Monitoring the Future is an annual drug use survey of eighth, 10th and 12th grade students conducted by researchers at the University of Michigan, Ann Arbor, and funded by the National Institute on Drug Abuse.

From February through June 2021, the Monitoring the Future investigators collected 32,260 surveys from students enrolled across 319 public and private schools in the United States.

The percentage of adolescents reporting substance use decreased significantly in 2021, according to the latest results from the Monitoring the Future survey of substance use behaviors and related attitudes among eighth, 10th, and 12th graders in the United States. In line with continued long-term declines in the use of many illicit substances among adolescents previously reported by the Monitoring the Future survey, these findings represent the largest one-year decrease in overall illicit drug use reported since the survey began in 1975. The Monitoring the Future survey is conducted by researchers at the University of Michigan, Ann Arbor, and funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

The 2021 survey reported significant decreases in use across many substances, including those most commonly used in adolescence – alcohol, marijuana, and vaped nicotine. The 2021 decrease in vaping for both marijuana and tobacco follows sharp increases in use between 2017 and 2019, which then leveled off in 2020. This year, the study surveyed students on their mental health during the COVID-19 pandemic. The study found that students across all age-groups reported moderate increases in feelings of boredom, anxiety, depression, loneliness, worry, difficulty sleeping, and other negative mental health indicators since the beginning of the pandemic.

“We have never seen such dramatic decreases in drug use among teens in just a one-year period. These data are unprecedented and highlight one unexpected potential consequence of the COVID-19 pandemic, which caused seismic shifts in the day-to-day lives of adolescents,” said Nora Volkow, M.D., NIDA director. “Moving forward, it will be crucial to identify the pivotal elements of this past year that contributed to decreased drug use – whether related to drug availability, family involvement, differences in peer pressure, or other factors – and harness them to inform future prevention efforts.”

The Monitoring the Future survey is given annually to students in eighth, 10th, and 12th grades who self-report their substance use behaviors over various time periods, such as past 30 days, past 12 months, and lifetime. The survey also documents students’ perception of harm, disapproval of use, and perceived availability of drugs. The survey results are released the same year the data are collected. From February through June 2021, the Monitoring the Future investigators collected 32,260 surveys from students enrolled across 319 public and private schools in the United States.

While the completed survey from 2021 represents about 75% of the sample size of a typical year’s data collection, the results were gathered from a broad geographic and representative sample, so the data were statistically weighted to provide national numbers. This year, 11.3% of the students who took the survey identified as African American, 16.7% as Hispanic, 5.0% as Asian, 0.9% as American Indian or Alaska Native, 13.8% as multiple, and 51.2% as white. All participating students took the survey via a web-based survey – either on tablets or on a computer – with 40% of respondents taking the survey in-person in school, and 60% taking the survey from home while they underwent virtual schooling.

This difference in location between survey respondents is a limitation of the survey, as students who took the survey at home may not have had the same privacy or may not have felt as comfortable truthfully reporting substance use as they would at school, when they are away from their parents. In addition, students with less engagement in school – a known risk factor for drug use – may have been less likely to participate in the survey, whether in-person or online. The Monitoring the Future investigators did see a slight drop in response rate across all age groups, indicating that a small segment of typical respondents may have been absent this year.

To address these limitations, the Monitoring the Future investigators conducted additional statistical analyses to confirm that the location differences for the survey, whether taken in-person in a classroom or at home, had little to no influence on the results.

“The Biden-Harris Administration is committed to using data and evidence to guide our prevention efforts so it is important to identify all the factors that may have led to this decrease in substance use to better inform prevention strategies moving forward,” said Dr. Rahul Gupta, Director of the White House Office of National Drug Control Policy. “The Administration is investing historic levels of funding for evidence-based prevention programs because delaying substance use until after adolescence significantly reduces the likelihood of developing a substance use disorder.”

