAT MAYBE THE MERIT AWARD
IS NOT THE IDEAL STRATEGY FOR
ACHIEVING THOSE ENDS.
HOWEVER, THE IDEA OF PROVIDING
STABLE FUNDING TO JUNIOR
INVESTIGATORS AT A CRITICAL TIME
IN THEIR CAREERS IS SOMETHING
THAT THE MERIT AWARD COULD DO.
AND THAT'S SORT OF WHERE WE
LANDED, THAT THAT MIGHT BE THE
BEST WAY FOR US TO USE THAT TYPE
OF AWARD GOING FORWARD.
SO THERE WAS STRONG SUPPORT FOR
AN ESI-FOCUSED MERIT AWARD,
THINKING ABOUT IT AS A 7-YEAR
AWARD, FIVE YEARS PLUS A
TWO-YEAR EXTENSION.
DISCUSSING SOME OF THE DIFFERENT
MECHANISMS, WE'VE KIND OF -- WE
LANDED ON THE IDEA THAT IT
SHOULD STILL BE FOR R01s ONLY.
SOME OF THE OTHER AWARDS WE HAVE
LIKE THE DP1 OR DP2 ARE ALREADY
CONSIDERED PRESTIGIOUS AWARDS
AND THEY'RE VERY MUCH
INVESTIGATOR-FOCUSED.
AND U AWARDS, THEY BY DEFINITION
INVOLVE SIGNIFICANT SCIENTIFIC
INPUT FROM NIDA STAFF OR OTHER
IC STAFF.
SO IT SEEMED LIKE THE R01 STILL
IS PROBABLY THE MOST -- THE BEST
AWARDS TO KIND OF STAY FOCUSED
ON FOR THESE MERITS.
WE WOULD CONSIDER MPI AWARDS IF
ALL THE P.I.s HAVE ESI STATUS
AT THE TIME OF THE AWARD.
AND WE DECIDED TO SUNSET THE
CURRENT MERIT AWARD, AND I'M
SURE WE CAN HAVE SOME DISCUSSION
ABOUT THIS AT THE END OF THIS
PRESENTATION.
THE ESI AWARD, WE WOULD WANT TO
BE EVALUATING IT AND WHETHER IT
BENEFITS AN INVESTIGATOR'S
CAREER TRAJECTORY WITH RESPECT
TO GETTING CONTINUED FUNDING,
PROMOTION OR TENURE, INNOVATION
AND RISK TAKING, AND SCIENTIFIC
AND PUBLIC HEALTH IMPACT.
SO THE INITIAL AWARD WOULD BE UP
TO FIVE YEARS, SIMILAR TO WHAT
WE HAVE NOW.
STAFF WILL BE SELECTING
APPLICATIONS FOR CONSIDERATION,
AND REQUEST PROVISIONAL APPROVAL
FROM OUR DIRECTOR.
THE DIVISION DIRECTOR WOULD BE
PRESENTING THE NOMINATION TO
COUNCIL FOR APPROVAL AND FOR
FINAL RECOMMENDATION TO THE NIDA
DIRECTOR.
AND THEN THE NIDA DIRECTOR WILL
OFFICIALLY SELECT THE MERIT
AWARDEE AND THEN BASE GRANT WILL
BE PROMOTED TO THE R37.
THE EXTENSION REQUEST PROCESS
WHICH WOULD AGAIN BE FOR JUST
TWO YEARS, THIS WOULD BEGIN
SIMILAR TO WHAT WE HAVE RIGHT
NOW FOR OUR CURRENT MERIT AWARD
FOR ESTABLISHED INVESTIGATORS.
THE P.O. WOULD REACH OUT ABOUT
1 1/2 YEARS PRIOR TO THE END OF
THE INITIAL AWARD PERIOD.
SORRY, THAT'S AN ERROR.
AND TO REQUEST THESE EXTENSION
MATERIALS.
AND THE MERIT AWARDS, WE'RE
TRYING TO MAKE THIS NOT TERRIBLY
BURDENSOME ON EITHER THE AWARDEE
OR THE NIDA STAFF SO THE REQUEST
WOULD BE FOR THE PROGRESS
REPORT, WHICH THE MERIT AWARDEE
WOULD HAVE TO BE WORKING ON
ANYWAY.
A FIVE-PAGE RESEARCH STRATEGY
FOR THE TWO-YEAR EXTENSION
PERIOD.
