From racist violence to the disproportionate impact of COVID-19 on Black Americans, events of the past year have thrown a harsh light on the racial inequities that persist in our society. Unfortunately, science is not immune to these inequities. Black people and other groups that have been marginalized face an array of challenges beginning early in their educations, and fewer ultimately pursue scientific careers. Abundant research has demonstrated that Black people and other minorities who do become scientists are then hindered via unconscious biases that influence their success in their academic work.

Today, NIH Director Francis Collins announced UNITE, an NIH-wide initiative already underway to end structural racism in biomedical science. UNITE is led by five committees with experts from all 27 NIH institutes and centers, tasked with finding new ways to support diversity, equity, and inclusion. The aim is to dismantle any NIH policies and discontinue any practices in our science that perpetuate racism. NIH is also seeking input from the public and interested stakeholders outside NIH through various mechanisms, including a Request for Information (RFI) issued today. For more information, see the UNITE website.

NIDA fully shares the goal of dismantling structural racism in our science as well as addressing the long history and current ways in which racism has shaped approaches to addressing drug use and addiction. In July, I established NIDA’s Racial Equity Initiative to organize our efforts to eliminate racism in NIDA’s workplace, scientific workforce, and research portfolio. Workgroups of committed volunteers from across NIDA’s various divisions including our Intramural Research Program (IRP) in Baltimore were established to take action in each of these three areas. As an important initial investment, NIDA has committed $100M over the next 10 years to this initiative.

An extensive series of listening sessions has helped us identify areas of need in the NIDA workplace, impacts of racism on the NIDA research workforce, and research gaps in the NIDA portfolio. This led to expanding NIDA’s workforce development initiatives across a wider span of education and career stages, from raising awareness of science careers for K-12 students from underrepresented minority groups to promoting racial/ethnic diversity in professional societies. For example, we have established a pilot internship program that gives students involved with the University of Maryland, Baltimore County’s STEM BUILD initiative and Meyerhoff Scholars Program the opportunity to conduct research at labs in our IRP; STEM BUILD and Meyerhoff are both focused on enhancing diversity in the biomedical and behavioral sciences workforce. We also held a scientific meeting last month to help shape research initiatives around health disparities and the impact of racism on drug use and addiction outcomes.

The effects of punitive approaches to substance use must be a particular focus of our attention as we address structural racism and its impacts on health. As I wrote last summer, white and Black Americans use drugs at similar rates, but overwhelmingly it is Black people who are singled out for punishment. The disproportionate arrest and incarceration of Black people has multiple radiating adverse effects on Black families and communities, including contributing to health disparities. A new study in Lancet Public Health, for example, shows that incarceration is associated with early death from a range of causes. At the 2016 meeting of the United Nations General Assembly Special Session on drugs, the 193 member nations unanimously voted to recognize that substance use disorders should be approached as public health issues, not punished as criminal offenses.

We must take advantage of the momentum of this moment in history to dismantle the unacceptable structural racism that has slowed biomedical progress and that has perpetuated health disparities in our society. I stand with Francis Collins and NIH in dedicating NIDA to this important goal.

Inherent in the mission of NIH is that biomedical research and its application can and should benefit all people. Significant events across our nation over the past year and frank discussions in the research community have led to deep reflection at NIH about biases and disparities faced by underrepresented groups in the research enterprise. As we strive to recognize our own role in these challenges, we affirm our commitment to diversity and to positive change to eliminate racism in our community and in our organization.

As a step towards that change, the NIH Institutes, Centers, and Offices that are part of the NIH Blueprint for Neuroscience Research and the NIH BRAIN Initiative, strongly encourage the neuroscience community to take advantage of the new NIH-wide Faculty Institutional Recruitment for Sustainable Transformation (FIRST) Program, supported by the NIH Common Fund. Although progress has been made to increase participation of historically underrepresented groups in biomedical training stages, members of these groups are still less likely to be hired into positions as independently funded faculty researchers. These populations include underrepresented racial and ethnic groups, individuals with disabilities, individuals from disadvantaged backgrounds, and women. 

