NOW I WANT TO THANK ALL OF THE
MEMBERS FROM COUNCIL AND STAFF
FROM NIDA FOR ALL OF THE GREAT
WORK THAT THEY DO AND FOR THE
TIME THAT YOU PUT INTO THIS
MEETING.
TODAY IS THE 147th MEETING OF
THE NATIONAL ADVISORY COUNCIL ON
DRUG ABUSE.
TODAY IS THE TIME WE SAY
GOOD-BYE TO SOME OF OUR COUNCIL
MEMBERS, WHICH IS SOMETHING I
REALLY, REALLY HATE TO DO
BECAUSE I ACTUALLY GET
CONDITIONED TO EVERYONE, AND
COUNCIL THIS IS A PARTICULARLY
STRONG PLACE TO CONDITION WITH
OUR MEMBERS.
WHO ARE WE LOSING TODAY?
WE ARE LOSING ANNA ROTH
CHILDRESS.
>> I'LL STILL BE HERE IN SPIRIT.
>> YES, ABSOLUTELY.
YOU'LL BE HEAR IN SPIRIT.
YOUR SPIRIT WILL BE ALL OVER THE
PLACE.
WE'RE ALSO LEARNING DANNY.
WE'RE LOSING SHELLY GREENFIELD.
WE'RE LOSING ANDRE, WHO I THINK
IS IN THE CLOUD SOMEPLACE OVER
THERE.
WE ARE LOSING TRAVIS RYDER.
I HOPE THAT IT'S A STRONG
CONDITIONING SO YOU COME BACK
AND STAY AROUND AND GIVE US
PERSPECTIVE.
ALSO, WE ARE LOSING RAJITA
SINGH.
AND FINALLY WE'RE LOSING MELISSA
WALL.
I THINK SHE MAY BE IN THE CLOUD.
IN ORDER TO MEMORIALIZE THIS
FOREVER, WE WANT TO TAKE A
PICTURE.
WHERE DO YOU WANT US?
HERE?
ALL OF THOSE MEMBERS THAT ARE
LEAVING, PLEASE COME UP HERE SO
WE CAN BE IMMORTALIZED.
>> THOSE WHO HAVE THEIR NAME
TAGS STILL ON.
PERFECT.
THANK YOU SO MUCH, EVERYONE.
ONE, TWO, THREE.
WE'RE GOING TO DO ONE MORE.
ONE, TWO, THREE.
>> NOW IT'S A PLEASURE FOR ME TO
WELCOME THE NEW MEMBERS.
THE FIRST MEMBER THAT I WANT TO
WELCOME IS DR. CHRISTIANE
DUARTE, WHO IS A PROFESSOR IN
ADOLES
ADOLESCENT PSYCHIATRY AT
COLUMBIA UNIVERSITY.
HER RESEARCH IS BASED ON
POPULATION BASED STORIES ABOUT
THE DEVELOPMENT OF MENTAL
DISORDERS IN CHILDREN, ADD LESS
LESSENTS.
SHE'S A MEMBER OF THE ONLY
MULTINATIONAL SOURCE OF
INFORMATION ABOUT HOW MENTAL
DISORDERS DEVELOP FROM CHILDHOOD
TO ADULTHOOD IN A LATIN X GROUP
OF PUERTO RICANS.
SHE HAS PUBLISHED ARTICLES IN
PUBLIC HEALTH AND PSYCHIATRIC
JOURNALS.
CHRISTIANE, WELCOME.
ALSO A PLEASURE TO WELCOME MS.
REGINA LABELLE.
SHE'S A DISTINGUISH ED DIRECTOR
AT THE O'NEILL INSTITUTE FOR
NATIONAL AND GLOBAL HEALTH AT
THE GEORGETOWN UNIVERSITY LAW
CENTER.
SHE LOOKS AT TREATMENT AND
REDUCTION AND RECOVERY SUPPORT
SERVICES.
SHE WAS AN APPOINTEE IN THE
BIDEN-HARRIS ADMINISTRATION AND
SERVED AS ACTING DIRECTOR IN THE
OFFICE OF THE NATIONAL CONTROL
POLICY IN THE EXECUTIVE OFFICE
OF THE PRESIDENT.
REGINA, WELCOME.
IT'S A PLEASURE TO HAVE YOU.
THE OTHER PERSON I WANT TO
INTRODUCE, AND I'M ACTUALLY
WELCOMING HER VIRTUALLY.
SHE'S SOMEPLACE IN THE CLOUD.
LET ME SEE IF I CAN SEE HER.
DR. ANGELA LAIRD, WHO IS A
PROFESSOR AND DIRECTOR OF THE
CENTER OF IMAGING SCIENCE AT
FLORIDA INTERNATIONAL
UNIVERSITY.
SHE IS DIRECTOR OF INFORMMATICS
AND CONNECTIVITY LABORATORY.
HER RESEARCH USES FUNCTIONAL MRI
TO UNDERSTAND LARGE SCALE
NETWORKS IN THE HUMAN BRAIN.
CURRENT PROJECTS EXAMINE CHANGES
ASSOCIATED WITH ADOLESCENT
DEVELOPMENT ON THE GRADUATE
SCIENCE EDUCATION AND ADDICTION.
ANGELA, WELCOME.
THE FINAL NEW MEMBER, WHO I ALSO
WANT TO WELCOME VIRTUALLY, IS
DR. DEBORAH CHASSLER.
SHE IS A SENIOR ACADEMIC
RESEARCHER AND ASSOCIATE
PROFESSOR AT THE BOSTON
UNIVERSITY SCHOOL OF SOCIAL
WORK.
SHE'S THE INAUGURAL FACULTY
FELLOW FOR THE OFFICE OF
DIVERSITY AND INCLUSION.
THE BROAD GOAL OF HER WORK IS TO
INCREASE EQUITABLE ACCESS TO
HARM REDUCTION AND TREATMENT
OPTIONS AND ADDRESS
DISPROPORTIONATELY EXPERIENCED
HARMS OF SUBSTANCE DISORDER.
MS. CHASSLER IS IN ENGAGED
PARTNERSHIPS TO SUPPORT A
COMMUNITY'S STATED NEEDS.
I'M GOING TO ASK FOR THOSE
MEMBERS WHO ARE HERE, IF YOU
COULD ALSO NOW COME ALSO HERE SO
WE CAN TAKE A PICTURE.
NOW I HAVE TO READ THIS
STATEMENT, THIS PARAGRAPH.
THE GOVERNMENT IN THE SUNSHINE
ACT AND THE FEDERAL ADVISORY
COMMITTEE ACT REQUIRES 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 BEING VIDEOCAST
AND RECORDED.
THE MINUTES OF THE MEETING WILL
BE AVAILABLE ON THE NIDA HOME
PAGE.
RECORDINGS OF THE OPEN COUNCIL
MEETINGS ARE POSTED ON THE NIH
VIDEOCAST SITES.
I'M GOING TO NOW ASK ALL OF YOU
FOR COMMENTS OR CORRECTIONS TO
THE MINUTES FROM THE FEBRUARY 20
COUNCIL MEETING.
A COPY OF THE MINUTES WAS MADE
AVAILABLE UNDER ELECTRONIC
COUNCIL BOOK UNDER THE NIDA
CURRENT COUNCIL TAB.
COMMENTS?
CORRECTIONS?
NOW I'M GOING TO -- I HAVE TO
GET THAT.
MOTION TO APPROVE?
SECOND?
ANYONE OPPOSED?
OKAY.
I'M GOING TO GET YOU THE FUTURE
COUNCIL DATES.
SEPTEMBER 11, 2024.
FEBRUARY 4, 2025.
MAY 13 AND 14, 2025.
I HOPE IT'S NOT THE APA.
WE WILL CHECK.
LET'S BE SURE WE DON'T HAVE THE
APA.
I'M GOING TO NOW DO THE
DIRECTOR'S REPORT.
LET ME DO IT FROM UP HERE.
LET ME GET MY GLASSES IN CASE I
DON'T SEE SOMETHING.
EVERY TIME I PRESENT AT COUNCIL,
IT'S A GREAT OPPORTUNITY FOR ME
TO LOOK AT WHAT HAS HAPPENED
SINCE THE LAST TIME WE MET FOUR
MONTHS AGO.
I KNOW THAT I HAVE A RESTRICTIVE
TIME AND I CANNOT PRESENT
EVERYTHING THAT IS MERITORIOUS,
SO I HAVE TO BE STRATEGIC, AND
THE WAY THAT I DO IT IS SAY WHAT
IS STRATEGIC TO ME IS AREAS
WHERE I WANT MORE DIRECT INPUT,
WHERE I WANT TO ALSO BE VERY
AWARE OF SOME OF THE MORE
CHALLENGING OR GAP AREAS WHERE
HAVING AWARENESS OF OTHERS SO
THAT THEY CAN CARRY THROUGH AND
MAKE A DIFFERENCE.
SO IT'S IN THIS CONTEXT THAT THE
PRESENTATION AND THE TOPIC
THAT'S I'M CHOOSING, WHY IT
EXPLAINS THE TOPICS THAT I'M
CHOOSING.
I WANT TO START WITH ACTUALLY
SOMETHING THAT IS VERY, VERY
RELEVANT FOR ALL OF US THAT ARE
IN THE RESEARCH WORLD, FOR ALL
OF US THAT GET DEEP RUNS FOR NIH
IN GENERAL, WHICH IS THE
DECISION BY THE NIH TO INCREASE
THE FUNDS TO PAY OUR POST DOCS
AND PRE-DOCTORAL GRADUATES.
THIS WAS OUR RECOMMENDATION FOR
THE ADVISORY COUNCIL AT THE NIH,
AND WE BASICALLY ARE FOLLOWING
THEIR RECOMMENDATIONS.
THE RECOMMENDATIONS OVERALL IN
TERMS OF WHERE WE WILL BE
INCREASING THE TOTAL SALARY WILL
BE DONE OVER A PERIOD OF TWO TO
THREE OR FOUR YEARS DEPENDING ON
THE PROJECT.
IT IS ACTUALLY GOING TO PERTAIN
TO ALL OF THE PRE-DOCTORAL AND
POST-DOCTORAL SCHOLARS OF N
NIH-FUNDED INSTITUTIONS.
IT APPLIES TO OVER 17,000
RESEARCH TRAINEES.
FOR PREDOCTORAL SCHOLARS, IT IS
AN ESTIMATED 4% INCREASE, WHICH
WILL BRING IT TO $28,224.
FOR THE POSTDOCTORAL SCHOLARS,
IT IS AN ESTIMATED 8% INCREASE
WITH PAY STARTING AT $61,008 AND
ADJUSTED BASED ON YEARS OF
EXPERIENCE.
ADDITIONALLY, THERE'S
ELIGIBILITY FOR UP TO 2$200 FOR
TRAINING AND $500 INCREASE FOR
CHILDCARE.
WE HAVE BEEN HEARING A LOT OF
CONCERNS.
A LOT OF PEOPLE FLYING AROUND ME
IS THEY WANT TO GET RID OF THE
LITTLE THING BELOW.
I DON'T THINK IT'S SO BAD.
I CERTAINLY TRY TO GET MY BRAIN
TO IGNORE IT, BUT IF YOU ALL GET
SO OBSESSED WITH IT -- NO, NO,
I'M JUST ACTUALLY TRYING TO
FIGURE OUT HOW TO DEAL WITH THIS
THING.
THERE'S A PROBLEM.
MY VIEW IS, IF IT REALLY BOTHERS
YOU A LOT, THEN WE CAN STOP.
LET'S GO OTHERWISE.
THIS IS ONE OF THE THINGS -- AND
WE HAVE DISCUSSED IT IN PRIOR
MEETINGS, THE NOTION THAT
POSTDOCS DON'T FEEL THEY HAVE
SUFFICIENT PAY IN ORDER TO MEET
THEIR NEEDS.
THEREFORE, WE WERE LOSING
RESEARCHERS.
IT HAS BEEN DIFFICULT TO RECRUIT
POSTDOCS BECAUSE WE DON'T
INCENTIVIZE IT ENORMOUSLY.
THIS IS THE RECOMMENDATIONS, AND
HOPEFULLY THIS WILL HELP US KEEP
PEOPLE THAT ARE INTERESTED IN
SCIENCE TO GO INTO RESEARCH
CAREERS.
THE OTHER THING THAT I WANT TO
MAKE YOU AWARE OF RELATES TO ONE
OF THE TWO PRIORITIES OF DR.
MONICA BERTONOLLI WITH REGARD TO
WHAT THE NIH WANTS TO
ACCOMPLISH.
I'VE SPOKEN ABOUT IT IN THE
PAST, BUT ONE OF IT IS TO
ESTABLISH A RESEARCH NETWORK IN
PRIMARY CARE SETTINGS.
WHY THIS IS RELEVANT, THIS IS
INCREDIBLY RELEVANT ALSO AT
NIDA, BUT IT IS ALSO VERY
RELEVANT FOR ANY DISEASE
CONDITION.
IT STEMS FROM ONE OF THE
SENSITIVITIES ABOUT THE WHOLE
ISSUE IS THE RECOGNITION THAT
HEALTHCARE AND THE HEALTH
QUALITY AND THE HEALTH OF
PEOPLE, PARTICULARLY OF
UNDERSERVED AND UNDERREPRESENTED
INDIVIDUALS, IS GOING DOWN.
WE SAW THIS CLEARLY AND
PAINFULLY DURING THE COVID
PANDEMIC.
PART OF IT REFLECTS THE FACT
THAT THERE'S CERTAIN AREAS OF
RESEARCH THAT ARE PRIORITIZED
AND CERTAIN ENVIRONMENTS WHERE
THAT RESEARCH IS DONE THAT DON'T
NECESSARILY INCLUDE UNDERSERVED
AND UNDERREPRESENTED PEOPLE.
PRIMARY CARE IS THE MAIN SOURCE
WE HAVE FOR GETTING CARE, AND
IT'S THE ONE THAT'S MOST
ACCESSIBLE TO ALL AMERICANS.
SO IN A VERY BOLD MOVE THAT
WOULD ACTUALLY TRY TO CHANGE
THAT DISTINCTION BETWEEN THE
SPECIALIZED CARE AND THE
RESEARCH THAT'S DONE IN
SPECIALIZED CENTERS, THIS
NETWORK WILL ESTABLISH A PRIMARY
CARE FOCUS CLINICAL RESEARCH
NETWORK THAT WILL BE DISEASE
AGNOSTIC, FACILITATING CLINICAL
RESEARCH IN MISSION AREAS ACROSS
ALL ICs.
IT WILL INTEGRATE INNOVATIVE
RESEARCH WITH ROUTINE CLINICAL
CARE IN REAL WORLD SETTINGS.
IN OTHER WORDS, IT WILL BRING US
INTO THE FUTURE OF HOW CLINICAL
RESEARCH SHOULD BE AT LEAST
DIRECTLY BEING DONE.
IT WILL CREATE A FOUNDATION FOR
SUSTAINED ENGAGEMENT WITH
COMMUNITIES UNDERREPRESENTED IN
TYPICAL CLINICAL RESEARCH.
WHAT IS THE ANTICIPATED BUDGET?
AS YOU KNOW, THE BUDGET THIS
YEAR HAS ACTUALLY BEEN QUITE
CONSTRAINED.
SO IT WILL BE START WITH FUNDS
FROM THE OFFICE OF THE DIRECTOR
AT $5 MILLION IN 2024, WITH A
PLAN TO ESCALATE THEM TO $25
MILLION IN 2025.
FROM THERE, ANTICIPATE A RAMPING
OF 50 MILLION TO $100 MILLION
PER YEAR AFTER ASSESSING THE
FEASIBILITY AND BUDGET
REQUIREMENTS.
WHAT IS THE TIMELINE?
THE TIMELINE IS MOVING VERY,
VERY FAST.
IT'S TO GATHER FEEDBACK IN THE
SPRING OF 2024, WHICH IS
HAPPENING AS WE ARE DISCUSSING,
INCLUDING THE PRESENTATION TO
COUNCIL.
A QUICK LAUNCH IN 2024 AND
EXPANDING IN 2025 AND BEYOND.
AS I THINK ABOUT IT, IT
ULTIMATELY RESONATES WITH THAT
INTEREST THAT WE HAVE IN THE
CLINICAL RESEARCH IN NIDA BOTH
FOR THE PREVENTION AND THE
TREATMENT OF SUBSTANCE USE
DISORDERS AND THE RECOGNITION
THAT ACTIVE INVOLVEMENT OF
PRIMARY CARE PHYSICIANS IN WAYS
THAT CAN BE EFFECTIVE OR
SIGNIFICANTLY HAVE A LARGE
IMPACT IN CONTROLLING AND
REDUCING THE TOLL OF ADDICTION
IN OUR COUNTRY.
SO I'M A VERY, VERY STRONG
SUPPORTER OF THIS NETWORK, AND I
THINK IT WILL BLEND VERY NICELY
WITH MANY OF THE PROJECTS
CURRENTLY BEING DONE ON THE
CLINICAL TRIAL NETWORK THAT HAS
EXTENSIVELY INCREASED THIS
COLLABORATION WITH PRIMARY
PHYSICIANS.
I ALSO WANT YOU ALL TO BE AWARE
THAT THIS YEAR IS THE TEN-YEAR
CELEBRATION FOR THE BRAIN
INITIATIVE, AND THE BRAIN HAS
JUST BEEN PHENOMENAL IN ITS
ABILITY TO UNCOVER SOME VERY
BASIC PROPERTIES OF THE BRAIN IN
RODENTS, IN THE BRAIN OF HUMAN
PRIMATES, AND MORE RECENTLY ALSO
OF THE BRAIN IN HUMANS.
AS A RESULT OF THAT, WE HAVE
COME TO REALIZE THAT THERE IS AN
ENORMOUS DIVERSITY OF NEURONS,
AND MICROBIAL AND ENDOTHELIAL
CELLS IN THE BRAIN.
THERE'S TREMENDOUS DIVERSITY IN
EACH ONE OF THESE CELLS, AND BY
CHARACTERIZING THESE SPECIFIC
CELLS AND UNDERSTANDING WHAT ARE
THE MOLECULAR SIGNATURES THAT
THEY HAVE, THEN YOU CAN IDENTIFY
THEM IN PSYCHIATRIC OR
NEUROLOGICAL OR INCLUDING
SUBSTANCE USE DISORDER
CONDITIONS IN WAYS THAT CAN
GUIDE US TO RECOGNIZE WHAT MAY
BE MOLECULAR TARGETS THAT ARE
IMPORTANT FOR TREATMENT
DEVELOPMENT, BUT ALSO WHAT IS
THE NEURAL CIRCUITRY IN A MUCH
MORE SORT OF TAILORED AND
SPECIFIC WAY.
AS A RESULT OF THIS, THAT
TEN-YEAR CELEBRATION, THAT WILL
BE THE ANNUAL MEETING WHICH IS
JUNE 16 AND JUNE 17, AND THERE
WILL BE SORT OF A PANEL
DISCUSSION WHERE THEY WILL HAVE,
MY UNDERSTANDING IS DR. FRANCES
COLLINS WILL BE THERE, WHO WAS
ACTUALLY THE ONE THAT LAUNCHED
THE B.R.A.I.N. TEN YEARS AGO.
SO I ENCOURAGE YOU VERY MUCH TO
REGISTER.
IF YOU CAN MAKE IT IN PERSON, OR
IF NOT, VIRTUALLY.
NOW I WANT TO GET INTO THE
ISSUES RELATED TO NIDA.
THE BUDGET FOR 2024 IS THE SAME
AS THE BUDGET FOR 2023.
THIS ACTUALLY IS ZERO INCREASE,
BUT THE REALITY IS BECAUSE OF
INFLATIONARY COSTS, IT IS MORE
COSTLY TO DO RESEARCH OVERALL,
INCLUDING WHAT WE'RE NOW
DISCUSSING, OF COURSE, WHICH IS
VERY, VERY JUSTIFIED, INCREASING
THE SALARIES OF POSTDOCS, THE
COSTS ARE GOING UP.
THAT MEANS WE HAVE LESS MONEY TO
DO THE SAME SERIES OF
PUBLICATION THAT'S WE HAVE, AND
THIS MEANS AN OVERDOSE CRISIS AS
WELL AS SOME VERY CHALLENGING
COMPONENTS OF SUBSTANCE USE.
NONETHELESS, WE RECOGNIZE THAT
THE BUDGETS HAVE BEEN TIGHT
ACROSS ALL OF THE AGENCIES, AND
SOME OF THE AGENCIES THE BUDGETS
HAVE GONE DOWN.
THE NIH, THE BUDGET WAS NOT CUT
DOWN EXCEPT FOR SOME SPECIFIC
PROGRAMS LIKE B.R.A.I.N., BUT
OTHERWISE, IT HAS REMAINED
STABLE.
TYPICALLY I'VE BEEN PRESENTING
OUR BUDGETS OF NIDA IN TWO
BUCKETS, THE BUCKET IS THAT IS
UNDER THE HEADING OF BASE BUCKET
AND THE BUCKET UNDER THE HEADING
HEAL BUCKET.
THE HEAL BUCKET WAS SPECIFICALLY
AUTHORIZED BY CONGRESS IN ORDER
TO ADDRESS THE URGENT NEEDS AND
THE SCIENCE THAT IS REQUIRED TO
ACCELERATE ADDRESSING THE
OVERDOSE CRISIS.
THAT BUDGET ALSO, NEITHER THE
BASE NOR THE HEAL BUDGET
INCREASED FOR 2024, SO IT IS A
FLAT BUDGET, FOR A TOTAL OF $1.6
MILLION.
IN TERMS OF OUR ORGANIZATION,
THERE ARE NEWS, AND I'M
DELIGHTED TO ACTUALLY CONVEY
THEM TO YOU, THAT WE NOW HAVE A
FINAL PERMANENT DIRECTOR OF THE
DIVISION OF THERAPEUTICS AND
MEDICAL CONSEQUENCES.
DR. MONTOYA, WHO I'M LOOKING AT
HERE, WHO I DON'T NEED TO
INTRODUCE AT ALL BECAUSE YOU ALL
KNOW DR. MONTOYA, I KNOW FOR
MANY, MANY YEARS, AND HE HAS
BEEN ACTING DIRECTOR OF DTMC FOR
A LONG TIME, AND BEFORE THAT, HE
WAS A VERY ABLE DEPUTY DIRECTOR.
IT'S A PLEASURE TO HAVE HIM
FINALLY CONFIRMED, SO WELCOME.
THE OTHER THING THAT I WANT TO
GIVE YOU -- AND I'M GOING TO DO
THEM SHORTLY BECAUSE TOMORROW WE
HAVE THE COUNCIL FOCUS, AND
YOU'RE GOING TO BE GETTING
UPDATES ON THESE TWO EXTREMELY
EXCITING PROJECTS, SOME OF THE
MOST TRANSFORMATIVE WE HAVE HAD
AT NIDA.
ONE OF THEM IS THE ADOLESCENT
BRAIN COGNITIVE DEVELOPMENT
STUDY, THE ABCD, WHICH WAS
STARTED IN SPRING.
IT STARTED BY RECRUITING 9 TO
10-YEAR-OLDS.
THOSE 9 TO 10-YEAR-OLDS, THAT'S
8 YEARS AGO, THEY'RE STARTING TO
GROW UP INTO THE AGE OF USE OF
SUBSTANCE.
THAT STUDY WAS DONE WITH A
PARTNERSHIP WITH NCI AND INH AND
OTHER INSTITUTES THAT ARE, OF
COURSE, VERY MUCH INVESTED INTO
UNDERSTANDING HOW THE HUMAN
BRAIN DEVELOPS IN THAT STAGE OF
ADOLESCENCE AND TRANSITIONING
INTO ADULTHOOD.
THE STUDY STARTED AT AGE 9 TO
10, NOT BECAUSE WE IGNORED THE
IMPORTANCE OF INFANCY AND
CHILDHOOD, BUT BECAUSE WE WANTED
TO AT THAT TIME, AND WE STILL
WANT TO, TO ADDRESS AN URGENT
NEED, WHICH IS TO UNDERSTAND
WHETHER EXPOSURE TO CANNABIS
EARLY ON DURING ADOLESCENCE CAN
HAVE NEGATIVE EFFECTS ON THE
HUMAN BRAIN AFFECTING COGNITION
OR INCREASING THE RISK FOR
MENTAL DISORDERS.
THESE TWO TOPICS HAVE BEEN
EXTREMELY CONTROVERSIAL, AND THE
DATA HAS BEEN DISMISSED BECAUSE
OF THE COMPLAINT THAT THE STUDY
THAT SHOWED INCREASED
EDUCATIONAL ACHIEVEMENT IN
INDIVIDUALS THAT SMOKED
MARIJUANA DURING ADOLESCENT
YEARS OR THOSE THAT ACTUALLY
DROP OUT OF SCHOOL OR THOSE THAT
DEVELOP PSYCHOSIS, CHRONIC
PSYCHOSIS, THAT THERE WAS NO
CONTROL FOR WHAT PREEXISTING
CHANGES THEY MAY HAVE HAD THAT
ACTUALLY MAY HAVE LED THEM TO
SMOKE MARIJUANA, CREATING THESE
DYSFUNCTIONS.
SO THE ABCD WAS EMPOWERED IN
ORDER TO BE ABLE TO ANSWER THAT
QUESTION, TO OBTAIN INFORMATION
BEFORE TEENAGERS START TO TAKE
MARIJUANA, HOW THEIR BRAIN
LOOKS, HOW THEIR COGNITIVE
PERFORMANCE WAS, WHAT THEIR
SOCIAL INTERACTIONS, AND TO
FOLLOW THEM LONGITUDINALLY.
THAT WAS SORT OF THE REASON WHY
IT STARTED AT AGE 9 TO 10.
IT ALSO BY CREATING -- BECAUSE
AT THAT TIME WE REALIZED THERE
WAS ALREADY PRECEDENCE OF LARGE
STUDIES THAT WERE ABLE TO GATHER
THE DATA AND MAKING IT OPENLY
ACCESSIBLE TO EVERYONE IN A WAY
THAT PROTECTED THE
CONFIDENTIALITY OF THE
PARTICIPANTS, BUT ALSO
FACILITATED ACCESS TO THIS DATA
TO EVERY RESEARCHER IN THE
WORLD.
IT'S OPEN FOR ANYONE THAT IS
INTERESTED.
AND VERY VISIONARY IN THE WAY
THAT IT WAS NOT JUST FOCUSING ON
HOW THE BRAIN DEVELOPS, HOW IT
CHANGES, WHICH OF COURSE IS
CRUCIAL, BUT IT WAS ALSO TO TRY
TO UNDERSTAND HOW GENES
INFLUENCE THAT DEVELOPMENT, AND
TWO, HOW OUR ENVIRONMENTAL
CONTEXT, AND IN PARTICULAR, THAT
IS DRIVEN BY SOCIAL SITUATIONS,
BY ECONOMIC SITUATIONS, BY
DISCRIMINATION ULTIMATELY AFFECT
THE HUMAN BRAIN.