PROPOSED BUDGET FOR THAT
EXTENSION PERIOD, AND THEN THE
P.O. WOULD SUBMIT A ONE-PAGE
MEMO THAT SUMMARIZES WHAT THE
MERIT AWARDEE'S ACCOMPLISHMENTS
WERE IN THE FIRST PHASE OF THE
AWARD, PLANS FOR THE TWO-YEAR
EXTENSION, AND PROACHTNESS OF AS
OF THE EXTENSION.
THE DIVISIONS WILL REQUEST
APPROVAL FROM THE NIDA DIRECTOR
AND FROM COUNCIL.
WE WERE NOT PLANNING TO BRING
THESE BACK TO COUNCIL FOR --
WITH AN ACTUAL PRESENTATION
DURING THE CLOSED SESSION, BUT
THE INFORMATION WOULD BE
INCLUDED IN THE ELECTRONIC
COUNCIL BOOK, AND IF THIS IS
APPROVED, THEN THE EXTENSION
WOULD BE FUNDED.
SO AGAIN, WE WOULD WANT THIS TO
BE SOMETHING WHERE NIDA STAFF
IDENTIFY APPLICANTS,
INVESTIGATORS CANNOT APPLY FOR
IT.
WE WOULD WANT THEM TO HAVE ESI
STATUS AT THE TIME OF THE AWARD
SO IT WOULD HAVE TO BE THEIR
FIRST R01 AWARD AND THEY WOULD
HAVE TO HAVE ESI STATUS.
WE DECIDED, AND THIS WAS BASED
ON LOOKING AT THE DATA FROM PAST
YEARS, TO SEE IF WE COULD GET
SORT OF ENOUGH PEOPLE WHO WOULD
MEET THE TYPES OF QUALIFICATIONS
THAT WE WOULD BE LOOKING FOR,
AND WE KIND OF CAME UP WITH A
GENERAL IDEA OF HAVING
R01 APPLICATION SCORING 24 OR
BETTER WHICH PUT THEM IN ABOUT
THE TENTH PERCENTILE, BUT WE
WOULD CONSIDER EXCEPTIONS WITH
STRONG JUSTIFICATION, SO
DIVISION DIRECTORS OR THE
DIVISION STAFF COULD IDENTIFY
PEOPLE WHO MIGHT BE A LITTLE BIT
OUTSIDE OF THOSE DRY T CRITERIAA
MAKE A CASE WHY THEY SHOULD BE
CONSIDERED FOR THIS AWARD.
WE ALSO WOULD CONSIDER MPI
AWARDS IF ALL THE P.I.s HAVE
ESI STATUS.
SO WE'VE NOT DECIDED ON WHAT WE
WOULD CALL THE AWARD.
IT COULD STILL BE CALLED THE
MERIT AWARD, IT COULD BE CALLED
MERIT ESI AWARD BUT WE ARE ALSO
OPEN TO OTHER IDEAS.
AND YOU CAN STOP SHARING MY
SLIDES NOW.
AND WE CAN OPEN THIS UP FOR
DISCUSSION.
PAUL, DID YOU HAVE ANY THOUGHTS
SINCE YOU JOINED US?
I APPRECIATE YOU JOINING US.
YOU WERE ON THE WORKING GROUP.
>> NO, SUSAN, NOT SPECIFIC.
I JUST WANTED TO THANK YOU FOR
ALL THE HARD WORK I KNOW YOU PUT
IN, YOUR TEAM PUT IN IN THE
BACKGROUND.
I THINK IT LANDED IN A REALLY
GOOD SPOT.
I GUESS IF THERE WAS ONE THING,
IT WOULD BE NICE TO SEE -- IT'S
A WAY OF TRACKING IMPACT, TO
SHOW THAT THOSE WHO ARE AWARDED,
WHATEVER THE NEW MERIT AWARD
ENDS UP BEING CALLED, WHAT KIND
OF CAREER BOOST THEY GET, JUST
TO REALLY SUPPORT THIS AS A
MECHANISM TO MAKE SURE IT'S KIND
OF WORTH EVERYONE'S WHILE.
I DON'T KNOW HOW YOU TRACK WITH
THOSE METRICS, BUT IT MIGHT BE
GOOD TO GIVE THAT SOME THOUGHT,
JUST TO SHOW IT'S WORKING.
>> YEAH, I THINK WE NEED TO
THINK ABOUT IT BECAUSE I'M NOT
SURE WHO THE COMPARISON GROUP
WOULD BE, AND SO I THINK THAT'S
WHAT WE'LL HAVE TO REALLY THINK
ABOUT.