The 2021 Monitoring the Future data tables highlighting the survey results are available online from the University of Michigan. Reported declines in the use of substances among teens include:

“In addition to looking at these significant one-year declines in substance use among young people, the real benefit of the Monitoring the Future survey is our unique ability to track changes over time, and over the course of history,” said Richard A. Miech, Ph.D., lead author of the paper and team lead of the Monitoring the Future study at the University of Michigan. “We knew that this year’s data would illuminate how the COVID-19 pandemic may have impacted substance use among young people, and in the coming years, we will find out whether those impacts are long-lasting as we continue tracking the drug use patterns of these unique cohorts of adolescents.”

Earlier findings from a different NIDA-supported survey, conducted as part of the Adolescent Brain Cognitive Development (ABCD) Study, showed that the overall rate of drug use among a younger cohort of people ages 10-14 remained relatively stable before and during the first six months of the COVID-19 pandemic. However, researchers detected shifts in the drugs used, with alcohol use declining and use of nicotine products and misuse of prescription medications increasing. Adolescents who experienced pandemic-related severe stress, depression, or anxiety, or whose families experienced material hardship during the pandemic, or whose parents uses substances themselves were most likely to use them too.

In addition, a follow-up survey of 12th graders who participated in the 2020 Monitoring the Future study found that adolescent marijuana use and binge drinking did not significantly change during the first six months of the COVID-19 pandemic, despite record decreases in the substances’ perceived availability. This survey was conducted between mid-July and mid-August 2020. It also found that nicotine vaping in high school seniors declined during the pandemic, along with declines in perceived availability of vaping devices at this time. These results challenge the idea that reducing adolescent use of drugs can be achieved solely by limiting their supply.

The Adolescent Brain Cognitive DevelopmentSM Study and ABCD Study® are service marks and registered trademarks, respectively, of the U.S. Department of Health and Human Services.

Today marks the 33rd  World AIDS Day. As we work to address the structural and social challenges that prevent many people from accessing both essential HIV services and addiction treatment, the HIV and addiction fields can learn from one another. Researchers, clinicians, and activists living and working at the intersection of HIV and substance use can shed light on reaching the most vulnerable groups with tailored, compassionate and quality care. This is crucial in ensuring that our national HIV response encompasses interventions that address the complex interactions between substance misuse and HIV.

One such group is the IDEA Exchange in Miami, Fla., a comprehensive syringe services program where Dr. Hansel E. Tookes, III, and his team work to deliver integrated HIV and harm reduction services to people who use drugs and those in recovery, and learn from research projects how to optimize care to achieve the best outcomes. Dr. Tookes is a 2021 recipient of NIDA’s HIV/AIDS Research Avenir Award for a new project designed to leverage telehealth-enhanced services to engage people who use drugs into HIV care in a city with the highest rate of new HIV cases in the country. This World AIDS Day, NIDA presents “At the Intersection: Stories of Research, Compassion, and HIV Services for People Who Use Drugs,” a web video series in which IDEA’s participants, peers, and clinicians relate their lifesaving approach to addressing the intertwined epidemics of HIV, overdose, and addiction.

Watch the new series below:

It was with immense sadness that I learned last week of the death of Paul Bowman. Paul was a peer recovery coach and advocate in Boston, Massachusetts, and was one of the leading voices for the HEALing Communities Study (HCS), which is testing ways to integrate various evidence-based practices to drastically reduce opioid overdose in 67 American localities. Paul was the national Steering Committee advisor for the Massachusetts arm of the study. His lived experience with recovery and addiction were central to his work, including his experience taking medication to treat his opioid use disorder, and it enriched his work with HCS. I extend my deepest sympathies to Paul’s family, colleagues, and everyone who knew and loved him.

Paul devoted his life to fighting for the rights and dignity of people with substance use disorders in Boston. He was also tireless in his work to combat the devastating stigma that surrounds addiction.