THIS WAS IN 2016.
WE DID NOT KNOW COVID WAS GOING
TO HIT.
WE DID NOT KNOW THE STRESSES
THAT WERE GOING TO HAPPEN.
THE STUDY HAS BEEN EXTREMELY
SUCCESSFUL IN RETAINING MOST OF
THOSE CHILDREN THAT WERE
RECRUITED, AND THAT'S SORT OF
CLOSE TO 12,000 CHILDREN THAT
WERE RECRUITED.
THE OPEN ACCESS FORMAT WHERE THE
DATA IS DEPOSITED -- IDEALLY, WE
HAD ONE TO TWO DEPOSITED IN DATA
THAT'S ACTUALLY GOOD QUALITY
DATA, ON A YEARLY BASIS.
THIS UNFORTUNATELY HAS HAD SOME
OF CHALLENGES TO MAKE IT
POSSIBLE.
SO THERE HAS BEEN SOME DELAYS,
UNFORTUNATELY, AS OF RECENTLY,
ON THE DEPOSIT OF THE LATEST
DATA, AND IN ORDER TO ADDRESS
THAT, WE'VE MOVED THE REPOSITORY
WHERE IT WAS, WHICH WAS A LESS
FLEXIBLE SORT OF STRUCTURE WHICH
WAS LOCATED AT THE NIMH, AND IT
WAS WONDERFUL TO HAVE ALL OF
THEIR SUPPORT.
BUT HAVING THE FLEXIBILITY
NECESSARY TO DEPOSIT THE DATA IN
A FASTER WAY WAS CRUCIAL AS WELL
AS TO HAVE THE FLEXIBILITY TO
PRESENT THE DATA, TO GET ACCESS
TO THAT DATA IN ITS ENTIRELY WAS
FUNDAMENTAL.
SO THIS FINALLY HAPPENED.
I DO WANT TO ALSO THANK DR. NIJA
DOWLING THAT IS SITTING OUT
THERE BECAUSE IT IS HER
PERSEVERANCE, WHEN THEY STARTED
TO COMMENT ON THESE DIFFICULTIES
AND REALIZED THIS WAS NOT GOING
TO BE AN EASY LIFT.
BUT HER PERSEVERANCE AND THE
SUPPORT OF ALL OF HER TEAM,
INCLUDING DR. SUSAN WEISS, WHO
MADE THIS POSSIBLE.
WHEN SHE TOLD ME, I WAS BEAMING.
SUMMER 2024 IT'S HAPPENING.
AS A RESULT, WE HOPE TO BE ABLE
TO UPDATE AND DEPOSIT THE DATA
IN A MORE TIMELY FASHION.
DR. DOWLING AND HER TEAM ARE
GOING TO BE GIVING US AN UPDATE
OF WHERE WE ARE.
JUST NOTICE HOW THIS OPEN
PLATFORM HAS ENABLED RESEARCHERS
TO JUMP IN RIGHT AWAY, NOT
WAITING TO LOOK AT THE
COMPLEXITY OF IT.
IT'S NOT THAT ONE LOOKS AT THE
BRAIN AND DETERMINES IF IT'S
ASSOCIATED WITH THIS BEHAVIOR,
IT'S THE ABILITY TO ENTER
SCIENTIFIC DISCUSSION THAT'S ARE
INCREDIBLY COMPLEX.
THAT'S THE WAY THAT CERTAINLY
THE BRAIN WORKS.
IT'S NOT AN ISOLATED AREA OF THE
BRAIN.
IT'S NOT THAT ONE MEASURE IS
ACTUALLY THE ULTIMATE REFLECTION
OF WHAT THE BRAIN DOES.
SO THIS IS WHAT IT HAS DONE.
IT HAS ADVANCED ENORMOUSLY TO
START WITH OUR UNDERSTANDING
ABOUT HOW TO ANALYZE BRAIN
IMAGES AND IT HAS LED TO NEW
MODELS OF ANALYSIS THAT HAVE
INSPIRED ARTIFICIAL INTELLIGENCE
AND DEEP LEARNING MODELS.
IT HAS ADVANCED OUR
UNDERSTANDING ABOUT HOW SOCIAL
ADVERSE ENVIRONMENTS INFLUENCES
THE DEVELOPMENT OF THE BRAIN AND
HOW ULTIMATELY TWO INSULTS IN
THE ENVIRONMENT ARE RESPONSIBLE
FOR AFFECTING THE BRAIN, SUCH AS
THINGS THAT WE NORMALLY DO NOT
THINK.
IT HAS GIVEN THE OPPORTUNITY OF
MANY RESEARCHERS COMING FROM
UNDER REPRESENTED INSTITUTIONS
TO BE ABLE TO HAVE ACCESS TO
DATA THAT OTHERWISE WOULD ONLY
BE AVAILABLE TO THE RICHEST
SCHOOLS THAT HAVE ALL OF THE
GRANTS.
SO IT'S BEEN AN EXTRAORDINARY
SUCCESS.
AND BECAUSE OF THAT SUCCESS AND
THE RECOGNITION THAT LIFE
DOESN'T START WHEN YOU ARE 9 TO
10, LAST YEAR WE STARTED THE
HBCD IN AN UNOFFICIAL WAY.
I THINK THE HBCD IS AIMING TO DO
WHAT THE ABCD DID, EXCEPT OF
COURSE LEARNING FROM THE LESSONS
OF HOW TO DO THINGS BETTER.
ONCE YOU'VE GONE THROUGH THAT,
YOU DON'T REPEAT THE SAME
MISTAKES, AND STARTING IN
INFANCY, WITH THE IDEA ALSO OF
FOLLOWING THIS COHORT FOR AT
LEAST TEN YEARS.
THE ISSUE THAT HAS BECOME MORE
CHALLENGING FOR THE HBCD IS THE
FACT THAT WE ARE ACTUALLY ONE TO
RECRUIT AT LEAST 15% OF THE
SAMPLE OF WOMEN THAT, WHEN THEY
ARE PREGNANT, ARE GETTING
EXPOSED TO OPIOIDS.
THIS IS CRUCIAL.
WE ARE ACTUALLY USING FUNDS THAT
ARE ALLOCATED FOR HEAL BECAUSE
WHAT WE ARE OBSERVING IS THAT
ONE OF THE GROUPS THAT IS VERY
NEGATIVELY AFFECTED DURING THE
OVERDOSE CRISIS ARE PREGNANT
WOMEN THAT HAVE AN OPIOID USE
DISORDER.
THEY'RE PROBABLY THE MOST
STIGMATIZED OF THEM ALL.
WE HAVE SEEN AN INCREASE IN THE
MORTALITY OF THREEFOLD NOT JUST
DURING PREGNANCY BUT ALSO
TOWARDS THE END OF THEIR ONE
YEAR FOLLOWING DELIVERY.
AND PART OF IT REFLECTS MULTIPLE
FACTORS THAT INCLUDE SOME OF THE
VERY COMMUNITY PRACTICES THAT
EXIST IN THE STATES FOR WOMEN
THAT ARE PREGNANT AND ARE TAKING
DRUGS.
THAT CAN LAND THEM EITHER IN
JAIL OR CAN LEAD THE CHILD
WELFARE SYSTEM TO TAKE OVER
THEIR CHILDREN.
SO THEY DON'T SEEK TREATMENT.
WHEN THEY SEEK TREATMENT, THE
MAJORITY OF THE STATES IN THE
UNITED STATES, THE DOCTOR HAS TO
REPORT IT.
WE'RE LOOKING AT THIS CONCEPT IN
A VERY DIFFERENT CONTEXT WHERE
WE SAY, IF I WERE A PREGNANT
WOMAN THAT IS ADDICTED, I WOULD
NOT GO TO TREATMENT BECAUSE I'M
GOING TO BE PUT IN JAIL OR
BASICALLY REPORTED.
SO HOW DO WE GENERATE DATA THAT
CAN INFORM OUR PRACTICES AND
POLICIES THAT MAKE SENSE, THAT
DON'T ACTUALLY ULTIMATELY MAKE
THE OVERDOSE CRISIS WORSE?
THE HBCD IS PREDICATED ON
HELPING US UNDERSTAND THAT,
HELPING US UNDERSTAND EXACTLY
THE SAME QUESTIONS THAT WE'RE
DOING, ASKING RIGHT NOW IN
ADOLESCENCE, HOW ADVERSE
CHILDHOOD EXPERIENCES AFFECT THE
HUMAN BRAIN, WHAT ARE PRACTICES
THAT WE KNOW RESULT IN
RESILIENCE AND HOW DO WE LEARN
FROM THEM?
AND ULTIMATELY, HOW DO GENES
INTERACT WITH ALL OF THESE
PHENOMENA?
ACTUALLY, I WANT TO THANK DR.
COLE, WHO HAS BEEN THE ACTING
DIRECTOR FOR THE HBCD ONCE
MICHELLE FREUND LEFT FOR
ACTUALLY TRANSITION INTO ANOTHER
POSITION AT THE CHILD MIND
INSTITUTE IN NEW YORK CITY.
THIS IS THE TIME WHEN I GIVE YOU
THE UPDATE.
THIS IS THE REPORT OF THE
OVERDOSE CRISIS.
THIS IS SOMETHING THAT WE CANNOT
TAKE OUR EYES OFF.
THIS IS THE LATEST DATA.
I GET IT FROM EMILE YA EVERY
MONTH, AND IT REFLECTS THE 12
MONTHS THAT END ON 2023.
IT IS THE FIRST TIME -- YOU HEAR
ME PRESENT THREE TIMES A YEAR
THIS TABLE -- THE FIRST TIME
I'VE PRESENTED WITH GREEN
NUMBERS WITH THOSE MORTALITY
DEATHS COMPARING THESE LAST 12
MONTHS ENDING IN 11/2023,
COMPARED TO THE LAST 12 MONTHS
ENDING IN 11/2022.
IT WENT DOWN.
IT'S THE FIRST TIME IT WENT
DOWN.
IT'S NOT A GREAT DOWN, JUST
0.49%, BUT BETTER THAN HAVING A
RED NUMBER.
IT'S INTERESTING.
LAST NIGHT WHEN I WAS SORT OF
THINKING, HOW CAN I NOT REJOICE?
IT'S A TINY LITTLE NUMBER, BUT
EVERY TIME I SEE A RED, A RED, A
RED, AND WE'RE DOING ALL THESE
ACTIVITIES.
FIRST OF ALL, THERE'S ENORMOUS
VARIATION.
I DON'T WANT TO SAY THIS IS
FACTUAL.
WE'RE GOING TO SEE NEXT MONTH.
WE WANT TO SEE IF THAT
MAINTAINS.
I CAN SAY DRAMATICALLY GOING
DOWN IS OVERDOSE DEATHS FROM
HEROIN.
AND OVERDOSE DEATHS FROM OPIOIDS
AND SYNTHETICS.
THIS DOES REFLECT A CHANGE
TOWARDS POLICIES AND PRACTICES.
I WOULD SAY MORE PRACTICES AND
GUIDELINES TO ACTUALLY BE MORE
CAUTIOUS OF THE WAY THAT
CLINICIANS ARE PRESCRIBING
OPIOIDS FOR THE MACKMENT OF
PAIN.
IT'S NOT THAT THE PROBLEM IS
SOLVED.
THERE'S STILL OVER PRESCRIPTION
OF OPIOID MEDICATIONS WHEN IT'S
NOT NECESSARY, BUT I DO BELIEVE
WE ARE TURNING INTO THE RIGHT
DIRECTION.
THEN YOU SEE A REDUCTION IN
OVERDOSE MORTALITY FOR
METHADONE, WHICH HAS MAINTAINED
ITSELF VERY, VERY LOW, IT HASN'T
CHANGED DESPITE IN THE PAST
METHADONE HAS BEEN EXPANDED,
WHICH LED TO THE FEAR THAT MAYBE
THAT WOULD RESULT IN DIVERSION
AND OVERDOSE, BUT NO, THAT
DIDN'T HAPPEN.
THEN WE HAVE THE RED NUMBERS TO
THE RIGHT, AND THOSE ACTUALLY WE
HAVE TO KEEP OUR EYES VERY
CLOSELY INTO IT.
SYNTHETIC OPIOIDS, PRIMARILY
FENTANYL, IS CONTINUING TO GO
UP.
THE LARGER NUMBERS, IN TERMS OF
OVERDOSE MORTALITY, ARE SEEN
WITH COCAINE AND OTHER
PSYCHO-STIMULANTS, WHICH MEANS
METHAMPHETAMINE.
BUT BY FAR THE DEATHS ARE
FENTANYL.
BUT COCAINE AND METHAMPHETAMINE,
THE MAJORITY ALSO CONTAINS
FENTANYL.
IN REALITY, THOSE TO THE RIGHT
PROJECT DRUG COMBINATIONS OF
FENTANYL WITH STIMULANT DRUGS.
THIS IS SOMETHING WE'VE BEEN
SEEING NOW FOR SEVERAL YEARS, I
WOULD SAY, THAT INCREASING LY
THAT WAS INITIALLY PAIN
MEDICATIONS TO HEROIN OVERDOSES
TO FENTANYL AT THE BEGINNING
INTO THE PERIOD OF
POLYSUBSTANCES.
THAT'S WHAT'S KILLING PEOPLE.
THIS MAKES IT VERY CHALLENGING.
I'M PRESENTING POLY SUBSTANCES
FOR WHICH WE HAVE THE REPORT
HERE, BUT WE KNOW THAT 15% OF
THE OVERDOSES ARE IN FENTANYL,
ARE ASSOCIATED WITH ALCOHOL.
15% MORE OR LESS ALSO ASSOCIATED
WITH BENZODIAZEPINES, AND
OTHERS.
SO IT IS POLY SUBSTANCE THAT NOW
IS THE MAIN PRESENCE OVERALL IN
THE PEOPLE THAT ARE ALSO TAKING
DRUGS.
NOW, IN THESE NUMBERS, AND WE
KNOW THE MAIN FOCUS FOR THIS
ADMINISTRATION WITH REGARD TO
THE OVERDOSE CRISIS REMAINS ON
IMPROVED PRESCRIPTION PRACTICES
FOR PAIN.
THAT'S ONE.
NOW, THE MAIN DRIVER OF OVERDOSE
DEATHS IS NOT PAIN.
THE MAIN DRIVER OF THE OVERDOSES
ARE BASICALLY PEOPLE TAKING
SUBSTANCES, MISUSING SUBSTANCES.
INITIALLY WHERE IT WAS SIMPLER
BECAUSE PEOPLE THAT WERE HEROIN
USERS OR WITH AN OPIOID USE
DISORDER, THEN THERE THE
STRATEGY IS GET THEM INTO
TREATMENT WITH MEDICATIONS FOR
OPIOID USE DISORDER BECAUSE THAT
WILL PROTECT THEM FROM DYING.
IT STILL HAS THE MOST
CONSEQUENTIAL INTERVENTION WE
CAN DO TO EXPAND TREATMENT FOR
MEDICATIONS FOR OPIOID USE
DISORDER.
HOW SUCCESSFUL HAVE WE BEEN IN
THAT?
UNFORTUNATELY, NOT AS SUCCESSFUL
AS WE WOULD WANT.
THIS IS A PAPER THAT WAS PUBD
RECENTLY, EVEN THOUGH THE DATA
IS FROM 2021.
IT IS SURVEYING THE NUMBER OF
PEOPLE THAT HAVE AN OPIOID USE
DISORDER, AND BASED ON THE
ESTIMATED 2.5 MILLION PEOPLE,
WHICH I ACTUALLY DON'T EVEN KNOW
THE LEVEL OF ACCURACY OF THESE
NUMBERS.
ONE OF THE THINGS THAT ALWAYS
HURTS MY BRAIN IN TRYING TO SAY
WHAT REALLY IS THE NUMBER OF
PEOPLE WITH AN OPIOID USE
DISORDER IN OUR COUNTRY?
LET'S BE CONSERVATIVE AND SAY
IT'S 2.5 MILLION PEOPLE, OF
WHICH 36% RECEIVED ANY
TREATMENT.
THAT DOESN'T MEAN QUALITY
TREATMENT, ANY TREATMENT
WHATSOEVER.
AND MEDICINE-BASE D TREATMENT I
ONLY 22%.
I ASKED EMILY, AND I SAID TRY TO
GET ME THE DATA ON PRESCRIPTIONS
TO TRY TO GET A SENSE OF WHERE
WE ARE WITH EXPANDING USE OF
BUPRENORPHINE, AND YOU SEE WE
HAVE IQVIA FROM 2017 TO 2020 WE
HAVE A STIFFER INCREASE, AND
THEN IT'S A LITTLE FLAT.
THIS IS THROUGH RETAIL, SO IT
MAY NOT NECESSARILY REPRESENT
BUPRENORPHINE ALL OVER, BUT I DO
THINK IT'S A GOOD REFLECTION.
AND I DO BELIEVE WE NEED TO KEEP
OUR EYES ON THAT ONE BECAUSE
BUPRENORPHINE IS BY FAR THE
MEDICATION THAT'S MOST WIDELY
UTILIZED.
HERE WE HAVE 800,000 PEOPLE.
THIS IS THE TOTAL PATIENT
TRACKER.
SO 800,000 PEOPLE, CLOSE TO
900,000 THAT ARE RECEIVING
BUPRENORPHINE.
THAT'S WHY I SAY WHAT IS
REALLY -- AGAIN, WHEN I SEE
NUMBERS LIKE THIS ONE, IT HURTS
MY BRAIN BECAUSE I SAY, I JUST
SAY THAT ONLY 22% RECEIVE
MEDICATIONS, AND THEY ARE 2.2.
THIS REPRESENTS THE
UNCERTAINTIES IN TERMS OF THE
NUMBERS OF WHAT WE HAVE.
BE THAT AS IT MAY, I DO BELIEVE
THAT THAT PLATEAUING THAT WE
HAVE SEEN OVER THE PAST THREE
YEARS, TO ME IS CERTAINLY
CONCERNING.
WE NEED TO UNDERSTAND WHY IS IT
THAT WE HAVE NOT BEEN ABLE TO
INCREASE IT FURTHER.
ALSO CONSIDERING THE FACT THAT
BASICALLY THE WAIVER WAS
REMOVED, AND THIS WAS DONE IN AN
ATTEMPT TO ACTUALLY INCREASE THE
NUMBER OF POSITIONS THAT WOULD
BE PRESCRIBING BUPRENORPHINE.
THESE NUMBERS, IF I AM
OBJECTIVE, DO NOT SEEM TO
SUPPORT IN MY BRAIN THESE WILL
BE CHANGED.
I THINK THAT WE NEED TO
UNDERSTAND WHY IT DIDN'T.
THE OTHER IMPORTANT, CRUCIAL
INTERVENTION IS THE ONE OF
EXPANDING INTERVENTION WITH
NALOXONE AND DOING IT TO ENSURE
THAT NALOXONE IS NOT JUST
DISTRIBUTED NO MATTER WHAT, BUT
WE ENSURE PEOPLE AT HIGHER RISK
HAVE ACCESS TO NALOXONE AT THE
CORRECT DOSES.
THESE, THE CURVES LOOK NICER TO
MY BRAIN.
I WAS HAPPIER WITH THESE CURVES.
IT DOES SEEM TO BE INCREASING.
THAT'S THE RED ONE, WHICH IS THE
MONTHLY DATA, AND YOU CAN
AVERAGE IT IN THE ORANGE ROLLING
THREE MONTHS AVERAGE.
YOU CAN SEE THERE IS AN INCREASE
IN THE AVERAGE FOR DISPENSING OF
NALOX
NALOXONE, AND THIS IS
PREDOMINANTLY FROM PHARMACIES.
THE PURPLE ONE, WHICH IS NOT
INCREASING AS MUCH, IS
NON-PHARMACY.
BUT IT IS OVERALL GOING IN THE
RIGHT DIRECTION.
I THINK THAT THE SUCCESS IN THE
DISTRIBUTION OF NALOXONE MAY BE
ACCOUNTING IN PART FOR WHY WE'RE
SEEING, AT LEAST IN CERTAIN
GROUPS, A REDUCTION IN THE
OVERDOSE MORTALITY.
IT'S ALSO AND PERHAPS -- AND
THIS THOUGHT JUST JUMPED INTO MY
BRAIN, AND YOU HEARD ME DISCUSS
IT, ONE OF THE REASONS WHY EVEN
THOUGH WE HAVE SEEN THE
INCREASES IN NALOXONE THAT MAY
BE REDUCING PERHAPS THE
OVERDOSES, BUT WE'RE NOT SEEING
INCREASES IN BUPRENORPHINE
BECAUSE WE'RE SEEING PEOPLE THAT
DON'T HAVE AN OPIOID USE
DISORDER DYING FROM AN OVERDOSE.
WHO ARE THOSE PEOPLE?
PEOPLE THAT ARE COCAINE USERS.
PEOPLE THAT ARE METHAMPHETAMINE
USERS.
OCCASIONAL USERS THAT GET A PILL
ON THE INTERNET AND IT CONTAINS
FENTANYL, AND THEY ARE DYING.
THESE PEOPLE, BUPRENORPHINE WILL
NOT HELP.
ON THE OTHER HAND, NALOXONE WILL
SAVE THEIR LIVES.
THIS IS ACTUALLY AN ASPECT THAT
CAN HELP US UNDERSTAND SOME OF
THESE DYNAMICS.
NOW, WHAT ARE SOME OF THE
INTERVENTION THAT'S HAVE BEEN
DONE FROM RESEARCHERS AT NIDA IN
ORDER TO ENHANCE ACCESS TO
MEDICATIONS FOR THOSE WITH
OPIOID USE DISORDERS AND EXPAND
ACCESS TO THOSE IN OPIOID USE
DISORDER TREATMENT AND EXPAND
USE OF NALOXONE.
WELL, YOU HEARD ME PRESENT.
TAKE ADVANTAGE OF THE HEALTHCARE
SYSTEM.
LET'S PERMEATE IT.
SECOND, LET'S TAKE ADVANTAGE OF
THE JUSTICE SETTINGS.
LET'S PERMEATE IT.
AND LET'S GET INTO THE
COMMUNITIES.
LET'S LEARN FROM WHAT THE
COMMUNITY ARE DOING.
WE HAVE BEEN VERY LUCKY TO HAVE
THE CLINICAL TRIAL NETWORK ABLY
LED BY DR. BETTY TYE, WHO
THROUGH THE CLINICAL TRIAL
NETWORK, THE INVESTIGATORS HAVE
BEEN ABLE TO FORM STRONG
COLLABORATIONS WITH HEALTHCARE
SYSTEMS.
WHETHER IT'S SPECIALIZING IN
TREATMENT LIKE THE EMERGENCY
DEPARTMENT OR PRIMARY CARE
PHYSICIANS TO ENGAGE THEM INTO
MODELS OF CARE THAT SHOW THAT
THE PROPER SCREENING AND
TREATMENT OF INDIVIDUALS WITH
OPIOID USE DISORDER CAN BE DONE
IN THESE SETTINGS.
THIS HAS QUITE DRAMATICALLY
CHANGED THE PRACTICE.
HAS IT CHANGED IT AT THE LEVEL
THAT I WANT?
NO.
BUT IT HAS BEEN VERY, VERY
CONSEQUENTIAL.
FOR EXAMPLE, NOW WE HAVE
MULTIPLE EMERGENCY DEPARTMENTS
ACROSS THE UNITED STATES THAT
ACTUALLY ARE IMPLEMENTED WHILE
DR. GAIL DENOFRE SHOWED THROUGH
THE CLINICAL TRIALS NETWORK THAT
ISSUING BUPRENORPHINE IN THE
EMERGENCY DEPARTMENT
SIGNIFICANTLY IMPROVED THE
LIKELIHOOD THAT PATIENT WILL
STAY IN TREATMENT FOR MEDICATION
FOR OPIOID USE DISORDER.
THIS IN THEORY HAS BEEN
FACILITATED BY DEVELOPMENT
THAT'S HAVE BEEN ACCELERATED
THROUGH THE DIVISION OF
THERAPEUTICS, OF FACILITATING
THE DEVELOPMENT OF EXTENDED
RELEASE FORMULATIONS OF
BUPRENORPHINE.
AGAIN, IT'S ALWAYS THIS FINDING
OF, YES, WE HAVE INNOVATION, BUT
WE FIND OUT IT CANNOT
NECESSARILY BE IMPLEMENTED
BECAUSE THERE'S NOT COVERAGE BY
THE INSURANCE.
OR THE PHARMACY MAY NOT CARRY.
SO AS A RESULT OF THAT, NOW THAT
WE HAVE THE OPPORTUNITY OF
HAVING THESE EXTENDED RELEASE
FORMULATIONS, WE ARE FINDING
OURSELVES SITTING IN
CIRCUMSTANCES THAT THEY CANNOT
BE IMPLEMENTED BECAUSE OF THESE
OBSTACLES.
AGAIN, THIS IS WHERE THE
CLINICAL TRIAL NETWORK COMES
INTO PLAY TO TRY TO UNDERSTAND
WHAT IS THE DATA AND TO WORK
THROUGH WHAT ARE THE POLICIES
THAT NEED TO CHANGE IN ORDER FOR
THIS TO HAPPEN?
ALSO VERY NOVEL APPROACHES LIKE
THE PHARMACY, DELIVERY OF
MEDICATIONS FOR OPIOID USE
DISORDER FOR WHICH RESEARCH HAS
SHOWN, INCLUDING JOHNS HOPKINS,
THAT THE DELIVERY OF PHARMACY,
WHETHER METHADONE OR
BUPRENORPHINE, ACTUALLY BY THE
PHARMACIST IS PROVIDING AS GOOD
OUTCOMES AS THOSE WHEN THEY GO
TO A METHADONE CLINIC.
BUT WE HAVE PRACTICES THAT ARE
VERY INFLEXIBLE.
IT HAS BEEN VERY DIFFICULT TO
CHANGE THAT.
UNFORTUNATELY, THE ONES THAT
HAVE SUFFERED ARE THE PATIENTS
BECAUSE THE PATIENTS ARE THE
ONES THAT CAN ONLY GET THEIR
METHADONE IN A METHADONE CLINIC,
AND THERE MAY NOT BE ANY
METHADONE CLINIC NEARBY.
SO WHAT ARE THEY SUPPOSED TO DO?
WHY IS IT THAT WE CANNOT HAVE
BOTH, METHADONE CLINICS WHERE
FOR PATIENTS THAT ACTUALLY DO
BENEFIT AND WANT TO ATTEND THE
METHADONE CLINIC, BUT ALSO
PHARMACY DELIVERY THAT WILL
ACTUALLY ALLOW FOR PATIENTS THAT
OTHERWISE WOULD NOT BE ABLE TO
GET INTO A METHADONE CLINIC
BECAUSE IT'S NOT THERE OR DON'T
WANT TO GO TO A METHADONE
CLINIC.