BUT I AGREE, IF WE'RE GOING TO
BE USING THIS AWARD AND WE WANT
TO USE THIS TO HELP PEOPLE THAT
ARE GETTING STARTED IN THEIR
CAREER, THEN WE WANT TO MAKE
SURE THAT IT'S DOING THAT.
ANNA ROSE?
YOU'RE MUTED.
>> SO IT'S BASICALLY OFFERING A
TWO-YEAR EXTENSION TO SOMEONE
WHO HAD A WELL-SCORED R01 WHO'S
AN EARLY STAGE INVESTIGATOR.
WOULD THERE BE AN ADVANTAGE TO
CALLING THAT AN AWARD OR WOULD
THERE BE AN ADVANTAGE TO SIMPLY
MAKING THAT KIND OF APPLICATION
FOR AN EXTENSION AVAILABLE TO
EARLY STAGE INVESTIGATOR THAT
ARE THREE YEARS INTO THEIR FIRST
R01?
I'M JUST ASKING.
I'M ON THE OWD SIDE LOOKING IN
HERE, BUT IT SOUNDS LIKE THE NET
BENEFIT IS TO GET AN EXTENSION.
>> THAT IS THE NET BENEFIT.
I THINK PART OF THE THINKING,
AND PART OF THE REASON FOR HAV
HAVING THIS NOT BE AN AWARD
PEOPLE WOULD APPLY FOR BUT BE AN
AWARD WHERE STAFF ARE SELECTING
PEOPLE IS TO ACKNOWLEDGE THE
PERSON AND TO SORT OF GIVE --
HOPEFULLY GIVE THEIR CAREER A
BOOST BY PUTTING THEM IN THIS
OTHER CATEGORY.
ALSO BRINGING INFORMATION ABOUT
THEM TO COUNCIL.
SO I DON'T KNOW THAT WE -- WE
DIDN'T TALK ABOUT THE IDEA OF
MAKING THIS MORE OF AN OPEN CALL
FOR ALL ESIs TO BE ABLE TO GET
AN EXTENSION AND I DON'T THINK
WE WANT TO DO THAT AT THIS
POINT, BUT WE DID DISCUSS THE
IDEA OF WHETHER THIS SHOULD BE
AN AWARD THAT SOMEBODY COULD
APPLY FOR, APPLY FOR A
SEVEN-YEAR AWARD WHERE THEY
WOULD GET FIVE YEARS AND THEN
HAVE THE POSSIBILITY OF THE
TWO-YEAR EXTENSION VERSUS ONE
THAT WOULD BE SELECTED BY STAFF,
AND WE OPTED FOR IT BEING ONE
SELECTED BY STAFF ONLY BECAUSE
WE THOUGHT THAT THAT MIGHT GIVE
THEM A BIT OF ANED AD BOOST IN
THEIR CAREER TRAJECTORY.
NORA, DID YOU WANT TO SAY
SOMETHING?
>> NO, NO, NO, I WAS JUST
LISTENING.
I DIDN'T HAVE ANYTHING SPECIFIC
IN TERMS OF ACTUALLY I THINK
THAT THE OTHER CONSIDERATION
THAT CAME INTO PLAY IN OUR
DISCUSSIONS WAS HOW TOUGH IT HAS
BECOME TO ACTUALLY GET THE
GRANTS, AND PARTICULARLY FOR
YOUNG PEOPLE, NOT TO SUSTAIN
THEM, AND THAT'S WHY CONSIDERING
THAT WE ARE FORESEEING THAT
THERE'S NOT GOING TO BE
INCREASES IN FUNDING AND THERE
COULD BE SIGNIFICANT DECREASES,
WE WANT TO CREATE A VERY STRONG
MESSAGE THAT WE DO WANT TO
ENCOURAGE AND SUPPORT THE NEW
GENERATION OF SCIENTISTS.
THAT'S AN ASPECT THAT WAS QUITE
FUNDAMENTAL IN WHAT WE WERE
DOING, AND AT THE SAME TIME THAT
WE'RE COMMIT TODAY DIVERSITY,
GCOMMITTED TO DIVERSITY,PROVIDIG
THAT BREATHING SPACE TO
RESEARCHERS WHO ARE STARTING
THEIR CAREERS WOULD BE VERY
VALUABLE, AT THE SAME TIME
CREATING A MECHANISM THAT WOULD
ALSO RECOGNIZE THEM.
SO IT'S LIKE AN ACHIEVEMENT.
SO THAT WAS ALSO -- THAT ALSO
CAME INTO PLAY.