To help address this disparity, the FIRST program aims to enhance cultures of inclusive excellence through institutional support for recruitment of diverse “cohorts” of early-stage research faculty. Here, “inclusive excellence” describes the cultivation of scientific environments that can engage and benefit from a full range of talent. Neuroscience continues to be one of the fastest growing areas of biomedical research. We want the FIRST program to enable researchers to thrive, and we believe the broader neuroscience community has much to gain. Indeed, the growing field of the Science of Diversity shows the positive impacts that result when heterogeneous teams apply diverse perspectives and expertise to research challenges. We are hopeful that the cohort hiring model in FIRST will succeed in turning the culture in neuroscience departments and their institutions toward greater inclusion and diversity. We fully recognize that there are structural barriers perpetuated by gaps and that critical improvements must be made, because many groups are severely underrepresented in neuroscience. To our neuroscientists: we encourage you to take advantage of this opportunity as a path to meaningful change. We are committed to fostering a more inclusive, equitable, and diverse neuroscience community, and the FIRST program is a step in the right direction, with many, many more steps to come.

The objectives of the FIRST program are twofold: to support institutions in hiring diverse cohorts of early stage research faculty; and to transform culture at NIH-funded extramural institutions by building a community of scientists who are committed to diversity and inclusive excellence. In addition to funds for hiring, the program will support new and strengthened institution-wide approaches to facilitating the success of cohort members and future faculty from diverse backgrounds. For cohort members, this is likely to include mentoring, sponsorship, and networking opportunities. For institutions, this may include training faculty in approaches known to foster inclusive excellence and changing the rubric for interviewing processes. The FIRST program will also fund a coordination and evaluation center, which will develop and guide the collection of common data metrics to rigorously assess the effects of FIRST faculty cohorts and institutional activities on the research culture at funded institutions. Lessons learned by these institutions will be shared with the broader biomedical research community.

The FIRST program is expected to fund 12 awards over the next three years, plus the coordination and evaluation center, with an estimated budget of $241M over nine years, contingent upon the availability of funds. The first receipt date for the program’s funding opportunities is March 1, 2021. For more information, please also view the recent technical assistance webinar.

Related Resources:

Inherent in the mission of NIH is that biomedical research and its application can and should benefit all people. Significant events across our nation over the past year and frank discussions in the research community have led to deep reflection at NIH about biases and disparities faced by underrepresented groups in the research enterprise. As we strive to recognize our own role in these challenges, we affirm our commitment to diversity and to positive change to eliminate racism in our community and in our organization.

As a step towards that change, the NIH Institutes, Centers, and Offices that are part of the NIH Blueprint for Neuroscience Research and the NIH BRAIN Initiative, strongly encourage the neuroscience community to take advantage of the new NIH-wide Faculty Institutional Recruitment for Sustainable Transformation (FIRST) Program, supported by the NIH Common Fund. Although progress has been made to increase participation of historically underrepresented groups in biomedical training stages, members of these groups are still less likely to be hired into positions as independently funded faculty researchers. These populations include underrepresented racial and ethnic groups, individuals with disabilities, individuals from disadvantaged backgrounds, and women. 

To help address this disparity, the FIRST program aims to enhance cultures of inclusive excellence through institutional support for recruitment of diverse “cohorts” of early-stage research faculty. Here, “inclusive excellence” describes the cultivation of scientific environments that can engage and benefit from a full range of talent. Neuroscience continues to be one of the fastest growing areas of biomedical research. We want the FIRST program to enable researchers to thrive, and we believe the broader neuroscience community has much to gain. Indeed, the growing field of the Science of Diversity shows the positive impacts that result when heterogeneous teams apply diverse perspectives and expertise to research challenges. We are hopeful that the cohort hiring model in FIRST will succeed in turning the culture in neuroscience departments and their institutions toward greater inclusion and diversity. We fully recognize that there are structural barriers perpetuated by gaps and that critical improvements must be made, because many groups are severely underrepresented in neuroscience. To our neuroscientists: we encourage you to take advantage of this opportunity as a path to meaningful change. We are committed to fostering a more inclusive, equitable, and diverse neuroscience community, and the FIRST program is a step in the right direction, with many, many more steps to come.