SIMILARLY, MOBILE DELIVERY OF
MOUD HAS PROVED TO BE VERY
HELPFUL IN SETTINGS THAT ARE
DIFFICULT TO REACH, WHERE THERE
MAY NOT BE A NEARBY PHARMACY,
LIKE RURAL AREAS.
AND WE HAVE INCREASED OUR
UNDERSTANDING OF HOW TO OPTIMAL
LY USE TELEHEALTH FOR THE MOUD
TREATMENT AND CARE.
IT WAS HELPFUL DURING THE COVID
PANDEMIC.
IT ALLOWED PHYSICIANS TO
ADMINISTER BUPRENORPHINE WITHOUT
THE PATIENT HAVING TO COME IN.
THAT SAVED THE DAY BECAUSE WITH
THE ADDITIONAL CHALLENGES WE
WOULD HAVE SEEN MORE OVERDOSES
THAN WE OBSERVED THE FIRST TWO
YEARS OF THE PANDEMIC.
JUST AS COMMUNITY OPIOID ABUSE
NETWORK, WHICH WAS OUR
PENETRATION INTO THE JUSTICE
SETTING, AND THIS HAS BEEN VERY,
VERY ABLY LED BY DR. WILEY AND
DR. CARLOS BLANCO AND
RECOGNIZING THIS IS A NUMBER
WHERE YOU SAY WHY ARE WE
ALLOWING SYSTEMS LIKE THIS?
25% OF PEOPLE THAT DIE FROM AN
OVERDOSE HAVE PASSED THROUGH A
JUSTICE SETTING IN THE PAST
YEAR, WHICH MEANS THAT, IF WE
HAD INTERVENED IN THE JUSTICE
SETTING TO ENSURE THAT THEY --
THEY ARE A CAPTIVE AUDIENCE.
WHY DON'T WE INITIATE TREATMENT?
WHY DON'T WE ENGAGE THEM INTO
PROGRESS BEFORE THEY ARE
RELEASED.
ALL OF THAT CAN MAKE A LARGE
IMPACT ON DECREASING FATALITY
FROM OVERDOSES, AND DECREASING
RE-INCARCERATION.
BUT IT IS IN MANY INSTANCES, OF
COURSE, YOU CAN SHOW THE DATA.
IT DOESN'T CHANGE A CULTURE.
HOW DO YOU CHANGE PRACTICE?
I THINK THIS IS WHERE JCOIN
COMES INTO PLAY AND HAS BEEN SO
SUCCESSFUL BECAUSE WHAT YOU NEED
TO DO SO BRING TOGETHER TWO
FIELDS THAT NORMALLY DON'T PLAY
WITH ONE ANOTHER.
SO WE ARE AN AGENCY FROM HHS,
HEALTH.
WE DON'T INTERACT WE MUCH WITH
JUSTICE.
AND YET JUSTICE HAS TO DEAL WITH
MANY OF THE PEOPLE SUFFERING
FROM OPIOID USE DISORDER.
THAT'S WHAT JCOIN HAS BEEN ABLE
TO DO, VERY, VERY SUCCESSFUL.
CREATING PARTNERSHIPS WHERE
RESEARCH IS DONE BY PEOPLE FROM
BOTH THE JUSTICE SIDE AND THE
HEALTHCARE SIDE, FROM THE
RESEARCH SIDE, FROM INDIVIDUALS
WITH L.E.A.P. AND LIVING
EXPERIENCES, AND BRINGING THEM
TOGETHER AND SHOWING IT MAKES A
BIG IMPACT IN IMPROVING THE
OUTCOMES, AND ALSO BUILDING
CAPACITY SO THE PEOPLE THERE IN
THE JUSTICE SETTING CAN BE
INVOLVED WITH RESEARCH BECAUSE
THEY ARE THE ONES OUT THERE IN
THE TRENCHES.
AND MAY BE ABLE TO DO THINGS
THAT OTHERWISE WE CANNOT THINK
OF.
HAS BEEN VERY, VERY SUCCESSFUL.
AND IT STARTED, ACTUALLY, JUST
LIKE I WAS SAYING IN TERMS OF
HEALTHCARE, WE'RE NOW STARTING
TO SEE MORE HEALTHCARE SYSTEMS
INVOLVED WITH THE SCREENING AND
TREATMENT OF PEOPLE WITH
SUBSTANCE USE DISORDER.
THAT'S IN BIG MEASURE TO ALL OF
THE WORK WITH CTM, SIMILARLY IN
THE JUSTICE SETTINGS WE'RE
SEEING, STILL SLOWLY, BUT
INCREASES IN THE NUMBER OF JAILS
AND PRISONS THAT ARE NOW
PROVIDING ACCESS TO MEDICATIONS
FOR OPIOID USE DISORDER.
IT HAS ALSO BEEN REINFORCING TO
SEE THE WILLINGNESS TO CHANGE
SOME OF THE POLICIES THAT WILL
ALLOW A PERSON THAT IS
INCARCERATED TO HAVE COVER
INSURANCE ONCE THEY GO INTO THE
COMMUNITY.
THIS HELPS BY BRINGING TOGETHER
PEOPLE AND UNDERSTANDING WHERE
EACH ARE COMING FROM AND SHOWING
THEIR RESULTS.
THIS IS THE SECOND ONE OF OUR
ENDEAVORS.
THE THIRD ENDEAVOR THAT WE'VE
DONE IS THAT ONE OF MAXIMIZING
THE KNOWLEDGE.
HOW DO WE MAXIMIZE THE KNOWLEDGE
THAT'S COMING FROM THE
COMMUNITIES?
PARTICULARLY THOSE THAT HAVE
BEEN MOST AFFECTED BY THE
OVERDOSE CRISIS.
BOTH URBAN AND RURAL.
THAT'S WHY WE LAUNCHED THE
HEALING COMMUNITIES STUDY, WHICH
WAS ACTUALLY LAUNCHED IN 2019,
2018, 2019, AROUND THAT TIME.
SELECTED FOR STATES THAT HAVE
SOME OF THE HIGHEST RATES OF
OVERDOSES, FOR A TOTAL OF 67
COMMUNITIES.
IT WAS A CLOSELY RANDOMIZED
PROJECT, WHERE HALF OF THE
COMMUNITIES WERE RANDOMIZED TO
GET THE INTERVENTION, AND THEY
WERE TREATED.
AND THE OTHER HALF OF THE
COMMUNITIES WERE USED AS
CONTROLS, BASICALLY PRACTICES AS
USUAL, WAVE 2.
THE IMPLEMENTATION IN BASICALLY
FOCUSING ON INCREASING NALOXONE
DISTRIBUTION, INCREASING ACCESS
AND UTILIZATION OF MEDICATIONS
FOR OPIOID USE DISORDER, AND
INCREASED HIGH -- DECREASE HIGH
RISK OPIOID PRESCRIPTIONS.
AND BRINGING TOGETHER
HEALTHCARE, JUSTICE, THE
COMMUNITY AND THE STATE AND
ENABLE THE COLLECTION OF DATA
THAT COULD BE PROVIDED TO THE
COMMUNITIES RAPIDLY IN A WAY
THAT THEY COULD UTILIZE THE DATA
TO TAILOR THEIR INTERVENTIONED
AND UNDERSTAND WHETHER THEY WERE
WORKING OR NOT.
THAT STUDY HAS COME TO
COMPLETION.
DESPITE THE FACT THAT ACTUALLY
COVID HIT IN 2020 WHEN THE STUDY
WAS INITIATING ITS
IMPLEMENTATION.
IN JANUARY 2020 THE HEALING
COMMUNITY STUDY STARTED THE
IMPLEMENTATION, AND IN MARCH
2020, THE COUNTRY CLOSED.
HERE WUF IT.
IT'S ONE OF THE MOST
UNPREDICTABLE EVENTS AND MOST
STRESSFUL THAT WE ALL EVER
EXPERIENCED AMIDST THAT
DEPLOYMENT OF THIS EXTREMELY
AMBITIOUS STUDY.
THE GOAL OF THE STORY WAS BY
DOING THESE INTERVENTIONS, THERE
WOULD BE A SIGNIFICANT REDUCTION
IN OVERDOSE MORTALITY, THAT
THERE WOULD BE A SIGNIFICANT
INCREASE IN NALOXONE
PRESCRIPTIONS, A SIGNIFICANT
INCREASE IN BUPRENORPHINE
INITIATION AND RETENTION, AND
THAT THERE WOULD BE A REDUCTION
IN OVERDOSE MENTALITY.
-- MORTALITY.
THE RESULTS ARE UNDER REVIEW,
AND DR. CHANDLER HAS BEEN THE
PERSON AT NIDA IN THIS PROGRAM
FROM ITS INCEPTION, AND SHE HAS
BEEN MAKING THIS HAPPEN.
THIS IS THE DATA.
IT SHOWS THAT OVERALL THERE WAS
IN WAVE 1 -- AGAIN, THOSE ARE
THE ONES THAT HAD THE
INTERVENTION, AND ON WAVE 2,
THOSE ARE THE ONES THAT WERE
CONTROLS, AND YOU HAVE THE RATE
OF OVERDOSES PER 100,000.
ONE OF THEM WAS 47.2 FOR WAVE 1
AND 51.7 FOR WAVE 2.
THIS IS A 9% REDUCTION, BUT IT'S
NOT SIGNIFICANT.
I THINK THAT, AS I THINK ABOUT
ALL OF THIS AND SAY, WELL,
SIGNIFICANCE IS A SPECIFIC
CONCEPT, AND WE NEED TO
UNDERSTAND WHAT IT'S TELLING US.
WOULD WE HAVE BEEN ELATED TO SEE
A 9% REDUCTION?
CORRECT.
BUT IN MANY INSTANCES WHERE WE
TRY TO AIM AND SAY, WELL, WHAT
IS IT I WOULD LIKE TO ACHIEVE,
WE AIM FOR THE SKY BECAUSE WE
WANT THAT.
BUT ALSO IT RISKS THAT CREATION
OF EXPECTATION THAT'S ARE NOT
NECESSARILY IN THE CONTROL OF
THINGS THAT CAN HAPPEN, LIKE THE
COVID PANDEMICS.
WELL, WHAT CAN WE UNDERSTAND
WITH THE 9% REDUCTION, LOOK AT
THE DIFFERENT FOUR STATES.
WHAT I SEE IS DECREASING IN
OVERDOSES IN MASSACHUSETTS, NEW
YORK, AND OHIO, BUT YOU'RE NOT
SEEING THE DECREASES IN OVERDOSE
INS KENTUCKY, AND THIS SURPRISED
ME ABSOLUTELY, BECAUSE ONE OF
THE THINGS THAT I'VE BEEN TO
KENTUCKY MANY, MANY TIMES, AND
YOU HAVE THE UNIVERSITY OF
KENTU
KENTUCKY, AND THAT'S ACTUALLY
ONE OF THE MOST COMMITTED PLACES
TO ADVANCE THE SCIENCE OF
ADDICTION, AND THE STATE ALSO
HAS BEEN VERY PROACTIVE IN
PROVIDING THE RESOURCES FOR
TREATING PEOPLE WITH OPIOID USE
DISORDER, FOR GIVING SUCCESS TO
MEDICATIONS.
SO I WAS SUSPECTING KENTUCKY
WOULD HAVE THE LARGEST EFFECT.
THEN IT OCCURRED TO ME MAYBE
WHAT HAPPENS IS IN THE WAVE 2,
THEY HAVE ALSO VERY SERIOUS --
AS I SAY, KENTUCKY HAS BEEN
NUMBER ONE, ALONG WITH WEST
VIRGINIA, IN OVERDOSE DECREASE
IN ABSOLUTE TERMS BECAUSE OF THE
SIGNIFICANCE OF THE CRISIS, BUT
THEY ALSO HAVE HAD A VERY, VERY
PROACTIVE TREATMENT OF PEOPLE.
THE QUESTION THAT MAKES ME THINK
IS WERE THE WAVE 2 INDIVIDUALS
GETTING THAT SUPPORT ALREADY SO
THAT THE WAVE 1 DIDN'T REALLY
ADD VERY MUCH MORE THAN WHAT'S
ALREADY THERE IN KENTUCKY?
THIS IS SOMETHING, AS WE GO
ALONG, WE'LL BE ABLE TO
UNDERSTAND IF THAT IS THE CASE.
MEANWHILE, THIS IS NOT THE MAIN
OUTCOME, BUT WHEN THEY LOOK AT
THE OVERDOSE DEATHS ASSOCIATED
WITH OPIOIDS PLUS
PSYCHOSTIMULANTS, AND THAT
PSYCHOSTIMULANT THERE
PREDOMINANTLY REFLECTS
METHAMPHETAMINE, THERE THEY DID
SEE A SIGNIFICANT REDUCTION IN
WAVE 1.
I WAS TRYING TO THINK ABOUT IT,
WHAT DOES THAT MEAN?
WHY ARE WE NOT SEEING IT SO MUCH
IN THE OPIOID OVERDOSE INS
GENERAL BUT IN THE COMBINATION?
IT SORT OF ACTUALLY MAKES ME
WONDER IF THIS SIGNIFICANT
REDUCTION MAY REFLECT, IN FACT,
THAT IN THIS POPULATION WHERE
THEY DO NOT HAVE AN OPIOID USE
DISORDER PERCENT NECESSARILY, I
EXPANDED THE ACCESS OF NALOXONE
HAS A LARGER IMPACT BY ITSELF.
THEY ARE ANALYZING THE DATA.
THIS HAS NOT BEEN REPORTED.
REGARDLESS OF ALL OF THESE, WE
KNOW THAT 525 OVERDOSE DEATHS
WERE AVERTED IN WAVE 1.
WE ALSO NEED TO RECOGNIZE THAT,
WHEN WE WERE INITIATING THE
STUDY, I WAS AFRAID.
I REMEMBER DISCUSSING TO AMIR AL
GARRAR, THE SECRETARY OF HEALTH,
WHERE I SAID I'M HESITANT TO PUT
IN THE REDUCTION OF THE NUMBER
OF OVERDOSES BECAUSE WHAT IF
METHAMPHETAMINE EXPANDS IN THE
RURAL AREAS?
AND METHAMPHETAMINE DID EXPAND,
AND FENTANYL EXPANDED MUCH MORE
THAN WE THOUGHT, BUT I DID NOT
KNOW ABOUT COVID.
COVID, THE MORTALITY OF
OVERDOSES DURING THE COVID
PANDEMIC DURING THE FIRST TWO
YEARS WAS 45% INCREASE.
TODAY I PRESENT A 0.5% DECREASE.
DURING THE COVID PANDEMIC, IT
WAS A 45% INCREASE, AND THAT WAS
DEVASTATING.
I THINK THE LESSONS LEARNED IN
ALL OF THIS IS, OF COURSE, WHEN
YOU HAVE A STRUCTURE, YOU CAN
PLAN ON THAT RESEARCH, IT IS SO
VERY IMPORTANT TO HAVE THE
COMMUNITIES INVOLVED.
IN THIS CASE, DESPITE THE
CHALLENGES, THE STUDY
CONTINUED, AND WE ACHIEVED BASIC
DECREASES.
BUT AS WE LEARN IN GREATER DEPTH
WHAT IS THE DIFFERENCE BETWEEN
THE STATES AND URBAN AND RURAL,
WE MAY HAVE A BETTER
UNDERSTANDING OF -- WE LEARN
FROM THIS ONE THAT WE CAN APPLY
INTO OTHER PROGRAMS SO THAT WE
CAN TRANSLATE THESE FINDINGS.
AMONG THE ISSUES TOO THAT WE
HAVE SORT OF SEEN, I MENTIONED
INITIALLY, WHEN YOU HAVE AN
OVERDOSE WITH MULTIPLE DRUGS ON
BOARD, IT IS MUCH HARDER TO
REVERT THE OVERDOSE.
YOU NEED TO GIVE FENTANYL -- YOU
NEED TO GIVE NALOXONE BECAUSE
THAT WILL REVERSE THE OVERDOSE
FOR FENTANYL.
IF YOU HAVE A METHAMPHETAMINE
AND YOU HAVE AN ARRYTHMIA, THAT
MAY NOT NECESSARILY SAVE THE
PERSON.
MEANWHILE, WE'RE ALSO SEEING
IT'S NOT JUST COCAINE, IT'S NOT
JUST METHAMPHETAMINE.
AS OF RECENTLY, THERE'S BEEN
ACTUALLY A LOT OF CONCERN THAT
XYLAZINE IS CONTAMINATING THE
DRUGS, ILLICIT DRUGS, AND THAT
APPROXIMATELY 12% OF PEOPLE THAT
ARE OVERDOSING WITH FENTANYL
HAVE IN OUR COUNTRY XYLAZINE.
XYLAZINE EXACERBATES THE
HYPERTENSIVE AND HYPOTOXIC
EFFECTS.
SO IT'S MUCH MORE LONG LASTING.
IF YOU GIVE NALOXONE, WHICH YOU
SHOULD GIVE, IT WILL BLUNT THE
PRESENT EFFECT OF THE OPIOID,
BUT IT WILL NOT COUNTERACT THE
DECREASE IN OXYGENATION
ASSOCIATED WITH XYLAZINE AS AN
ALPHA 2 ANERGENIC.
SO THEY NEED TO TRY TO DECIDE
WHAT ARE THE RECOMMENDATIONS TO
TREAT PEOPLE WHO COME WITH
COMBINED OVERDOSES OF THESE TWO
DRUGS.
THEY ALSO IDENTIFY SOME VERY
SIGNIFICANT AREAS OF RESEARCH
THAT I'M THROWING AT YOU, WHICH
IS WE NEED TO UNDERSTAND BETTER
THE FENTANYL-XYLAZINE OVERDOSES.
ARE PEOPLE TAKING LESS FENTANYL
WHEN THEY HAVE XYLAZINE, WHICH
HAS BEEN TAINTED BY SOME
FINDINGS?
AND ARE THERE SOME PEOPLE WHO DO
BETTER OR MUCH WORSE, AND THOSE
THAT SURVIVE, DO THEY HAVE MORE
NARROW TOXICITY?
WE HAVE ABSOLUTELY NO IDEA.
XYLAZINE PRODUCES PROBLEMS THAT,
WHEN YOU'RE GOING THROUGH
WITHDRAWAL, THEY HAVE THE
WITHDRAWAL FROM THE NALOXONE
PRECIPITATING THE OPIOID, BUT
ALSO THE WITHDRAWAL PRECIPITATED
BY HAVING THE LACK OF XYLAZINE.
THE MANIFESTATIONS, WHICH YOU'VE
PROBABLY SEEN IN THE NEWSPAPERS,
ARE NOT YOUR TYPICAL SORT OF
INFECTIOUS ULCER THAT IS BROUGHT
BY INJECTING INFECTED SUBSTANCES
INTO THE SKIN, AND UNDERSTANDING
HOW TO OPTIMALLY TREAT THEM.
IMPORTANTLY, HOW DO WE RAMP OUT
ACCESS TO INFORMATION THAT GIVES
US TIMELY DATA ON EXPOSURE TO
XYLAZINE THAT WE CURRENTLY DO
NOT HAVE, WHICH IS CRUCIAL AND
FUNDAMENTAL.
WE DO REQUIRE, IF WE DO NOT HAVE
ACCESS, TO UNDERSTANDING WHAT IS
IT THAT PEOPLE WHO END UP IN AN
EMERGENCY DEPARTMENT OR A
TREATMENT PROGRAM, WHAT ARE THEY
TAKING?
WE BASICALLY ARE OPERATING IN
THE DARK.
SO ONE OF THE PRIORITIES OF NIDA
THROUGH THE PROGRAM WAS TO
FACILITATE THE APPROVAL AND
DEVELOPMENT OF FENTANYL TEST
STRIP THAT WOULD BE APPROVED BY
THE FDA.
FENTANYL TEST STRIPS ARE OUT
THERE.
THEY COST BETWEEN $1 AND $2, YOU
CAN BUY THEM.
BECAUSE THEY ARE NOT FDA
APPROVED, THEY CANNOT BE USED IN
THE TREATMENT.
ONE OF THE THINGS THAT NATIONAL
INSTITUTE ON DRUG ABUSE
ADDRESSED HERE AT COUNCIL FOR
MANY OF YOU, THE DESPERATION
THAT YOU DON'T HAVE ACCESS.
YOU DON'T KNOW IF THE PATIENTS
IN THE EMERGENCY DEPARTMENT
COMING THERE HAVE FENTANYL OR
NOT BECAUSE YOU CANNOT MEASURE T
IT'S NOT THAT YOU DON'T HAVE
MASS SPECTOMETRY.
THAT MAY TAKE SEVERAL DAYS.
YOU NEED THE INFORMATION RIGHT
THERE.
THROUGH A GRANT FUNDED THROUGH
OTP, I AM VERY DELIGHTED TO
BASICALLY REPORT THAT THE
STENOSIS, A COMPANY THAT FUNDED
THROUGH THE OPTIQ PROGRAM FROM
NIDA GOT A BREAKTHROUGH ON
OCTOBER 5, 2023.
AND LESS THAN ONE YEAR LATER,
ACTUALLY GOT FDA 510 (K)
APPROVAL, MARCH 28, 2024.
THESE PRODUCTS ARE GOING TO BE
SOON AVAILABLE SO THAT
CLINICIANS CAN UTILIZE THEM, AND
THEY CAN BE USED TO MONITOR
ACTUALLY HOW THE PHYSICIANS KNOW
WHAT THEY ARE TAKING.
THE LAST PART, COMMENTS THAT I
WANTED TO SAY ARE JUST GIVE YOU
AN UPDATE ON SOMETHING THAT HAS
BEEN CONCERNING, AND I'VE BEEN
PRESENTING, WHICH IS THE NOTION
THAT, YES, WE'RE SEEING SOME
REDUCTION IN OVERDOSES, AND YOU
CAN SEE THE WHITE GROUP IN THE
UNITED STATES, WHICH IS THE
MINORITY, IS SHOWING A
REDUCTION, 35.4 DEATHS PER
100,000.
THAT GOES IN THE RIGHT
DIRECTION, IS GOING DOWN.
BUT LOOK AT THE AMERICAN
INDIAN/ALASKA NATIVE, LOOK AT
THE BLACK PEOPLE.
THERE THE NUMBERS ARE STEEPLY
GOING UP.
THAT'S 0.5% IS NOT TOUCHING
THEM.
IT'S ACTUALLY POINTING THE
FINGER IN TERMS OF WHAT ARE THE
RESEARCH PROJECTS?
WHAT ARE THE NEEDS?
HOW CAN WE USE SCIENCE TO
ADVANCE HOW WE CAN IMPROVE THE
OUTCOMES IN THESE POPULATIONS?
YOU HAVE HEARD ME PRESENT ON THE
PROGRAM, WHICH IS BASICALLY
INTENDED TO DRIVE
INFRASTRUCTURE, TO DRIVE SOME
NATIVE AMERICAN SERVING
ORGANIZATIONS SO THEY CAN DO
RESEARCH THAT THEY PRIORITIZE IN
ORDER TO ADDRESS THE HORRIFIC
OVERDOSE MORTALITY THAT THEY ARE
ACTUALLY EXPERIENCING.
THE PROJECT ARE ORGANIZED IN TWO
PHASES.
PHASE 1, WHICH IS THE FIRST TWO
YEARS, WHICH ACTUALLY THE GRANTS
ARE GOING TO BE RELEASED SOON.
THEN IN ORDER TO GIVE THEM THE
TIME TO CREATE NETWORKS TO SHOW
VISIBILITY, THEY'RE GOING TO THE
NEXT STEP.
WHERE ARE WE WITH THIS PROJECT?
AS I SAY, IT WAS THE OPPORTUNITY
ANNOUNCEMENT WAS RELEASED IN
JUNE OF 2023.
THE APPLICATIONS WERE DUE ON
NOVEMBER OF 2024.
THEY WERE REVIEWED THIS
FEBRUARY, AND WE ARE EXPECTING
TO GIVE THE AWARD ON JUNE 24.
DR. KATHY ETTES, WHO HAS BEEN
BASICALLY SPEAR HEADING THIS
PROJECT AND HAS BEEN RELENTLESS
WILL BE GIVING YOU AN UPDATE
ONCE WE HAVE SPECIFIC
INFORMATION IN TERMS OF WHAT ARE
GOING TO BE THE SITES THAT HAVE
BEEN SELECTED AND WHAT ARE THE
PROJECTS GOING TO COVER?
IT IS VERY EXCITING, VERY, VERY
AMBITIOUS.
IT'S ONE OF THOSE INSTANCES
WHERE WE HAVE FAILED AT THE NIH
TO REALLY EXPAND ON THE NUMBER
OF OVERDOSE THAT'S ARE NATIVE
AMERICAN.
WE HAVE A DEVASTATING CRISIS.
AS I HAVE BEEN THINKING HOW TO
MOVE IT FORWARD, I WAS THINKING
THIS, IF WE CAN SEE GROUPS THAT
ACTUALLY UNDERSTAND THIS CULTURE
SO THAT THEY CAN TAKE ADVANTAGE
OF THE TREMENDOUS NUMBER OF
RESILIENCE THAT EXISTS IN THESE
COMMUNITIES, AND DESPITE THAT
RESILIENCE, THEY ARE SUFFERING
SO MUCH, WE CAN LEARN TO
UNDERSTAND THAT.
BASICALLY, WE CAN FACILITATE
COMING UP WITH SOLUTIONS THAT
SPEAK TO THEM AND NOT JUST
IMPOSING WESTERN CULTURE.
THEN IN THE FIELD OF
INTERVENTIONS, I BASICALLY SAID
WE'RE VERY AWARE THAT PEOPLE ARE
DYING FROM POLY SUBSTANCES.
SO WE'RE LOOKING AT INTRODUCING
THERAPEUTICS THAT ADDRESS NOT
JUST ONE, ALCOHOL, NICOTINE, BUT
TO ACTUALLY TARGET THE COMMON
ADDICTION SUBSTANCES IN GENERAL.
THE GENES THAT MAKE YOU
VULNERABLE, MOST OF THEM MAKE
YOU VULNERABLE IN GENERAL, NOT
JUST ONE OR THE OTHER.
SIMILARLY, THE NEUROCIRCUITRY
THAT IS IMPLICATE NORTHBOUND
ADDICT
ADDICTION THAT IS NOT JUST FOR
CANNABIS OR ALCOHOL, ET CETERA.
LOOKING AT THE KNOWLEDGE AND
EXPANDING INTO TREATMENT THAT'S
GO AFTER THAT.
SIMILARLY, WE NEED TO DEVELOP
AND EXPAND RESEARCH ON OVERDOSE
REVERSAL AGENTS THAT ARE NOT
JUST LIMITED TO ACTUALLY OPIOID
RECEPTOR AND ANTAGONISTS, BUT
ALSO LOOKING AT MONOCLONAL
ANTIBODIES THAT MAY BE ABLE TO
HELP IN WHAT WE CURRENTLY HAVE,
NOT JUST LIMITED TO THE OPIOID
ANTAGONIST OR RESPIRATORY
STIMULATION.