>> CAN I ASK A QUESTION?
CAN THE EXISTING MERIT AWARDS --
ARE THEY GOING TO BE STAYING AND
THEN BEING PHASED OUT, AND THIS
IS SORT OF AN OVERLAP HOW THIS
WILL BE PHASED IN OR HOW DO YOU
ENVISION THIS?
>> WE HAVEN'T BEEN GIVING NEW
MERIT AWARDS FOR ABOUT -- WHEN
WE STARTED HAVING THIS
DISCUSSION, WE ALSO STOPPED
DOING NEW MERIT AWARDS.
SO THE IDEA WOULD BE THAT WE
WOULD BE PHASING IT OUT.
PEOPLE THAT ALREADY HAVE MERIT
AWARDS AND THAT ARE COMING UP
FOR EX-TENG EXTENSIONS, WE WOULD
CONTINUE THOSE EXTENSIONS, AND
THERE WERE A COUPLE TODAY THAT
WE HAD, THAT WE DISCUSSED
EARLIER.
SO THOSE WOULD FINISH OUT THE
COURSE, BUT WE WOULDN'T BE
GIVING NEW MERIT AWARDS TO
ESTABLISHED INVESTIGATORS.
>> I DON'T SEE ANY MORE HANDS
RAISED, SUSAN.
>> I DON'T EITHER.
WELL, IF YOU HAVE THOUGHTS ON A
NAME, OTHERWISE WE CAN STILL
CALL IT THE MERIT AWARD FOR
ESIs OR MERIT ESI.
IF YOU HAVE ANY IDEAS OR ANY
CREATIVE SUGGESTIONS, SEND THEM
TO US.
>> I THINK -- WE HAVE 13
MINUTES.
DO YOU WANT TO START EARLY OR
DELAY UNTIL 3:45?
>> I WANT TO -- SEE IF ANYBODY
WANTS TO CONTINUE THE
CONVERSATION WITH YOU THAT I CUT
OFF SINCE THERE WAS STILL -- IF
YOU DON'T MIND.
WOULD THAT BE OKAY WITH YOU?
>> OF COURSE.
ABSOLUTELY, YEAH.
>> OKAY.
SO I CUT OFF RAJITA, AND I'M NOT
SURE IF SHE'S --
>> HI, SUSAN.
I AM HERE.
I'M JUST ON AUDIO-ONLY NOW
BECAUSE I'M TRYING TO GET TO THE
HEAL MEETING.
BUT THANK YOU FOR OPENING IT UP.
I JUST WANTED TO FOLLOW BACK ALL
OF THE RICH DISCUSSION AROUND
THE THRESHOLD ISSUE AND MAKE A
COMMENT AND THEN ANOTHER
QUESTION THAT I WANTED TO RAISE.
THE COMMENT WAS -- AND NORA
REMEMBERS THIS, T.K. LEE HAD PUT
TOGETHER THE WORKING GROUP IN
THE LATE '90S TO COME UP WITH
HAZARDOUS AND NON-HAZARDOUS
DRINKING LEVEL, I BELIEVE, AND
THEN THAT GOT TRANSLATED INTO --
AS WE ALL KNOW, THE U.S. DIETARY
GUIDELINES HAVE HAZARDOUS
DRINKING LEVELS, THE CDC HAS
BINGE DRINKING LEVELS AND IT'S
BEING USED IN A LOT OF DIFFERENT
WAYS, AND I THINK THOSE
THRESHOLDS LED TO THEN THE
GROWTH OF RESEARCH FOR
IDENTIFYING BIOMARKERS, WHICH
WAS CHARLIE'S POINT.
SO I JUST THINK IT WOULD BE
REALLY AMAZING AND SUCH A GOOD
DOVETAIL OF WORK THAT YOU HAVE
ALREADY DONE WITH THE STANDARD
UNITS FOR CANNABIS.
SO THAT'S JUST A COMMENT.
THE OTHER THING I JUST WANTED TO
ASK ABOUT WAS RFAs AND THE ONE
TIME RFAs VERSUS RFAs THAT
ARE OPEN MULTIPLE TIMES.
THE REASON -- AND THINKING OF
ESIs AND ALSO OTHER
INVESTIGATORS WHEN IT'S A
SINGLE, YOU KNOW, SUBMISSION
RFA, THINGS ARE ON THE CUSP,
THINGS THAT DON'T GET FUNDED,
THERE ARE GOOD IDEAS THAT -- I
KNOW THEY CAN GO INTO THE
REGULAR POOL, BUT IF IT'S A
PRIORITY AREA, I WONDER IF
THERE'S DISCUSSION OF EXTENDING
RFAs ACROSS A FEW DEADLINES,
JUST TO CONTINUE THE PRIORITY
AREA AND THE WORK THAT GOES ON,
SORT OF IDENTIFYING THAT AND
HOPING TO GET GOOD RESEARCH IN
THE AREA GOING.
