The National Institute on Drug Abuse (NIDA) is the lead federal agency supporting scientific research on drug use and addiction. After decades of research, we now understand substance use disorders (SUDs) to be chronic but treatable brain disorders that emerge from the complex interplay of biological, social, and developmental factors. Adverse social determinants of health enable biological vulnerabilities to SUDs to emerge, just as protective factors in one’s social environment reduce the risk of substance use and addiction. NIDA-supported research has illuminated these risk and protective factors and led to the development of effective prevention and treatment interventions, providing hope for the more than 40 million people in the United States with SUDs and their loved ones. Yet, NIDA’s mission remains critical, given the challenges that SUDs present to the nation today.
Drug overdoses in the United States have been increasing exponentially for at least 40 years, but different substances have driven this increase over time.1 Opioids have been involved in most overdoses over the past two decades. The opioid overdose crisis was initially driven by misuse of prescription opioids and later by heroin use. However, since 2016, synthetic opioids, such as fentanyl, have accounted for the largest fraction of overdose deaths. Provisional data from the Centers for Disease Control and Prevention show a record high of close to 109,000 overdose deaths in 2021, with more than 75 percent involving opioids.2 Stimulants also have reemerged as an overdose threat. From 2012 through 2021, the number of deaths involving methamphetamine increased nearly 13-fold (from ~2,600 to nearly 33,500); the number involving cocaine increased nearly six-fold (from ~4,400 to nearly 25,000).3 The alarming increase in stimulant-involved overdose deaths is a stark illustration that we face an evolving addiction and overdose crisis characterized by shifting use of different substances and use of multiple drugs and drug classes together.4
The collision of the overdose crisis with the coronavirus disease 2019 (COVID-19) pandemic puts people with SUDs at particular risk. Drug use and overdose markedly increased after the pandemic began;5 the 34 percent increase in overdose deaths between 2019 and 2020 was the largest one-year increase ever recorded.6 Individuals with SUDs are at higher risk for COVID-19 and its adverse outcomes.7 Social isolation and stress—factors long known to drive substance use and relapse—are likely contributing factors.
In the face of an ongoing addiction and overdose crisis and a global pandemic, NIDA’s FY 2022-2026 Strategic Plan represents an opportunity to take stock of how far we have come in drug addiction research while also redoubling our focus on the priorities and values that will move our mission forward. The strategic plan reflects our commitment to advancing all aspects of addiction science in the service of improving people’s lives. Today’s landscape of substance use poses both unique challenges and unprecedented opportunities to leverage the amazing potential of science toward that goal. While we have made impressive progress, there is more to be done.
I profoundly thank all those who contributed their thoughts and expertise to this strategic plan. I look forward to continuing to work together to achieve NIDA’s ambitious goals.
Nora D. Volkow, M.D.
Director, National Institute on Drug Abuse