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I have written previously about intersections of substance use and substance use disorders (SUDs) with vulnerability to COVID-19 and adverse clinical outcomes. But we also cannot overlook important research on the overlaps of substance use and HIV and AIDS. NIDA and other NIH institutes are using supplementary funds to expand or adapt existing research projects to study the intersection of various health issues with the COVID-19 pandemic. We are prioritizing research into how the coexisting crises of COVID-19, HIV, and substance use, including the opioid crisis, combine to create a disastrous storm, taking lives and overtaxing America’s public health systems.

Research has demonstrated that people with SUDs are at increased risk for acquiring and transmitting HIV, both as a result of sharing injection equipment and because substance use may increase the likelihood of impulsive sex and sex without use of condoms or other HIV prevention tools. For decades, NIDA has devoted considerable resources to support research at the intersection of HIV and substance use. NIDA has the second largest HIV research portfolio at NIH, building unique knowledge related especially to the vulnerable SUD population.

To encourage transformative science and coordinate HIV related research across the institute, NIDA created its AIDS Research Program (ARP) in 2004. In 2008, the ARP established the Avant Garde Awards for HIV/AIDS Research to support individual scientists who propose research relevant to HIV and substance use with high impact potential and that would not typically be funded because of its high risk. In 2015, we launched the Avenir Awards for HIV/AIDS Research to provide grants to early-stage investigators who also propose highly innovative studies.

These commitments to research have led to several significant scientific contributions. A decade ago,  NIDA supported a seminal study demonstrating that HIV treatment is prevention, finding that scaling up HIV treatment in people who inject drugs resulted in reductions in community-level viral load and HIV transmission. NIDA-funded research also demonstrated that addiction treatment, especially medications for opioid use disorder, is a necessary part of HIV care and leads to improved viral load, CD4 cell count, and retention in HIV care. A study from NIDA’s Clinical Trials Network found that HIV testing can be integrated into SUD treatment and that counseling offered no additional benefit—findings with broad clinical and public health implications.

The ARP aims also to expand support of basic science research including HIV pathogenesis and the immune response in the presence of addictive substances, including those substances’ ability to promote or interfere with HIV reservoirs in the brain. We are also funding clinical research to develop effective interventions for HIV, substance use, and SUD prevention and treatment, as well as implementation and services research including developing integrated models of care for HIV and SUDs, implementing effective evidence-based practices in routine healthcare settings, and determining the cost and cost-effectiveness of HIV and SUD care. Developing new pre-exposure prophylaxis (PrEP) products to prevent HIV transmission is an ongoing area of research, and NIDA is committed to supporting research to determine feasibility and acceptability of PrEP among people who use drugs.

With additional funds now available to study COVID-19, there is great opportunity for HIV and addiction researchers to make important advances in understanding how COVID-19 intersects with substance use, the opioid epidemic, and HIV.  It is already clear that these crises are intertwined and especially impacting vulnerable populations, but many gaps in our understanding remain.

Several co-occurring health problems, including cardiovascular and pulmonary diseases and diabetes, confer greater risk of SARS-CoV-2 infection, severity of disease, and poor outcomes. Additional research could inform us about the clinical impact of COVID-19 on people who use drugs and are living with HIV, as well as the impact that mitigation strategies like social distancing is having on individual health, mental health, and substance use and access to HIV and SUD treatment services. And while knowledge is expanding on how substance use and HIV impact the brain and central nervous system, we know nothing of synergistic short or long-term effects in the presence of COVID-19.  There is great potential for knowledge and experience from AIDS care to inform COVID-19 treatment, and conversely, care strategies learned during the COVID-19 crisis could be adapted to HIV outbreaks still seen worldwide that are often connected to injection drug use.