Paul leaves behind an impressive legacy. As a social worker and activist in recovery, Paul devoted his life to fighting for the rights and dignity of people with substance use disorders in Boston. Paul advocated for greater access to medications to treat opioid use disorder, the use of naloxone to prevent overdose, harm-reduction measures to prevent other negative outcomes, and expanded access to housing. As a peer recovery coach, he guided many through treatment and recovery with encouragement and understanding. He was also tireless in his work to combat the devastating stigma that surrounds addiction.

Paul’s obituary shares more about his life, and reports his sudden death from a drug overdose. This news underscores how difficult the recovery journey can be and how essential compassionate, consistent support is at every stage. It should strengthen our resolve to support those with substance use disorders and to do everything we can to end this deadly crisis.

This article previously appeared on AAMCNews, a publication of the Association of American Medical Colleges. It is reprinted with permission.

Far too often, shame and stigma fuel addiction and prevent treatment, argues Nora Volkow, MD, director of the National Institute on Drug Abuse. But replacing judgment with compassion can save lives.

When I was six years old, as I was having dinner with my mother and three sisters, my mother received a telegram. She broke down crying as she read it. Her father — my grandfather — had died. In her grief, she locked herself in her room and would not let me console her. The memory of my inability to relieve my mother’s suffering still haunts me.

My sisters and I were led to believe that our grandfather had died of a heart attack. It was only decades later, when I had already been an addiction researcher for several years and my mother was herself dying, that she revealed the truth: My grandfather had had an alcohol addiction. Unable to stop drinking, he had taken his own life in a final moment of futility and shame. 

Overwhelmed by this revelation, I asked my mother, “Why didn’t you tell me until now?” Her response was that she did not want me to lose respect for him or love him less.

As a society, we still keep addiction in the shadows, regarding it as something shameful, reflecting lack of character, weakness of will, or even conscious wrongdoing, not a medical issue.

My mother knew that I had devoted my life to understanding the neurobiological effects of chronic substance use. She had seen me speak about addiction as a disease of the brain and not a character defect. Of all people, I was someone she should have been able to speak to openly about why and how her father died. Yet, for her, the stigma of addiction and suicide was more powerful than the scientific understanding I was trying to bring to medicine.

Things have not changed much since that day. As a society, we still keep addiction in the shadows, regarding it as something shameful, reflecting lack of character, weakness of will, or even conscious wrongdoing, not a medical issue warranting compassionate medical care. Unfortunately, many in the medical profession harbor this mindset.

In fact, stigma remains one of the biggest obstacles to confronting America’s current drug crisis.

Last year alone, more than 96,000 people in the United States died from overdoses — usually from opioids but also increasingly from stimulants — and the pandemic worsened an already dire public health crisis. If you have not lost a family member or friend to drug or alcohol addiction or its consequences, which include diseases like cancer, you likely know someone whose family has suffered such a loss. Additionally, untreated substance use exacerbates many other health conditions or interferes with their treatment.

The direct and indirect health effects of drug and alcohol addiction are so numerous and devastating that they are considered root causes of the declining life expectancy in our country.

What the Science Tells Us

Science has shed much light on addiction. We now understand that changes in brain networks needed for self-regulation cause substance use to become compulsive in some individuals — despite their best efforts to decrease or stop use. We are also gaining an understanding of the genetic, developmental, and environmental factors that cause susceptibility to drug experimentation and to the brain changes underlying addiction.

For instance, data from a large longitudinal study of adolescents funded by the National Institute on Drug Abuse in close partnership with other National Institutes of Health entities have provided insights into the adverse effects of poverty and adversity on the developing brain, including neurobiological changes that make drug use and addiction more likely.  

On the positive side, prevention research shows that providing targeted interventions to families with low incomes or lacking social supports can avert — or even reverse — these neurobiological changes. What's more, decades of research on brain signaling systems have demonstrated that even once addiction takes hold, it is still reversible and recovery is achievable.

Unfortunately, stigma limits the impact of this knowledge and the reach of our tools.

The Role of Stigma

Stigma pervades medicine, policy, and communities.