The objectives of the FIRST program are twofold: to support institutions in hiring diverse cohorts of early stage research faculty; and to transform culture at NIH-funded extramural institutions by building a community of scientists who are committed to diversity and inclusive excellence. In addition to funds for hiring, the program will support new and strengthened institution-wide approaches to facilitating the success of cohort members and future faculty from diverse backgrounds. For cohort members, this is likely to include mentoring, sponsorship, and networking opportunities. For institutions, this may include training faculty in approaches known to foster inclusive excellence and changing the rubric for interviewing processes. The FIRST program will also fund a coordination and evaluation center, which will develop and guide the collection of common data metrics to rigorously assess the effects of FIRST faculty cohorts and institutional activities on the research culture at funded institutions. Lessons learned by these institutions will be shared with the broader biomedical research community.

The FIRST program is expected to fund 12 awards over the next three years, plus the coordination and evaluation center, with an estimated budget of $241M over nine years, contingent upon the availability of funds. The first receipt date for the program’s funding opportunities is March 1, 2021. For more information, please also view the recent technical assistance webinar.

Related Resources:

ADAPT-2 Trial Results Deliver a Breakthrough in Long Search for Methamphetamine Use Disorder Medication
mfleming
Wed, 01/13/2021 - 14:15

The U.S. is facing a surge of overdose deaths involving the use of stimulant drugs, including cocaine and methamphetamine. Multiple drug surveillance systems indicate that methamphetamine is a more pressing danger to public health and safety than opioids in some localities, yet developing medications to treat stimulant use disorders has proven especially challenging. As more patients and providers become familiar with the multiple effective medications now available to treat opioids, the lack of any medication to treat addiction to methamphetamine is increasingly frustrating. That is why the results of a successful multi-site clinical trial of a combined treatment approach for methamphetamine use disorder using two already approved medications, published today in the New England Journal of Medicine, is such important and encouraging news for our field.

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©iStock/Morsa Images

The Accelerated Development of Additive Pharmacotherapy Treatment for Methamphetamine Use Disorder (or ADAPT-2) study, conducted by NIDA’s Clinical Trials Network and led by Madhukar H. Trivedi, M.D., of the University of Texas Southwestern Medical Center, Dallas, found that a combination of oral bupropion, a commonly prescribed medication used to treat depression and for nicotine cessation, and injectable naltrexone, an opioid antagonist widely prescribed for treating opioid and alcohol use disorders, successfully reduced methamphetamine use and cravings in a large sample of treatment-seeking people with methamphetamine use disorder, compared to placebo. The investigators found that the effectiveness of the combination is similar to the effectiveness of analgesics for treating pain and most medical treatments for mental health disorders, including antidepressants prescribed for depression and naltrexone prescribed for alcohol use disorder. There were no significant adverse effects of the medication combination, and participants generally adhered to the treatment. (For more information about the trial and the results, see our News Release.)

Currently, the only treatments available for stimulant use disorders are behavioral therapies such as cognitive behavioral therapy and contingency management, in which modest material incentives are given for negative urine tests. The latter, although the most effective, remains underutilized. Given methamphetamine addiction’s devastating health effects and the extreme stigma that surrounds it, developing medications or immunotherapies would provide additional therapeutic alternatives, which could also be used to augment the benefits from behavioral interventions.

The multiplicity of physiological effects of addictive drugs in the body and their complex disruption of neuronal circuits in the brain necessary for everyday actions makes developing medications to treat any addiction difficult. Stimulants act principally on dopamine signaling in the brain. Cocaine boosts dopamine by preventing its reuptake and clearance from the synapses, whereas methamphetamine releases dopamine into the terminal and synapse, thus markedly and temporarily enhancing dopamine signaling. Because dopamine is involved in so many basic functions such as motivation and drive as well as movement and learning, treating stimulant use disorders by targeting stimulants’ effects on dopamine has been challenging.