>> RAJITA, ABSOLUTELY AND WE DO
THAT.
THERE ARE TWO WAYS OF COURSE OF
GOING THROUGH IT, ONE WAS THE
NUMBER OF APPLICATIONS WE GOT IN
TERMS OF A REQUEST FOR
APPLICATION, SO IN A SPECIFIC
TOPIC AREA AND WHETHER IT COVERS
BASICALLY SUFFICIENTLY WELL THE
AREAS THAT ARE RELEVANT.
AND IF THERE WERE INDEED
INVESTIGATORS THAT HAVE
MERITORIOUS PROPOSALS BUT DIDN'T
REACH IT, WE PERHAPS CAN COME TO
THE REGULAR MECHANISM AND GUIDE
THEM THROUGH IT.
AND THERE'S BEEN ALSO INSTANCES
WHERE WE HAVE AN RFA AND WE
DON'T FEEL THAT WE WERE ABLE TO
CAPTURE ALL OF THE
POSSIBILITIES, SO WE REISSUE IT.
SO YES, WE TREAT THESE THINGS
WITH FLEXIBILITY, DEPENDING ON
THE OUTCOMES.
BY ALL MEANS.
RAJITA, DID THAT ANSWER YOUR
QUESTION?
>> YES, YES, IT ABSOLUTELY DID.
YOU KNOW, I HAVE SEEN SOME
RFAs THAT ARE OPEN FOR A FEW
DEADLINES AND IT'S ENCOURAGING
TO SEE THAT THEY COULD GET SHEP
SHEPHERDED INTO THE REGULAR
POOL.
SOMETIMES I THINK THAT MAYBE
THERE ARE APPLICATIONS THAT DO
DROPOFF AND FALL TO THE WAYSIDE
WHEN THERE ARE GREAT IDEAS.
BUT AGAIN, IF YOU'RE TRACK BEING
THEM, THAT'S FANTASTIC.
>> -- IS VERY RIGOROUS WITH
THAT AND THEY WILL BRING UP
GRANTS THAT ARE VERY, VERY --
SOMEONE WITH A LOT OF POTENTIAL
THAT DIDN'T DO WELL ON THEIR
REVIEW, THEN THEY WORK WITH THEM
TO BE MORE SUCCESSFUL.
SO THEY ARE PROACTIVE IN THAT
PROCESS.
AND THE SAME THING, SOMETIMES --
FOR WHATEVER REASON, I GUESS
SOMETIMES -- IF YOU WANT TO
BUILD A NEW AREA OF SCIENCE, FOR
EXAMPLE, AND THIS HAPPENED WITH
THE SOCIAL DETERMINANTS OF
HEALTH FOR ONE OF OUR --
RELEASES, AND WE DIDN'T GET
SUFFICIENT APPLICATIONS, SO WE
HAVE BEEN REISSUING THE RFA
BECAUSE, AGAIN, IT'S MUCH HARDER
WHEN YOU'RE GETTING INTO A NEW
AREA SINCE PEOPLE HAVEN'T REALLY
THOUGHT ABOUT IT, SO BY KEEPING
IT THERE, YOU INCREASE THE
LIKELIHOOD OF PEOPLE GETTING
EXCITED ABOUT IT, AND GETTING
BETTER PROPOSALS.
SO YES, THIS IS SOMETHING THAT
WE NEED TO DO.
BECAUSE IT IS ACTUALLY THE WAY
THAT WE MAXIMIZE OUR ABILITY TO
ADVANCE SCIENCE AREAS THAT ARE
VERY IMPORTANT FOR THE MISSION
OF THE INSTITUTE.
>> THANK YOU SO MUCH.
>> SUSAN, I DON'T SEE ANY MORE
HANDS RAISED.
>> I DO NOT EITHER.
SO WE CAN THEN GO ON TO THE
CONCEPT CLEARANCE.
PART OF THE
MEETING.
>> OKAY.
SO IF WE GO TO THE CONCEPT
CLEARANCE, I GUESS -- DO YOU
WANT ME TO DRIVE OR DO YOU WANT
TO DRIVE, SUSAN?