Medical schools until recently offered little or no training in screening for or treating substance use disorders because, for many years, addiction was not seen as a medical problem. Even now, when medical systems offer treatment, it may be limited or inadequate. Among dedicated addiction treatment programs, fewer than half offer medications, which is tantamount to denial of appropriate medical care, according to a National Academies of Sciences, Engineering, and Medicine report.

Insurers are often reluctant to cover addiction treatment, including medications for opioid use disorder, and coverage is limited when it is provided. Inadequate coverage puts these life-saving treatments out of reach for many people who need them. Stigma also prevents the use of medications in most justice settings — even though at least half of incarcerated individuals in the United States have a substance use disorder, often an opioid use disorder.

[Stigma] contributes to the tragic reality that fewer than 13% of people with an illicit drug use disorder received any treatment for their addiction in 2019.

What’s more, many communities fail to provide harm-reduction measures, such as syringe services programs and the overdose medication naloxone, out of a moralistic — as well as factually incorrect — belief that those measures encourage illegal drug use.

Even when treatments and other supports are available, people with addiction may not seek them, fearing the judgments of those around them and the discrimination they routinely experience in the health care system. Patients are often hesitant to disclose their substance use to their physicians.

This contributes to the tragic reality that fewer than 13% of people with an illicit drug use disorder received any treatment for their addiction in 2019 and just 18% of people with opioid use disorder received one of the three safe, effective, and potentially lifesaving medications that could facilitate their recovery. The proportion of people with alcohol addiction who received medications is even lower: 3%.

Government policies, including criminal justice measures, often reflect — and contribute to — stigma. When we penalize people who use drugs because of an addiction, we suggest that their use is a character flaw rather than a medical condition. And when we incarcerate addicted individuals, we decrease their access to treatment and exacerbate the personal and societal consequences of their substance use. What’s more, drug laws are disproportionately leveraged against Black people and Black communities, driving societal and health disparities.

The aura of illegality affects the treatment of people with addiction. For example, some treatment programs expel patients for positive urine samples, as if relapse were not simply a known symptom of the disorder and a clinical signal to adjust the treatment approach but instead actual wrongdoing.

Prescribers of addiction medications are themselves monitored and subjected to strong limitations that don’t apply to other medications — or even to the same medications in different circumstances, such as prescribing buprenorphine for pain. Such oversight tacitly signals that there is something suspect about these treatments and the people who receive them.

Help and Healing

Stigma’s damaging effects go well beyond impeding care and care-seeking. Painful social and emotional effects like rejection, isolation, and shame — internalized stigma — drive drug-taking to alleviate one’s suffering, leading to a vicious cycle. It was internalized stigma that led my grandfather to end his life.

If we’re going to end the current addiction and overdose crisis, we must treat combating stigma as no less important than developing and implementing new prevention and treatment tools.

Research supports the lesson I learned firsthand in my own family — that stigma is not alleviated solely by educating people on the science of a disease. Partly, it requires facilitating contact between a stigmatized group and the wider community. If people with substance use disorders can share their experiences, then empathy and compassion can begin to replace judgment and fear.

For that to happen, addressing stigma must be a central prong of our public health efforts. If we’re going to end the current addiction and overdose crisis, we must treat combating stigma as no less important than developing and implementing new prevention and treatment tools.

We need a large-scale social intervention to change public attitudes toward addiction and people who have the disease. Besides ensuring proper training and the resources needed to help patients with substance use disorders, we need to seriously reconsider policies — not only laws but  regulations and practices in health care and other settings — that promote viewing substance use as wrongdoing. And we must make it safe for patients and families to discuss addiction and remove the shame that interferes with its treatment.

Data from a nationally representative survey indicate that in 2019, nearly three-fourths of U.S. adults reporting buprenorphine use did not misuse the medication in the past 12 months. In addition, buprenorphine misuse among people with opioid use disorder trended downward between 2015-2019, despite increases in the number of people receiving buprenorphine treatment. The study, published today in JAMA NetworkOpen, was conducted by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and the Centers for Disease Control and Prevention.