Finding a compound that can safely modify the action of dopamine transporters within neurons to reduce methamphetamine’s rewarding effects is one approach being investigated by NIDA-funded researchers at the Universities of Kentucky and Arkansas. A monoclonal antibody designed to neutralize methamphetamine before it enters the brain is currently in Phase-2 trials conducted by a NIDA-funded team at the University of Arkansas for Medical Sciences and InterveXion Therapeutics. Vaccines against methamphetamine are being studied preclinically, and other approaches, including combinations of already existing compounds, are also in various stages of the drug development pipeline.

Multipronged approaches using combinations of already-existing compounds, as in the ADAPT-2 trial, are one strategy that has the advantage of using medications whose safety is already established. Previously, both bupropion and naltrexone had been tried on their own in the treatment of methamphetamine use disorder, with modest but inconsistent results in both cases. The reason bupropion has seemed like a promising drug has to do with its unique actions. Because it can increase dopamine and norepinephrine, it has stimulant-like effects in addition to (or that may underlie) its effectiveness as an antidepressant. Compounds that can mimic the effects of a misused drug but less rapidly and intensely are obvious choices as addiction medication candidates. For example, two of the three effective treatments for opioid use disorder, methadone and buprenorphine, ease withdrawal symptoms and cravings by activating mu-opioid receptors but without causing euphoria when given at prescribed doses.

Naltrexone is an antagonist, or blocker, of mu-opioid receptors, which underlie opioids rewarding and analgesic effects. While naltrexone does not interact directly with the dopaminergic and noradrenergic systems that methamphetamine energizes, opioid signaling in brain reward circuits is believed to underlie the rewarding euphoric effects of stimulants and other non-opioid drugs. Blocking these effects may reduce the pleasure of drug-taking and is also thought to reduce cue-induced craving for stimulants, and thus could help a person with methamphetamine use disorder reduce or stop their use of the drug.

The combination of bupropion and naltrexone in the treatment of methamphetamine use disorder has not yet been submitted for regulatory review, and more research would be needed to learn how best to implement this medication combination as part of a treatment plan. But the success of the ADAPT-2 trial represents an encouraging advance toward a medication that could address one of the most pressing drug use disorders that we face in the current addiction and overdose crisis.

As 2020 Closes, Many Questions Remain about Youth Substance Use Trends
mfleming
Mon, 12/14/2020 - 14:53

The results of the 2020 Monitoring the Future (MTF) survey of drug use and attitudes in middle and high school students were released today, with the encouraging news that the alarming rises in teen vaping both of nicotine and marijuana seen in prior years had leveled off, although use remained high. But as with so many other efforts in 2020, the MTF survey was impacted by the COVID-19 pandemic. And we are left at the end of this tumultuous year with many questions about how circumstances have affected youth, their substance use, and their mental health more generally.

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©iStock/izusek

The MTF survey is ordinarily conducted from February until May, with the results released later the same year. This year, schools closed in mid-March before the majority of the students could be surveyed, leaving the University of Michigan researchers who conduct the survey with a smaller-than-usual sample—11,821 students in 112 schools. Although only a quarter the size of the usual sample, it remained nationally representative and contained much valuable data.

Generally, the 2020 MTF showed continued low levels of most forms of substance use among teens, including very low levels of opioid use despite the devastating effects opioids have had on all older age groups including young adults. However, there are other indications that the evolving addiction and overdose crisis is directly affecting youth. For example, a study by CDC researchers just published in the journal Pediatrics shows increases in suspected nonfatal overdoses involving stimulants (a category that includes prescription stimulants, cocaine, and methamphetamine) in children and teens between 2016 and 2019. MTF shows decreases in use of prescription stimulants in 10^th and 12^th graders but a trend toward increased use among 8^th graders. It will be important to closely monitor adolescent stimulant use in future MTF surveys.

