Unintentional, opioid-related overdose and HCV infections as sequelae associated with the prescription opioid epidemic ought to be a key priority area; as should the recent increase in heroin use and injection among young adults, given that non-medical injections are the driver of HCV infection incidence in both urban and non-urban settings. Support for studying HCV treatment patterns can be expanded to investigate the efficacy of co-localizing HCV treatment in substance abuse treatment settings, including both in-patient and out-patient settings.
The diverse harms associated with drug addiction is a clear indication of the need to investigate the efficacy of integrated health services for persons who inject drugs. Given the cost effectiveness of safer injection facilities in controlling infectious diseases, as indicated from research results and demonstration projects in other countries, it seems important to facilitate research and programmatic projects about this valuable intervention within a comprehensive set of interventions and policies for persons who use drugs.
Assess and address methamphetamine use and it addiction and infectious diseases consequences ang heterosexual populations. Overall the plan is a well thought out approach to the science behind the treatment of addiction, the need to educate and such. Seems far too general as to the stages of drug use disorders and addiction and should also speak to a greater extent to science of prevention, early intervention and long term recovery in the community.
RFI Comments - Public Health | National Institute on Drug Abuse (NIDA)
Much like diseases like diabetes, cancer and heart disease the need for supports beyond the treatment of addiction are crucial. I cannot say enough about the ability to intervene with at-risk populations early and often and not require a diagnosis per se. Established in as the only statewide advocacy organization in Illinois focusing solely on substance use disorder issues, we represent more than 50 prevention, treatment and recovery organizations across the state.
Our mission is to advocate for people interested in the substance use disorder field, including clinicians, consumers, family members, individuals in recovery and youth. We work hard to educate the general public about the disease of addiction, sharing the message that addiction can be prevented, it can be treated and people can recover from it. Interest in substance abuse- amongst policy makers, the public, and health care professionals are also at an all time high. A confluence of factors, including but not limited to the legal status of marijuana, a resurgence in heroin use, and the ever increasing abuse of opioid painkillers, has led us to this moment.
As advocates and activists demand more action, NIDA must be one of the leaders in this fight. Its research, and perhaps more importantly its dissemination of this research, should lead the way forward, just as research led us to the advances we have made against modern plagues such as HIV, or even diseases no longer considered commonplace, such as whooping cough, small pox, or diphtheria. It is our belief that research at NIDA exists for one reason above all others: to improve the treatment of substance abuse and addiction.
In this vein, we wish to see a continued emphasis on the translation of research into practice.
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Addiction and abuse are just as costly to this country as cancer, hypertension, or diabetes, yet the research dollars appropriated to finding better substance abuse and addiction treatment pales in comparison to that of the institutes that study these other diseases. This must be remedied. The economic impact of addiction and abuse either equals or outpaces that of almost every other disease, so the economic investment in finding cures has to keep pace. While policymakers have given substance abuse increased attention in recent years, they only do so in response to increased use in specific narcotics.
For example, for most of last decade, a large amount of legislation was introduced aimed at curbing the use and abuse of methamphetamine. Over the first part of this decade, attention has shifted to opioids. Congress responds to the drugs that make headlines, yet rarely- if ever- do they address the underlying disease of addiction. We believe it is the role of NIDA to emphasize- to both policymakers and the public- that no matter what advances are made in the fight against specific narcotics, the larger picture must always remain the effort to cure this one underlying disease.
This includes research on treatment settings, treatment protocols, and a variety of other factors. It is no longer an issue of simply how treatment is provided- also in need of consideration is the where, by whom, and when. The treatment of substance abuse and addiction is a continuum, and a complex one at that.
Often this continuum is broken down into three categories- prevention, treatment, and recovery. Yet even these categories can be divided. Prevention strategies for youth differ from prevention strategies for other age groups- and other age groups do need prevention strategies. Older Americans are abusing drugs at a rate never before seen, and at a rate not matched by other demographics. The over-availability of powerful prescription drugs has contributed to this, and new prevention strategies are in order.
Within treatment, we need to see more research done on the medical aspects of detoxification. In many states, the only addiction treatment service covered by Medicaid is detoxification. While this needs to change, at present, detox is the only bite at the treatment apple that many will get, so it must be done while guided by the most recent, proficient research.
In terms of other treatment protocols, treatment is far from one-size fits all. There are setting considerations: inpatient, outpatient, intensive outpatient, and more. Settings can be hospitals, clinics, private treatment facilities, public treatment facilities, and on and on. Then there are cultural and ethnic considerations to address.
