Government Funds Begin To Flow For More Research On Addiction

Federal agencies welcome ideas for developing new medications to curb, treat, or prevent a host of drug addictions. WASHINGTON--The federal government is strengthening its commitment to research on drug addiction. And that means a greater demand for scientists. "We are in desperate need of both Ph.D. and M.D. clinical researchers," says Marvin Snyder, director of the Division of Preclinical Research at the National Institute on Drug Abuse (NIDA). "And we have the money." NIDA wants to develop drugs to treat a range of addictions in much the same way that methadone is used to treat heroin addicts. It's the research prong of the government's overall attack on the drug epidemic that so far has consisted mainly of more prisons, more police, and more aid to countries where some of the illegal drugs are grown. Last year NIDA funded some $31 million in addiction research, $10 million of which came from a special appropriation by Congress. Just last month NIDA awarded eight new grants to scientists around the country in an announcement that noted their relevance to the government's fight against AIDS. Current funding is expected to reach $41 million, and the president's request to Congress for fiscal 1991, which begins in October, calls for some $60 million. NIDA officials hope that the agency's request will get a favorable response from the legislators that control the agency's pursestrings. And some congressmen are prepared to go the administration one better. Sen. Joseph Biden (D-Del.), the chairman of the Senate Judiciary Committee that oversees the government's current drug campaign, has proposed increases that would raise spending levels to $100 million in five years and $150 million by the end of the decade. That's good news for scientists like research psychiatrist Thomas Kosten of Yale University's substance abuse treatment unit. Kosten, whose lab recently received a $3 million NIDA grant, has been working for several years with the drug buprenorphine, investigating the hypothesis that it can block the "highs" caused by ingesting cocaine. But even $3 million over five years isn't enough to do what he has in mind. With additional funding, he says, "we could look at three or four drugs instead of only one, we could recruit more researchers, and we could develop an inpatient facility to use as a research unit." It's Lonely At The Top The annual press briefings to explain the president's new budget traditionally provide a rare opportunity for federal agencies to trot out all their top aides. But on January 29 Allan Bromley, director of the Office of Science and Technology Policy, was forced to appear with only a skeletal staff because of the slow pace of presidential appointments to top positions at OSTP. Only two of the agency's four associate directors--James Wyngaarden and Thomas Ratchford--have been confirmed by the Senate and could therefore accompany him on the dais. The other two appointments--Berkeley electrical engineer Eugene Wong to handle the physical sciences and William Phillips, of the Missouri Advanced Technology Institute, to handle industrial policy--were forced to sit in the audience and wave to the assembled press because their names had been sent up to the Senate only a few days before the briefing. It could be several weeks more before the Senate acts on their nominations, although both are expected to spend a fair portion of their time at OSTP acquainting themselves with their new jobs. Easy Come, Easy Go This year's election for foreign secretary of the National Academy of Sciences has attracted more attention than is usual because one of the candidates is OSTP's James Wyngaarden. The former NIH director joined Allan Bromley's staff last fall after he had thrown his hat into the ring for the half-time academy position. And Wyngaarden says that he made it clear to Bromley that he'd leave his government post if elected to a three-year term that begins July 1. The foreign secretary handles the academy's various international activities and travels extensively, duties that Wyngaarden says he finds very appealing. His opponent has similar global interests: he's Rudi Schmid, professor of medicine and associate dean for international affairs at the University of California, San Francisco. The results are due out shortly; if Wyngaarden is victorious, Bromley will once again face a vacancy in his top staff. The only drugs now used to treat addicts are methadone and naltrexone. And their effectiveness is limited to heroin addiction. NIDA is overseeing research on nearly 30 medications that have shown some promise against a variety of addictions, but definitive results have been slowed by a lack of capacity. "We have more medications than we have facilities to test them," Snyder says, noting that some of the money from the new round of grants will go toward additional sites. Several of the drugs have advanced to the stage of clinical trials, while for others, animal models are still being developed. One drug, Levo Alpha Acetylmethadol (LAMM), dates from 1948. Although much of the necessary testing has been completed, no manufacturer has been found for LAMM because the drug is owned by the public and, therefore, cannot be patented. NIDA officials expect the medications to work against drug abuse in various ways. They could block or reverse the effects of the abused drug, reduce the cravings for such drugs, moderate withdrawal symptoms, or, under certain