THIS IS MY FINAL SLIDE IN TERMS
OF SCIENCE.
THIS JUST GETS YOU AN IDEA OF
SOME OF THE ISSUES THAT WE
FACED.
I THINK, BECAUSE THIS IS AN OPEN
SESSION, I WANT TO HIGHLIGHT
WHERE THE ISSUES THAT ARE
ACTUALLY IN MY BRAIN SEEM TO
KEEP AND ARE ACTUALLY NECESSARY.
I'VE HEARD FROM ALL OF YOU, AND
AT THE APA, THIS WAS SOMETHING
THAT WAS ALSO DISCUSSED.
TREATMENT IS MUCH HARDER WITH
PEOPLE WITH POLY SUBSTANCES.
IT'S MUCH HARDER TO INITIATE ON
MEDICATIONS FOR OPIOID USE
DISORDER.
MUCH HARDER FOR BUPRENORPHINE
AND METHADONE ALSO.
WE ACTUALLY DON'T KNOW WHAT ARE
THE CORRECT DOSES AND WE DON'T
KNOW THE LONG TERM OUTCOMES.
THIS, I THINK, IS A HUGE GAP IN
THE FIELD.
WE NEED TO START TO FOLLOW OUR
PATIENTS FOR A LONGER PERIOD OF
TIME BECAUSE WITHOUT THAT
INFORMATION WE'RE MISSING THE
LINK OF WHAT IS IT, WHAT ARE
FACTORS THAT MAY BE DETERMINING
RECOVERY.
AGAIN, WE NEED TO PROGRESS THE
HARD TO REACH POPULATIONS.
AMERICAN INDIANS/ALASKAN
NATIVES, BLACK AMERICANS, RURAL,
HOMELESS, PREGNANT WOMEN.
THESE ARE NEGLECTED GROUPS.
WE NEED TO ADDRESS THE OTHER
REALITY THAT MOST INDIVIDUALS
WITH SUBSTANCE USE DISORDER HAVE
COMORBID MEDICAL CONDITIONS, AND
PARTICULARLY COMORBID
PSYCHIATRIC CONDITIONS THAT, IF
THEY ARE NOT DEALT WITH THEY ARE
VERY UNLIKELY TO ACHIEVE
RECOVERY.
WE NEED TO UNDERSTAND THAT NOT
EVERYBODY IS READY TO GO INTO
TREATM
TREATMENT, AND THAT RIGHT NOW
LEAVING THEM UNPROTECTED IS VERY
DANGEROUS BECAUSE OF THE HIGH
RISK OF OVERDOSES.
THIS IS AGAIN WHERE WE NEED TO
UNDERSTAND WHAT AREAS OF
RESEARCH IN NOVEL HARM REDUCTION
PRACTICES CAN IMPROVE THE
SURVIVAL OF THESE PEOPLE.
SIMILARLY, WE NEED TO HAVE A
MUCH BETTER ACCESS TO DATA,
TIMELY DATA OF THE DRUGS THAT
ARE HITTING IN THE COMMUNITIES,
AND THIS IS ACTUALLY I'M
PRESENTING XYLAZINE, BUT IT'S
NOT GOING TO END IN XYLAZINE.
SOME PLACES ARE SEEING AN
INCREASE IN THE EXPOSURE WITH
TYLENOL.
THERE ARE COMBINATIONS THAT ARE
NOT NECESSARILY EVEN OF DRUGS
BUT CAN HAVE CONSEQUENCES.
IT'S ALSO, I THINK, HIGHLIGHTS
HOW CRUCIAL, EVEN THOUGH IT'S
NOT -- IT DOESN'T ATTRACT OR
MESMERIZE THE SAME WAY THAT
TREATMENTS, PREVENTION IS
NONETHELESS.
WE NEED TO MODIFY AND REALLY PUT
NOT JUST THE SCIENCE, THE
SCIENCE, BUT ALSO A MODEL THAT
COULD MAKE THE PREVENTION AND
INTERVENTIONS WORK AND SUSTAIN.
I WANT TO BE VERY GRATEFUL TO
DR. AMY GOLSTON, WHO HAS BEEN A
LEADER AT PREVENTION OF OVERDOSE
AT NIDA.
AND ALSO JUST LOOKING AT GENETIC
AND BIOLOGICAL COMPONENTS, BUT
IF IT'S FED BY INEQUALITIES AND
ECONOMIC DEPRIVATION THAT WE SEE
ACROSS THE COUNTRY.
IF WE WANT TO PREVENT AND
PROTECT PEOPLE, WE WANT TO
PROVIDE RESILIENCE, WE NEED TO
ADDRESS IN A WAY THAT IS
SUSTAINABLE, THOSE SOCIAL
DETERMINANTS OF HEALTH THAT ARE
MAKING SO MANY PEOPLE
VULNERABLE.
I ALSO WANT TO BRAG, WE ARE
GOING TO BE 50 YEARS OLD.
WE HAVE OUR ANNIVERSARY ON MAY
14th.
EVERYONE IS INVITED.
THERE WILL BE A PANEL A SET OF
PANELISTS TO AGAIN TRY TO PUSH
THE ENVELOPE.
WE'VE DONE ALL OF THESE OVER 50
YEARS.
WE HAVE A LOT OF CHALLENGES.
WHAT DO WE WANT?
WE HAVE GREAT OPPORTUNITIES.
WHAT ARE THE THINGS, WE NEED TO
KEEP CLOSE, CLOSE EYES BECAUSE
THEY ARE THE HARDEST ONES TO
ADDRESS.
THAT MEANS WE JUST NEED TO PUT
MORE ENERGY.
AND JUST ALSO I WANT TO SAY
GOOD-BYE TO ALL OF THE MEMBERS,
AT LEAST FOR THE COUNCIL ITSELF,
AND THANK YOU FOR ALL OF YOUR
CONTRIBUTIONS.
AND I WANT TO WELCOME THE NEW
MEMBERS.
WITH THAT, I WANT TO THANK YOU
FOR YOUR ATTENTION.
THIS IS THE POINT WHERE WE HAVE
TIME FOR QUESTIONS.
>> THANK YOU FOR THAT LOVELY
TALK.
I WANT TO ECHO THE IMPORTANCE OF
INCREASING -- THAT'S BEEN VERY
ENCOURAGING TO OUR TRAINEES.
NIDA HAS BEEN ORGANIZING THESE
MEETINGS OF DIRECTORS WHERE WE
KIND OF CO-MENTOR EACH OTHER.
I'LL SPEAK FOR OUR TEAM, WE
LEARN A LOT FROM EACH OTHER.
YOU CAN DO THAT SOMETIMES AT
CONFERENCES, BUT TO HAVE A
DEDICATED TIME TO BE ABLE TO DO
THAT, THAT'S EXTREMELY HELPFUL.
THANK YOU SO MUCH FOR BEING
THERE FOR US.
THE OTHER COMMENT I HAD, AND
MAYBE IT'S A QUESTION, IS WHAT
NIDA MIGHT BE ABLE TO DO TO
ENCOURAGE AND PROMOTE
RESPONSIBLE USE OF AI AND
MACHINE LEARNING.
I THINK, WITH ALL THE DATA WE'RE
ABLE TO GET OUT THERE, ONE OF
THE CHALLENGES WE'RE INCURRING
IS HOW MACHINE LEARNING
ALGORITHMS, DEEP LEARNING, CAN
ACTUALLY BE IMPLEMENTED IN A WAY
THAT'S NOT GIVING US THE BEST
USE OF DATA.
I WONDER IF THERE ARE CHECKS AND
BALANCES OR TRAINING
OPPORTUNITIES, SOMETHING THAT
THE AGENCY COULD SUPPORT TO
ENSURE THAT AI IS USED IN
ADDICTION RESEARCH.
>> AND THE ANSWER IS YES, OF
COURSE.
THIS IS ONE OF THE ISSUES THAT
WE'VE DISCUSSED AT LENGTH.
IT PERTAINS NOT JUST TO NIDA.
IT PERTAINS TO THE WHOLE OF NIH.
HOW DO WE ENSURE THE DATA IS
PROPERLY UTILIZED?
BECAUSE OTHERWISE YOU END UP
WHERE IT CONTRIBUTES.
PEOPLE HAVE WRITTEN ABOUT IN OUR
CASE IT'S ALSO VERY CHALLENGING
BECAUSE WE'RE DEALING WITH A
DISEASE THAT IS HIGHLY
STIGMATIZED.
IT'S AN ILLEGAL ACTIVITY IN SOME
PLACES.
RIGHT NOW WITH AI, I SUSPECT
SOME OF THESE LEARNING MODELS
AND GENERATIVE MODELS YOU CAN
PROBABLY OBTAIN INFORMATION OF
OUR PARTICIPANTS.
THE ASPECT OF CONFIDENTIALITY,
THE ASPECT OF DATA EQUALITY, THE
ASPECT OF DATA EQUITY IS
CRUCIAL.
IT'S NOT LIKE WE HAVE A SIMPLE
SOLUTION.
THE NIH HAS A GROUP.
TO TRY TO ALSO LEARN WHAT
PRACTICES MAY BE UTILIZED IN
OTHER PLACES.
IF WE DON'T SOLVE IT, THEN WE
COULD DO A LOT OF HARM.
I'M VERY AWARE.
I THINK IT'S AN EXTRAORDINARY
OPPORTUNITY WHAT THESE LARGE
DATABASES ARE GIVING US.
BUT SPEAKING OF THE ABCD AND
HBCD, IT COMES WITH
RESPONSIBILITY.
IT HAS MANY NUANCES.
JUST SORT OF SPEAKING IN GENERAL
TERMS.
YES, ABSOLUTELY.
IT IS ONE OF THE THINGS THAT I
ALSO BUG WILSON, I SAY, WILSON,
WE NEED TO ENSURE WE ARE
TRAINING THE SCIENTISTS ON DATA.
WE BASICALLY CANNOT AFFORD NOT
TO.
HE ALWAYS SAYS, YES, NORA, WE
ARE.
WE ARE OF COURSE TAKING
ADVANTAGE OF CORPORATE PROGRAMS
FOR LEARNING AND TRAINING THAT
ARE GIVEN ACROSS THE WHOLE NIH,
BUT IF YOU HAVE SUGGESTIONS,
PLEASE COME TO US.
THIS DATA WORLD IS NEW TO ALL OF
US.
WE'RE ALL LEARNING IN THE
PROCESS.
>> THANKS FOR AN INCREDIBLE
PRESENTATION AS ALWAYS.
THERE'S ONE COMMENT I WANT TO
MAKE ABOUT THE EFFORTS TO EXPAND
ACCESS TO NALOXONE.
WHEN I WAS CHECKING INTO MY
MARRIOTT HOTEL FOR THIS TRIP, I
WAS LOOKING FOR A PLACE TO BUY
TOOTHPASTE, AND I COULDN'T
BECAUSE I FORGOT TO BUY
TOOTHPASTE.
I WENT TO THE VENDING MACHINE IN
THE LOBBY, AND YOU CAN BUY
NALOXONE IN THE VENDING MACHINE.
SO YOUR EFFORTS ARE WORKING.
I APPLAUD YOU.
I DON'T KNOW HOW MUCH IT COSTS,
BUT IT'S THERE.
>> NO, THAT'S WONDERFUL.
I DIDN'T KNOW.
I'LL GO AND TAKE A PICTURE.
>> I'LL TAKE A PICTURE FOR YOU
AND SEND IT.
>> THIS IS ALWAYS MY FAVORITE
PART.
I FEEL I HAVE TO TRIAGE WHAT
QUESTIONS I WANT TO ASK YOU.
I WAS REALLY INTERESTED TO SEE
THAT THERE IS THE EARLY DATA
COMING IN FROM THE HBCD.
I WAS ON THE EARLY PLANNING
GRANTS, THINKING ABOUT THE
ISSUES WITH THIS.
ONE OF THE THINGS I CONTINUED TO
THINK ABOUT IS, AS THE STATE
LAWS GOVERNING WE PRODUCTION OR
COSTS TO ALLAY THE RISKS OF
THESE WOMEN WHO ARE PREGNANT AND
USING DRUGS.
THE THING I WAS WONDERING IS
HAVE THERE BEEN ANY CONCERNS SO
FAR, CLOSE CALLS, REPORTS, LAW
ENFORCEMENT INVOLVEMENT, SOCIAL
SERVICES INVOLVEMENT FOR ANY OF
THESE WOMEN WHO ARE BEING
ENROLLED IN THIS STUDY AND USING
DRUGS WHILE THEY ARE PREGNANT?
>> I WILL ALLOW ED TO RESPOND TO
IT.
THIS WAS ONE OF OUR BIG, BIG
CONCERNS, AND THEY ADDRESSED IT,
I THINK, IN A PRETTY IMPRESSIVE
WAY.
>> I'M NOT AWARE OF ANYTHING
DIRECTLY, BUT WE'VE SPENT MANY,
MANY MONTHS AND A LOT OF
DISCUSSIONS ABOUT HOW TO AVOID
THIS PROBLEM.
WE DON'T WANT ANYBODY THAT'S
RECRUITED INTO THE STUDY TO BE
PUT IN JEOPARDY BECAUSE OF THEIR
PARTICIPATION.
THE PROCESSES THAT WE USE ARE
SUCH THAT PEOPLE WHO ARE AT THE
SITE ARE NOT GIVEN THE DATA FROM
THE PARTICIPANTS ABOUT WHAT
THEIR DRUG USE IS.
IT GOES THROUGH THE REPOSITORY,
AND THEY'RE GIVEN FEEDBACK IN
GENERAL ABOUT WHAT PARTICIPANTS
THEY NEED TO BE RECRUITING.
THE WHOLE POINT IS TO NOT PUT
THEM IN A SITUATION WHERE THEY
HAVE TO REPORT SOMETHING WHERE
THEY'RE GOING TO PUT SOMEONE IN
JEOPARDY.
RATHER EVERYBODY IS GIVEN
INFORMATION ABOUT A HEALTHY
PREGNANCY AND RESOURCE THAT'S
THEY CAN USE TO TRY TO GET HELP
IF THEY WANT TO.
WE HAVE PEER NAVIGATORS ALSO AT
EVERY SINGLE SITE.
THERE ARE PEOPLE THERE THAT CAN
HELP THEM COME UP WITH RESOURCES
IF THEY'RE INTERESTED.
WE REALLY WENT TO GREAT LENGTHS
NOT TO HAVE THE INDIVIDUAL DATA
AVAILABLE TO PEOPLE AT THE
SITES.
>> IS THERE LIKE A PLAN FOR
REPORTING SHOULD SOMETHING
HAPPEN?
IS THIS ONE OF THE STOPPAGE
CRITERIA?
I CAN JUST IMAGINE THIS BEING
LIKE A REALLY BIG DEAL IF
SOMETHING LIKE THIS WERE TO
HAPPEN?
>> I THINK WE'RE TRYING TO THINK
ABOUT WE HAVE AN OBSERVATIONAL
STUDY MONITORING BOARD, AND WE
HAVE A BIOMEDICAL UNIT AND A LOT
OF DIFFERENT GROUPS WE CONSULT
WITH.
I THINK RIGHT NOW WHAT WE'RE
TRYING TO DEAL WITH IS THAT
WE'VE HAD SOME POSITIVE FENTANYL
REPORTS.
NOT WHAT WE'VE GOTTEN IN TERMS
OF WHAT PEOPLE ARE REPORTING,
AND WE'VE BEEN STRUGGLING WITH
THAT PEOPLE BECAUSE WE DON'T GET
THE BIOSPECIMENS IMMEDIATELY.
THOSE ANALYSES DON'T COME IN
IMMEDIATELY WHEN SOMEBODY IS
THERE.
WE DON'T KNOW THE PERSON KNEW
THEY WERE BEING EXPOSED.
IF WE START GETTING INTO THIS
INDIVIDUAL LEVEL DATA, THEN
WE'RE GOING TO RUN INTO THOSE
PROBLEMS.
ALL OF THESE ISSUES, I THINK,
ARE GOING TO KEEP -- THEY'RE ON
EVERYBODY'S RADAR, AND WE'RE
TRYING TO HAVE THE ACTIVE
DISCUSSIONS TO FIGURE WHAT THE
MOST EFFECTIVE SOLUTIONS ARE.
AT THIS POINT AT THE VERY LEAST,
IT'S MAKING SURE PEOPLE ARE
AWARE THAT FENTANYL IS IN THE
DRUG SUPPLY AND ADDING THAT TO
THE HEALTHY PREGNANCY
INFORMATION WE GIVE, AND WE'RE
DEVELOPING A SPECIFIC FLIER
ABOUT FENTANYL.
IT'S VERY CHALLENGING FOR THAT
REASON BECAUSE YOU'RE REALLY
BALANCING TWO DIFFERENT SETS OF
FORMS, WHICH CAN BE EQUALLY --
AND WE HAVE A CRISIS
COMMUNICATIONS TEAM TO DEAL WITH
IT BECAUSE WE RECOGNIZE THAT
THINGS ARE GOING TO HAPPEN AND
THAT WE'RE GOING TO NEED TO BE
ABLE TO ADDRESS THEM AS BEST WE
CAN.
>> IS THE ETHICS TEAM INVOLVED?
>> YES, SHE'S IN THE WORK GROUP
THAT'S SORT OF LEADING THE LEGAL
AND ETHICAL CONSIDERATIONS.
BUT THEN THE OSMB, THEY WORK
SEPARATE.
THEY ARE A VERY ACTIVE GROUP.
THEY WERE NOT HAPPY WITH JUST
TWO MEETINGS A YEAR.
THEY WANT FOUR MEETINGS A YEAR.
WE'RE VERY INTERESTED IN REALLY
BEING INVOLVED IN HELPING US
WORK THROUGH SOME OF THESE
TRICKY THINGS.
>> THANK YOU, NORA, FOR THAT
REALLY WONDERFUL PRESENTATION.
SO MANY IMPORTANT NUGGETS YOU
TOUCHED ON.
I WANT TO SECOND THE POINT ABOUT
THE TRAINING AND THE T-32s.
THAT'S VERY, VERY HELPFUL.
I HOPE THAT WILL IMPACT THE
CURRENT CURRENT RENEWALS AND
GRANTS AS WELL.
THE TWO THINGS I WANTED TO POINT
OUT AND MAKE THE COMMENT AND ASK
A QUESTION ABOUT WAS FIRST ON
THE THERAPEUTICS FOR POLY
SUBSTANCES, AND WE'VE KNOWN FOR
SO LONG THERE ARE GATEWAY DRUGS
THAT ARE COMMONLY USED.
I WANT TO COMMEND YOU ON REALLY
MOVING IN THAT DIRECTION.
IT'S REALLY NEEDED, THE OVERDOSE
PREVENTION, BUT REALLY
PREVENTION OF DEVELOPING EVEN
SEVERE SUBSTANCE USE DISORDER,
POLY SUBSTANCE USE DISORDER.
BUT THE QUESTION ABOUT
PREVENTION, AND I WONDER IF
THERE WAS ANY EFFORTS ON THE
PREVENTATIVE SIDE OF POLY
SUBSTANCE USE.
OF COURSE PSYCHOSOCIAL
INTERVENTION BUT EVEN
THERAPEUTICS BECAUSE THEY'RE
ALREADY EXPOSED TO ALCOHOL AND
NICOTINE AND MARIJUANA, AND IN
OUR HANDS, WE'RE LOOKING AT VERY
HIGH LEVELS OF SOCIAL
DETERMINANTS OF HEALTH AND
TRAUMA LEVELS IN THAT EARLY
CONTEXT.
JUST WANTED TO ASK ABOUT
THERAPEUTICS AND SORT OF
PREVENTING MORE SEVERE SUBSTANCE
USE.
THAT'S ONE.
IT TIES TO THE OTHER THING THAT
SEEMED REALLY EXCITING COMING
FROM THE NIH DIRECTOR'S OFFICE,
THIS PRIMARY CARE CLINICAL
SERVICE INITIATIVE.
I WONDER IF YOU COULD EXPAND ON
HOW NIDA WOULD INTERFACE WITH
THAT.
I KNOW IT'S EARLY DAYS AND NOT
MUCH FROM THE COMMON FUND, BUT
NEXT YEAR THERE WILL BE MORE.
IT SEEMS LIKE IT'S SUCH AN
OPPORTUNITY FOR OUR AFFECTED
GROUPS AND FAMILIES WHO ARE NOT
GOING INTO INITIAL TREATMENT BUT
THEY ARE SHOWING UP IN PRIMARY
CARE.
YOU ALSO ALLUDED TO THAT.
IF THERE'S A PLACE FOR US TO
REALLY GET IN ON THE PREVENTION
SIDE THERE TOO.
JUST YOUR THOUGHTS ON THAT.
>> IN FACT, ONE OF THE THINGS I
LOVED ABOUT THE PRIMARY CARE
RESEARCH NETWORK, MANY THINGS,
BUT ONE OF THE THEM IS THE
OPPORTUNITY TO DO RESEARCH ON
PREVENTION.
THAT IS WHERE YOU'LL BE ABLE TO
FIND PEOPLE IN THE EARLY STAGES
AND ACTUALLY DO NOT
AINTERVENTION THAT WILL PREVENT
THE ESCALATION INTO GREATER
SEVERITY.
THAT IS THE SPACE THAT WE WE'VE
ACTUALLY NOT PROPERLY TACKLES,
AND I THINK IT GIVES US -- IF
WE'RE GOING TO MAKE AN IMPACT,
IT HAS TO BE IN THE PRIMARY CARE
SETTINGS BECAUSE, IF WE GO TO
SPECIALIZED, IT'S ALREADY TOO
LATE.
THAT WOULD BE ONE OF THE
PROJECTS I WOULD LOVE TO DO.
IT'S AN AREA WE NEED TO ADVANCE
AS THERE'S A TREMENDOUS GAP.
THE PRIMARY CARE NETWORK WOULD
BE PERFECT IS FOR DEVELOPMENT
RESEARCH AND TREATMENT OF
ADOLESCENTS WITH MILD OPIOID USE
DISORDER OR EVEN WITH A MOTHER
OPIOID USE DISORDER.
PRIMARY CARE NETWORK, SAY, FOR
EXAMPLE, ALSO FOR DEVELOPMENT OF
INTERVENTIONS FOR THERAPEUTICS
OF NICOTINE ADDICTION.
WE HAVE NOTHING RIGHT NOW IN
ADOLESCENTS.
BEING ABLE TO HAVE THAT
INFRASTRUCTURE AND THE
OPPORTUNITY TO SCREEN PROPERLY
AND TO IDENTIFY THEM, TO START
TO PAY ATTENTION TO
CO-MORBIDITIES THAT CAN LEAD YOU
TO DETERMINE THIS IS A HIGHER OR
LOWER RISK.
THIS PRIMARY CARE NETWORK,
RESEARCH NETWORK, THE OTHER
GIGANTIC MAJOR PRIORITY FOR DR.
BERTONOLLI IS TO COLLECT THE
DATA FOR AN ORGANIZATION OF
HEALTH NETWORKS.
SO IF YOU HAVE A PRIMARY CARE
NETWORK FOR RESEARCH AND BETTER
IN PRACTICE THAT IS COLLECTING
DATA, YOU CAN THEN SEE THE
OPPORTUNITY OF REALLY
UNDERSTANDING HOW THESE POLY
SUBSTANCES MAY BE PLAYING OUT
AND HOW THEY CHANGE AND THE
DIFFERENT TRAJECTORIES ON
DIFFERENT PEOPLE FOR WHICH WE
DON'T HAVE KNOWLEDGE.
IN MY BRAIN, I SAID THIS WOULD
BE WONDERFUL.
WITH RESPECT, IT WOULD BE AN
OPPORTUNITY FOR US TO EXPAND
SOME OF THE THINGS THAT THE
CLINICAL TRIALS NETWORK IS
DOING.
THE CLINICAL TRIALS NETWORK IS
NECESSARY IN THE WAY IT IS NOT
AN ETHICS AGENCY.
IT BASICALLY, DEPENDING ON THE
PROJECT, IT REACHES OUT TO
PRIMARY CARE PHYSICIANS OR TO
SPECIALISTS IN ORDER TO DEPLOY
THE PROJECTS.
WE COULD RELY MORE ON PRIMARY
CARE PHYSICIANS, WHICH ARE THE
FIRST LINE OF TREATMENT FOR
ANYONE IN THE UNITED STATES.
SORT OF WHY IT'S SO VERY, VERY
CONSEQUENCE.
>> THANK YOU.
THAT WAS AN INSPIRING TALK.
I ALSO GOT -- I WASN'T ABLE TO
ATTEND YOUR KEYNOTE LECTURE AT
THE AMERICAN PSYCHIATRIC
ASSOCIATION, BUT I GOT SOME
INDICATION FROM SUSAN ABOUT
YOU'RE REALLY FOREGROUNDING
SOCIAL DETERMINANTS, AND I GOT
SOME HINTS OF THAT FROM YOUR
PRESENTATION TODAY.
I DID NOTICE ON THE SLIDE ABOUT
CHALLENGES AT THE BOTTOM OF THE
LIST, WHERE PREVENTION ACROSS
THE LANDSCAPE AND SOCIAL
DETERMINANTS OF HEALTH, AND IT
SEEMS THAT THOSE TWO THEMES
REALLY RUN THROUGH ALL OF THE
OTHER CHALLENGES AT THE TOP OF
THE LIST, THEY'RE KIND OF
FOUNDATIONAL.
I AM VERY INTERESTED IN YOUR
THINKING ABOUT A THROUGH GOING
SYSTEMATIC AND DELIBERATE
APPROACH TO THE SOCIAL
DETERMINANTS AGENDA AT NIDA
WITH, OF COURSE, SOCIAL
DETERMINANTS BEING
DISPROPORTIONATE DRIVERS OF
OUTCOMES, BAR NONE, AND ALSO
VERY EFFECTIVE AND COMPREHENSIVE
INFLUENCES ON PRIMARY,
SECONDARY, AND TERTIARY
PREVENTION.
ADDRESSING SOCIAL DETERMINANTS,
YOU INFLUENCE INITIATION OF DRUG
USE.
YOU INFLUENCE TREATMENT ACCESS
AND OUTCOMES.
YOU INFLUENCE OVERDOSE RATES.
AND THE EFFECTIVENESS OF HARM
REDUCTION APREEPROAAPPROACHES.
AND YOU ALSO AFFECT MANY
DIFFERENT CHRONIC CONDITIONS
WITH ONE INTERVENTION.
ALSO, IF WE LOOK
INTERNATIONALLY, INDUSTRIALIZED
PEER COUNTRIES DO MUCH BETTER
THAN WE DO WITH SOCIAL
DETERMINANTS APPROACHES,
INCLUDING PRIMARY PREVENTION
APPROACHES.
THAT'S ONE PLACE WHERE WE REALLY
STAND OUT.
