The Trump administration released a “skinny” budget late last winter detailing $5.8 billion in proposed cuts to the National Institutes of Health (NIH) for fiscal year 2018. That represents 20% of the NIH's total budget. Then in an additional hit in late March, the White House wants the NIH immediately to find $1.2 billion in cuts for the fiscal 2017 budget—the budget year that is half over.
While the complete White House budget proposal isn’t out yet, it will include details on which NIH agencies are affected by its proposals. Congress, as with all budget matters, will have the final say.
Still, indications that the White House proposes to cut health research so drastically has drawn concerns from the substance use disorder field, particularly in the face of two enormous challenges: the opioid epidemic and the rising legalization of marijuana with its unknown consequences on health.
Advocates, researchers object
Addiction Professional interviewed experts in the field on the possible effects of the proposed cuts on the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA).
“It’s confusing to me because this president has claimed he wants to expand innovation, infrastructure, and to address the opioid crisis,” says Andrew Kessler, principal with Slingshot Solutions, a lobbying firm representing behavioral health clients. “Investing in the National Institutes of Health and in NIDA and NIAAA does all that.”
Kessler adds, “You’re fighting drug abuse, alcohol abuse, you’re taking on underage drinking, creating jobs around the country for researchers, getting innovation—you do all those things when you invest in NIH. By cutting the NIH budget, you’re doing in essence the opposite of everything you’re trying to accomplish.”
NIH research isn’t just about cures and science, Kessler points out. It’s important to note that money goes out to local economies because the research is conducted at universities and laboratories around the country.
Research at NIDA and NIAAA is particularly crucial, Kessler says, because these diseases have been studied for a relatively short time. “Other diseases have been studied for a century,” he says. “We’ve only been looking at addiction for a few decades.”
NIDA just launched its massive ABCD study, which will be critical in terms of understanding the impact of substance use and other factors on the adolescent brain, notes Kessler. “When you’re cutting NIDA and NIAAA, you’re saying you have no interest in learning about what is healthy for our children,” he says.
Research is not typically top of mind among grassroots advocates, who focus more on treatment, recovery and prevention, says Kessler. “But all that comes from research,” he says. “We saw how research helped pass the Comprehensive Addiction and Recovery Act, the Cures Act, how it helped defeat repeal of the Affordable Care Act.”
And a great example of NIDA-funded research that led to treatment advances is buprenorphine, says Kessler. “Research is the driver,” he says. “And NIDA and NIAAA have worked very hard to speed up their translation of research to practice, bench to bedside.”
Some of the most eminent drug researchers in the country were appalled by the proposed cuts. Contacted by Addiction Professional, here’s what some had to say.
“This will be devastating for the NIDA program,” says Charles O'Brien, MD, PhD, Kenneth Appel Professor at the University of Pennsylvania. “I don’t know which grants will be cut, but any cut this large will cost more in lost productivity than it will save in dollars.”
Most recently, O’Brien has been working on studies of medication-assisted treatment within the criminal justice system. Based on his work with released former prisoners, he believes that “more of them will relapse to addiction and commit crimes.”
Frank J. Vocci, PhD, president of Friends Research Institute in Baltimore, said that the misuse of drugs and alcohol costs the United States $442 billion a year in increased health care costs, crime, and lost productivity. Tobacco dependence results in more than $300 billion a year in health care costs, premature death, and lost productivity. “Research into the causes and treatment of substance use disorders is necessary to optimize existing treatments and to develop new treatments that arise from basic science discoveries,” says Vocci, a former director of the Division of Pharmacotherapies and Medical Consequences of Drug Abuse at NIDA.
Effect on opioid epidemic
“The opioid epidemic will not abate anytime soon, and best practices of current treatments and new treatments are needed,” says Vocci. Funding from NIDA and NIAAA is vital to research in this area for several reasons, he says:
The majority of pharmacotherapies for alcohol use disorder, opioid use disorder, and smoking cessation in the last 30 years are based on government-funded science and/or collaborations with NIDA and NIAAA;
The science base for developing new pharmacotherapies must come from new research that is mostly funded by NIH, and the pharmaceutical industry requires a strong science base before committing to develop new medications for substance use disorders;
The pharmaceutical industry remains to be convinced that developing medications for treatment of cannabis, cocaine and methamphetamine use disorders would be profitable; and
Cost-sharing and collaboration among government, academia and industry are essential for development of new treatments for cannabis, cocaine and methamphetamine use disorders.