Simply developing effective treatments is no guarantee people using drugs will receive benefit, therefore we cannot expect the development of vaccines or treatments for COVID-19 to confer benefit to this population.  When these interventions are available, research will be needed to ensure people using drugs and living with HIV have access.  Particularly crucial to study are intersections of HIV, SUD, and COVID-19 among racial and ethnic minority groups, including African Americans, who are consistently disproportionately burdened with poor outcomes across these health conditions.  With African Americans suffering and dying from COVID-19 and HIV at higher rates and facing rapidly increasing rates of overdose mortality, research into structural racism and resulting health disparities is more critical than ever. This should include research into stigma within healthcare, which can impede access to care for people of color and those living with HIV and drug addiction.  

We cannot forget that in the intense climate of COVID-19, HIV remains a high-priority research area for NIDA.  We must develop interventions that are both effective and widely available to address HIV among people who use drugs.  The ambitious goal of ending the transmission of HIV will never be realized if we do not also address drug use while ensuring there are no disparities in access to treatment of HIV and SUD. 

More information, including funding opportunities, is available through NIDA’s AIDS Research Program.

Twice each decade, NIDA (like other NIH Institutes and NIH as a whole) drafts a strategic plan to guide its research and funding decisions. NIDA’s strategic plan is meant to be a high-level articulation of our principles and priorities over the next five years, and how we intend to apply them to capitalize on exciting opportunities or break down research barriers. NIDA has begun drafting its strategic plan for 2021-2025, and to best inform that process, we are seeking input from the public and the scientific community.

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©iStock/AndreyPopov

The current outline includes elements ranging from basic science to generate knowledge about the brain and how drugs affect it, to clinical, implementation and policy research in healthcare, justice, and other settings. Translational science will accelerate deployment of research findings to inform policy and practice. Specifically, the plan has three main goals:

• Understand Drug Use, Addiction, and the Brain.
• Develop and Test Novel Prevention, Treatment, and Recovery Support Strategies.
• Implement Evidence-Based Strategies in Real-World Settings.

The goals also share three major cross-cutting research approaches identified in the strategic plan outline: leveraging knowledge, technology and innovation, capitalizing on big data analytics and open data sharing, and developing models that capture the real-world complexity of substance use (for instance, use of multiple substances).

We have also identified four topics that straddle multiple goals and that merit specific focus in the years to come: finding ways to reduce the stigma around substance use and use disorders; finding ways to reduce health disparities; understanding sex/gender differences related to substance use and addiction; and understanding the relationships between substance use and other co-occurring conditions like HIV, pain, and mental illness.

The strategic plan is not intended as an exhaustive or prescriptive list of everything NIDA will be doing and funding. NIDA will remain committed to supporting promising research based on investigators’ ideas even when those fall outside these priority areas of focus. But the plan serves as an overarching vision to shape addiction science through our activities over the next five years, as well as a constant reminder of top research topics to address as they appear from our vantage point in the present.

The strategic plan will also have a section outlining how NIDA intends to responsibly steward its public funds over the next five years. Key focus areas including promoting high quality research training and a diverse research workforce, effectively translating and disseminating NIDA-funded research to inform policy and practice, fostering collaboration with public and private partners, supporting the development of a cutting-edge research infrastructure, and doing everything possible to enhance the rigor and reproducibility of scientific evidence.

For more information, including the complete draft outline and instructions for contributing comments, see NIDA’s request for Information (RFI). Again, members of the public as well as the research community are strongly encouraged to respond. Responses are due August 7^th to the NIDA Strategic Plan inbox as noted in the RFI.

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Image courtesy of University of Mississippi

Cannabis plants are covered by microscopic, mushroom-shaped, hair-like compounds called trichomes. These outgrowths surround the budding marijuana flower and produce the plant’s cannabinoids. Different varieties of trichomes can be collected. The resulting products—collectively called cannabis concentrates—can contain very high levels of tetrahydrocannabinol, commonly referred to as THC, the psychotropic ingredient in marijuana. These THC-rich marijuana products may be vaporized and inhaled using a vape pen or through a process called dabbing.¹

How are concentrates made?