The MTF data collected at the beginning of this year reflect a certain point of relative normality before the COVID-19 pandemic threw all our lives into upheaval, including the lives of teens. As we seek to understand adolescent substance use in this new reality, we look to research to answer many important questions on how the stresses of the pandemic may have affected substance use by teens. For example, it is important to investigate the consequences of social distancing and virtual classes on adolescent drug experimentation and use, since those are strongly influenced by peer pressure and group dynamics.

NIDA has issued supplemental funds to existing grantees to help study the impact of the pandemic on adolescents’ risk of substance use; their access to prevention and treatment services; and the pandemic’s effects on families. Future research, including the results of next year’s MTF survey, can help us understand how school closures and lockdowns affected adolescent substance use.  

Although research has suggested that the pandemic’s stresses have increased many forms of substance use in adults, it remains to be seen whether reduced ability to interact with peers or other sources of drugs may be a mitigating factor in youth. There is already evidence that reduced commercial availability of vape products during the pandemic may be affecting teen vaping. Researchers at Stanford and University of California San Francisco captured self-reported vaping habits of 2,167 teen and young-adult e-cigarette users in May, two months after the national emergency was declared and after MTF stopped gathering data for the 2020 survey. Over half of the respondents reported changing their use of vaping products, with 68 percent of those reporting that they had reduced their use or quit. Inability to purchase the products was one reason cited.

2020 has posed many urgent questions for science. Finding out the different ways the pandemic and other stresses of the year have affected young people is a high priority. Adolescence is an important period of social and emotional development, and the pandemic has disrupted many of the processes that impact that development. NIDA research has pivoted to ensure we address this unique time in history as we pursue scientific solutions to the impacts of drug use and addiction across the lifespan.

HIV is inextricably entwined with substance use. This fact is central to the development of new tools to prevent and treat HIV and the implementation science that informs how these tools can be successfully deployed in diverse communities around the world. On World AIDS Day (December 1), we applaud the substantial strides that scientific research has made to help prevent and treat HIV while recognizing the complex challenges that still need to be addressed. For more than three decades NIDA has supported research at the intersection of substance use and HIV, which has resulted in important advances in knowledge that has had clinical, public health and policy implications

When the intersection of substance use and HIV is discussed, most people think about transmission among people who share injection equipment. In 2017, one in 10 new HIV diagnoses were among people who inject drugs, a 31% decrease since 2010. Harm-reduction programs like syringe service programs have been proven to decrease sharing of injection equipment and encourage hygienic practices. For example, according to findings from a NIDA-funded study published in 2015, the average monthly rate of new HIV cases among people who inject drugs in Washington, D.C., dropped by approximately 70 percent after the city implemented a syringe-services program in 2008.

However, sexual behavior is also a critical yet often overlooked component of the complex relationship between HIV and substance use. Substance use affects behavior in ways that increase engagement in unprotected sex and increase the possibility of sexual transmission of HIV and other infections. Stimulants like methamphetamine increase libido while also decreasing impulse control and can increase unprotected sexual contact. This is particularly concerning as methamphetamine use rises in the United States, including among gay men and others who face higher risks for HIV. A recent study found methamphetamine use to be the single biggest risk factor for becoming HIV positive among gay and bisexual men. In some cases, people with a substance use disorder engage in survival sex, where sex is exchanged for shelter, food, or access to drugs.

People who have substance use disorders are a hardly reached population, often lacking access to health care. High levels of stigma exist in our healthcare system toward people with substance use disorders and research has demonstrated this is a factor in the timely receipt of antiretroviral therapy (ART) to treat HIV. Fear of stigma or legal consequences are two powerful reasons why people who use drugs may avoid healthcare settings. This lack of access to clinical care means that an individual may not receive prevention services, diagnoses, or treatment for substance use disorders and co-occurring infections like HIV or hepatitis C.