WE HAVE THE WORST HEALTHY
OUTCOMES, INCLUDING SUBSTANCE
USE DISORDER, HEALTH OUTCOMES OF
INDUSTRIALIZED COUNTRIES, AND WE
HAVE THE WORST SOCIAL
DETERMINANT APPROACHES.
SO IT WAS INTERESTING ON THE ICD
STUDY AND THE WINDOW THEY GIVE
US ON NOT ONLY A HEALTH SCIENCE
AS APPROACH THAT LOOKS AT SOCIAL
DETERMINANTS, BUT A NEUROSCIENCE
AGENDA THAT LOOKS AT THE
UNDERLYING MECHANISMS BY WHICH
SOCIAL EXPOSURES INFLUENCE BRAIN
BIOLOGY.
THAT'S AN APPROACH THAT IS
INTRIGUING TO ME, AND ONE OF MY
COLLEAGUES AT UCLA JUST GOT
MAJOR FUNDING FROM DANA
FOUNDATION TO START A
NEUROSCIENCE AND SOCIETY CENTER
THAT BOTH RETHINKS NEUROSCIENCE
METHODOLOGY AND IS DEVELOPING A
COMMUNITY PARTICIPATORY
NEUROSCIENCE.
SO THE COMMUNITY MEMBERS FROM
AREAS LIKE SOUTH L.A. IN THE
COUNTRY THAT HAVE NOT BEEN WELL
SERVED AND INTEGRATED INTO THE
NEUROSCIENCE AGENDA ACTUALLY
HELP TO DECIDE THE RESEARCH
QUESTIONS THAT WE'RE GOING TO
PURSUE.
IT PROBABLY WOULDN'T BE
SURPRISING THAT LEARN THAT THOSE
QUESTIONS THAT REALLY DO LOOK AT
TOXIC SOCIAL EXPOSURES AND THEIR
INFLUENCE ON BRAIN DEVELOPMENT
AND LEARNING, FOR EXAMPLE, AND
MULTIGENERATIONAL EFFECTS ARE
COMING TO THE FORE.
THE INITIAL PILOT STUDY HAD TO
DO WITH THE IMPACT OF LOW FLYING
LAW ENFORCEMENT SHERIFF'S
HELICOPTERS ON SLEEP DISRUPTION
LATE AT NIGHT, EARLY IN THE
MORNING AS THEY TARGET SOUTH
L.A. NEIGHBORHOODS.
AND THE IMPACT ON BRAIN
DEVELOPMENT AND LEARNING ON
LOCAL CHILDREN, WHICH WE'RE NOW
MODELING IN THE LAB AND WITH
DROSOPHILA.
IT HAD PROFOUND SCIENTIFIC
IMPLICATIONS AS WELL AS POLICY
IMPLICATIONS.
THIS IS WHERE NEUROSCIENCE COULD
BE LEADING THE WAY AND LOOKING
AT EPIGENETICS, THE MICROBIOME,
EMERGING LIFE SCIENCE MODELS
THAT WE'RE BEHIND IN
NEUROPSYCHIATRY AND KIND OF
TAPPING INTO.
SO ALL OF THESE THINGS ARE
HAPPENING AT ONCE.
I WANT TO KNOW IN YOUR MIND WHAT
WOULD BE A SYSTEMATIC AND KIND
OF VERY RIGOROUS APPROACH TO
MAKING SURE THAT WE'RE
APPROACHING SOCIAL DETERMINANTS
IN THE MOST EFFECTIVE WAY
POSSIBLE AND THAT WE HAVE THE
RIGHT PEOPLE AROUND THE TABLE,
SOCIAL SCIENTISTS, THOSE THAT
REALLY SPECIALIZE IN MODELING
AND MEASURING THE SOCIAL, AS
WELL AS, FOR EXAMPLE, COMMUNITY
PARTNERS, PEOPLE FROM MULTIPLE
SECTORS THAT WOULD HAVE TO BE
INVOLVED IN ANY KIND OF
IMPLEMENTATION FROM HOUSING TO
LAW ENFORCEMENT TO EDUCATION.
>> I WOULD SAY IT'S EVIDENT THAT
THIS IS A KEY COMPONENT ON
EVERYTHING THAT WE DO.
WHAT ARE THE SOCIAL DETERMINANTS
FOR PREVENTION, FOR TREATMENT,
FOR RECOVERY, FOR OVERDOSE
DEATHS?
THEY ARE FUNDAMENTAL.
I ACTUALLY -- SO LIKE IN THE
PAST, I MEAN, YOU DO A CLINICAL
TRIAL AND YOU SEE SOME PATIENTS
RESPONDED YES OR NO AND WE LOOK
AT THE GENETICS TO TRY TO SEE IF
THAT EXPLAINS IT.
THAT'S THE CONSENSUS OF THE
PERSON.
PROBABLY HAD A MUCH HIGHER
IMPACT ON WHETHER THEY RESPONDED
OR NOT.
THEY'VE BEEN NEGLECTED.
NOW WE DON'T NEGLECT THEM
ANYMORE.
SO THROUGHOUT ALL OF THE WORK
THAT WE'RE DOING, WE'RE
EMPHASIZING THAT WE ARE
COLLECTING DATA RELATED TO THE
SOCIAL DETERMINANTS OF HEALTH.
OF COURSE, AS WE GO ALONG, WE
LEARN NEW THINGS AND HOW TO DO
IT OPTIMALLY.
ALSO WE HAVE TO -- BECAUSE AT
THE ESSENCE OF ALL OF THIS, OUR
STRUCTURAL SYSTEMS THAT HAVE
CREATE
CREATED TREMENDOUS INEQUALITY.
WE DON'T NEED TO DISCOVER THE
WATER TO KNOW THAT IS THE CASE.
THE QUESTION IS WHAT IS THE DATA
THAT WILL HELP US CHANGE IT?
THAT'S THE WAY I VIEW ALL OF
THESE ISSUES.
WHAT INFORMATION CAN CHANGE
POLICIES SO THAT
TRAJECTORIES.
BECAUSE IN THE PAST WHERE YOU
WERE SEEING, FOR EXAMPLE, THE
LOWER PERFORMANCE AMONG CHILDREN
OF UNDERREPRESENTED GROUPS.
AND SORT OF THIS WAS TO ME TO
JUSTIFY WHY THERE ARE PEOPLE
WITH PRIVILEGE AND OTHERS NOT.
AND NOW THAT WHAT WE CAN SHOW IS
THAT IS ACCOUNTED BY THE FACT
THAT THERE ARE FACTORS RELATED
TO POVERTY, TO DISCRIMINATION,
THAT IS DIRECTLY RESPONSIBLE TO
CHANGING THE BRAIN.
THAT IS HARDER TO PUT UNDER THE
ROCK.
THIS IS WHY ALSO WE'RE VERY
EXCITED.
BECAUSE THAT'S EARLY ON YOU ARE
LIKELY TO HAVE A GREATER IMPACT.
THE ABCD HAS BEEN ILLUMINATING
ALREADY.
MOVE THE CULTURE THAT HAD
CREATED SYSTEMS THAT ARE REALLY
TREAT PEOPLE DIFFERENT.
SORT OF AGAIN, HOW DO YOU CHANGE
CULTURE?
CHANGING THE JUSTICE SYSTEM.
CHANGING THE SYSTEM THAT IS SO
UNEQUAL.
IN OUR MISSION.
IN THE MISSION OF SCIENCE AND
SO.
SO THAT'S WHERE WE HAVE TO BE,
AGAIN, STRATEGIC.
AND I THINK THERE IS GETTING
NERVOUS.
THE TIME IS PAST.
AM I READING YOUR NONVERBAL
BEHAVIOR PROPERLY?
YES, IT'S 2:31.
I THINK THAT -- YEAH.
>> IT'S ON OPPORTUNITY FOR
SOCIAL SCIENTIST.
>> I THINK THIS IS A QUICK
COMMENT ACTUALLY.
I REALLY APPRECIATED WHAT THE
DOCTOR JUST SAID AND THE
COMPLEXITY WHICH WITH YOU
DESCRIBED THE INITIATIVES THAT
YOU'RE SEEING.
I WAS JUST THINKING ONE THING
THAT YOU MAY ALREADY BE DOING AT
NIDA, BUT IF NOT, IT MIGHT BE
GOOD TO TRACK ACROSS GOING
FORWARD THE NEXT SEVERAL YEARS
AMONGST ALL THE FUNDED GRANTS.
WHICH ONES ARE TAKING INTO
ACCOUNT THE SOCIAL DETERMINANTS
OF HEALTH ACROSS ALL THE
DIFFERENT TYPES OF FUNDING
MECHANISMS.
AND THEN TO BEGIN TO DEMONSTRATE
THAT GOING FORWARD, JUST BECAUSE
IT'S A WAY OF TRACKING THROUGH
EVERYTHING THAT'S GETTING FUNDED
FROM BASIC TO TRANSLATIONAL TO
POPULATION-BASED, ET CETERA,
SCIENCE.
AND I THINK THAT MIGHT BE VERY
INFORMATIVE AS TO HOW WE'RE
DOING YEAR TO YEAR GOING FORWARD
GIVEN THAT EVERYBODY IS IN FULL
AGREEMENT OF HOW IMPORTANT THAT
IS.
JUST A COMMENT AND A THOUGHT.
>> YEAH.
AND IT'S A GREAT SUGGESTION.
AND I WOULD BRING IT UP TO THE
WHOLE NIH.
I THINK THE SOCIAL DETERMINANTS
OF HEALTH.
WIDE VARIETY OF THINGS.
COMING UP WITH A STANDARDIZED
METRIC THAT CAN BE FOLLOW-UP
EASILY.
I MEAN, RIGHT NOW IF YOU
EXPLICITLY SAY THIS IS SOCIAL
DETERMINANTS, WE WANT TO GO
BEYOND THAT.
I WANT CLINICAL TRIALS TO
DETERMINE SOCIAL DETERMINANTS OF
HEALTH.
YES, YOU WANT ME TO JUMP INTO
THE NEXT TOPIC?
I'M GOING TO GO UP THERE.
AND IT IS A PLEASURE FOR ME NOW
TO GET INTO GETTING THE LIFETIME
ACHIEVEMENT AWARD TO WILLIAM
DEWY WHICH ANYONE WHO HAS BEEN
DOING RESEARCH IN THE SUBSTANCE
USE FIELD.
YOU DON'T NEED AN INTRODUCTION.
BUT I WANT TO GO OVER SOME OF
HIS ACHIEVEMENTS, WHICH IS IT'S
EXTRAORDINARY.
THIS IS A TOKEN FOR EVERYTHING
THAT HE HAS GIVEN US AND HAS
GIVEN THE FIELD.
SO IT IS AN HONOR AND MY
PRIVILEGE TO BE ABLE TO DO THIS.
AND IT'S ALSO AN HONOR TO SEE
YOU HERE WITH ALL OF YOUR
FAMILY.
YOUR WIFE WHO I HEARD A LOT,
EVERY TIME THAT BILL AND I MET.
AND SPEAKS ABOUT HIS WIFE.
AND HIS CHILDREN.
SO I KNOW THAT HE'S VERY VERY
DEVOTED TO HIS FAMILY.
JUST LIKE HE'S DEVOTED TO
SCIENCE AND TO HIS STUDENTS AND
TO ADDICTION.
SO I CAN SAY THAT HE IS NOT JUST
A COLLEAGUE, HE'S ALSO I VALUE
HIM VERY MUCH AS A FRIEND.
AND I VALUE HIS OUTSTANDING
CONTRIBUTIONS TO THE FIELD.
HIS COMMITMENT TO SUBSTANCE USE
AND TO THE PEOPLE THAT SUFFERING
FROM ADDICTION, HIS COMMITMENT
TO THE STUDENTS, AND FROM
INSPIRING THROUGHOUT HIS STELLAR
CAREER.
HE BEGAN HIS CAREER 50 YEARS AGO
IN ASSOCIATION WITH VIRGINIA
COMMONWEALTH UNIVERSITY.
AND THAT WAS IN 1972 WHERE HE
WAS RECRUITED AS ON SOCIETY
PROFESSOR OF PHARMACOLOGY.
FOUR YEARS LATER, HE WAS
PROMOTED TO PROFESSOR AND --
OVER THE FOLLOWING YEARS, HE
TOOK ON KEY LEADERSHIP ROLES OF
INCREASING INSTITUTIONAL
VISIBILITY IN VARIOUS RESEARCH.
IN 2008, HE WAS NAMED A
PROFESSOR AND CHAIR OF THE
DEPARTMENT OF PHARMACOLOGY AND
TOXICOLOGY.
AND A POSITION HE HELD WITH
DISTINCTION UP TO THIS DAY.
UP TO 400 SCIENTIFIC
PUBLICATIONS.
AND CONTRIBUTIONS THAT REFLECT
HIS LIFELONG INTEREST IN
UNDERSTANDING HOW ADDICTIVE
DRUGS IN GENERAL WORK.
IN THIS CONTEXT, HIS FOCUS HAS
BEEN THE -- UNDERLYING THE
TOLERANCE, DEPENDANCE.
USING MULTIPLE INVESTIGATIONAL
TOOLS AND APPROACHES THAT
INCLUDES NEUROCHEMISTRY,
PHARMACOLOGY, AND BEHAVIORAL
RESEARCH.
AS I SAID AT THE BEGINNING, HIS
CONTRIBUTIONS GO WELL BEYOND HIS
SCHOLARLY WORK.
HE HAS BEEN AMONG THE SUPPORTS.
20 YEARS AGO, HE CREATED THE
FRIENDS OF NIDA.
AND SERVE AS ITS CHAIRMAN UNTIL
THIS YEAR.
UNDER HIS LEADERSHIP, THE
FRIENDS OF NIDA COALITION
LEVERAGED THE POWER OF THOSE
ORGANIZATIONS INCLUDING
SCIENTIFIC AND PROFESSIONAL
SOCIETIES, PATIENT GROUPS,
COMMUNITY ORGANIZATIONS AND
OTHERS.
POLICY MAKERS AND THE PUBLIC ON
THE VALUE OF ADDICTION RESEARCH
THROUGH EDUCATION AND ADVOCACY.
HIS WORK HAS BEEN INSTRUMENTAL
IN RAISING THE PROFILE OF AND
BOLLSTERING THE SUPPORT OF NIDA
ON CAPITOL HILL.
PERHAPS THE GREATEST MARK IS THE
LIFELONG COMMITMENT TO RESEARCH
TRAINING.
BILL IS THE REGIONAL AND CURRENT
PI OF THE TRAINING IN
PHARMACOLOGY OF ABUSED DRUG.
TWO GRANTS FUNDED UNINTERPRETED
SINCE 1986.
THIS ENDISCOVER HAS BEEN A
SOURCE OF INSPIRATION AND A
NURTURING SPACE, SO THEY CAN
TAKE RISK, PURSUE THEIR IDEAS,
AND IN THE ACADEMIC OR OTHER
PURSUITS.
THE PROGRAM THAT HE CREATED AND
SO LOVINGLY NURTURED HAS SPAWNED
A MULTI-GENERATIONAL FAMILY OF
SCIENTISTS.
A RARE ENVIRONMENT AND
ACHIEVEMENT INDEED.
NOT SURPRISINGLY, BILL'S
MULTIFACETED WORK RECEIVED
ACCOLADES AND HONORS THROUGH THE
YEARS.
LIKE THE 2009 AWARD FROM CPDD.
THE 2003 LIFETIME ACHIEVEMENT IN
SCIENCE AWARD FROM THE
COMMONWEALTH OF VIRGINIA.
THE 2006 PUBLIC SERVICE AWARD
FROM NIDA.
THE 2012 PRESIDENTIAL MEDALLION.
AND THE 2013 AWARD, JUST TO NAME
A FEW.
IN HONORING WILLIAM WITH THE
NIDA LIFETIME SCIENTIFIC
ACHIEVEMENT AWARD, WE NOT ONLY
RECOGNIZE HIS MANY CONTRIBUTIONS
TO SCIENCE AND TRAINING OF
FUTURE GENERATIONS TO HAVE
SCIENTISTS BUT PAY TRIBUTE TO
THE ENDURING POWER OF HUMAN
CURIOSITY, GOOD CITIZENSHIP, AND
UNWAIVERING SUPPORT OF
COLLEAGUES AND TRAINEES.
JOIN ME IN CONGRATULATING HIM ON
THIS WELL DESERVED HONOR.
EXPRESSING OUR DEEP SKWUS EST
GRATITUDE.
BILL, THANKS VERY MUCH.
>> ALL RIGHT, THANK YOU VERY
MUCH FOR THIS.
I REALLY VERY MUCH APPRECIATE
IT.
YOU KNOW, JUST TO BE A SCIENTIST
IS AN AMAZING WAY TO SPEND YOUR
LIFE.
I DON'T THINK ANY OF US DO
THINGS INDIVIDUALLY IN THIS
BUSINESS.
I THINK WE DO THINGS TOGETHER.
WE RELY ON THE LITERATURE AND
OUR LEAGUES, OUR FACULTY
MEMBERS, STUDENTS.
WE RELY ON GROUPS OF PEOPLE.
AND I THANK YOU FOR THIS.
AND I THANK YOU FOR TWO SPECIFIC
GROUPS.
ONE IS SITTING RIGHT OVER THERE.
THAT'S THE GROUP.
THAT WIFE OF MINE AND THOSE
CHILDREN.
AND THEIR SPOUSES,
GRANDCHILDREN.
THEY MADE MY LIFE BETTER.
IT WAS EASY TO WORK.
I DO THIS JOB, ANYTHING THAT YOU
DO, HELPS THE HEALTH OF A HUMAN
BEING.
WHAT'S A BETTER REASON FOR BEING
ON THIS EARTH?
YOU SAVE THEIR LIFE BECAUSE YOU
HAVE SOME IDEA THAT OTHERS COME
OUT AND BUILD ON IT.
WE DON'T DO IT ALONE.
TOGETHER WE'RE GOING TO STOP
THIS.
100,000 PEOPLE DYING A YEAR.
THIS IS RIDICULOUS.
AND YOU ARE SMARTER.
WE ARE ALL SMARTER.
PEOPLE SAID I SHOULD RETIRE.
HOW DO YOU RETIRE FROM THIS?
YOU KNOW WHEN YOU RETIRE?
WHEN THIS NUMBER IS ZERO.
WE HAVE TO CONVINCE CONGRESS.
BUT THAT BUDGET DIDN'T CHANGE.
THAT WAS FRUSTRATING.
MORE AND MORE PEOPLE ARE DYING.
WE NEED TO STOP THAT.
IT'S GOING TO TAKE SCIENCE.
THINGS DON'T HAPPEN BY CHANCE.
BUT, YOU KNOW.
I SEE SO MANY FRIENDS IN THIS
ROOM.
I SEE THEIR FAMILY OVER THERE.
I GOTTEN TO KNOW NORA WELL.
AND OTHERS OF YOU.
I CAN SAY THANK YOU VERY MUCH.
ON BEHALF OF THOSE TWO GROUPS.
THANK YOU.
>> OKAY.
SO WE NOW HAVE A BREAK UNTIL
WHEN?
>> UNTIL 3 O'CLOCK.
>> YOU HAVE 15 MINUTES.
THANKS VERY MUCH, EVERYBODY.
>> HELLO.
ALREADY 3 O'CLOCK IN THE
AFTERNOON.
AND IT'S A PLEASURE FOR ME TO
INTRODUCE THE NEXT SPEAKER.
WHICHEVER WAY YOU WANT.
YOU CAN GO OVER HERE OR THERE.
WHO IS A DIRECTOR OF THE
DIVISION OF NEUROSCIENCE AND
BEHAVIOR.
AND SHE WILL BE GIVING US AN
ESSAY ON THE PORTFOLIO ON THE
SCIENTIFIC QUESTIONS AND
FINDINGS.
>> OKAY.
THIS IS ON NOW.
THANK YOU VERY MUCH.
IT'S REALLY A PRIVILEGE TO BE
ABLE TO GIVE YOU AN UPDATE FROM
THE DIVISION OF NEUROSCIENCE AND
BEHAVIOR.
AND IT'S OUR 50TH ANNIVERSARY.
AND OVER THE LAST 50 YEARS, NIDA
HAS SUPPORTED BASIC RESEARCH
THAT'S LED TO A NUMBER OF
TRANSFORMATIVE DISCOVERIES.
THESE HAVE ALLOWED US TO ADVANCE
OUR KNOWLEDGE IN THE
NEUROBIOLOGY OF MOTIVATED
BEHAVIOR AND OF EXECUTIVE
FUNCTION LIKE DECISION MAKING.
AND HAVE CHARACTERIZED THE
PHARMACOLOGY MECHANISMS OF MANY
DRUGS.
AND THIS HAS LED TO ADVANCES IN
MEDICATION DEVELOPMENT,
PARTICULARLY IN THE TREATMENT OF
OVERDOSE, AND IN THE TREATMENT
OF WITHDRAWAL.
AND IMPORTANTLY, ALL OF THIS
SUPPORT OF BASIC RESEARCH HAS
BEGUN TO CHANGE OUR PERSPECTIVE
OF ADDICTION FROM BEING A
DEVIANT BEHAVIOR TO BEING A
HEALTH CONDITION.
BUT WE STILL HAVE A WAYS TO GO.
AND BASIC RESEARCH IS TASKED
WITH DEALING WITH MANY OF THE
CHALLENGES, CURRENT CHALLENGES
OF SUBSTANCE USE DISORDER.
MANY THAT WE TALKED ABOUT TODAY.
SO WE STILL HAVE THIS RAGING
OVERDOSE CRISIS.
WE ARE TRYING TO NAVIGATE A VERY
COMPLEX LANDSCAPE OF POLY
SUBSTANCE USE.
WE RECOGNIZE THAT DRUG USE
REALLY IS A TRAJECTORY THAT IT'S
COMPOSED OF MANY DIFFERENT
STAGES THAT ARE CHARACTERIZED BY
DIFFERENT COGNITIVE PROCESSES
AND UNDERLYING THESE PROCESSES
ARE SUBSTRAITS.
AND WE NEED TO UNDERSTAND THE
MECHANISM OF TRANSITIONS FROM
ONE STATE TO ANOTHER.
WE RECOGNIZE THAT SUBSTANCE USE
DISORDER IS PART OF SOMETHING
BIGGER; PART OF A COMPLEX
MORBILITY.
IT'S MORBID WITH PAIN, WITH
SLEEP DISORDERS, AND MENTAL
HEALTH DISORDERS.
THERE MAY BE A BROADER NETWORK
THAT SUBSERVES ALL OF THESE
DISORDERS.
AND WE NEED TO TARGET THESE
BROADER NETWORK IF WE'RE GOING
TO TREAT IT.
IT'S COMPLICATED BY OTHER
CONDITIONS: PREGNANCY,
INFLECTION.
AND ONE OF THE MAJOR QUESTIONS
THAT WE'RE TRYING TO ADDRESS IS
WHAT'S THE BASIS FOR INDIVIDUAL
VARIABILITY IN THE RISK TO
DEVELOP SUBSTANCE USE DISORDERS?
THERE ARE DETERMINANTS: GENETIC
DETERMINANTS, SEX IS A
DETERMINANT, ENVIRONMENTAL
DETERMINANTS, AND ENVIRONMENT.
HOW DO ALL THESE FACTORS
INTERACT TO DETERMINE THE RISK
TO DEVELOP SUBSTANCE USE
DISORDER.
I WANT TO GIVE YOU HIGHLIGHTS OF
REPRESENTATIVE RESEARCH THAT
WERE SUPPORTING THAT ADDRESSES
EACH OF THESE CHALLENGES.
AND FIRST TO SHOW YOU THE
ORGANIZATION OF DMV.
SO IT'S LEADERSHIP LEVEL.
MYSELF AND COULDN'T DO THIS
WITHOUT THE ASSISTANCE OF ROGER
LITTLE.
ORGANIZED INTO FOUR SCIENTIFIC
BRANCHES.
THEY ARE INTEGRATED AND WORK
TOGETHER.
BONNIE, JONATHAN IS THE CHIEF OF
GENETICS.
TRISTA IS THE CHIEF OF A BRANCH.
AND SAM IS THE CHIEF OF
CHEMISTRY, PHYSIOLOGY BRANCH.
AND THEN WE HAVE NHIB RESEARCH
PORTFOLIO THAT CUTS ACROSS THE
BRANCHES.
I WON'T BE ABLE TO TELL YOU
ABOUT THE RESEARCH TODAY.
WE WORK WITH PEOPLE TO
ADMINISTER THAT RESEARCH
PORTFOLIO.
AND THEN CUTTING ACROSS THE
BRANCHES, WE HAVE A PORTFOLIO OR
PROGRAM IN DATA SCIENCE AND
THAT'S HEADED UP BY SUSAN
WRIGHT.
SO ADDRESSING THE OVERDOSE
CRISIS.
ONE OF THE MAJOR PROGRAMS THAT
WE HAVE IS DIRECTED BY MURRAY IN
THE CHEMISTRY PHARMACOLOGY
BRANCH.
AND THIS IS THE CHEMICAL COUNTER
MEASURES RESEARCH PROGRAM.
SO THIS IS A PROGRAM THAT WE
HAVE IN COLLABORATION WITH
NIAID.
AND IT'S REALLY TO SORT OF
ADDRESS OR TO IDENTIFY COUNTER
MEASURES TO AGENTS THAT COULD BE
USED AS WEAPONS AGAINST THE
POPULATION.
AND ON THAT LIST IS -- THIS
PROGRAM ALLOWED US TO FUND
RESEARCH THAT'S REALLY TRYING TO
GET AT THE BASIS OF THE
NEUROBIOLOGY OF THE TOXICITY DUE
TO THESE AGENTS.
IT ALSO SUPPORTS RESEARCH FOR
USING METHODS FOR SCREENING
COMPOUNDS THAT WOULD COUNTER ACT
THESE.
TO STIMULATE RESPIRATION,
CHEMICALS AND DEVICES, TO CHANGE
THE FORMULATION OF CHEMICALS
THAT THEY HAVE A LONGER DURATION
OF ACTION.
AND THIS PROGRAM HAS ALSO
SUPPORTED THE DEVELOPMENT OF
IMMUNE THERAPIES OR EARLY
RESEARCH IN IMMUNE THERAPIES
LIKE VACCINES AND ANTIBODIES.
AND THIS PROGRAM SUPPORTED SOME
OF THE EARLY WORK ON ANTIBODIES
THAT LED UP TO THE ONES THAT ARE
IN CLINICAL TRIALS TODAY.
AND IT'S ALSO SUPPORTED WORK ON
AGENTS THAT ARE SEQUESTER.
AND DRIVE THEM TO PATHWAYS.
AND WE SUPPORTED THROUGH THIS
PROGRAM SOME OF THE EARLY
RESEARCH THAT LED TO ONE OF
THESE THAT'S NOW IN CLINICAL
TRIAL.