Marijuana concentrates can be made in a commercial environment with modern equipment or prepared in a home setting.² They are produced in various ways, including:

• dry processing (kief, finger hash)
• dry ice processing
• water-based processing (bubble hash)
• combining pressure with heat
• using nonflammable carbon dioxide solvents
• using flammable solvents, including butane (lighter fluid), propane, ether or alcohol¹

Using flammable solvents is popular because the products have high THC levels,¹ users report longer-lasting effects,¹ and it is a relatively inexpensive and efficient production method.² Butane is a commonly used solvent, producing the potent marijuana concentrate butane hash oil (BHO), also known as amber, dab, glass, honey, shatter, or wax.²

What does the final product look like?

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Image courtesy of pixabay.com, CC0

The products resulting from these methods may be:

• a gooey liquid wax (hash oil or honey oil)
• a soft solid with a texture like lip balm (wax or budder)
• a hard, amber-colored solid (shatter)

Hash oil and waxes can be consumed using vape pens. Solids can also be placed on a heated platform usually made of titanium, quartz, or ceramic, where they are vaporized by high heat and inhaled through a dabbing tool, often called a rig.²

What’s the difference between concentrates, extracts, and dabs?

The terms used to describe these products vary. Concentrates is a broad term referring to all products that have been extracted from the plant. Although extracts and concentrates are often used interchangeably, some people define extracts as products manufactured using solvents, but not those pulled from the plant with non-solvent methods. Dabs may refer to products made exclusively from butane hash oil; however, the term is sometimes used colloquially for concentrates extracted in other ways. There are also post-production methods that lead to further variations in products and terms.³

What are the health effects of concentrates?

There are adverse effects associated with marijuana use in any form,³ though additional research is needed to understand how the use of concentrate may differ from smoking dried marijuana buds. Marijuana concentrates have very high levels of THC. Solvent-based products tend to be especially potent, with THC levels documented at an average of about 54-69% and reported to exceed 80%, while non-solvent based extraction methods produce average THC levels between 39-60%.⁴ In comparison, the THC content in marijuana plant material, which is often used in marijuana cigarettes, is lower—with samples seized by the U.S. Drug Enforcement Agency averaging just over 15%.⁵ Not only do concentrates have high levels of THC, but dabbers inhale the entire amount all at once—in a single breath.² As a result, concentrates can deliver extremely large amounts of THC to the body quickly. The risks of physical dependence and addiction increase with exposure to high concentrations of THC, and higher doses of THC are more likely to produce anxiety, agitation, paranoia, and psychosis.⁶ Additional research is needed to understand how the use of concentrate affects these risks.

In addition, contaminants in concentrate products may be cause for concern. One study noted that 80% of tested concentrate samples were contaminated in some form, not only with pesticides (which is also a concern for dried bud), but also with residual solvents that were not fully purged in the manufacturing process. Users of BHO, for example, likely inhale some butane and other impurities along with the vaporized THC.² It is important to note that direct inhalation of concentrated butane among recreational inhalant users carries multiple risks, including reported deaths.⁷ However, it is unclear what negative health outcomes result from the inhalation of residual butane, other solvents, or leftover contaminants during the dabbing process.

Is it dangerous to make solvent-based concentrates?

When solvents are used to produce concentrates, the preparation process itself can be dangerous. A number of people using butane to make extracts at home have caused fires and explosions and have been seriously burned.⁸ A study conducted in 2015 looking at implications from marijuana legalization in Colorado reported that in a 2-year period the University of Colorado burn center saw a substantial increase in the number of flash burns that occurred during amateur THC extraction using butane, some involving more than 70% of body surface area and most requiring skin grafting.⁹