WHAT'S YOUR FAVORITE?
>> I'M HAPPY TO DRIVE.
>> DRIVE!
JUST DON'T GO TOO FAST.
>> SO WE HAVE A NUMBER OF
CONCEPTS BEING PRESENTED.
WE USUALLY DO QUITE BRIEF
PRESENTATIONS, BUT YOU HAVE
INFORMATION IN THE ELECTRONIC
COUNCIL BOOK ABOUT THEM.
BUT PLEASE STOP US WHEN WE'RE
DOING THE PRESENTATION IF YOU
WANT TO HAVE MORE OF A
DISCUSSION OR IF YOU HAVE ANY
QUESTIONS ABOUT THESE CONCEPTS.
SO THE FIRST GROUP IS GOING TO
COME FROM THE DIVISION OF
NEUROSCIENCE AND BEHAVIOR, AND
KATHLEEN BORGMANN IS GOING TO BE
THE PERSON PRESENTING THEM.
>> GOOD AFTERNOON.
THE FIRST CONCEPT IS ADVANCING
RESEARCH ON PLEAK ALREADY
TARGETS AND MECHANISMS THAT
INFLUENCE THE INTERPLAY BETWEEN
SEX HORMONES, ADDICTIVE SUCK
SUBSTANCES AND HIV █INFECTION.
IT WAS PROPOSED BY DR. SAM
ANANTHN.
DESPITE THE KNOWN NEXUS, OUR
KNOWLEDGE REGARDING THE
BIOCHEMICAL MECHANISMS BY WHICH
SEX HORMONES POSITIVELY OR
NECKTIVELY INFLUENCE THE COURSE
OF HIV INFECTION IN DRUG-USING
POPULATIONS IS LIMITED.
THIS CONCEPT WILL SUPPORT BASIC
RESEARCH ON DELINEATING THE
MECHANISMS BY WHICH HORMONES
INFLUENCE THE OUTCOME OF
CO-MORBID HIV AND DRUG USE AND
RESEARCH ON THE TRANSLATIONAL
POTENTIAL OF TARGETING SPECIFIC
MECHANISMS FOR THE DEVELOPMENT
OF EFFECTIVE INDIVIDUALIZED
THERAPEUTIC APPROACHES TO TREAT
HIV IN PEOPLE WITH SUBSTANCE USE
DISORDERS.
OUR SECOND CONCEPT IS TITLED
MITOCHONDRIAL-ASSOCIATED
MECHANISMS OF NEUROPATHOLOGICAL
AND IMMUNODEFICIENT AGING IN THE
CONTEXT OF HIV AND SUD.
I PROPOSE THIS HAD CONCEPT.
THE LIFELONG CONSEQUE CONSEQUENF
LIVING WITH HIV HERITAGE
ANTIRETROVIRAL THERAPIES AND/OR
USE OF ADDICTIVE SUBSTANCES
REMAINS UNDERSTUDIED.
THESE LIFE FACTORS HAVE BEEN
INDEPENDENTLY ASSOCIATED WITH
MECHANISMS THAT CONTRIBUTE TO
NEUROPATPATHOLOGICAL AND -- AGIG
SUCH AS INFLAMMATION, OXIDATIVE
STRESS AND CELLULAR SENESCENCE,
ALSO REGULATED BY MYOCON DREE A
IN BRAIN AND IMMUNE CELLS.
THIS CONCEPT WILL SUPPORT BASIC
RESEARCH VIGHTING MITOCHONDRIAL
ASSOCIATED MECHANISMS OF
PROTECTIVE AND PATHOGENIC AGING
IN PEOPLE LIVING WITH HIV AND
SUBSTANCE USE DISORDERS.
OUR THIRD CONCEPT IS WASTE NOT,
WANT NOT: EXPLORING
INTERACTIONS BETWEEN BRAIN WASTE
CLEARANCE AND RENEWAL SYSTEMS IN
HIV AND ADDICTION.
I ALSO PROPOSED THIS CONCEPT.
WHILE THE WASTE CLEARANCE AND
RENEWAL SYSTEMS IS HIGHLY
DEPENDENT ON SLEEP, IT IS ALSO
REGULATED BY OTHER PHYSIOLOGICAL
MECHANISMS THAT ARE, IN TURN,
LIKELY AFFECTED BY SUBSTANCE USE
AND HIV.
DESPITE EXTENSIVE RESEARCH IN
ALZHEIMER'S DISEASE AND AGING,
THE MECHANISMS REGULATING THE
WASTE CLEARANCE AND RENEWAL
SYSTEM IN THE CONTEXT OF
SUBSTANCE USE DISORDERS AND HIV
ARE LARGELY UNKNOWN.