SO I THINK ONE REALLY GOOD
REPRESENTATIVE EXAMPLE OF HOW
THE BASIC RESEARCH WE SUPPORT
HAS REALLY ADVANCED SCIENCES IN
THE STRUCTURES OF RECEPTORS AS
WELL AS RECEPTORS THAT DRUGS OF
ABUSE INTERACT WITH.
AT THE ATOMIC LEVEL.
THIS CAME IN ADVANCES.
AND IT'S NOT JUST THE STRUCTURE
THE RECEPTOR, BUT REALLY THE
STRUCTURAL DYNAMICS OF THE
RECEPTOR.
HOW THE RECEPTOR CHANGE THE --
MODULATORS AND SO ON.
AND THIS INFORMATION HAS BEEN
VERY IMPACTFUL BECAUSE IT'S
ALLOWED FOR HIGH THROUGH-PUT
COMPUTATIONAL SCREENING OF THESE
VERY LARGE CHEMICAL LIBRARIES TO
IDENTIFY OPTIMAL COMPOUNDS.
ONE OF THE CHALLENGES THAT COMES
WITH THIS IS THAT THE CHEMICAL
SPACE BECOMES SO LARGE THAT IT
TAKES A LOT OF RESOURCES TO
SCREEN THIS SPACE, IT TAKES A
LOT OF TIME TO SCREEN THIS
SPACE.
SO WE ARE ALSO SUPPORTING WORK
THAT IS IDENTIFYING NEW METHODS
TO OPTIMIZE THESE SCREENING
APPROACHES.
SO ONE EXAMPLE OF THESE IS
FRAGMENT-BASED APPROACH FROM THE
LAB WHICH HAS GONE ON TO
IDENTIFY RECEPTORS.
ANOTHER APPROACH IS TO USE
GENERATIVE DEEP LEARNING MODELS.
A
SO WE HAVE A LARGE GENETICS
PROGRAM THAT'S HEADED UP BY
JONATHAN, WHO IS THE CHIEF.
AND WE HAVE A HUMAN GENETICS
PROGRAM.
AND COMPLEMENTARY TO THAT IS THE
ANIMAL GENETIC PROGRAM.
THE HUMAN GENETICS PROGRAM
SUPPORTS A NUMBER OF STUDIES
DESIGNED TO IDENTIFY THE GENETIC
VARIANCE THROUGH THE BASIS OF
DEVELOPMENT OF SUBSTANCE USE
DISORDER.
AND SENSITIVITY TO TOXICITIES OF
ABUSED DRUGS.
ONE OF THE CHALLENGES IN THESE
GWAS STUDIES, YOU IDENTIFY
VARIANTS IN NONCODING REGENTS.
WE ARE LOOKING AT THE 3D
ARCHITECTURE TO ASSIGN THE
VARIANT TO THE GENE THAT IT
REGULATES.
AND IN THIS WAY ARE IDENTIFYING
NEW RISK GENES AND MAPPING THESE
OUT IN THE BRAIN.
ANOTHER CHALLENGE OF THESE GWAS
STUDIES IS THAT TO HAVE ENOUGH
POWER IT REALLY TAKES A LARGE
POPULATION, A DIVERSE POPULATION
ANCESTRY SO THE RESULTS AREN'T
BIASSED.
AND THIS CAN BE CHALLENGING TO
GET AND VERY COSTLY.
SO WE HAVE BEEN SUPPORTING
RESEARCH THAT IS APPLYING
COMPUTATIONAL.
AND AN EXAMPLE OF THIS IS WORK
FROM ALEX ANDER.
APPLYING THIS TO EXISTING DATA
SETS.
AND FROM THIS HE HAS IDENTIFIED
AN ADDICTION RISK FACTOR WHICH
BASICALLY IS THE SHARED GENETIC
ARCHITECTURE ACROSS OPIOID USE
DISORDER, NICOTINE USE DISORDER,
AND CANNABIS USE DISORDER.
THIS RISK FACTOR SHARES GENETIC
LIABILITY WITH CERTAIN FEATURES
OF INDIVIDUALS WITH SUBSTANCE
USE DISORDER.
SO RISK TAKING BEHAVIOR,
NEGATIVE AFFECT, AND IMPAIRMENTS
IN EXECUTIVE FUNCTION.
SO GENETICS IS INTIMATELY LINKED
TO DEVELOPMENT AND DEVELOPMENT
IS AN IMPORTANT DETERMINANT OF
DEVELOPING RISK FOR SUBSTANCE
USE DISORDER.
WE KNOW THAT THERE ARE CRITICAL
WINDOWS OF DEVELOPMENT WHEN
CELLS ARE BORN, MIGRATE, WHEN
THEY FORM CONNECTIONS, AND WHEN
THE CONNECTIONS ARE PRUNED.
AND THIS REALLY REQUIRES A VERY
PRECISE GENETIC PROGRAMMING AND
EXPOSURE TO DRUGS AT THESE
DIFFERENT WINDOWS OF DEVELOPMENT
THROUGH EPI-GENETIC AFFECTS
INTERFERE WITH THAT PROGRAMMING
AND CAUSE A RESHAPING OF
CIRCUITS OR A DISRUPTION OF THE
FORMATION OF CIRCUITS.
AND THAT CAN HAVE LONG-TERM
EFFECTS ON BEHAVIOR THAT LAST
INTO ADULTHOOD.
SO WE SUPPORT A LOT OF RESEARCH
THAT IS FOCUSED ON DETERMINING
OR IDENTIFYING THE EFFECTS AND
THE MECHANISMS BY WHICH EXPOSURE
TO DRUGS DURING THESE DIFFERENT
WINDOWS ALTERS THESE
DEVELOPMENTAL PROCESSES.
AND YOU KNOW, RECENTLY THERE'S A
LOT OF ATTENTION THAT'S BEEN
GIVEN PARTICULARITY TO CANNABIS
BECAUSE OF GREATER EXPOSURE TO
CANNABIS.
GREATER AVAILABILITY TO TAKE
CANNABIS.
AND TO PURCHASE THIS.
AND GREATER USE BY INDIVIDUALS
THAT ARE IN THESE PARTICULAR
DEVELOPMENTAL WINDOWS SUCH AS
PREGNANCY AND ADOLESCENCE.
LIKE DRUGS, ADVERSE EVENTS
DURING PARTICULAR CRITICAL
WINDOWS OF DEVELOPMENT CAN ALSO
CHANGE THE DEVELOPMENT OF THE
BRAIN AND THEN HAVE LONG-TERM
EFFECTS ON BEHAVIOR.
AND YOU HEARD FROM THE DOCTOR
TODAY TWO STUDIES ON BRAIN
DEVELOPMENT.
AND YOU WILL HEAR TOMORROW IN
THE DETAILS OF THAT.
AND COLLEAGUES THAT DIRECT THAT
PROGRAM.
THE ABCD PROGRAM AND HBCD
PROGRAM.
AND THESE PROGRAMS THEY ARE
OBSERVATIONAL STUDIES, THEY ARE
COLLECTING DATA ON BRAIN IMAGES,
BIO SAMPLES, GENETICS,
NEUROCOGNITIVE FUNCTION, AND
SOCIO ENVIRONMENTAL FACTORS.
AND TRYING TO DETERMINE HOW THEY
INTERACT TO SHAPE THE TRAJECTORY
OF MENTAL HEALTH.
WE'RE EXCITED FOR A NUMBER OF
REASONS.
WE'LL BE GETTING DATA.
AND THESE STUDIES ARE GOING TO
GENERATE HYPOTHESIS THAT CAN BE
BACK TRANSLATED.
AND SO WE'LL BE ABLE TO TEST
THESE HYPOTHESIS, FOR EXAMPLE,
IN RODENT MODELS TO DETERMINE
HOW CHANGES IN SOCIAL OR
ENVIRONMENTAL FACTORS INFLUENCE
THE DEVELOPMENT OF BRAIN.
AND HOW THIS CHANGES THE
TRAJECTORY TO BIAS TOWARDS
RESILIENCE OR VULNERABILITY TO A
SUBSTANCE USE DISORDER.
AND A NEW PROGRAM THAT WE HAVE
THAT'S SUPPORTING THIS RESEARCH
IS THE TRANSLATING SOCIO
ENVIRONMENTAL INFLUENCES ON
NEUROCOGNITIVE DEVELOPMENT OR
RISK.
DEVELOPING BY HOLLY MOORE OF THE
BEHAVIORAL COGNITIVE
NEUROSCIENCE BRANCH.
ONE QUESTION THAT WE'RE TRYING
TO ANSWER THAT KIND OF GOES
ACROSS ALL OF THE BRANCHES IS
WHAT IS THE BASIS OR WHAT'S THE
MECHANISM OF TRANSITION FROM IN
THESE DIFFERENT STAGES THROUGH
THE TRAJECTORY OF DRUG USE FROM
THE CELLULAR TO THE CIRCUIT TO
THE NETWORK TO THE BEHAVIORAL
LEVEL?
AND AT THE CELLULAR LEVEL, THE
MOST AMBITIOUS PROGRAM WE HAVE
IS THE SCORCH PROGRAM THAT WAS
DEVELOPED BY JOHN.
AND THIS PROGRAM IS SUPPORTING
WORK THAT'S DOING SINGLE CELL
AND SINGLE NUCLEUS PROFILING AND
GETTING THE PROFILING AND THE
EPI GENETIC PROFILE OF
INDIVIDUAL CELLS THAT ARE IN
BRAIN REGIONS THAT HAVE BEEN
ASSOCIATED WITH SUBSTANCE USE
DISORDER.
AND DOING THIS IN THREE
DIFFERENT SPECIES.
SO IN THE MOUTH, IN THE NONHUMAN
PRIMATE, AND IN HUMAN
POSTMORTEM.
WE'LL HAVE AN ATLAS.
LAYERED ON TOP OF THIS IS THE
CONDITION OF HIV.
SO IN THE CONTEXT OF HIV AND IN
THE PRESENCE OF HIV OR IN THE
ABSENCE OF HIV.
SO WE CAN BEGIN TO UNDERSTAND AT
THE CELLULAR LEVEL THE
COMORBILITY BETWEEN HIV AND
SUBSTANCE USE DISORDER.
AT THIS POINT WE ARE NOW
SUPPORTING 15 DATA GENERATING
CENTERS.
AGAIN, LOOKING AT DIFFERENT
SPECIES AND AT DIFFERENT STAGES
OF THAT TRAJECTORY.
DATA IS GOING INTO THE SCORCH
DATA COORDINATING CENTER.
AND THAT DATA IS GOING TO BE
AVAILABLE FOR USE BY THE
SCIENTIFIC COMMUNITY.
SO THAT'S AT THE CELLULAR LEVEL.
BUT BUILDING FUNCTIONALITY ON TO
SCORCH IS OUR NEW PROGRAM, THE
NEXTUS PROGRAM.
THE IDEA HERE IS TO IDENTIFY
NEURAL ENSEMBLES THAT BECAME
ENGAGED DURING THESE STAGES OF
OPIOID USE.
IT'S IDENTIFICATION OF THOSE
CELLS, IDENTIFICATION OF THEIR
MOLECULAR PROFILE,
IDENTIFICATION OF THEIR SPATIAL
LOCALIZATION IN BRAIN, THEIR
ACTIVITY, AND THEIR
CONNECTIVITY.
AND THE PRIMARY GOAL OF THIS,
THE GOAL IS TO REALLY TRY TO
UNDERSTAND THE MECHANISMS BY
WHICH CELLS BECOME RECRUITED
INTO ENSEMBLES THAT ENCODE FOR
ADDICTIVE-RELATED
NEUROBEHAVIORS.
AND THIS REALLY JUST STARTED.
WE JUST STARTED FUNDING THE
FIRST COHORT.
AND AT THE END OF THIS MONTH
WE'RE HAVING A MEETING OF THE
COLLABTORY OR ALL THE PROGRAMS
COLLABORATING ON THIS PROJECT.
GOING FROM CELLS TO CIRCUITS TO
BEHAVIOR.
I WANT TO GIVE A SHOUT OUT TO
HOLLY MOORE AT THE BEHAVIORAL
COGNITIVE NEUROSCIENCE BRANCH.
SHE DEVELOPED THIS PROGRAM
THAT'S REALLY A PART OF A LARGER
BRAIN INITIATIVE PROGRAM.
IT'S THE BDQS.
THE GOAL OF THIS PROGRAM IS TO
BE ABLE TO QUANTITIFY BEHAVIOR
AT A HIGH RESOLUTION OF ANIMALS
THAT ARE IN A NATURAL SOCIAL AND
PHYSICAL ENVIRONMENT.
AND SO SYNCHRONIZE THIS WITH
NEURAL ACTIVITY.
SO WE CAN BEGIN TO UNDERSTAND
THE NEURAL CODE OF BEHAVIORS.
THIS SHOWS ONE EXAMPLE PROJECT.
THEY ARE LOOKING AT A COHORT OF
GERBLES.
THEY ARE SOCIAL AND VOCAL
ANIMALS.
FOLLOWING MOTOR ACTIVITY, VOCAL
SKW
IZATION.
AND RECORDING.
AND WE CAN GET THE NEURAL
ENCODING OF THE COMMUNICATIVE
BEHAVIOR AND MOTOR BEHAVIOR.
SO THIS ALONG WITH THE SCORCH
PROGRAM AND THE NEXUS PROGRAM
ARE GOING TO BE GENERATING VAST
AMOUNTS OF DATA THAT ARE GOING
TO BE AVAILABLE TO THE
SCIENTIFIC COMMUNITY TO MINE.
ONE OF OUR GOALS IS TO BE ABLE
TO IDENTIFY BRAIN SIGNATURES OF
CRAVING.
CRAVING HAS BEEN ASSOCIATED WITH
RELAPSE, HIGHLY ASSOCIATED WITH
CONTINUED DRUG USE.
AND SO OUR BEHAVIORAL COGNITIVE
NEUROSCIENCE BRANCH IS
SUPPORTING RESEARCH THAT IS
APPLYING COMPUTATIONAL
APPROACHES ACROSS DIFFERENT
IMAGES FORMATS TO IDENTIFY
NEUROBIOLOGY SIGNATURES OF
CRAVING.
THIS IS JUST ONE EXAMPLE.
APPLYING MACHINE LEARNING TO MRI
STUDIES.
WHICH INDIVIDUALS WERE EXPOSED
TO FOOD OR DIFFERENT ABUSED
SUBSTANCES.
FROM THIS THEY WERE ABLE TO GET
A NEUROBIOLOGICAL CRAVING
SIGNATURES THAT DISTINGUISHED
DRUG USERS FROM NONUSERS.
THIS BRANCH HAS BEEN SUPPORTING
RESEARCH THAT IS APPLYING
COMPUTATIONAL APPROACHES TO
PREDICT TREATMENT OUTCOMES.
AN EXAMPLE IS USING MODELLING
AND IN THIS CASE THIS IS WHERE
FROM LICHENSTEIN.
LOOKING AT COCAINE USERS AND
CANNABIS USERS, AND SHOWING THEY
WENT USE THIS TO ACTUALLY
PREDICT TREATMENT OUTCOMES.
AND IMPORTANTLY THAT'S AN
ASSOCIATED WITH THE OUTCOME IS
REALLY DRUG-SPECIFIC.
IT'S DIFFERENT FROM COCAINE, FOR
EXAMPLE, THAN CANNABIS. ONE OF
THE GOALS OF GENERATING THESE
DATA IS THAT WE CAN THEN BE ABLE
TO USE THESE TYPES OF SIGNATURES
TO GUIDE NEUROMODULATION STUDIES
THAT THEN CAN CHANGE THESE
CIRCUITS AND PREVENT RELAPSE OR
TO SHAPE THE CIRCUITS TO BIAS
THEM TOWARDS BETTER OUTCOMES.
SO JOHN HAS BEEN DEVELOPING A
PROGRAM IN A PORTFOLIO IN
NEUROMODULATION.
TO DO THIS HE'S PUT OUT A COUPLE
OF RFAS ON THIS.
THE MOST RECENT ONE IS TO
CHARACTERIZE USING
NEUROMODULATION TO CHARACTERIZE
A CONTINUUM BETWEEN SUBSTANCE
USE AND MENTAL HEALTH DISORDERS.
AND THIS GOES BACK TO WHAT I WAS
SAYING EARLIER IN THE TALK ABOUT
THE IMPORTANCE OF REALLY
TARGETING A BROADER CIRCUIT THAT
IS ADDRESSING THE COMORBILITY
BETWEEN MENTAL HEALTH DISORDERS
AND SUBSTANCE USE DISORDERS.
AND FINALLY, THE OTHER THING
COMORBILITY THAT WE'VE PUT A LOT
OF FOCUS ON RECENTLY IS THAT
BETWEEN SLEEP DISORDERS AND
ADDICTION.
WE KNOW THAT THERE IS AN
INTERSECTION BETWEEN SLEEP AND
ADDICTION.
THAT DRUGS THAT ARE ABUSED CAN
INTERFERE WITH SLEEP.
SLEEP DISORDERS CAN MAINTAIN
DRUG USE, CAN DRIVE DRUG USE,
CAN PRECIPITATE RELAPSE IN
INDIVIDUALS THAT ARE UNDERGOING
TREATMENT.
AND BASIC RESEARCH THAT WE'VE
SUPPORTED IS BEGINNING TO
UNCOVER SOME OF THE NEURO --
SUBSTRAITS.
AND ONE OF THE SUBSTRAITS HAS
BEEN IDENTIFIED AS THE SYSTEM.
ONE PIECE OF EVIDENCE IS IN
POSTMORTEM.
IT'S A LARGE INCREASE IN
NEURONS.
AROUSAL RELATED PEPTIDE.
THIS WORK INSPIRED THE
HYPOTHESIS THAT AGENTS THAT
INTERFERE WITH IT MIGHT BE
USEFUL IN TREATING SUBSTANCE USE
DISORDER.
AND WE NOW HAVE DTMC IS
SUPPORTING WORK ON THE USE OF IT
FOR TREATMENT OF SUBSTANCE USE
DISORDER.
AND FINALLY I WANT TO GIVE A
SHOUT OUT.
JUST DEVELOPED THIS
COLLABORATIVE PROGRAM.
OPIOID USE AND SLEEP
INTERSECTION STUDY.
THIS IS A HEAL-SUPPORTED STUDY.
WHERE WE'RE TRYING TO USE
SLEEP-BASED PREDICTORS OF OPIOID
USE DISORDER MEDICATION
TREATMENT RESPONSE.
SO BASICALLY WE'RE FUNDING FOUR
DIFFERENT CLINICAL CENTERS.
EACH IS TESTING THEIR OWN
HYPOTHESIS THAT IS LINKING SLEEP
TO OPIOID USE DISORDER.
THEY ARE GENERATING DATA THAT'S
GOING TO THE COORDINATING CENTER
AND PARTICULARLY EEG DATA.
AND WE'RE HOPING TO GET OUT OF
THAT SIGNALS THAT CAN BE USED TO
PREDICT TREATMENT RESPONSE.
SO THROUGH THE YEARS, WE REALLY
BEEN NAVIGATING A VERY
EVER-CHANGING LANDSCAPE THAT
EACH LANDSCAPE HAS ITS OWN
CHALLENGES.
THROUGH THIS WE HAVE BEEN
ADVANCING FUNDAMENTAL BRAIN
SCIENCE, ADVANCING PHARMACOLOGY
TO NEW THERAPEUTIC TARGETS AND
PROBES.
AND ELUCIDATING BIOLOGICAL AND
SOCIO ENVIRONMENTAL
INTERACTIONS.
SO THANK YOU.
AND THANKS FOR YOUR ATTENTION.
I'M READY TO TAKE ANY QUESTIONS.
>> I HAVE A COUPLE QUESTIONS.
THE FIRST IS YOU WERE TALKING
ABOUT SLEEP.
BASICALLY IT'S A PREDICTOR.
PREDICTOR OF OPIOID USE
DISORDER.
I'M WONDERING IF ANY RESEARCH
HAS BEEN DONE ON WE KNOW THAT
PEOPLE WHO ARE EXPERIENCING
HOMELESSNESS OFTEN USE METH TO
STAY AWAKE WHEN IT'S DANGEROUS.
I WAS CURIOUS IF THERE WAS ANY
RESEARCH BEING DONE IN THAT
REGARD.
>> YEAH.
NOT PARTICULARLY IN THIS STUDY
RELATED TO SLEEP.
YOU KNOW, THROUGH SOME OF OUR
STUDIES WE'RE LOOKING AT
POTENTIALS TO PREVENT OVERDOSE
DUE TO THAT COMBINATION.
BUT NO, IT'S A REALLY GOOD POINT
THERE THAT THEY ARE TRYING TO
COUNTER ACT EACH OTHER.
AND THAT MAY BE PART OF THE
DRIVE FOR THAT POLY SUBSTANCE
USE.
>> MY SECOND QUESTION, IS
THERE ANY RESEARCH GOING ON ON
GAMING AND THE OVERLAY BETWEEN
GAMBLING USE DISORDER, GAMBLE
DISORDER AND SUBSTANCE USE
DISORDER.
>> I HAVE GIVEN A LOT OF
THOUGHT TO THAT, PARTICULARLY I
WAS THINKING OF SOCIAL
DETERMINANTS OF HEALTH.
IF YOU EVENED EVERYTHING OUT,
WOULD THERE STILL BE ADDICTION?
AND I THOUGHT TO MYSELF,
GAMBLING ADDICTION.
THAT'S SOMETHING THAT'S VERY
DIFFERENT AND IT'S A VERY
DIFFERENT SOCIAL ENVIRONMENTAL
FACTOR THERE.
AND SO WE ARE NOT -- I DON'T
THINK WE HAVE ANYTHING IN OUR
PORTFOLIO THAT'S INVESTIGATING
THAT, BUT IT'S REALLY IMPORTANT
BECAUSE -- IT'S SORT OF A
CONTROL IN SOME WAYS.
BECAUSE YOU STILL HAVE AN
ADDICTION BUT IT'S REALLY
DIFFERENT FACTORS THAT ARE
DRIVING IT.
>> NO, WE HAVE.
AND THROUGH THE ABCD STUDY.
AND IN FACT, ONE OF THE MORE
CHALLENGING ISSUES AS YOU KNOW
IS THE CONCERNS THAT PEOPLE HAVE
THAT THE OVERRELIANCE ON THE
DEVICES INCLUDING VIDEOGAME,
AMONGTILY YOUNG BOYS IS
CONTRIBUTING.
AN AREA THAT I ALSO -- AND I'M
GLAD YOU BRING IT UP.
WE DO NOT HAVE GRANTS RIGHT NOW
IN GAMBLING ADDICTION.
BUT IT HAS ME EXTRAORDINARILY
WORRIED.
BUT THE LEVEL OF ACCESS TO
GAMBLING RIGHT NOW IS ALL OVER
THE PLACE.
AND WHICH CAN LEAD TO VERY
DEVASTATING CONSEQUENCES.
IS BEING NEGLECTED.
NO ONE IS KEEPING EYES ON THAT
POLICY.
THE WORLD HEALTH ORGANIZATION
HAS RECOGNIZED IT ALREADY.
MUCH MORE AHEAD OF US.
AND I WISH -- IF OUR BUDGET WERE
BETTER WE WOULD.
GUESS WHAT?
IT'S THE SAME.
AND WHEN WE'RE DISCUSSING THIS
ISSUE OF IDENTIFYING MOLECULES
THAT CAN IDENTIFY -- THAT HYPER
ACTIVATION THAT YOU GET WHEN YOU
ARE OBSESSED ABOUT SOMETHING.
I BET YOU THAT'S EXACTLY THE
SAME THING IN GAMBLING.
AND PEOPLE HAVE COMMENTED.
WE ARE NOT FUNDING IT DIRECTLY
IN THE BIG MEASURE JUST BECAUSE
OF LACK OF FUNDING, BUT WE ARE
KEEPING AN EYE WITH THE ABCD.
IT WILL BE PART OF THE HBCD.
YEAH, WE NEED TO DO IT.
AND I'M GLAD YOU BROUGHT IT UP.
WE NEED TO MAKE PEOPLE AWARE
THIS IS AN ISSUE THAT WE CAN NOT
NEGLECT.
ONE OR TWO YEARS FROM NOW, WE
HAVE A SERIOUS PROBLEM.
>> THERE IS LEGISLATION ON
CAPITOL HILL THAT WOULD ERECT
THE GAMBLING PROCEEDS THAT GOES
TO THE FEDERAL GOVERNMENT TO
DEDICATE IT TO RESEARCH AND WORK
FORCE.
BUT, YOU KNOW, WE'LL SEE IF
ANYTHING PASSES.
>> BUT I THINK THAT WHAT WOULD
BE INTERESTING TOO IS TO HAVE
CERTAIN REGULATORY PROCESSES
ESTABLISHED FROM THE BEGINNING,
BECAUSE NOW YOU CAN -- I MEAN,
ANYONE CAN GAMBLE IN THEIR CELL
PHONES.
AND NOW IT MIGHT BE WITH
ARTIFICIAL INTELLIGENCE,
GENERATE A
IT COULD GET MUCH WORSE OUT OF
CONTROL WHAT WE'RE GETTING RIGHT
NOW.
SPEAKING ABOUT IT, AND AGAIN, WE
NEED TO KEEP OUR EYES ON THESE
THAT WE HAVE.
BUT IN TERMS OF SPEAKING, I
MEAN, THIS IS REWARDING, AND
IT'S THE SAME CIRCUIT AND IT'S
THE SAME PROCESS.
>> SO YOU MENTIONED IN YOUR
PRESENTATION, WHICH I THOUGHT
WAS GREAT THE CHALLENGE OF
GENETIC STUDIES WHEN YOU HAVE
NOT DIVERSE ENOUGH ANCESTRY AND
HOW THIS IS IMPORTANT.
AND IF I UNDERSTOOD YOU WELL YOU
WERE SHOWING US THE DIFFERENT
METHODOLOGIES WE COULD USE IN
ORDER TO OPTIMIZE SO THAT YOU
DON'T NEED AS LARGE SAMPLES SO
CAN YOU DO YOUR INVESTIGATION.
SO MY QUESTION IS, WHAT ARE WE
DOING IN TERMS OF ACTUALLY
DIVERSIFYING THE SAMPLES OF THE
PEOPLE WHO ARE PART OF THE STUDY
SO THAT WE ACTUALLY HAVE --
>> WE DO HAVE -- SOME OF THE
MORE RECENT STUDIES THAT WE ARE
SUPPORTING ARE LOOKING AT A
BROADER AND MORE DIVERSE
ANCESTRY.
>> THAT'S GREAT.
>> WE RECOGNIZE THAT'S A
PROBLEM.
SHAKING THEIR HEADS THERE
BECAUSE, YEAH.
>> I'LL JUST ADD TO THAT THAT I
THINK THAT IS THE GAP AND THAT
WE HAVE TO FILL THAT GAP QUICKLY
OR OTHERWISE WE'RE NOT DOING
EQUITABLE RESEARCH.