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Men and women approach treatment differently. Latinos, Native Americans, African Americans, and other ethnic groups have different considerations to address. Special populations such as veterans, active duty military, and others deal with issues that can impact treatment and recovery. We need to see NIDA fund research that takes all of these factors and variables into consideration.
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There are many regulatory issues that surround substance abuse treatment, which NIDA cannot fix directly, but can indeed contribute to a fix. The IMD Exclusion was enacted in to prevent Medicaid funds from covering treatment in large psychiatric hospitals. The medical understanding and treatment of substance abuse and mental disorders has changed considerably since NIDA research on effective treatment in terms of facility or group size can be of great value in illustrating the arbitrary bed limit for facilities receiving Medicaid reimbursement.
Research could also feasibly be conducted on the efficacy of not only group size, but on network size as well, and on the best ratios for practitioners to patients. Marijuana is not only a hot button topic politically, but scientifically as well. Public policy regarding marijuana continues to be made at a high rate, and too often science does not play a large enough role in the debate.
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NIDA needs to make the availability of research findings- both current and past- more visible and readily available. In addition, because policies are moving so quickly, NIDA must investigate research that can be conducted and disseminated rapidly. We understand that the scientific process is a deliberate one, and scientific findings should not be compromised because research was conducted hastily. Yet in a situation such as this one, rapid results are a necessity if the science is to play a role in formulating policy, as well as influencing public opinion.
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A very high percentage of consumers who utilize substance abuse treatment services suffer from other health disorders as well. NIDA must continue its work in co-occurring disorders. Often, these consumers first point of contact with any form of health care is treatment for their addiction or abuse. Yet with the right treatment protocols in place, they can also be treated for other health issues. NIDA should explore studying how those who get treated for substance abuse may have difficulty addressing other public health problems, and how those who enter the health care system for a substance abuse disorder can benefit by becoming a healthier person on the whole.
At present, NIDA does excellent work in the dissemination of its findings, but these efforts appear limited to major research grants or events, such as Monitoring the Future, or National Drug Facts Week. Research in addiction and substance abuse treatment should be given the same attention and reverence usually reserved for breakthroughs in research pertaining to cancer or HIV. While there has definitely been more attention paid to these advances over the last decade, more still needs to be done.
When a scientific breakthrough has the ability to improve the lives of millions of people, full advantage must be taken. The first bulleted point focuses on the importance of understanding the factors that affect the integration of evidence-based research findings into healthcare policy and practice implementation science. Empirically rigorous and theoretically grounded implementation science research is critical in helping to close the research to practice gap.
If we really want to ensure that evidence-based practices are incorporated into routine care, then is it essential to focus effort on the frontline professionals who deliver services to patients in treatment programs and allied mental health care facilities. This includes research on recruitment, training, career development, retention, and performance management of counselors and other mental health care professionals.
In addition, research on the role that clinical supervisors play in encouraging, rewarding, and increasing the uptake of evidence-based practices in treatment settings is sorely lacking, even though these individuals play a critical role in shaping the climate for implementation and use of evidence-based treatment as well as creating a psychologically healthy work environment for counseling staff. Interventions to help stabilize the drug treatment workforce are also needed as well as increase the attractiveness of this profession to individuals preparing to enter the workforce.
Given the high demand for drug treatment services ensuring that we have a workforce that is prepared qualified , motivated, and stable is essential to ensuring high quality care to patients seeking treatment. Although companies are affected in many ways, efforts to engage the business sector in these programs have been only marginally effective. In terms of research, this topic is highly underrepresented. The few available papers and programs from this particular field suggest that there are ways to involve companies in the fight against substance abuse See for instance the attached poster presented last year at the NIDA session of the SPR Annual Meeting in Washington D.
However, more rigorous research would needed. Use sound experimental design and hypothesis testing to improve our understanding of the ethical implications of research in terms of impact on study subjects, participation of study subjects, communication of research results, and application of research findings to underserved populations. Although research exists on these topics, the majority is qualitative rather than quantitative. Develop methodology to support research on implementing effective prevention, service, and treatment programs.
Increase the support of early career investigators, especially those from underrepresented minority populations. Strengthen the focus on bi-directional translational research involving communities. We commend NIDA for renewing its vision for increasing our knowledge about drug addiction. The draft strategic priorities outlined in the request for information are wide-ranging and are appropriately highlighted as valuable for the field and for future research. However, health services research is a clear omission in the draft strategic priorities.
Health services research is a tool to study drug use and addiction in the context of other substance use, health issues, biopsychosocial factors and the systems of care that serve individuals with drug problems.