Finding tools that work in the lives of people who need them, including people who use drugs, is imperative to ending the HIV epidemic in the United States and abroad. An array of choices for HIV prevention and treatment are needed, and they must be accessible, affordable, and desirable to the people who could benefit. Research has delivered two highly effective methods of HIV prevention: Daily oral pre-exposure prophylaxis, or PrEP, is 90 percent effective when taken as prescribed. Undetectable Equals Untransmittable (U=U), also known as treatment as prevention, means that people living with HIV who achieve and maintain an undetectable viral load by taking ART as prescribed cannot transmit HIV. Both of these strategies require taking a daily oral pill, which can be challenging for many people, including people who use drugs.

Research into long-acting methods of prevention and treatment hold great promise in alleviating the burden of taking daily medications. In November, an NIH-funded trial conducted in several African countries found that long-acting (8 weeks) injection of the already-approved HIV drug cabotegravir was safe and was more effective at preventing HIV in sexually active cis-gender women than daily oral pre-exposure prophylaxis, or PrEP. Another study found similar results earlier this year for long-acting injectable cabotegravir in cisgender men and transgender women who have sex with men.

We celebrate these advances, yet important research questions remain to help address real-world complexities of implementation. We must ensure that new HIV prevention tools are not only safe and effective but also desirable to individuals with complex needs including people who use drugs. NIDA is funding research on how to integrate the prevention and treatment of substance use and HIV in a way that addresses individual need and decreases stigma. For example, NIDA is supporting research to determine how to integrate PrEP into substance use disorder treatment, decrease delays in ART initiation for people who use drugs by addressing barriers including stigma on the part of many healthcare providers and practitioners, and understand how chronic drug exposure impacts the HIV reservoir in the brain.

Successful implementation of safe and effective tools to prevent and treat HIV and substance use disorders cannot occur without understanding and addressing social determinants of health. People at risk for or living with HIV and people with substance use disorders carry the burden of stigma perpetuated by society as well as stigma that is internalized or self-inflicted. Laws in the United States and in other countries criminalize aspects of exposing others to HIV, and enforcement of these laws often disproportionately impact Black Americans, similar to how enforcement of drug possession charges are brought disproportionately against Black Americans and other marginalized groups. Racism, poverty, discrimination against sex and gender minorities, and lack of access to healthcare all constitute social determinants of health. Research is needed to better understand how to address these complex issues and remove barriers to high quality care for substance use and HIV.

If we want to successfully leverage new biomedical advances for HIV prevention and treatment, we must address substance use and people with substance use disorders. Research to understand how best to implement tools in real-world situations for these individuals is an important first step. Today on World AIDS Day we honor the achievements of dedicated researchers, health care professionals, clinical trial participants, advocates, and members of the global community, and reaffirm NIDA’s commitment to a robust research agenda with findings that will hopefully one day result in a world without HIV.

Although we often talk about individual drugs and drug use disorders in isolation, the reality is that many people use drugs in combination and also die from them in combination. Although deaths from opioids continue to command the public’s attention, an alarming increase in deaths involving the stimulant drugs methamphetamine and cocaine are a stark illustration that we no longer face just an opioid crisis. We face a complex and ever-evolving addiction and overdose crisis characterized by shifting use and availability of different substances and use of multiple drugs (and drug classes) together.

Overdose deaths specifically from opioids began escalating two decades ago, after the introduction of potent new opioid pain relievers like OxyContin. But actually, drug overdose deaths have been increasing exponentially since at least 1980, with different substances (e.g., cocaine) driving this upward trend at different times. Overdose deaths involving methamphetamine started rising steeply in 2009, and provisional numbers from the CDC show they had increased 10-fold by 2019, to over 16,500. A similar number of people die every year from overdoses involving cocaine (16,196), which has increased nearly as precipitously over the same period.