THAT'S A PRIORITY FOR EVERYBODY
IN THE FIELD.
WE APPRECIATE NIDA'S SUPPORT AND
GETTING OUR SAMPLES UP TO
RESPOND TO EVERYBODY IN THE
POPULATION BECAUSE THIS IS GOING
TO MOVE TOWARDS DRUG REPURPOSING
AND POLY WORKFORCE RETENTION AND
WE CAN'T DO IT JUST IN ONE
GROUP, MOVING ACROSS ALL GROUPS.
I HAD A QUICK QUESTION.
AND THAT HAD TO DO WITH
COMORBIDITIES WITH OTHER MENTAL
HEALTH CONDITIONS.
ONE OF THE THINGS WE WANTED TO
DO OBVIOUSLY IN ADDITION TO ALL
THE SUBSTANCE USE DISORDERS
SHARING GENETIC UNDERPINNINGS WE
SHARED FACTORS, SHARED GENETIC
FACTORS AND DEPRESSION AND
ANXIETY ALL OF THEM.
THEY TEND TO CLING TOGETHER BUT
THEY ALSO HAVE GENETIC
CORRELATIONS.
THIS PROBABLY HAPPENS IN ALL THE
POSTMORTEM SINGLE CELL DATA
THAT'S COMING OUT.
THAT'S SOMETHING THAT I'VE
ALWAYS WONDERED, I DON'T KNOW IF
THERE'S EFFORTS TO DISENTANGLE
THAT BECAUSE IN SOME WAYS FOR
SUBSTANCE USE DISORDERS I THINK
PARTICULARLY CHALLENGING THAT WE
ARE BOTH A CAUSE AND A
CONSEQUENCE, LOOKING AT GENE
EXPRESSION CHANGES THAT BECAUSE
IT'S SUBSTANCE USE DISORDER IS
THAT BECAUSE BENEATH BTL YOU
BRING WITH IT THE FACT THAT AN
INDIVIDUAL WHO POTENTIALLY DIES
FROM AN OPIOID OVERDOSE OR
DEPRESSION, PTSD, ARE YOU SEEING
CONDITIONS THAT ARE CARRY OVERS,
OPPORTUNITIES TO PRIORITIZE THE
DISENTANGL
DISENTANGLEMENT.
>> THAT'S AN EXCELLENT POINT,
TO BE ABLE TO DISENTANGLE.
WE HAVE POSTMORTEM TISSUE, WE'RE
GETTING MULTIPLE RECORDS OF THAT
IN THESE STUDIES AND THAT YES
IT'S AN IMPORTANT THING LIKE YOU
SAY TO DISENTANGLE.
THANKS FOR THE GREAT
PRESENTATION JUST AS A FOLLOW ON
TO WHAT WAS ASKED, I ASSUME THAT
THIS IS THE ANSWER TO THIS IS
YES BUT WOULD LOVE TO HEAR A
LITTLE MORE ABOUT HOW YOU
ACCOUNT FOR SEX DIFFERENCES AS
YOU'RE LOOKING ACROSS ALL THE
STUDIES BECAUSE I THINK THERE'S
SOME FUNDAMENTAL BIOLOGICAL AND
ENVIRONMENTAL INTERACTIONS BY
SEX AND GENDER, WONDERING WHAT
THE PROCESS IS AND THE FRAME
THAT YOU USE FOR THIS.
>> WELL, I THINK IN ALL OF THE
GENETIC SEGMENTS, SCORCH STUDY,
THAT'S ALL -- SEX AS A
BIOLOGICAL VARIABLE IS BEING
CONSIDERED AND REALLY IN ALL OF
THE ANIMAL STUDIES NOW, THIS
IS -- YOU REALLY CAN'T EVEN
PUBLISH WITHOUT CONSIDERING
THAT.
AND WHAT'S GREAT ABOUT THAT IS
THAT YOU OFTEN -- IT OFTEN LEADS
YOU TO NEW HYPOTHESES BECAUSE
YOU FIND DIFFERENCES AND THEN
THAT TELLS YOU SOMETHING ABOUT
THE PROCESS.
SO THIS IS CLEARLY IN OUR RADAR,
AND SOMETHING THAT WE'RE
SUPPORTING AND ENCOURAGING.
ARE THERE ANY QUESTIONS FROM
PEOPLE IN THE CLOUD?
I'M LOOKING AND I'M NOT SEEING
ANY HANDS RAISED.
THANK YOU VERY MUCH.
THAT WAS A WONDERFUL
PRESENTATION.
NOW 3:35, WE'RE GOING TO GO INTO
THE PRESENTATION OF THE NEW
CONCEPTS.
AND THE FIRST FOR CLEARANCE, AND
THE FIRST ONE IS GOING TO BE
PRESENTED BY DR. TISHA WYLIE
PREVENTION RESEARCH AND ENGAGING
LOVED ONES AND RECOVERY AND
OUTCOMES.
TISHA, GOOD AFTERNOON.
>> SO THANK YOU FOR THE
OPPORTUNITY TO PRESENT -- SORRY.
IT WASN'T ON.
SO EARLIER TODAY NORA MENTIONED
HOW DEVASTATING THE OVERDOSE
CRISIS IS AND THE CRISIS THAT'S
MOST DEVASTATING FOR PEOPLE WHO
ARE LOVED ONES OF PEOPLE WHO
HAVE THE DISORDERS, THEY ALSO
FORM THE NETWORK THAT IS THE
FOUNDATION FOR PEOPLE'S RECOVERY
SUPPORT, RECOVERY CAPITAL AND
THEIR RECOVERY PATHWAYS.
SO THE GOAL OF THIS CONCEPT IS
TO ADDRESS SIGNIFICANT RESEARCH
GAPS AROUND OUR UNDERSTANDING OF
HOW TO BEST ENGAGE LOVED ONES IN
THE TREATMENT ENGAGEMENT AND
RECOVERY PATHWAYS.
IT WILL FOCUS ON SUPPORTING
PRAGMATIC TRIALS THAT CAN
SUPPORT SCALABLE SUSTAINABLE
SOLUTIONS TO EXISTING EVPs AND
SERVICE DELIVERY FRAMEWORKS THAT
EMPHASIZE THE ENGAGEMENT OF
LOVED ONES, SPECIFIC AREAS OF
INTEREST FOR THIS INCLUDE BUT
ARE NOT LIMITED TO STRATEGIES
THAT FOCUS ON REDUCING STIGMA
TOWARD ADDICTION AND MOUD AMONG
PERSONS, AND TO PROVIDE
ASSISTANCE TO SUPPORT PERSONS
AND NAVIGATING CARE FOR OPTIONS
FOR THEIR LOVED ONES, FIRMLY
ENGAGING PERSONS IN SERVICES,
AND LEVERAGING THE SUPPORT
PERSONS AS LATE INTERVENTIONIST
TO DELIVER INTERVENTION AND
ENHANCING COPING SKILLS.
THAT'S THE FOCUS OF THIS EFFORT.
TAKE QUESTIONS?
ANY QUESTIONS?
>> ANYONE ON THE SCREEN?
I CANNOT SEE THE SCREEN AS WELL.
I'M FASCINATED BY THIS TOPIC,
WONDER HOW YOU OPERATIONALIZE
AND TRACK RECOVERY CAPITAL.
>> I THINK WE WILL ENCOURAGE
PEOPLE TO LOOK AT THE VARIOUS --
THERE'S MANY RECOVERY CAPITAL
FRAMEWORKS WAYS OF MEASURING IT,
WHAT I WOULD EXPECT IS WE WOULD
COURAGE PEOPLE TO CHOOSE A
RECOVERY CAPITAL FRAMEWORK AND
OPERATIONALIZE IT THROUGH THIS
EFFORT AND HOPEFULLY PERHAPS
EVEN ADVANCE OUR UNDERSTANDING
OF THE RECOVERY CAPITAL THROUGH
A DIFFERENT LENS.
ANY OTHER QUESTIONS?
IF NOT, TISHA, THANKS VERY MUCH.
>> NEXT PRESENTATION FROM THE
OFFICE OF TRANSLATIONAL
INITIATIVES.
WELCOME.
>> THANK YOU AND GOOD
AFTERNOON.
SO OUR FIRST CONCEPT IS
FOSTERING LAY COMMUNITY AND
COMMUNITY WITH LIVED EXPERIENCE
AWARENESS ON BIOMEDICAL PRODUCT
DEVELOPMENT FOR SUBSTANCE USE
DISORDER PROPOSED BY DR. JESS
LIEUUP.
IT'S COSTLY AND A LONG PROCESS,
THE PUBLIC FINDS MYSTERIOUS AND
DIFFICULT TO COMPREHEND.
THIS IS ESPECIALLY PROMINENT IN
SUBSTANCE USE DISORDERS LEADING
TO DISENFRANCHISEMENT OF THE
POPULATIONS.
THEREFORE, IT'S CRITICAL TO
ADDRESS THE GAP IN KNOWLEDGE AND
ENGAGEMENT.
RAISING SOCIETAL AWARENESS IN
THE PRODUCT DEVELOPMENT AREA
WOULD SIGNIFICANTLY FACILITATE
THAT OF INT VENTIVE
INTERVENTIONS INTO THE CARE.
THIS OFFERS A UNIQUE OPPORTUNITY
TO BRING TOGETHER THE EXPERTS
FROM THE PHARMACEUTICAL
INDUSTRY, ACADEMIA, PATIENT
ORGANIZATION, HEALTH
PROFESSIONALS, ETHICAL BODIES,
REGULATORY AUTHORITIES AND MEDIA
TO JOINTLY WORK IN AN OPEN AND
TRANSPARENT WAY TO IMPROVE THE
UNDERSTANDING OF THE BIOMEDICAL
RESEARCH AND DEVELOPMENT ALONG
THE PATIENTS, CAREGIVERS AND
INTERESTED LAY PEOPLE.
THE SECOND CONCEPT IS PROMOTING
DEVICE DEVELOPMENT FOR THE YOUTH
AFFECTED BY THE DRUG ADDICTION
AND SUBSTANCE MISUSE AND IT'S
PROPOSED BY DR. ANGELIONI.
MEDICAL THERAPEUTIC AND
DIAGNOSTIC DEVICES OFFERS
PROMISING MEANS TO MONITOR,
DIAGNOSE, TREAT YOUTH FROM
SUBSTANCE USE DISORDERS.
IN PARTICULAR DIGITAL HEALTH
TECHNOLOGIES, THE OPPORTUNITIES
FOR PEOPLE WHO ARE AVID USERS OF
SUCH TECHNOLOGY.
HOWEVER, UNDER THE CURRENT
PARADIGM, DEVICES ARE OFTEN
DESIGNED FOR ADULTS LIMITING THE
POTENTIAL FOR USABILITY AND
ACCEPTABILITY BY THE ADOLESCENT
POPULATION.
SIMILARLY, THE EXISTING A LEVELS
SUPPORTING THE MEDICAL DEVICES
ARE OFTEN BASED ON AN ADULT DATA
AND IT'S NOT OPTIMIZED FOR
ADOLESCENTS.
SO THE PROPOSED CONCEPT INVITES
RESEARCH AND DEVELOPMENT OF
NOVEL MEDICAL THERAPEUTIC AND
DIAGNOSTIC DEVICES, INCLUDING
SOFTWARE AS A MEDICAL DEVICE
SPECIFICALLY DESIGNED AND
DEVELOPED FOR YOUTH AND
ADOLESCENT POPULATION.
THE THIRD CONCEPT IS RAPID DRUG
AND AGNOSTIC IDENTIFICATION OF
EMERGING THREATS AND IT'S
PROPOSED BY DR. DAN COSTA.
NEW DRUGS ARE ENTERING THE DRUG
SUPPLY CONSTANTLY.
FIRST IT WAS FENTANYL, THEN
SILIN BECAME UBIQUITOUS.
FUTURE TECHNOLOGIES CAN DETECT
EMERGING THREATS IN REAL TIME
WITHOUT THE BURDEN OF LONG
DEVELOPMENT CYCLES SO THE
CONCEPT SOLICITS THE DEVELOPMENT
OF TECHNOLOGIES, SIMILAR IN
ANALYTICAL CAPABILITIES TO THIS
COMBINATION OF LIQUID
COMETOGRAPHY AND MASS
SPECTOGRAPHY, AND IT SHOULD BE
COST PER TEST.
SO HAVE A VERY SMALL FORM FACTOR
AND ALSO BE MORE AGILE,
POTENTIALLY AALLOWING THE RAPID
DETECTION OF THE IMAGING DRUGS
AT THE POINT OF MEET.
AND OUR FINAL CONCEPT IS
BUILDING AN INNOVATION PLATFORM
FOR THE REPURPOSING OF MEDICINAL
PRODUCTS FOR SUBSTANCE USE
DISORDERS AND IT'S PROPOSED BY
MYSELF.
SO DRUG PROPOSING FOR NEW
INVESTIGATIONAL DRUGS.
ALTHOUGH THE BASIC DRUG
ADDICTION RESEARCH IS HIGHLY
ACTIVE, THE TRANSITION TO THE
CLINIC IS SERIOUSLY LIMITED.
THE DRUG REPURPOSES HAS BARRIERS
CHALLENGES, INTEGRATING THE
EXTENSION OF DRUGS.
SO THIS CONCEPT WILL SUPPORT THE
DEVELOPMENT OF FIRST IN CLASS
COHORT AND THE EFFICIENT DRUG
REPURPOSING FOR SUBSTANCE USE
DISORDER ENSURING THE GLOBAL
MEDICAL IMPACT.
THIS PLATFORM WILL OPERATE AS A
HUB FOR KEY INFORMATION TRAINING
RESOURCES AND COOPERATION IN
DRUG REPURPOSING, PROVIDING
EXTENSIVE EXPERTISE THROUGHOUT
THE WHOLE VALUE CHAIN OF DRUG
REPURPOSING, AND IT CAN
ACCELERATE THE DRUG DISCOVERY
AND DEVELOPMENT FOR SUBSTANCE
USE DISORDER.
THANK YOU.
HAPPY TO TAKE ANY QUESTIONS.
>> ANY QUESTIONS?
>> I WANTED TO COMMENT THAT
BASICALLY DO SPEAK UP WHEN YOU
SEE THESE CONCEPTS BECAUSE IT
WAS ONLY A COUPLE OF YEARS AGO
WHERE THE POSSIBILITY OF
FENTANYL STRIPS WAS RAISED AND
THE NEED FOR IT WAS RAISED.
ATEPI ROSE TO THE CHALLENGE AND
ELAINE AND OUR TEAM AND COSTA.
HERE WE ARE YOU SAW THE EARLY
RESULTS TODAY.
I'M EXCITED ABOUT THE DRUG
IDENTIFICATION EMERGING THREATS
AND INNOVATIVE PLATFORM, THE
REPURPOSING.
THESE THINGS CAN BE MORE THAN A
GLEAM IN YOUR EYE.
THEY CAN ACTUALLY TURN OUT TO BE
SOMETHING PRETTY COOL AND VERY
HELPFUL.
SO JUST A COMMENT.
>> THANKS.
THANKS VERY MUCH.
>> THE NEXT PRESENTATION IS
GOING TO BE GIVEN BY DR. MONTOYA
MEDICAL CONSEQUENCES.
IVAN.
>> THANK YOU, NORA.
WE HAVE FOUR CONCEPTS TO
PRESENT.
THE FIRST ONE IS BY RAUL MANDLER
IN COMBINATION WITH THE HIV
RESEARCH PROGRAM AND WITH
MADONNA CHANDLER IS THE DIRECTOR
OF THE PROGRAM, AND THE TITLE IS
CLINICAL RESEARCH ON HIV
ASSOCIATED PAIN IN THE CONTEXT
OF SUBSTANCE USE DISORDERS.
YOU KNOW CHRONIC PAIN IS A
SIGNIFICANT BURDEN FOR PEOPLE
WHO LIVE WITH HIV, ESPECIALLY
THOSE WHO USE DRUGS, AND IT'S
FREQUENTLY ASSOCIATED WITH
DECREASED QUALITY OF LIFE, HIGH
DISABILITY AND, OF COURSE, DRUG
USE RELAPSE.
UNFORTUNATELY, LITTLE IS KNOWN
ABOUT THE MECHANISMS AND FACTS
ASSOCIATED WITH PAIN AND PEOPLE
WHO LIVE WITH HIV AND SUBSTANCE
ABUSE.
THERE'S LITTLE INFORMATION ABOUT
SAFE AND EFFECTIVE TREATMENT FOR
THIS POPULATION.
SO THE GOAL OF THIS CONCEPT IS
TO SUPPORT THE FUNDING
OPPORTUNITY TO PORT THE RESEARCH
TO HELP ELUCIDATE THE MECHANISMS
AND PATHWAYS OF PAIN IN PEOPLE
WHO LIVE WITH HIV AND SUBSTANCE
ABUSE AND THE DEVELOPMENT OF
SAFE AND EFFECTIVE TREATMENT
INCLUDING PHARMACOLOGICAL
DEVICES AND/OR KINDS OF
TREATMENTS FOR THIS COMORBIDITY.
THE SECOND CONCEPT IS BY DREW
THOMPSON TO DEVELOP MEDICATIONS
AND DEVICES FOR COMORBID
SUBSTANCE USE DISORDER.
SO WE HAVE A THEME HERE OF
COMPARABLILITY.
WE HEARD THIS MORNING FROM NORA
INVOLVING THOSE WITH MULTIPLE
DRUGS THOSE ARE VERY FREQUENT
AND THE MAJORITY OF OVERDOSE IN
THE UNITED STATES ARE WITH
MULTIPLE DRUGS.
POLYSUBSTANCE USE IS ASSOCIATED
WITH WORSE TREATMENT AND WORSE
OUTCOMES.
AND THIS IS TO SUPPORT RESEARCH
TO IDENTIFY NEW TARGETS AND
DEVELOP THERAPEUTIC APPROACHES
WHERE COMORBID USE DISORDERS AND
POLYSUBSTANCE OVERDOSE.
THE THERAPEUTIC COULD BE ALONE
OR IN COMBINATION.
THE ULTIMATE GOAL IS TO ADVANCE
DEVELOPMENT OF SAFE AND
EFFECTIVE FOR POLYSUBSTANCE USE
DISORDERS.
THE THIRD CONCEPT IS BY JAYBI
WONG THE DISCOVERY OF NATURAL
PRODUCTS TO TREAT SUBSTANCE USE
DISORDERS.
NATURAL PRODUCTS IN NATURAL
PRODUCT LIKE COMPOUNDS REPRESENT
THE HIGHLY DIVERSE AND PROMISING
CHEMICAL SPACE FOR DISCOVERY AND
DEVELOPING MEDICATIONS TO TREAT
DISEASES, INCLUDING CNS
DISEASES.
SO RECENT TECHNOLOGICAL ADVANCES
HAVE FACILITATED THE PROCESS OF
DISCOVERY OF NOVEL BIOACTIVE AND
NATURAL PRODUCTS, INCLUDING
PREFRACTIONISTATION, AND NATURAL
PROTEIN INSPIRED LIBRARY
GENERATION, CELL-FREE AND
CELL-BASED CLEANING AND TOOLS
FOR RAPID COMPOUND DEAL
REPLICATION FROM NATURAL
PRODUCTS.
AND ALSO ARTIFICIAL INTELLIGENCE
IN MATCHING ALGORITHMS ARE BEING
USED NATURAL PRODUCT DRUG
DISCOVERY TO INCREASE THE
PIPELINE OF THESE PRODUCTS.
SO THE GOAL OF THIS CONCEPT IS
TO LEVERAGE THE RECENT
TECHNOLOGY DEVELOPMENTS IN
PARTNERSHIP WITH THE NATIONAL
CANCER INSTITUTE, THE NATIONAL
CENTER FOR COMPLEMENTARY
INTEGRATIVE HEALTH AND NATIONAL
CENTER FOR ADVANCING
TRANSLATIONAL SCIENCE TO
ENCOURAGE AND SUPPORT THE
FUNDING OPPORTUNITY TO ADVANCE
RESEARCH OF NATURAL PRODUCT
FOCUSED RESEARCH INVOLVING FROM
LEAD DISCOVERY ALL THE WAY TO
DRUG DEVELOPMENT TO ADDRESS THE
CHALLENGE OF TREATMENT OF
SUBSTANCE USE DISORDERS.
AND THE LAST CONCEPT I AM THE
AUTHOR AND IT'S KIND OF A
DIFFERENT CONCEPT.
THE OTHERS ARE MORE LIKE
RESEARCH FOCUSED, AND THIS
CONCEPT IS TO REQUEST TO PUBLISH
A FUNDING OPPORTUNITY TO REQUEST
APPLICATIONS, LOOKING AT ANNUAL
CONFERENCE IN THERAPEUTICS
DEVELOPMENT FOR SUBSTANCE USE
DISORDERS.
SO THIS IS THE IDEA OF THIS
CONCEPT IS TO -- WE KNOW THAT
THE BODY OF RESEARCH OF NEW
THERAPEUTICS FOR SUBSTANCE USE
DISORDERS HAS BEEN INCREASING
ESPECIALLY AS A RESULT OF
HEALED.
AND MULTIPLE RESEARCH QUESTIONS
AND CHALLENGES HAVE EMERGED
DURING THIS TIME AND NEW TOOLS
TO IDENTIFY COMPOUNDS VALIDATE
AND LOOK AT THE PREDICTABILITY
OF PRECLINICAL MODELS, CLINICAL
TRIALS DESIGN, OUTCOME MEASURES,
REGULATORY REQUIREMENTS, ET
CETERA.
WE KNOW THAT MOST OF THE
PSYCHIATRIC CONFERENCE ARE NOT
FOCUSED ON SUBSTANCE ABUSE, AND
WE KNOW THE SUBSTANCE ABUSE
CONFERENCES ARE MORE FOCUSED ON
EITHER PRECLINICAL OR CLINICAL
RESEARCH.
THERE'S NO SINGLE CONFERENCE
WHERE PEOPLE WHO ARE DEVELOPING
TREATMENT OR SUBSTANCE USE
DISORDERS CAN GET TOGETHER AND
DISCUSS AND HAVE ALL THOSE
CHALLENGES.
AND TRY TO SOLVE THE CHALLENGES
ASSOCIATED WITH THE DEVELOPMENT
OF NEW THERAPEUTICS.
SO THE GOAL OF THIS CONCEPT IS
TO SUPPORT A FUNDING OPPORTUNITY
TO SUPPORT A CONFERENCE TO
DEVELOP AND IMPLEMENT AN ANNUAL
SCIENTIFIC MEETING THAT INVOLVES
PARTICIPANTS FROM ACADEMIA,
INDUSTRY AND, OF COURSE, NIDA TO
ADVANCE THE DEVELOPMENT OF
THERAPEUTICS AND SUBSTANCE USE
DISORDERS.
SO THE GOAL IS THIS FACILITATE
KNOWLEDGE SHARING, ENCOURAGING
INFORMATION BY IDENTIFYING AND
ADDRESSING COMMON CHALLENGES
FACED BY ALL SECTORS.
AS I SAID INCLUDING INDUSTRY,
FOSTER COLLABORATION, FACILITATE
TRANSACTIONS AND VERY IMPORTANT
IS TO INVOLVE THE FDA SO WE CAN
HAVE A VERY PRODUCTIVE
COMMUNICATION WITH THE FDA TO
ADVANCE THE DEVELOPMENT OF
PRODUCTS TOWARDS FDA APPROVAL.
THOSE ARE THE FOUR CONCEPTS THAT
WE HAVE FROM THE TMC.
YOU HAVE ANY QUESTIONS.
YES, PLEASE.
>> QUESTION ON THE LAST ONE,
SOUNDS LIKE A GREAT IDEA.
WONDERING IF THERE'S ANY THOUGHT
GIVEN TO HOW TO ENGAGE PEOPLE
WITH LIVED EXPERIENCE OR IF THAT
WOULD BE SOMETHING THAT YOU
WOULD EMPHASIZE?
>> ABSOLUTELY, YES.
THAT WILL BE PEOPLE WHO DEVELOP
COMMUNICATIONS AND PEOPLE WHO
HAVE HISTORY AND CAN PROVIDE
FEEDBACK ABOUT LIKE, FOR
EXAMPLE, OUTCOMES OR WAYS TO
TREAT DIFFERENT INNOVATIVE
APPROACHES.
SO IT WILL BE OPEN TO BASICALLY
ANYONE INTERESTED IN THE
TREATMENT OF SUBSTANCE USE
DISORDERS.
>> I THINK THAT'S WHAT HE'S
SUGGESTING THAT THEY SHOULD BE
AN INTEGRAL PART OF THE
OPERATIONS BECAUSE OTHERWISE
THEY ARE NOT NECESSARILY
INCLUDED.
NOT JUST WAITING FOR THEM TO
COME IN.
>> ABSOLUTELY.
OKAY. AND NEUROSCIENCE AND
BEHAVIOR.
>> GOOD AFTERNOON, EVERYBODY.
SO THE FIRST CONCEPT THAT I'LL
BE PRESENTING I'M A SIGNATURE
AND COLLABORATION AMONGST MYSELF
AND DOCTORS KATHLEEN BORGMAN
OTHERS.
ASSOCIATED WITH HIV PAIN IN THE
CONCEPT OF SUBSTANCE USE
DISORDERS.
PAIN IS MORE THAN JUST
NOCICEPTION IT'S COMPLEX AND
CHALLENGING TO BOTH STUDY AND
TREAT.
FOR HIV WITH COMORBID SUBSTANCE
USE DISORDER MYRIAD CONTRIBUTING
FACTORS ARE EMERGING IN BOTH THE
MOLECULAR AND BEHAVIORAL LEVELS
THAT SHOULD BE ADDRESSED WITH
TARGETED RESEARCH INTO CORE
MECHANISMS OF HOW AND WHY PAIN
IS EXPERIENCED BY PEOPLE LIVING
WITH HIV AND COMPLICATED BY SUV.
IT WILL PROBING AND MEDICATIONS
AND PAIN THE PAIN IN CONTEXT OF
HIV INFECTION WITH SPECIAL
ASPECTS OF GUIDING INTERVENTION
AND REDUCE THE RISK OF ANALGESIC
MEDICATION OVER LONG-TERM USE.
THE SECOND TOPIC THAT I'LL
PRESENT IS ALSO COLLABORATIVE
EFFORT WITH MYSELF AND DR
DR. PAWLICK.
THIS IS THE DISCOVERY OF CIRCUIT
MECHANISMS REWARD PROCESSING IN
THE BRAIN IS OBVIOUSLY A CORE
COMPONENT OF THE NEUROBIOLOGY OF
ADDICTION.
HOWEVER, THE REWARDING ACUTELY
REWARDING PROPERTIES OF A DRUG
DO NOT ALWAYS PREDICT THE RISK
OF ADDICTION FOR THAT DRUG,
PARTICULARLY THE INDIVIDUAL
LEVEL.