It is against federal law to manufacture BHO,¹⁰ and even in some states where adult use of marijuana is legal, like Colorado and California, it is illegal to make hash oil using flammable liquids. In Colorado, state officials recommend alternate methods using nonflammable dry ice (CO₂), ice water, or purchasing the product from a licensed marijuana retail store.¹¹ Most licensed, commercial production facilities use a safer extraction system that prevents solvents from being wasted or exposed to the open air where they could inadvertently be ignited, similar to decades-old systems used in the production of many commercial products.²

Learn More

For more information about marijuana and marijuana use visit

• Marijuana webpage
• Drugged Driving DrugFacts

References

1. Raber JC, Elzinga S, Kaplan C. Understanding dabs: Contamination concerns of cannabis concentrates and cannabinoid transfer during the act of dabbing. J Toxicol Sci. 2015;40(6):797-803. doi: 10.2131/jts.40.797
2. Al-Zouabi I, Stogner JM, Miller BL, Lane ES. Butane hash oil and dabbing: Insights into use, amateur production techniques, and potential harm mitigation. Subst Abuse Rehabil. 2018;9: 91–101.
3. Volkow ND, Baler RD, Compton WM, Weiss SRB. Adverse Health Effects of Marijuana Use. N Engl J Med. 2014;370(23): 2219–2227. doi:10.1056/NEJMra1402309.
4. Meier MH, Docherty M, Leischow SJ, Grimm KJ, Pardini D. Cannabis concentrates use in adolescents. Pediatrics. 2019;144(3):e20190338. doi:10.1542/peds.2019-0338.
5. National Institute on Drug Abuse. Is marijuana addictive? drugabuse.gov. https://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-addictive. Updated April 8, 2020. Accessed June 17, 2020.
6. Freeman TP, Winstock AR. Examining the profile of high-potency cannabis and its association with severity of cannabis dependence. Psychol Med. 2015;45(15):3181-9. doi: 10.1017/S0033291715001178.
7. Sironi L, Amadasi A, Zoja R. Recreational inhalation of butane and propane in adolescents: Two forensic cases of accidental death. Forensic Sci Int. 2016;266:e52-e58. doi: 10.1016/j.forsciint.2016.05.028.
8. Romanowski KS, Barsun A, Kwan P, et al. Butane hash oil burns: A 7-Year perspective on a growing problem. J Burn Care Res. 2017;38(1):e165-e171. doi: 10.1097/BCR.0000000000000334
9. Monte AA, Zane RD, Heard KJ. The implications of marijuana legalization in Colorado. JAMA. 2015;313(3):241-2. doi: 10.1001/jama.2014.17057.
10. Two charged in connection with drug lab explosion. dea.gov. https://www.dea.gov/press-releases/2018/09/06/two-charged-connection-drug-lab-explosion. Published September 6, 2018. Accessed June 17, 2020.
11. Safety with hash oil. Colorado.gov. https://www.colorado.gov/pacific/marijuana/safety-hash-oil. Accessed June 17, 2020.

This publication is available for your use and may be reproduced in its entirety without permission from NIDA. Citation of the source is appreciated, using the following language: Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.

What We Do

The Office of Research Training, Diversity, and Disparities (ORTDD) offers a wide range of programs, workshops, and funding mechanisms to support the development of substance use and addiction research scientists throughout the career pipeline. The ORTDD is committed to providing training opportunities to ensure a cutting-edge diverse research workforce that will advance the knowledge base needed to address urgent public health substance use and addiction problems.

Offices within the ORTDD

The Office of Research Training and Career Development (ORT)

The Office of Research Training and Career Development (ORT) provides research grants to promising scientists to meet the Nation’s need for drug abuse and addiction research. NIDA’s portfolio includes research in basic, clinical, and translational sciences. Read more about the NIDA ORT career development fellowships and grants.