Although stimulant use and use disorders fluctuate year to year, national surveys have suggested that use had not risen considerably over the period that overdoses from these drugs escalated, which means that the increases in mortality are likely due to people using these drugs in combination with opioids like heroin or fentanyl or using products that have been laced with fentanyl without their knowledge. Fentanyl is a powerful synthetic opioid (80 times more potent than morphine) that since 2013 has driven the steep rise in opioid overdoses.

During the last half of the 1980s, when cocaine surged in popularity, many overdoses occurred in people combining this drug with heroin. The recent rise in deaths from co-use of stimulants and opioids seems to reflect a similar phenomenon. According to a recent examination of barriers to syringe services programs published in the International Journal of Drug Policy, staff at some programs report that increasing numbers of individuals are injecting methamphetamine and opioids together. Some also report that individuals are switching from opioids to methamphetamine because they fear the unpredictability of opioid products that may contain fentanyl (even though methamphetamine may be laced with fentanyl too).

A 2018 study by researchers at Washington University in St. Louis and published in Drug and Alcohol Dependence found that methamphetamine use has increased significantly among people with an existing opioid use disorder (OUD). People with OUD in their study reported substituting methamphetamine for opioids when the latter are hard to obtain or are perceived as unsafe, or that they sought a synergistic high by combining them. People who purposefully combine heroin and cocaine or methamphetamine report that the stimulant helps to balance out the soporific effect of opioids, enabling them to function “normally.” However, the combination can enhance the drugs’ toxicity and lethality, by exacerbating their individual cardiovascular and pulmonary effects.

Much more research is needed on the co-use of stimulants and opioids as well as how their combination affects overdose risk. Unfortunately, death certificates do not always list the drugs involved, and when they do, they may not always be accurate about which drugs principally contributed to mortality, making it difficult to know exactly the role opioids and stimulants play in mortality when people deliberately or unknowingly take the two together.

Overdose is not the only danger. Persistent stimulant use can lead to cognitive problems as well as many other health issues (such as cardiac and pulmonary diseases). Injecting cocaine or methamphetamine using shared equipment can transmit infectious diseases like HIV or hepatitis B and C. Cocaine has been shown to suppress immune-cell function and promote replication of the HIV virus and its use may make individuals with HIV more susceptible to contracting hepatitis C. Similarly methamphetamine may worsen HIV progression and exacerbate cognitive problems from HIV.

The use of methamphetamine by men who have sex with men has been found to be an important factor in the transmission of HIV in that population. According to a new study in the Journal of Acquired Immune Deficiency Syndromes by researchers at the City University of New York and the University of Miami, more than a third of the gay and bisexual men in their sample who acquired HIV in a 12-month study period reported that they used methamphetamine both before and during that period. Among the variables examined, methamphetamine use was the single biggest risk factor for becoming HIV positive, pointing to use of this drug as an important target for intervention in this group. Another NIH-funded study by a team at the University of California San Francisco School of Nursing published in the Journal of Urban Health in 2014 found that delivering cognitive-behavioral therapy for SUD as a harm reduction measure reduced stimulant use and sexual risk-taking behavior in a sample of men who have sex with men.

For now, the best available treatments for stimulant use disorders are behavioral interventions. Contingency management, which uses motivational incentives and tangible rewards to help a person attain their treatment goals, is the most effective therapy, particularly when used in conjunction with a community reinforcement approach. Despite its effectiveness for treating both methamphetamine and cocaine use disorders, contingency management is not widely used, stemming in part from a policy limiting the monetary value of incentives allowable as part of treatment.

Currently, there are no approved medications for the treatment of stimulant use disorders, but hopefully that will change in the not-too-distant future. Multiple NIDA-funded research teams have been hard at work, in some cases for many years already, testing new medication targets as well as immunotherapies for methamphetamine addiction, such as vaccines.

Linda Dwoskin, a NIDA-funded researcher at the University of Kentucky College of Pharmacy, is developing compounds that will alter the function of  molecules called vesicular monoamine transporters that affect how neurons recycle dopamine and that are targets for methamphetamine’s activity, in order to reduce craving and relapse in people addicted to the drug. (Her two-decade quest to develop a medication for methamphetamine addiction is chronicled in a multi-part series in NIDA Notes—the most recent installment is here.)