conditions, even prevent the initial intake of the drug. Snyder speculates that some day medications might exist to prevent addiction, much as vaccines are able to prevent disease. "If someone has an innovative treatment, we would like to hear about it," he adds. So would a lot of people. The pressure from society to find a way to halt the spread of drugs has increased, not only because of the increased violence that has accompanied the illegal drug trade but also because of the increased spread of AIDS among addicts who use drugs intravenously or sell sex for crack cocaine. "We view prevention of drug abuse as AIDS prevention as well," says Snyder. That link is evident in a new round of grants awarded last month by NIDA. "AIDS is very clearly going to continue to spread among drug abusers unless we do something," says psychologist James Sorenson, principal investigator in a $8.7 million, five-year study at the University of California, San Francisco. The grant will support a new treatment research unit that includes a clinic and a site to evaluate experimental drugs. NIDA is funding eight such centers. In addition to Sorenson's program and Kosten's at Yale, the grants went to centers at Johns Hopkins and Harvard universities, the universities of Pennsylvania and Virginia, the Addiction Research and Treatment Corp. in New York, and the Friends of Medical Science Research in Los Angeles. Biden thinks that "pharmacotherapy" holds great promise. On December 13 he unveiled a committee report that recommended spending about $1 billion over the decade on research. The goal would be to make effective medications widely available for cocaine, heroin and other drug addictions. Such a program, if adopted as part of legislation that Biden plans to introduce shortly, would represent a sharp break from the recent past and erase the impression in the minds of some scientists that NIDA has lagged in the overall campaign against drug addiction. A Judiciary Committee hearing last fall highlighted the decline in the medications development program during the past 15 years. "The National Institute on Drug Abuse has been a failure as an institution," testified James Halikas, a research psychiatrist at the University of Minnesota. "Almost from the inception, NIDA has been staffed by well-meaning, sincere, bright scientists who have been figuratively puttering in their ivory tower laboratories while the nation's vulnerable burned in the flames of drug abuse." Snyder acknowledges that the institute's program functioned at a modest level during the 1970s, approximately $2 million to $3 million annually. But he says that its efforts were progressing reasonably well until the Reagan administration took office. Funds were cut back and eventually eliminated, he notes, and the "Just Say No" approach replaced drug development as the preferred way of dealing with the problem. In 1988, however, Congress re-established the Medications Development Program as part of the Anti-Drug Abuse Act. The program was reconstituted as a consortium between government, industry, and academia. Many experts say that the pharmaceutical industry has also been slow to embrace addiction research. And its absence has hampered progress. "Ultimately, drugs will be sold by private agencies," says Robert Balster, an addiction researcher at Virginia Commonwealth University in Richmond. "If the pharmaceutical companies aren't willing to pick up the ball and run with it, then it won't work." A NIDA task force led by Snyder is hoping to sign up drug companies in the search for new medications. But such a program must make financial sense to a company. One lure is an amendment to the Orphan Drug Act of 1983, sponsored by Biden and Sen. Edward Kennedy (D-Mass.), that would include drug treatment medicines. The 1983 law gives drug companies exclusive rights to market drugs to treat rare diseases to entice them to create products for which there is not a mass market. Biden also has proposed that FDA adopt an accelerated approval process for addiction treatment drugs to parallel the speed-up in approval of AIDS drugs. Otherwise, says Biden, "by the time the 10.5 years of study are completed on a treatment for, say, cocaine, drug dealers will have developed new substances for abuse." Drug companies say that they are already lending a hand to combat addiction. "The pharmaceutical industry is making a strong effort to develop medications for drug addiction despite the many challenges and problems," says Gerald Mossinghoff, president of the Pharmaceutical Manufacturers Association, a Washington, D.C.,-based trade association. Davis Temple, a senior vice president at Bristol-Myers Squibb Co., notes that "NIDA has put together a very good program. And it is finally adequately funded." Scientists at Bristol-Myers will be part of preclinical research at one of the eight new NIDA-funded centers, Temple says. They will be looking at drugs that weren't originally designed to treat drug abuse but which have since shown promise in this area. "Most companies have several such drugs," he says. Temple admitted that drug companies have been absent in previous wars against drugs. But he says that won't happen again. "Now we have a social responsibility to become involved. Whether there are profits or not for the companies is no longer the issue." Susan Landers is a freelance writer based in Washington, D.C.

Government Funds Begin To Flow For More Research On Addiction

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