Introduction to Research Training at NIDA

NIDA offers a strategic set of funding mechanisms to support the development of research scientists through multiple stages of their careers. These awards are designed to ensure that scientists of the very highest caliber are available to meet the Nation’s need for substance use and addiction research. NIDA’s portfolio includes research in basic, clinical, and translational sciences. This includes genetics, epigenetics, molecular biology, neuroimaging, cognitive and social neuroscience, pharmacological and behavioral therapies, prevention, epidemiology, health services, health disparities, HIV/AIDS and other related domains.  NIDA also promotes opportunities for quantitative scientists from fields such as mathematics, bioengineering, and physics to apply their knowledge to the study of substance use and addiction.

The Office of Diversity and Health Disparities (ODHD)

The Office of Diversity and Health Disparities (ODHD) offers programs to help undergraduate and graduate students, postdoctoral fellows, and early-stage investigators from underrepresented backgrounds launch their independent research careers. NIDA aims to enhance the representation of these scientists in the biomedical research workforce through outreach, education, and other research training initiatives. Read more information about NIDA ODHD programs and initiatives.

What We Do

To enhance the pool of underrepresented populations in the sciences, the National Institute on Drug Abuse established the Office of Diversity and Health Disparities (ODHD) 20 years ago. The mission of the ODHD is to strengthen the NIDA extramural research portfolio through a more diverse and robust extramural research workforce, attracting and retaining talented individuals from all populations in order to fulfill the mission of NIDA. The ODHD’s goals are to:

• Promote and support underrepresented scholars and researchers actively participating in research;
• Enhance the pool of underrepresented scholars and researchers independently funded to conduct substance abuse research;

Ensure that research addressing health disparities is adequately represented in NIDA’-supported substance abuse research.

Underrepresented researchers face a number of challenges that influence their success in obtaining independent support from NIDA, the NIH, and other federal funding agencies.  Some of these challenges include limited/poor mentoring, lack of adequate knowledge of NIH funding opportunities and processes, limited access to novel high priority research projects and design, low publication records, and limited professional networking to successfully bridge to the next career level.  Collectively, these factors impact NIDA's efforts to retain underrepresented investigators conducting substance abuse research and further develop the research infrastructure within this community.  To that end, NIDA has implemented several key early stage outreach programs which play a vital role at recruiting, training, and retaining underrepresented researchers from underrepresented backgrounds in order to develop and support their research careers.

The U.S. is now facing two intersecting health crises, the ongoing opioid overdose epidemic and the COVID-19 pandemic. Regrettably, each has the potential to exacerbate the effects of the other. In March, NIDA released a Notice of Special Interest to alert researchers with existing grants to our interest in supporting applications for administrative supplements and urgent competitive revisions that could be used to investigate aspects of COVID-19 as they intersect with substance use and related areas in NIDA’s research portfolio, like HIV. These applications are being reviewed on a rolling timeline (and we will continue to update this blog as new supplements are awarded).

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Courtesy of NIAID

NIDA has thus far issued nearly $4 million in funding for COVID-19-related projects that could leverage current infrastructure, projects, or scientific knowledge and resources. Those projects range from assessing the virus’s impact on individuals with a substance use disorder (SUD), including those who are homeless or incarcerated, to basic research to investigate potential interactions between drugs and COVID-19, including effects on the immune system. At the same time, researchers at NIDA’s Intramural Research Program (IRP) quickly responded to the pandemic with new ideas to exploit their knowledge and research capabilities. 

Since substance use may put people at increased risk for infection with SARS-CoV-2 or the most serious outcomes of COVID-19, several research projects will be assessing this. Smoking and vaping—both of nicotine and cannabis—may be risk factors for worse COVID-19 outcomes, so we are funding supplements to examine COVID-19 in people who smoke and/or vape. A project at Boston University will use single-cell transcriptomics (a method to study gene expression via RNA) to examine whether smoking and vaping are risk factors for severe COVID-19 and its associated cytokine storm—an immune response that proves fatal in some patients. Researchers at the University of Tennessee-Knoxville studying the effects of text-messaging-delivered peer network counseling in young adults with cannabis use disorder will use supplemental funding to examine the impact of COVID-19 on health, smoking/vaping, and other substance use behaviors in this population.