THIS CONCEPT WILL SUPPORT BASIC
RESEARCH INTO ITS ROLE IN
REGULATING ADDICTION AND HIV
BRAIN INFECTION AND IMMUNE
INJURY, WHICH WILL PROVIDE NEW
INSIGHTS FOR THE DEVELOPMENT OF
EFFECTIVE INTERVENTIONS.
AND OUR FINAL CONCEPT FOR THE
DIVISION OF NEUROSCIENCE AND
BEHAVIOR IS MECHANISMS OF
CELL-TO-CELL INTERACTIONS AND
COMMUNICATION IN CENTRAL NERVOUS
SYSTEM HIV REPLICATION, AND THIS
WAS PROPOSED BY DR. ANNE TSAI.
HIV COMPARTMENTALIZES WITHIN
BRAIN IMMUNE CELLS TO ESTABLISH
RESERVOIRS.
RECENT STUDIES HAVE SHOWN THAT
ASTROGLIA BECOME INFECTED
THROUGH A CELL-TO-CELL CONTACT
MECHANISM.
UNDERSTANDING THE MECHANISMS OF
CELL COMMUNICATION AND VIRAL
TRANSFER UNDER THE INFLUENCE OF
SUBSTANCE USE IS ESSENTIAL FOR
AN HIV CURE.
THIS CONCEPT WILL SUPPORT
INVESTIGATIONS ON HOW SUBSTANCE
USE AFFECTS CELLULAR SIGNATURES
BY WHICH HIV LATENCY IS
INITIATED, ESTABLISHED AND
MAINTAINED IN THE CENTRAL
NERVOUS CYST TE. THANK YOU.
>> ARE THERE ANY QUESTIONS OR
COMMENTS?
>> I JUST WANTED TO COMMENT ON
THAT THEY'RE REALLY INCREDIBLY
TARGETING VERY CRITICAL ISSUES
THAT WE CURRENTLY ARE DEALING
WITH IN HIV PATHOGENESIS, BUT
SPECIFICALLY CORE CURE RESEARCH,
AND I THINK REALLY APPLAUDING
FOR THESE INITIATIVES.
>> THANK YOU.
ANYONE ELSE?
THEN WE CAN GO ON TO THE NEXT
CONCEPT, WHICH IS GOING TO BE
ON -- IT'S FROM THE OFFICE OF
RESEARCH TRAINING, DIVERSITY AND
DISPARITIES, AND IT'S PRESENTED
BY DR. YOHANSA FERNANDEZ.
I'M SORRY IF I MISPRONOUNCED
YOUR NAME.
>> YOU DID NOT.
THANK YOU SO MUCH.
APPRECIATE THAT.
WE ARE PRESENTING THE DATA
SCIENCE TRACK AWARD FOR RESEARCH
TRANSITION OR D-START.
DATA SCIENCE IS AN IMPORTANT
CROSS-CUTTING PRIORITY FOR NIDA,
AND INCREASING THE CAPACITY OF
EXPERTS IN ADDICTION RELATED
DATA SCIENCE IS CRITICAL.
THE CONCEPT IS INTENDED TO
FACILITATE THE ENTRY OF
INVESTIGATORS TO THE AREA OF
ADDICTION RELATED DATA SCIENCE
INCLUDING NEWLY INDEPENDENT DATA
SCIENTISTS OR ESTABLISHED
INVESTIGATORS SEEKING TO
INCORPORATE NOVEL AND CROSS --
CUTTING EDGE DATA SCIENCE
METHODOLOGIES INTO THEIR
RESEARCH PROGRAMS FOR THE FIRST
TIME.
APPLICANTS ARE ENCOURAGED TO USE
EXISTING DATASETS, FOLLOW FAIR
PRINCIPLES AND WHEN APPLICABLE,
ATTEND TO ETHICAL CONCERNS IN
THE CONDUCT OF RESEARCH
INVOLVING HUMAN SUBJECTS.
ULTIMATELY, THE AIM IS TO
EXPEDITE THE DEVELOPMENT OF
ROBUST RESEARCH PROGRAMS FOCUSED
ON THE CONVERGENCE OF INNOVATIVE
DATA SCIENCE TECHNIQUES AND
ADDICTION RESEARCH WITH INITIAL
PROPOSALS SERVING AS PRECURSORS
FOR MORE SUBSTANTIVE RESEARCH
PORTFOLIOS.
