Monday, April 30, 2012

More Bad News for Methamphetamine Abusers: Increased Risk for Death

The study reviewed records of nearly 820,000 people in California who during hospitalization were diagnosed as abusers or dependent upon alcohol, cannabis, cocaine, methamphetamine, or opioids, within the 16-year period from January 1990 through December 2005.  Death records also were reviewed during this period.  For subjects who died within the study period, the average duration between index hospitalization and death ranged from 7.4 – 10.7 years, with mean duration for methamphetamine abusers of 8.5 years (4122 deaths).  The study did not include polydrug abusers (who were diagnosed as abusing more than one substance).
Standardized mortality rates (SMRs), adjusted for age and for racial and sex differences in substance abuse and death rates, were calculated for each abused substance.  The SMR for methamphetamine abusers was 4.67, meaning that the risk for death was nearly 5-fold that in the general population.  This SMR exceeded SMRs for alcohol, cocaine, and cannabis abusers, and only was exceeded by the SMR for opioid abuse which was 5.71 (nearly 6-fold the death rate in the general population).
The authors noted that their study provides the first data from a large US cohort documenting the SMR in methamphetamine abusers, and suggests that additional steps should be taken to reduce the death rate in this group.
Graphic evidence of the ravages of methamphetamine abuse can be found in the story of Shawn Bridges, a methamphetamine abuser who died in 2007 at age 35.  Shawn recorded some of his struggles in hopes that others might not share his fate.
CPDDBLOG welcomes CPDD member’s thoughts on this issue.

Tuesday, April 3, 2012

Webinar on the Development of a Scientific Strategic Plan for the New NIH Addiction Research Institute

A webinar was held yesterday to discuss development of the scientific strategic plan for the new substance use and addiction disorders research Institute, which will be constituted primarily via a structural merger of the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

The webinar, hosted by Lawrence A. Tabak, D.D.S., Ph.D., NIH Principal Deputy Director and Executive Director of the Advisory Committee to the NIH Director, included over 300 participants. Dr. Tabak presented slides describing the process of formulating the new Institute, and he outlined the anticipated time line for the reorganization:

The public comment period to inform the strategic plan remains open until May 11, 2012. Development of the draft plan including research portfolio analysis and integration will continue through the fall of 2012, when the draft plan including research portfolio assignment will be published.

Another public comment period will be opened to provide feedback on the draft plan through the fall of 2012. Final recommendations will be made to the NIH Director in December 2012. The new Institute budget will be proposed in the President’s FY 2014 budget in January or February of 2013, and the first budget period for the new Institute will start in October, 2013. However, the new Institute will effectively commence operations in early 2013, when elements of the final Scientific Strategic Plan not requiring reorganization will begin to be implemented.

Dr. Tabak noted that no final research portfolio assignments have been made yet, that NIH wants stakeholder input to guide portfolio assignment for existing program elements, and that NIH especially seeks recommendations for potential new opportunities to address research needs and areas not currently in focus either at NIDA or NIAAA. He also mentioned that the name that has been circulated for the new Institute, the National Institute of Substance Use and Addiction Disorders (NISUAD), is just a placeholder at this time, and that the actual name for the new Institute has yet to be established.

Dr. Tabak indicated that his slides will be posted online at a later date. A screenshot of his last slide, showing how to contribute ideas via the Request for Information and how to obtain more information about the process, is posted at right.

Dr. Tabak then fielded questions from the audience. CPDD was well represented with questions submitted by CPDD President Scott Lukas, CPDD Executive Officer Martin Adler, and other CPDD members.

Scott asked whether the new Institute’s budget would be the sum of the existing NIDA and NIAAA budgets. Dr. Tabak replied that the budget would not be set until the research portfolio is established, but that since it is anticipated that some research activities will be transferred both to and from other Institutes, the expectation is that the budget will not be a sum of the existing budgets.

Marty asked whether research portfolio elements relevant to HIV would remain in the new Institute. Dr. Tabak indicated that it remains to be decided whether the entire HIV portfolio will remain in the new Institute or be broken up. He again directed stakeholders and other interested parties to comment on research issues such as this by responding to the Request for Information comment period open until May 11, 2012.

Several other questions focused on budgetary issues, including whether or not an analysis has been performed to determine the cost to NIH of creating the new Institute, whether or not this is the right time for this change, and how the budget will support establishment of addiction research in areas of new opportunity or existing need, a key initiative for the new Institute.

Dr. Tabak replied that the budgetary goal for the reorganization is to make it budget-neutral, and that it is not a cost-savings exercise. He anticipates that there may be budgetary savings in future years as a result of economies of scale. With regard to the timing of the reorganization, he said that the timing was selected after close discussion with colleagues both on Capitol Hill and in the Department of Health and Human Services (DHHS), who view the reorganization as a means to enhance science, not reduce budgets. In response to the question about new initiatives and opportunities, he indicated that it is anticipated that NIH budgets will be flat over the next few years, so to accommodate new programs, existing resources will have to be redirected, in part by contraction or attrition of existing programs. Dr. Tabak followed by reporting that NIH experiences turnover/attrition of roughly 20-25% of its portfolio each year, so it is anticipated that resources will become available to support new initiatives.

Most of the other questions focused on specific elements of the research portfolio and where they would be assigned. Dr. Tabak responded to these questions by repeatedly urging stakeholders to provide feedback that will be considered in the planning process.

Stay tuned to CPDDBLOG for updates on the process.

CPDDBLOG welcomes CPDD member’s thoughts on this issue.