Buprenorphine is an FDA-approved medication to treat opioid use disorder and to relieve severe pain. Buprenorphine used to treat opioid use disorder works by partially activating opioid receptors in the brain, which can help reduce opioid cravings, withdrawal, and overall use of other opioids.

In 2020, more than 93,000 people lost their lives due to drug overdoses, with 75% of those deaths involving an opioid. However, in 2019, less than 18% of people with a past-year opioid use disorder received medications to treat their addiction, in part due to stigma and barriers to accessing these medications. To prescribe buprenorphine for treatment of opioid use disorder, clinicians must do so within a certified Opioid Treatment Program, or submit a notice of intent to the federal government, and are limited in how many patients they can treat at one time. Only a small proportion of clinicians are eligible to treat opioid use disorder with buprenorphine, and even fewer prescribe the medication.

“High quality medical practice requires delivery of safe and effective treatments for health conditions, including substance use disorders. This includes providing lifesaving medications to people suffering from an opioid use disorder,” said NIDA Director Nora D. Volkow, M.D. “This study provides further evidence to support the need for expanded access to proven treatment approaches, such as buprenorphine therapy, despite the remaining stigma and prejudice that remains for people with addiction and the medications used to treat it.”

In April 2021, the U.S. Department of Health and Human Services released updated buprenorphine practice guidelines to expand access to treatment for opioid use disorder. However, barriers to the use of this treatment remain, including provider unease with managing patients with opioid use disorder, lack of adequate insurance reimbursement, and concerns about risks for diversion, misuse, and overdose. Misuse is defined as patients taking medications in a way not recommended by a physician, and can include consuming someone else’s prescription medication, or taking one’s own prescription in larger amounts, more frequent doses, or for a longer duration than directed.

To better understand buprenorphine use and misuse, researchers analyzed data on use and misuse of prescription opioids, including buprenorphine, from the 2015-2019 National Surveys on Drug Use and Health (NSDUH). The NSDUH is conducted annually by the Substance Abuse and Mental Health Services Administration. It provides nationally representative data on prescription opioid use, misuse, opioid use disorder, and motivation for the most recent misuse among U.S. civilian, noninstitutionalized populations.

The researchers found that almost three-fourths of U.S. adults who reported buprenorphine use in 2019 did not misuse buprenorphine in the past 12 months. Overall, an estimated 1.7 million people reported using buprenorphine as prescribed in the past year, compared with 700,000 people who reported misusing the medication. Moreover, the proportion of people with opioid use disorder who misused buprenorphine trended downward over the study period, despite recent increases in the number of patients receiving buprenorphine treatment.

Importantly, for adults with opioid use disorder, the most common motivations for the most recent buprenorphine misuse were “because I am hooked” on opioids (27.3%), indicating that people may be taking buprenorphine without a prescription to self-treat craving and withdrawal symptoms associated with opioid use disorder, and “to relieve physical pain” (20.5%). Moreover, among adults with buprenorphine use, those receiving drug use treatment were less likely to misuse buprenorphine than those not receiving drug use treatment. Together, these findings highlight the urgent need to expand access to buprenorphine treatment, because receipt of treatment may help reduce buprenorphine misuse. Furthermore, it is necessary to develop strategies to continue to monitor and reduce buprenorphine misuse.

The study also found that people who received no drug use treatment and those who lived in rural areas were more likely to misuse the medication. However, other factors, such as being a racial/ethnic minority or living in poverty, had no effect on buprenorphine misuse. The study authors suggested that to address the current opioid crisis, both access to and quality of buprenorphine treatment for people with opioid use disorder should be improved.

“Three-quarters of adults taking buprenorphine do not misuse the drug,” said Wilson Compton, M.D., M.P.E., Deputy Director of NIDA and senior author of the study. “Many people with opioid use disorder want help, and as clinicians, we must treat their illness. This study also underscores the urgency of addressing racial and ethnic, health insurance, economic, and geographic disparities in treatment access, to ensure that everyone with opioid use disorder can access this lifesaving medication.”