The NIDA-funded National Drug Early Warning System (NDEWS) is a network of researchers at 18 sites across the country collecting and sharing data on drug use trends. With new supplemental funds, NDEWS will be expanding its efforts to track substance-use-related COVID-19 consequences in several urban, rural, and suburban areas with the help of local informants including funeral directors, emergency medical technicians, and staff at syringe services programs, to rapidly share the information gathered.

NIDA-funded researchers at the University of California-San Diego are looking at social networks, drug markets, and drug tourism among people who inject drugs in San Diego and Tijuana. Supplemental funds will enable them to expand their study to test this population for SARS-CoV-2 infection using nasal and fecal samples. This data will provide information about transmission of the virus among people who use drugs on both sides of the US-Mexico border and potentially inform policymakers about the impact of proposed mitigation strategies such as closure of the border.

Social distancing to prevent the spread of the coronavirus may lead to more individuals using drugs alone, raising the risk of overdose because bystanders may not be present to intervene or may be reluctant to intervene. Another project by researchers at New York University will study the effects of COVID-19 on opioid overdose risk behavior and how it is affecting access to and use of naloxone. The need for social distancing has increased the use of telemedicine and has resulted in the relaxation of rules governing the dispensing of controlled medications like methadone and buprenorphine. Building on their ongoing study of HIV/hepatitis and opioid prevention and treatment, supplemental funds will allow researchers at Oregon Health and Science University to examine how opioid treatment programs are implementing the new policy allowing four weeks’ worth of take-home doses of methadone for stable patients (and two weeks’ worth for others, based on clinics’ discretion), as well as assess the effects of this change. The researchers will also analyze Medicaid claims to study COVID-19 diagnoses and estimate treatment burden among people with opioid use disorder.

Social distancing has also made it harder to access behavioral treatment and recovery supports.

NIDA research has already supported numerous devices and apps to help people with SUD connect virtually to peers and counselors, and some startups are adapting their innovations to address the COVID-19 crisis. Researchers at the University of Wisconsin-Madison are using a NIDA supplement to adapt their ACHESS smartphone recovery app to help users with social distancing, adjusting to isolation, and using virtual SUD treatment and recovery services. They will also assess the impact of their app on users’ anxiety, loneliness, and reported COVID-19 infections.

An ongoing study by NIDA IRP researchers finding ways to measure psychosocial stress in people receiving treatment for OUD is being modified to allow participants to complete questionnaires and answer questions online rather than visiting a clinic or physically engaging with research staff. This will enable the researchers to measure the impact of COVID-19 on recovery, relapse, and medication adherence in this group.

Several projects are also looking at COVID-19 as it relates to HIV. Using supplemental funds to their existing grant to study implementation of pre-exposure prophylaxis for HIV prevention (PrEP) among people who inject drugs, researchers at Boston University Medical Campus will interview clients and staff of syringe-service programs to assess the impact of COVID-19 on drug markets, HIV-risk behaviors, use of HIV prevention services, and the way those services have adapted to the pandemic.

Two projects, one at the University of Maryland, Baltimore, and another at Massachusetts General Hospital, will also examine how underlying HIV infection affects COVID-19 disease progression in people who use opioids. A project at Johns Hopkins University will study barriers to receiving drug treatment and HIV/HCV care caused by the requirements of social distancing during the COVID-19 pandemic. And a study by researchers at the University of Miami School of Medicine will examine whether there are synergistic associations of methamphetamine use and HIV with SARS-CoV-2 prevalence in men who have sex with men.

