Addiction research funding focused on “abstinence only”?

Federal grant search for active projects with the terms methadone, buprenorphine and naloxone
Federal grant search for active projects with the terms methadone, buprenorphine and naloxone

DJ Mac picks up on a story that also caught my eye and catches a line moaning about research bias in favor of abstinence-based programs. He pulled this quote.

The gorilla in the room around this question turns out to be the ideology of the decision makers. “There are ideological constraints tied to what gets funded,” says Ethan Nadelmann, founder and executive director of the Drug Policy Alliance in New York City. An example? The tendency to fund “abstinence only” programs and the war on drugs at the expense of drug prevention research. “There is not a lot of evidence of what works because it does not get studied. Today, kids lose their drug virginity before their sexual virginity. What’s the needle exchange of today?”

This struck me as odd, because NIDA seems to be heavily invested in promoting buprenorphine. So, I went to projectreporter.nih.gov and looked up active projects with the search terms “methadone OR buprenorphine OR naloxone”. It’s not a perfect method, but it tells you something, right?

Here’s what I found:

  • 220 active projects
  • $103,152,353 in total funding for these projects
  • These projects have generated 2028 publications that are now part of the evidence-base

“What’s the needle exchange of today?” It’s obviously naloxone, right? If you limit the search to just naloxone, you still get over $35,000,000. A search for “opioid AND abstinence” returns $41,450,238 in funding.

These results are consistent with the articles theme of research being oriented toward PhRMA, but not with Nadelmann’s argument that “abstinence only” rules the playground.

Why we can’t agree

Official portrait of United States Director of...

The Obama administration just released their annual drug control strategy report and all the headlines say it emphasizes treatment over incarceration.

Sounds great, but the stories are short on details.

Others, from the Drug Policy Alliance are dismissing it as more of the same.

More of the same? Really? I think Obama’s safely within the herd on this, but one doesn’t have to go back very far to reach a time when it would be a certain death sentence for a national politician to say that we should incarcerate fewer people for drug crimes. Change may not be coming as quickly as the DPA would like, but to say that the current state of affairs is “same old, same old” is pretty silly.

All of this is mildly interesting. What is was much more interesting was this quote:

Is it a disease of the brain? I asked Columbia University psychology professor Carl Hart, who is also a board member of Drug Policy Alliance. Hart laughed. “A behavioral disease, therefore the brain is involved? OK, we can say that about everything.”

I admit, the addiction-is-an-illness line never worked for me. It leaves out personal will. It sanitizes destructive decision making. It suggests that people cannot get clean without a health care professional.

Art Caplan, director of the Center for Bioethics at the University of Pennsylvania, came up with the best explanation I’ve heard for the disease argument. People don’t want to see addicts jailed, he said, so they’ve come up with a scenario to spare users from incarceration. Ergo: “The whole drug establishment is invoking the disease model as an antidote to the criminal-justice model.”

I think it goes a long way toward explaining the difficulty in explaining the difficulty in finding any common ground on drug policy.

  • The question of free will is an important and under-addressed matter. Though I’m pretty confident it’s under-addressed because it’s not empirically knowable.
  • The suspicion of the disease model is a huge barrier. If there are profound disagreements about the nature of the issue, it’s very difficult to even begin to come up with solutions that address each other’s concerns.
  • The suspicion of each other’s motives is a huge barrier—”so they’ve come up with a scenario”. This paints advocates of the disease model as disingenuous. We’re manufacturing the model we need rather than describing what is.