Apart from medications, another novel approach being tested to treat several substance use disorders is compounds that recruit the body’s own immune system against specific types of drugs, or the direct delivery of antibodies to neutralize a drug’s effects. A team at the University of Arkansas for Medical Sciences and the biotech company InterveXion Therapeutics is currently conducting Phase 2 trials of a monoclonal antibody capable of holding methamphetamine in the bloodstream and disabling its entry into the brain. (A recent NIDA Notes series also details this research program.)

Unfortunately, the COVID-19 pandemic and its associated stresses have made the need for new prevention and treatment approaches more urgent. Researchers at the Department of Health and Human Services and Millennium Health recently published in JAMA that since the beginning of the national emergency in March there has been a 23 percent increase in urine samples taken from various healthcare and clinical settings testing positive for methamphetamine nationwide, a 19 percent increase in samples testing positive for cocaine, and a 67 percent increase in samples testing positive for fentanyl. Another recent study of urine samples by researchers at Quest Diagnostics, published in Population Health Management, found significant increases in fentanyl in combination with methamphetamine and with cocaine during the pandemic. 

Efforts to address stimulant use should be integrated with the initiatives already underway to address opioid addiction and opioid mortality. The complex reality of polysubstance use is already a research area that NIDA funds, but much more work is needed. The recognition that we face a drug addiction and overdose crisis, not just an opioid crisis, should guide research, prevention, and treatment efforts going forward.

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Dr. Amy Hauck Newman

Amy Hauck Newman, Ph.D., has been appointed the Scientific Director of the National Institute on Drug Abuse’s (NIDA) Intramural Research Program (IRP) in Baltimore. NIDA is part of the National Institutes of Health (NIH).

Dr. Newman has served as NIDA’s IRP Acting Scientific Director for the past two years. She is also Chief of NIDA’s Molecular Targets and Medications Discovery Branch, and Director of the NIDA IRP Medication Development Program. She has coauthored more than 300 original articles and reviews on the design, synthesis, and evaluation of central nervous system (CNS) active agents as potential treatment medications for substance use disorders, with an emphasis on selective ligands for the dopaminergic system. She is also an inventor on several licensed NIH patents.

"Dr. Newman will continue to bring tremendous strength to NIDA’s robust intramural research portfolio," said NIDA Director Nora D. Volkow, M.D. "She has served exceptionally as our Acting Scientific Director, and her valuable work on CNS agents is bringing us closer to new and better medicines for the treatment of addiction."

In 2019, Dr. Newman received the NIH Ruth L. Kirschstein Mentoring Award from the NIH Office of the Director. In 2018, she was honored as a "Remarkable Woman in Medicinal Chemistry" at the 255th American Chemical Society National Meeting. In 2016, she was the first woman to receive the Philip Portoghese Lectureship Award, awarded by the Division of Medicinal Chemistry and the Journal of Medicinal Chemistry, American Chemical Society. In 2014, she received the Marian W. Fischman Lectureship Award from the College on Problems of Drug Dependence.

Dr. Newman received her doctorate in medicinal chemistry from the Medical College of Virginia, Virginia Commonwealth University, under the mentorship of Richard Glennon, Ph.D. For her postdoctoral studies, she joined the laboratory of Kenner Rice, Ph.D., at NIH, where she conducted total opiate synthesis as a NIDA-funded NIH National Research Service Award fellow.

"As a career NIH scientist, it is indeed an honor and privilege to lead the NIDA IRP in cutting edge basic, preclinical and clinical addiction science to be translated into the prevention and treatment of substance use disorders," said Dr. Newman.

Dr. Newman officially began her new position at the NIDA IRP on November 22, 2020.

For more information, go to Dr. Amy Newman.

Contact: NIDA press office at media@nida.nih.gov or 301-443-6245. Follow NIDA on Twitter and Facebook.