Reference: B Han, CM Jones, EB Einstein, WM Compton. Trends in and characteristics of buprenorphine misuse among adults in the US. JAMA Network Open. DOI: 10.1001/jamanetworkopen.2021.29409 (2021).

Last week, the first grant awards were made for the HEALthy Brain and Child Development (HBCD) study, which will recruit a large cohort of pregnant women at 25 centers around the country and follow them and their children from the prenatal period through early childhood. Similar in conception to the Adolescent Brain Cognitive Development (ABCD) study already underway, HBCD will utilize regular neuroimaging in the infants and children as well as collecting a wide array of biospecimen and behavioral data to chart the development and health of the participants through the first decade of life. The cohort will include a population of mothers who used drugs during their pregnancy as well as mothers from similar backgrounds who did not use drugs, in order to answer longstanding questions about the long-term impact of environmental adversity during pregnancy, including prenatal substance exposures, neglect, trauma, and social and economic challenges.

In a world radically changed by the pandemic, longitudinal studies of child development have never been more crucial, and these grant awards couldn’t come at a more opportune time. For the past year and a half, parents and caregivers have been burdened by troubling questions about their children’s development and mental health. Those who have had to improvise non-optimal childcare solutions for young children wonder about the effects of reduced physical activity and socialization and increased screen time. Parents of school-aged children want to know whether a year of at-home learning may have set their kids behind academically. And researchers want to know how traumatic events associated with the pandemic, like loss of a parent or home eviction, influence their developmental trajectories. These are exactly the kinds of questions ABCD and, soon, HBCD will be poised to answer.

Despite challenges caused by the pandemic, the ABCD study, currently in its fifth year, continues to collect vast quantities of data on a wide range of topics including early adolescent substance use and obesity, brain development as related to socioeconomic status, and the impact of discrimination on suicidality. Researchers are already publishing data on changes in adolescents’ alcohol and nicotine use after the start of the pandemic. That study cohort is large and diverse enough to be able to compare brain development and other health and behavioral outcomes in adolescents who participated in at-home learning through the entire 2020-21 school year with those whose schools remained open for some of that time. Now the HBCD study will enable scientists to examine how early childhood development and health are impacted by some of the stressors affecting young families that have arisen during the pandemic, including the impact of maternal COVID-19 infection on their offspring. 

We still have major gaps in our understanding of how infants’ and children’s brains develop and how that development is affected by exposure to adversity. Because the brain undergoes major and rapid development throughout infancy, childhood, and adolescence, many of our traits and aptitudes, as well as our resilience or vulnerability to challenges that may lead to substance use and mental illnesses, are being powerfully shaped by our experiences throughout the first two decades of life. Social disruption and dislocation produced by wars, natural disasters, economic crises, social unrest, and pandemics may have lasting impact, sometimes in ways that are not immediately apparent and that manifest in problems years down the road.

Yet while the extreme plasticity of the developing brain makes children vulnerable, it can also be a strength. Children can be enormously resilient, and studies are showing that with the right supports and targeted prevention programs, the neurocognitive impacts of adverse environments like poverty can be compensated for or overcome. Information provided by HBCD and ABCD will help us understand the relative magnitude of different risks such as lack of social interaction or physical activity or financial instability, as well as how different risks interact, who is most affected, and whether some environmental adversity can be countered or compensated for. With insights gleaned from these studies, it may be possible to predict which children are most at risk from the multiple and varied stresses of the pandemic and to design interventions to prevent adverse consequences or intervene early with those children.

The pandemic has posed an unprecedented challenge to life, health, and well-being for everyone on the globe. Science rose to the challenge of developing vaccines in record time. Now, with two major longitudinal studies of development covering the prenatal period through young adulthood, NIH-funded science is poised to address some of the urgent questions facing America’s parents: How are kids affected by the stresses and transformations that are reshaping our society before our very eyes? What challenges can they expect? Which children are the most vulnerable? And how can we help them meet those challenges and thrive?