RATHER, THERE ARE INTRICATE
CIRCUITS OF OPPOSING SIGNALS AND
CONTEXTUAL MODIFIERS OF THE
DRUG'S PERCEIVED EFFECTS THAT
MUST ALSO BE CONSIDERED IN THE
MECHANISMS AND TRAJECTORIES OF
ADDICTION.
THIS CONCEPT WILL ADDRESS
CIRCUITS AND THE SIGNALLING
MECHANISMS ASSOCIATED WITH THOSE
CIRCUITS THAT ACT TO OPPOSE OR
OTHERWISE MODULATE THE ADDICTIVE
PROPERTIES OF DRUGS.
THIS WILL BE USED FOR POTENTIAL
TARGETS FOR FUTURE THERAPEUTICS
AND ALSO TO ADVANCE OUR
UNDERSTANDING OF HOW THE BRAIN
PROCESSES DRUG ASSOCIATED
STIMULI AND HOW THE BALANCE
BETWEEN ACTIVE AND COUNTER
ADDICTIVE ANALYSIS CONTRIBUTE TO
THE SPECTRUM OF SUBSTANCE ABUSE
DISORDER PATHOLOGY THAT WE
OBSERVE.
THE THIRD CONCEPT IS
NEUROMODULATION CONTROLLERS IN
SUBSTANCE USE DISORDER.
NEUROMODULATION IS ADVANCING IN
ITS DEVELOPMENT OF TARGETS TO
INTERVENE NEUROPSYCH CONDITIONS
AND NEUROSUBSTANCE DISORDERS AND
NEUROMODULATION IS AN INTENSIVE
ITERATIVE PROCESS WITH TRIAL AND
ERROR STIMULATION MODALITIES,
PARAMETERS AND ANATOMICAL
TARGETS BEFORE SIGNIFICANT
THERAPEUTIC IMPROVEMENTS ARE
ACHIEVED IF AT ALL.
HOWEVER ONE OF THE MOST
ATTRACTIVE ASPECTS OF THIS
THERAPY IS ITS ADAPTABILITY
POTENTIAL FOR INDIVIDUALIZATION
BUT TO ENSURE THE MOST ROBUST
AND WIDESPREAD APPLICATION AND
ADOPTION OF THESE APPROACHES THE
PROCESS NEEDS TO BE STREAMLINED.
THIS CONCEPT WILL MOTIVATE THE
DESIGN BUILD TEST CYCLE FOR
SYSTEM CONTROL THEORY PHASED
LOOP EVALUATION OF
NEUROMODULATION THERAPIES AND
SUBSTANCE USE DISORDER.
IT WILL CHALLENGE THE FIELD TO
PRESENT RATIONALE FOR KEY
MARKERS OF TARGETED ENGAGEMENT
RESPONSE TO MODULATION AND THE
OPTIMIZATION PROCESS RELATIVE TO
CURRENT METHODS.
THE NEXT CONCEPT IS
MULTI-SENSORY INTEGRATION
INTRACEPTION, DISORDER.
THE PSYCHO ACTIVE DRUGS
INCLUDING ADDICTIVE ONES IS KEY
TO THE IMPACT THE EXPERIENCE
WILL HAVE ON SUBSEQUENT
BEHAVIOR, SUCH AS THE DESIRE TO
HAVE THE EXPERIENCE AGAIN OR
NOT.
ADDICTIVE DRUGS IS PART OF THEIR
CONSTELLATION OF EFFECTS WITHIN
THE BRAIN MAY ALSO ACT WITH
SECONDARY REINFORCING PROPERTIES
THAT AUGMENT THE INTENSITY OF
STIMULI LIKE SENSORY
INFORMATION.
INTRIGUELY, NOVEL STIMULI IS
BEING EXPLORED FOR POTENTIAL
VALUE AS THERAPEUTICS AND
THERAPEUTIC ADJUVANTS BUT LITTLE
IS KNOWN ABOUT THE COMPLEX
INTERPLAY BETWEEN DRUG EFFECTS
AND CONTEXTUAL PROCESSING AND
WHETHER IT MAY BE LEVERAGED AS A
MEAN TO INTERVENE IN THE CYCLE
OF ADDICTION.
THIS CONCEPT WILL MOTIVATE
RESEARCH INTO NEUROCIRCUITS THAT
ARE RESPONSIBLE FOR INTEGRATING
COMPLEX MULTI-SENSORY INPUTS HOW
DRUGS ACT ON THESE CIRCUITS TO
MODIFY SUBJECTIVE EXPERIENCES
AND HOW FORMS OF LASTISTY MAY BE
USED AS THERAPEUTICS IN
SUBSTANCE USE DISORDER.
AND LASTLY, AT LEAST FOR THIS
SLIDE, WE HAVE THE MATERNAL
MORTALITY FROM DRUG OVERDOSE.
THIS IS PRESENTED BY NARE.
WHILE NIDA RESEARCH FOCUSES ON
THIS BUT NONE ON THE OVERDOSE.
THE BIOLOGICAL MECHANISMS
INCREASING TO MORTALITY AND
MIGHT ENHANCE TREATMENT QUALITY
DURING PREGNANCY IN THE
POSTPARTUM PERIOD.
THE GOAL OF THIS CONCEPT IS TO
ESTABLISH RESEARCH THAT CAUSES
THE UNDERSTANDING BY OVERDOSE
AND THE EPIDEMIOLOGY AND
TREATMENT STRATEGIES IN THIS
HIGH RISK POPULATION.
NOW I'LL BE HAPPY TO TAKE ANY
QUESTIONS.
>> YES, SHELLY.
>> THANKS SO MUCH FOR THAT.
I JUST WANTED TO COMMENT AND ASK
YOU A QUESTION ABOUT THE LAST
CONCEPT THAT YOU JUST PRESENTED
ON MATERNAL MORTALITY.
JUST BECAUSE COUPLE THINGS THAT
HAVE OUTLINED AROUND THE
IDENTIFICATION OF SPECIFIC
WINDOWS OF VULNERABILITY DURING
GESTATION AND POSTPARTUM
PERIODS.
HOW YOU IDENTIFY THE POSTPARTUM
PERIOD WILL BE CRITICAL TO YOUR
CONCEPT BECAUSE POSTPARTUM IS
JUST DEFINED AS PERRY PARTUM
LEVEL, EIGHT WEEKS, FOUR WEEKS,
IT'S ACTUALLY 12 TO 24 MONTHS IS
THE POSTPARTUM PERIOD.
MASSACHUSETTS ONE OF THE HIGHEST
PERIODS OF OVERDOSE FROM OPIOIDS
MAYBE YOU KNOW THIS WAS IN THE
FINAL PART OF THE FIRST YEAR
FOLLOWING BIRTH.
AND SO IN FACT I THINK HOW
YOU'RE GOING TO DEFINE THAT IS
CRITICAL TO THE WAY IN WHICH YOU
WILL RECEIVE APPLICATIONS AS
LIKE ONE CRITICAL THING.
NOW, THE SECOND THING IS HOW YOU
MIGHT DEFINE THE DIAD, WHEN
YOU'RE TALKING ABOUT THE
POSTPARTUM PERIOD YOU NEED TO
DISCUSS THE INFANT THAT'S ALSO
THE -- IT'S NOT LIKE A LOT OF
WHAT WE DO IS WE LOOK AT THE
INFANT OR WE LOOK AT THE MOTHER
BUT WE DON'T LOOK AT THE DIAD,
VERY IMPORTANT AS KNOWN FOR 100
PLUS YEARS.
AND THE THIRD THING WOULD BE
WHEN YOU'RE LOOKING AT THE WHOLE
BUNCH OF FACTORS THAT GO INTO
THIS.
I KNOW YOU WANT THEM AS A COAL
SOCIO CULTURAL AND ENVIRONMENTAL
AREA, I THINK WE REALLY DO NEED
PERTINENT TO THESE CONVERSATIONS
WE HAD WE DO NEED TO LOOK AT THE
LACK OF SUPPORT FOR MATERNAL
HEALTH, WHICH FOLLOWS ON IN THE
POSTPARTUM PERIOD AND CAN
INCLUDE EVERYTHING FROM TRYING
TO FOOD SECURITY, HEALTH
INSECURITY, IT'S SLEEP RELATED
ISSUES, PAIN RELATED ISSUES IT'S
ALL THOSE ISSUES.
I KNOW YOU CAPTURED ONE GREAT
THING HERE WHICH IS THE
MORBIDITIES, POSTPARTUM AND
MENTAL HEALTH CONDITIONS, I
THINK ALL THOSE THINGS
EXPLICITLY WITH THE SOCIO
ENVIRONMENTAL FACTORS ARE GOING
TO BE REALLY CRITICAL.
I WOULD JUST SAY POSTPARTUM, 12
TO 24 MONTHS, AND THE DAD.
THOSE TWO THINGS ARE REALLY
CRITICAL TO THIS.
IT'S A GREAT CONCEPT.
>> ABSOLUTELY.
THIS IS SANILA.
THANK YOU VERY MUCH FOR THOSE
COMMENTS.
I JUST WANTED TO -- SO ONE OF
THE GOALS IS DEFINITELY IF YOU
LOOK AT THE POSTPARTUM PERIOD
WITH GREATER GRANULARITY.
IN FACT, THERE WAS A STUDY WHICH
SHOWS THAT THERE'S AN INCREASE
IN VULNERABILITY.
THE POSTPARTUM PERIOD AND NOT IN
THE POSTPARTUM PERIOD, IT'S
CRITICAL TO LOOK AT THE
POSTPARTUM PERIOD WITH THE
REALLY FINE LENS TO FIGURE OUT
PERIODS OF VULNERABILITY AND
THEN TO UNDERSTAND MECHANIC SCLI
WHAT'S GOING ON THERE.
>> THESE ARE GREAT CONCEPTS.
I WANTED TO ESPECIALLY FOR THE
ANTI-ADDICTIVE CIRCUITS AND
MULTI-SENSORY AND MODULATION, I
THINK YOU WOULD -- WITH THE
NOTICES BEING BOTH HUMAN AND
BASIC STUDIES?
>> OKAY.
GREAT.
>> I WOULD ENCOURAGE THAT.
ANY OTHER QUESTIONS?
IF NOT, WE THANK YOU VERY MUCH
AND NOW WE MOVE TO DR. JONATHAN
PAWLICK.
>> GOOD AFTERNOON.
SO WE HAVE FIVE OTHER CONCEPTS
TO PRESENT.
THE FIRST ONE IS THE EFFECTS OF
HIV ON DRUG SEEKING AND
IMPULSIVE BEHAVIOR.
WHICH IS A CONCEPT I DEVELOPED.
WHILE SUBSTANCE USE AND HIV ARE
HIGHLY COMORBID DISORDERS AND
SUBSTANCE ABUSE EXACERBATES IT,
EMERGING EVIDENCE SHOW VIRAL
PROTEINS MIGHT HAVE EFFECTS FOR
SOME ADDICTIVE SUBSTANCES THE
KEY QUESTION IS WHETHER HIV
INCREASES THE SEVERITY OF THE
DRUG USE AND ADDICTION AND
UNDERSTANDING WHETHER HIV
INFECTION ALTERS DRUG SEEKING
BEHAVIOR AND IMPULSIVITY IS
IMPORTANT FOR BETTER MANAGING
THE TREATMENT OF SUD AND HIV
INFECTION.
MUCH OF OUR RESEARCH HAS BEEN
FOCUSED ON LOOKING WHETHER THE
DRUG ACTUALLY EXACERBATES HIV.
THIS IS SORT OF THE INVERSE OF
IT.
THE SECOND CONCEPT BY WOO IN MY
BRANCH IS IN VIVO RESEARCH ON
THE EFFECTS OF HIV EXPRESSION
PERSIST
PERSISTENCE, IT FOCUSES ON THE
COMPLEX INTERACTION BETWEEN
METHAMPHETAMINE USE AND HIV
DISEASE BIOLOGY IN VIVO, BECAUSE
MOST OF THE RESEARCH THAT WE
HAVE DONE IS IN IN VITRO.
SO IT REALLY SUPPORTS
MECHANISTIC STUDIES AND RESEARCH
CONNECTING RESEARCH OUTCOMES
WITH THE IN VIVO MODELS OF HIV
AND CLINICAL STUDIES IN PEOPLE
WHO HAVE HIV ACROSS THE HUMAN
LIFESPAN.
NEXT ONE IS ANOTHER CONCEPT BY
WOO IN MY BRANCH.
IT IS EXPLORING THE ROLES OF
ENDOCABINOIDS AND ENDOGENOUS ON
BRAIN DEVELOPMENT.
WE'RE SEEING INCREASING, WOMEN
ARE INCREASINGLY USING CABINOIDS
AND CANNABIS DURING DEVELOPMENT.
SO THIS INITIATIVE SEEKS TO
FOSTER STUDIES ON THE ROLE OF
THE ENDOCABINOIDS AND THE IMPACT
THAT AN EXOGENOUS EXPOSURE
DURING BRAIN DEVELOPMENT.
SPECIFIC PROGRAM INTERESTS
INCLUDE ARE THE ROLE OF THE
ENDOCABINOIDS AND THE GENETIC
EPIGENETIC REGULATION OF
DEVELOPMENT, THE NEURAL AND
GLIAL PROGRESSION AND
NEUROCIRCUIT AND SYNAPTIC
PLASTICITY AND THE EXPOSURE ON
THE DEVELOPING BRAIN.
THE NEXT CONCEPT IS BY JOHN
SATTERLY, LOOKING AT SUSTAINED
ADDICTION RECOVERY MECHANISMS,
ATTRIBUTES, PROCESSES AND
PERSISTENCE CALLED STARMAP.
AND THIS SEEKS TO SUPPORT
RESEARCH ON MECHANISMS ON
SUSTAINED RECOVERY.
AND THE LAST CONCEPT BY SUSAN
WRIGHT IS ON DATA INTEGRATION TO
REVEAL BY LOCAL PATHWAYS
UNDERLYING SUBSTANCE USE
DISORDER IT TRIES ATTEMPTS TO
INTEGRATE IMAGING ACROSS
MODALITIES DTI RESTING STATE OF,
MFRI AND IMAGING WITH GENETIC
SURVEY DATA.
THANK YOU.
QUESTIONS.
>> COMMENT I THINK IT'S A
USEFUL FIELD TO LOOK AT SOME OF
THE THINGS THAT ARE GOING ON
WITH LONG-TERM RECOVERY.
IT'S VERY TOUGH IN HUMAN
POPULATIONS TO GET LARGE
POPULATIONS OF PEOPLE, TO GET
THEM TO CHARACTERIZE THEM.
SO GOOD CONCEPT.
BY ALL MEANS.
>> THANKS.
I HAD A QUESTION ABOUT THE FIRST
ONE, DRUG SEEKING IS USUALLY
TYPICALLY IN MY WORLD ANYWAY
IT'S A CRIMINAL JUSTICE TERM.
I WAS CURIOUS ABOUT --
>> THE TERMINOLOGY IS MOSTLY
BEING APPLIED TO ANIMAL STUDIES.
>> I'M SORRY.
>> IT'S BEING APPLIED HERE
ANIMAL STUDIES IN TERMS OF
RELAPSE, FOLLOWING EXTENSION OR
DRUG INDUCED RELAPSE.
>> DO YOU HAVE A CONCERN?
>> IT SEEMS AS A SOMEWHAT
STIGMATIZING TERM.
>> YOU SUGGEST THE --
>> BASICALLY.
>> REINSTATEMENT OR --
>> IF YOU HAVE ANOTHER TERM FOR
IT, WE'RE HAPPY TO CHANGE THE
TERM.
>> IT'S BASICALLY THE
INTERPLAY.
YOU'RE LOOKING AT THE CHRONIC
CONDITION AND WHETHER OR NOT THE
PERSON IS USING MORE SUBSTANCES
THAT'S THE INTERPLAY BETWEEN HIV
AND --
>> SO THE QUESTION IS IN TERMS
OF THE BASIC SCIENCE MECHANISM
OF WHETHER THE ACTUAL PROTEINS
OR THE INFECTION ALTERS THE
REWARD PATHWAYS TO ENHANCE
ADDICTION OR THE COMPULSIVITY OF
DRUG USE.
I'M ASKING YOU IF YOU HAVE A
BETTER TITLE.
>> WELL WHAT YOU JUST SAID.
ON COMPULSIVE DRUG USE AND
IMPULSIVE BEHAVIOR, NOTED.
>> IF IT'S INDIVIDUAL ANIMAL
MODELS I DON'T KNOW IF YOU HAVE
TO LEVERAGE DRUG SEEKING.
THE SIGNALS, THE CUES.
>> THIS IS AGAIN WHERE THE
PRECLINICAL WORLD AND THE
CLINICAL WORLD RELIES BECAUSE
THIS IS THE TERMINOLOGY THAT'S
USED EVERYWHERE AND I HAD
ANNETTE WAS CONSIDERED
STIGMATIZING.
IS IT NOT JUST PER SE COMPULSIVE
BECAUSE THE COMPULSIVE YOU'RE
ACTUALLY TAKING THIS AND YOU
JUST TAKE IT COMPULSIVELY DRUG
SEEKING IS GETTING TO THE STAGE
WHERE YOU'RE GOING TO BE
ADMINISTERING.
SO IT ENTAILS OTHER COMPONENTS.
LET'S THINK IF THERE'S ANOTHER
WORD.
IT'S NOT JUST COMPULSIVE THAT
COULD BE USEFUL.
>> IT'S REINSTATEMENT OF DRUG
USE.
IT'S THE ACQUISITION OF DRUG USE
SO DRUG SEEKING TO ME NEVER -- I
NEVER THINK OF IT AS
STIGMATIZING.
RATHER I THINK OF THE ACTIONS,
BEHAVIOR OF OUR -- IF IT'S
STIGMATIZING IN TERMS OF THE
CLINICAL TIME --
>> I BET I KNOW SORT OF HOW
YOU'RE THINKING ABOUT IT,
THOUGH, BECAUSE IF PATIENTS ARE
PEOPLE STRUGGLING WITH ADDICTION
ARE SEEKING A PRESCRIPTION,
SOMEWHERE, AND SAID, OH, THESE
DRUGS, SHE'S DRUG SEEKING, THAT
OF COURSE IS DIFFERENT THAN
THESE MODELS.
>> ARE THESE ACTUAL STUDIES?
>> THIS IS GOING TO BE AN
ANIMAL STUDY.
>> CALL IT BOARD --
>> ON MOTIVATED DRUG.
>> IT DOESN'T TYPICALLY
CAPTURE.
>> CAPTURE IT.
>> ACTUALLY --
>> NO, IT'S NOT OLD.
>> THEY'RE SEEKING IT --
>> LET'S THINK ABOUT IT.
I DON'T THINK IT'S A SIMPLE ONE.
I THINK IT WILL BE GOOD TO ASK
QUESTIONS ANIMAL MODELS LIKE
GEORGE, WHAT OTHER WORDS COULD
CAPTURE IT.
PEOPLE WITH THESE LIVES THE
ANIMAL MODEL.
>> CAN I JUST MAKE ONE QUICK
COMMENT?
I THINK IT'S A REALLY
INTERESTING -- I THINK IT'S A
REALLY INTERESTING CONVERSATION,
AND BECAUSE TRYING TO FIGURE OUT
THE TERMINOLOGY THAT ACCURATELY
WILL REFLECT THE PRECLINICAL
ANIMAL MODELS IS REALLY
IMPORTANT AND ALSO I THINK WE
THINK ABOUT ADDICTION, SOME OF
THOSE TERMS THEN MAKE A LEAP
ACROSS INTO THE CLINICAL
POPULATIONS WHERE THEY TAKE ON A
MEANING THAT IS INCREDIBLY
HIGHLY STIGMATIZED, LIKE DRUG
SEEKING IS WITHIN CLINICAL
POPULATIONS VERY STIGMATIZED.
SO IT'S JUST -- WE'RE NOT GOING
TO SOLVE THIS HERE, BUT IT IS
ONE OF THESE REALLY INTERESTING
CONVERSATIONS BECAUSE WE ALL
KNOW THE LANGUAGE IS REALLY
IMPORTANT.
AND SO I'M TRYING TO FIGURE OUT
WHAT'S GOING TO BE ACCURATE WHEN
YOU'RE STUDYING ANIMAL MODELS,
BUT RECOGNIZING IN FACT -- I
DON'T KNOW HOW TO SOLVE THAT
PROBLEM, RECOGNIZING IN FACT THE
TERMINOLOGY TAKES A LEAP OVER
INTO CLINICAL SCIENCE AND THEN A
LEAP INTO POLICY AND
STIGMATIZING POPULATIONS.
SO WE'RE NOT SOLVING IT TODAY,
BUT I THINK THE CONVERSATION'S
INCREDIBLY IMPORTANT JUST IN
TERMS OF HOW WE THINK OF THE
SCIENCE OF ADDICTION, YOU KNOW?
>> YOU HAVE SOME MORE THOUGHTS.
PLEASE CONTACT ME OR NORA AND --
>> ABSOLUTELY, WE'LL WORK ON
IT.
ACTUALLY THE CONCEPT YOU HAVE
TERMS THAT ARE BASICALLY VERY
NEUTRAL THEN THEY GET INTO A
CONTEXT AND IF SOMETHING
HAPPENS, THEN THEY BECOME
STIGMATIZING.
THE LANGUAGE IS SOMETHING THAT
IS CHANGING AND IS VERY MUCH
DEPENDENT ON CIRCUMSTANCES AND
CULTURE.
SO I ACTUALLY WOULD AGAIN
SEEK -- THE FIRST TIME, JUST
LIKE SEEKING.
I'M GOING TO BE SEEKING ADVICE
FOR GETTING ALTERNATIVE
TERMINOLOGIES THAT WILL REFLECT
WHAT WE WANT TO DO, BECAUSE
CREATING THAT ENHANCED
MOTIVATION FOR THE DRUG WHICH
WILL LEAD WHAT THESE MODELS ARE
TO DO TO SEEK TO CHANGE
BEHAVIORS TO ENRICH IT.
I GUESS SOMEONE WHO IS GOING
INTO THE PHARMACIES TO GET THEIR
MEDICATION IS DOING BECAUSE THEY
ARE SEEKING IT.
IT STARTS TO GET ALCOHOL.
THEY'RE SEEKING THE DRUG.
>> THERE COULD BE ENHANCED DRUG
MOTIVATION, ENHANCED DRUG USE.
>> IT'S MOTIVATION.
>> NO, WE'RE NOT GOING TO SOLVE
IT.
>> WE'RE NOT GOING TO TRY TO
SOLVE IT HERE.
SO I THINK THE WAY THAT SHELLY
BROUGHT IT UP IS VERY GOOD.
IN TERMS OF WHAT WE'RE USING IN
THE CLINICAL WORLD WE NEED TO BE
MINDFUL THEY CAN HAVE
STIGMATIZED PERSPECTIVES IN THE
CLINICAL WORLD AND UNDERSTANDING
HOW TO USE THEM PROPERLY.
WE ALSO UNDERSTAND THAT LANGUAGE
CHANGES.
>> COULD I MAKE A COMMENT?
>> ABSOLUTELY, YES.
>> ACKNOWLEDGING THAT WE'RE NOT
GOING TO SOLVE IT.
WOULD IT BE POSSIBILITY TO
INCLUDE IN THE ACKNOWLEDGMENT OF
STIGMATIZATION, IF WE DON'T DO
THAT IS FOR THIS AND OTHER
WORDS.
>> WE CAN.
IF YOU FEEL THERE'S CERTAIN
TERMS WE HAVE THAT COULD BE THE
POTENTIAL FOR STIGMATIZING,
ABSOLUTELY, WE'RE REQUESTING
PROPOSAL THAT'S NOT WORTH HUMAN
STUDIES BUT THAT COULD BE A
MISUSE.
WE CAN DEFINITELY LOOK A
CLARIFYING STATEMENT NOT JUST
FOR THIS ONE, BUT FOR OTHERS
EMERGING IN THE FUTURE.
JUST A SUGGESTION.
>> THANKS VERY MUCH.
I DIDN'T SEE ANY HANDS ON OUR
CLOUD PARTICIPANTS.
NOW IT IS 4:15.
WE'RE GOING TO GO TO THE NEXT
STAGE.
WE CAN JUMP INTO PUBLIC COMMENTS
AT THIS POINT.
SO AT THIS POINT I'M GOING TO
ASK IF THERE ARE ANY MEMBERS OF
THE PUBLIC THAT WISH TO COMMENT.
IF THAT IS THE CASE, PLEASE
INTRODUCE YOURSELF AND KEEP YOUR
COMMENTS TO UNDER THREE MINUTES.
MEMBERS OF THE PUBLIC NOT IN THE
ROOM WHO WISH TO EXPRESS ON ANY
ITEMS DURING THIS MEETING MAY DO
SO WRITING TO DR. SUSAN WHITE
THE EXECUTIVE SECRETARY WITHIN
TEN DAYS OF THE MEETING.
SO IF THERE'S ANY MEMBER OF THE
PUBLIC THAT WANTS TO SPEAK NOW,
PLEASE COME TO THE MICROPHONE,
INTRODUCE YOURSELVES AND POSE
YOUR QUESTION.
OR COMMENT.
I DON'T THINK WE HAVE ANY
COMMENTS.
I DIDN'T GET ANY WRITTEN
BEFOREHAND.
THAT MEANS THAT WE CAN ADJOURN.
YES, WE HAVE TIME TOMORROW.
YOU WANT TO GUIDE US, WE START
AT 10:00 A.M.
>> WE START AT 10:00 A.M. AND
IT'S IN A DIFFERENT -- WE START
AT 10:00 A.M. AND IT'S IN A
DIFFERENT PLACE.
THE ADDRESS IS 5700 ROCKLESS
DRIVE YOU SHOULD HAVE THAT
INFORMATION ON THE AGENDA.
AND WE MAY NEED TO TAKE -- IT'S
SEVERAL MILES FROM THE HOTEL BUT
YOU MAY NEED TO TAKE --
>> BY THE WAY, IT'S REALLY NICE
THAT THE MARRIOTT THEY HAVE
SUPERS IN THE CIRCLE.
UBERS.
ONE MINUTE.
>> ONE MINUTE.
SOMEONE'S READING MY MIND.
>> I THINK IT'S NICE OUT.
MAY BE GOOD TO TAKE A WALK.
ANYWAY, I LOOK FORWARD TO SEEING
YOU TOMORROW.
YOU'LL ALSO HEAR THE UPDATES ON
THE ABCD STUDY AND A LITTLE BIT
ON THE HBD STUDY AS WELL AND
DATA ON SOME OF OUR AGENCY AND
THE INVESTIGATORS THAT WE'VE
BEEN TALKING ABOUT HOW THEY USED
ABC BEFORE.
>> THANKS VERY MUCH.
AND HAVE A NICE EVENING AND LOOK
FORWARD TO SEEING YOU TOMORROW.
>> THANK YOU.
>> THANKS.
4:16.