Another especially vulnerable population is mothers and their children, in part because of limited access to health services during the pandemic. Researchers at Oklahoma State University for Health Sciences who are doing a feasibility study related to the proposed HEALthy Brain and Child Development (HBCD) study will use supplemental funds to assess the ability of pregnant women and new mothers (both with and without a history of SUD) to access treatment and mental health services during the COVID-19 crisis. Researchers at seven other sites across the country who are already recruiting pregnant and postpartum women for the HBCD study will also examine COVID-19’s impact on birth outcomes, parenting stress, and early childhood developmental milestones.

Researchers in the ABCD Study, now in its third year of data collection, will also leverage their infrastructure by surveying participating children and their parents about the impact of COVID-19 and the associated social, behavioral, and economic impacts on multiple aspects of their lives. A subset of children (N=500) who were issued Fitbits prior to the COVID-19 shutdown of schools and research site visits, continue to wear their devices so that information about their physical activity and sleep before, during, and after pandemic can be studied and compared.

Basic research supported by NIDA could also contribute to the development of new treatments for COVID-19. The Coronavirus-2 spike protein is known to bind to human angiotensin converting enzyme 2 (ACE2) receptors, and this is the focus of multiple investigations. A two-year project by researchers at Icahn School of Medicine at Mount Sinai will seek to identify molecules that could block this interaction, keeping the virus from invading host cells; they will also screen potential COVID-19 medications for interactions with medications used to treat SUD. A lab at NIDA’s IRP in Baltimore will also study the SARS-CoV-2 spike protein’s binding and affinity for various human cell types and test possible molecules that could be therapeutically useful.

A team at Scripps-Howard Research Institute has already developed a type of therapeutic agent (aminoadamantane nitrates) that has a protective effect on the neurons of people with Alzheimer’s disease and of people with HIV who use methamphetamine. These agents show activity in the ion channel in the envelope of the SARS-CoV-2 virus and may be able to enter it, so these compounds will be tested as possible molecular “warheads” to disrupt viral activity. Since viruses can cause damaging stress responses in a cellular structure called the endoplasmic reticulum, another laboratory at the NIDA IRP will test the effects of FDA-approved and novel drugs that might modulate these responses in the context of SARS-CoV-2 infection.

Pandemics are devastating, and COVID-19 is proving to be no exception, coming while America is already in the midst of the opioid crisis. But we now live in a world where science can be quickly mobilized to find solutions to mitigate its worst effects. Along with the other Institutes and Centers of the NIH, NIDA has swiftly responded to the COVID-19 crisis by supporting research in areas of basic science, prevention, treatment, epidemiology, and implementation, particularly at the intersection with SUD.  I am hopeful that these supplemental funds will contribute to lessening the impact of the collision between the opioid and COVID-19 crises.

Also see NIDA's COVID-19 Resources Page

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This is a painful week in the United States as we again confront the systemic racism that has plagued our country since its founding. Listening to the conversation on racism taking place right now in response to the recent violent deaths of African Americans is critical, and I encourage readers to hear what Black/African Americans are saying about their experiences.

NIH’s mission is to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability. Science has told us repeatedly that systematic, widespread discrimination of Black/African-American people is diametrically opposed to these aims, and what’s more, it is unacceptable and wrong.

The long history of discrimination against racial minorities in America bears directly on NIDA’s mission to address addiction as a disease rather than a moral failing to be dealt with through punishment. Whites and Black/African Americans use drugs at similar rates, but it is overwhelmingly the latter group who are singled out for arrest and incarceration. This use of drug use and addiction as a lever to suppress people of a particular race has had devastating effects on communities of color.

We know that science itself is at its best when it is most inclusive, and humans are best when we embrace diversity. Conversations about systemic racial inequalities can be uncomfortable but are clearly needed. Entrenched, systemic, pervasive racism is perpetuated by silence, and we cannot let it continue. I look forward to working with the addiction science community – researchers, the medical community, law enforcement, advocates, policymakers, other stakeholders and the public – to eradicate discrimination and promote equality.

Nora D. Volkow, M.D.
Director