For decades, a significant portion of NIDA’s research portfolio has funded science at the intersection of substance use and HIV, due to the intertwined nature of these two health conditions. Sharing of injection equipment is a major mode of viral transmission, and many kinds of substance use increase the likelihood of engaging in unprotected high-risk sex. Research demonstrates substance use disorders (SUDs) exacerbate the effects of HIV in the body, reduce the effectiveness of anti-retroviral therapy, serve as a barrier to prevention and treatment access, impede care-seeking, and decrease the likelihood of retention in treatment.   

NIDA’s portfolio of HIV-related research is the second largest at NIH (after the National Institute of Allergy and Infectious Diseases), and it is diverse, ranging from basic science to implementation research. NIDA created its AIDS Research Program (ARP) in 2004 to coordinate this research across our Institute and to encourage transformative science addressing SUD and HIV. Now, to better characterize our scientific investment as we move into the third decade of the century and to help combat the stigma that still attaches to HIV, we have decided to rename this office the HIV Research Program. It is a change of name but not of mission.

Much has changed in the landscape of HIV and HIV research since the ARP was founded. AIDS describes the often-fatal condition of severe damage to the immune system caused by untreated HIV, but thanks to antiretroviral treatments, most people with HIV in the U.S. do not develop AIDS. Consequently, NIDA research now focuses on the virus itself and the many ways it continues to intertwine with drug use and addiction. Today, it is more accurate to say NIDA’s research focuses on HIV, not AIDS.  

The name change also better aligns our Institute with the desire of patients, families, and communities to use less stigmatizing language. The term AIDS can evoke the haunting images from the early days of the HIV pandemic, when there was no treatment, there were few prevention options, and too many people succumbed to extreme illness. Antiretroviral medications developed in the late 1990s turned HIV from what had been a fatal disease into a manageable and livable condition, and we now know they can also prevent transmission of HIV.

While the reality for many people living with HIV has moved beyond the images of an earlier era, AIDS activism played a key role in scientific and societal advancements over the last 40 years. HIV/AIDS activists revolutionized the concept of disease advocacy, informing and improving the work of governments, scientists, medicine, and industry in the United States and globally. The progress we make today honors those contributions.  

The scientific advances over the past two decades have been instrumental in reducing the stigma of HIV, but we still have a long way to go in eliminating that stigma. The stigma of HIV intersects with that of substance use disorders, still among the most stigmatized of health conditions. For both HIV and addiction, advocates have emphasized how important it is to underscore that medications and other treatments allow people to lead vibrant, long, and otherwise healthy lives. Nor do either HIV or an SUD need to define the individual.

NIDA’s investment in HIV research has advanced the science in significant ways. For instance, over a decade ago we supported the seminal study showing that treatment of HIV in people who inject drugs is prevention, reducing transmission in the community and community-level viral load. NIDA also funded a phase 3 trial showing that medication treatment for opioid use disorder improves viral load, infection-fighting CD4 cell count, and HIV treatment retention and is thus vital in HIV care. Recently another study conducted through NIDA’s Clinical Trials Network demonstrated the successful integration of HIV testing into SUD treatment.

Though the program’s name is changing, NIDA’s commitment to HIV research, its HIV budget, and its HIV research priorities are not. We will continue to support a wide range of studies, from the basic science of HIV pathogenesis and the immune response in the presence of addictive substances to research on feasibility and acceptability of new pre-exposure prophylaxis (PrEP) products among people who use drugs. NIDA-funded scientists are also now investigating the intersections of SUD, HIV, racial inequity, and COVID-19, as well as contributing to the effort to develop an HIV vaccine.

I am proud of the accomplishments of the office now called the HIV Research Program, under the capable leadership of Dr. Redonna Chandler and with the help of Dr. Vasundhara Varthakavi. I look forward to many more years of cutting-edge research with the aim of developing and implementing effective prevention and treatment interventions for HIV and SUDs and eliminating HIV transmission among people who use drugs.

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