THANK YOU.
>> THANK YOU.
ANY COMMENTS, QUESTIONS?
OKAY.
THANK YOU VERY MUCH.
THE LAST CONCEPT IS FROM THE
DIVISION OF EPIDEMIOLOGY,
SERVICES AND PREVENTION, AND
ANGELA LEE-WINN WILL BE
PRESENTING.
>> THANK YOU, AND GOOD
AFTERNOON.
WE'RE PROPOSING A CONCEPT TITLED
RESEARCH TO ADDRESS SYSTEMIC AND
STRUCTURAL BARRIERS AND
FACILITATORS TO IMPROVE THE HIV
PRE-EXPOSURE PROPHYLAXIS CARE
CONTINUUM FOR PEOPLE WHO USE
SUBSTANCES.
PRE-EXPOSURE PROPHYLAXIS, ALSO
KNOWN AS PREP, IS A SAFE, HIGHLY
EFFECTIVE MEDICATION FOR
PREVENTING TRANSMISSION OF HIV
FROM SEX OR INJECTION DRUG USE,
YET CONTINUES TO BE
UNDERUTILIZED, PARTICULARLY
AMONG PEOPLE WHO USE SUBSTANCES.
THE GOAL OF THIS CONCEPT IS TO
SUPPORT RESEARCH TO EXAMINE AND
ADDRESS SYSTEMIC AND STRUCTURAL
FACTORS THAT IMPEDE OR
FACILITATE THE PREP AWARENESS,
UPTAKE, AND ADHERENCE AMONG
PEOPLE WHO USE SUBSTANCES.
PROJECTS WILL DEVELOP, IMPLEMENT
AND EVALUATE EFFECTIVE
STRATEGIES THAT MEET THE NEEDS
OF PEOPLE WHO USE SUBSTANCES TO
IMPROVE THE PREP CARE CONTINUUM.
THANK YOU.
>> THANK YOU.
AGAIN, ANY COMMENTS, QUESTIONS?
OKAY.
THEN THANK YOU VERY MUCH.
NORA, I CAN TURN IT BACK OVER TO
YOU.
WE DID NOT RECEIVE ANY PUBLIC
COMMENTS AHEAD OF TIME.
>> SO IF WE DON'T HAVE RECEIVED
ANY PUBLIC COMMENT BEFORE OUR
TIME, WE ARE UNABLE TO ACTUALLY
ANSWER THEM BECAUSE THERE ARE
NONE, BUT IF YOU DO WANT, IF YOU
HAVE QUESTIONS, COMMENTS THAT
YOU WOULD LIKE US TO BRING UP IN
THE NEXT COUNCIL, WHICH WILL BE
MAY, PLEASE SEND THEM TO
DR. SUSAN WEISS.
AND HAVING GONE THROUGH THE
PROGRAM AND THERE'S NOTHING MORE
ON THE AGENDA, I'M GOING TO GIVE
EVERYONE A CHANCE IF THEY WANT
ANYTHING THAT THEY WOULD WANT TO
BRING UP BEFORE WE ADJOURN.
SO PLEASE RAISE YOUR HAND, AND
IF I DON'T SEE ANY RAISED HAN
HANDS -- IT'S 5, 4, 3, 2, 1.
I DON'T SEE ANY HANDS.
SO I THINK THAT WITH THAT, WE
CAN ADJOURN, AND I WANT TO THANK
ALL OF THE COUNCILMEMBERS VERY
MUCH.
THEIR WILLINGNESS TO HELP US.
AND EVEN THOUGH WE ARE RIGHT NOW
ENDING OUR COUNCIL, THAT DOES
NOT MEAN THAT WE ARE
DISCONNECTING OUR COMMUNICATION
AND IF YOU HAVE SUGGESTIONS,
PLEASE REACH OUT TO ME, SUSAN
WILSON, AND WE WILL ADDRESS YOUR
CONCERN, SO IF YOU HAVE
QUESTIONS OR SUGGESTIONS.
MEANWHILE, I HOPE YOU ENJOY THE
REST OF THE DAY, AND THANKS VERY
MUCH FOR YOUR ATTENTION.
>> AND I JUST WANT TO THANK YOU
AS WELL.
WE REALLY APPRECIATE YOUR TIME
AND YOUR ATTENTION.
>> LOOK FORWARD TO SEEING YOU IN
PERSON IN MAY.
>> YES, DEFINITELY.
>> THANK YOU.
>> THANK YOU, BYE-BYE.